Self-management behavior of children with cancer based on behavioral economics: a systematic review and meta-analysis

Advances in pediatric oncology have significantly improved survival rates among children with cancer. As survival increases, attention has shifted toward long-term health outcomes and quality of life, emphasizing the importance of effective self-management behaviors such as medication adherence, symptom monitoring, and lifestyle regulation. However, children's self-management behaviors are often constrained by developmental, cognitive, emotional, and contextual factors, limiting the effectiveness of traditional educational approaches.

This systematic review and meta-analysis synthesizes existing evidence on self-management interventions for children with cancer that are informed by behavioral economics principles and evaluates their effectiveness in improving self-management-related outcomes.

This review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251274173). We systematically searched multiple electronic databases. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, cohort studies, and mixed-methods studies that reported original empirical data on behavioral economics-informed self-management interventions in pediatric oncology populations. Two reviewers independently assessed risk of bias using Cochrane tools. We performed a random-effects meta-analysis and evaluated heterogeneity using Cochran's Q test, τ², and the I² statistic. Certainty of evidence was assessed using GRADE, and qualitative findings were assessed using GRADE-CERQual.

A total of 30 studies (N ≈ 3,400 participants) were included, spanning 14 countries and employing behavioral economics strategies including nudging, framing, incentives, reminders, and choice architecture modifications. Behavioral economics-informed interventions were associated with a pooled standardized mean difference of SMD ≈ 0.55 (95% CI: 0.47-0.63; GRADE: MODERATE) for primary self-management outcomes, representing a moderate positive effect compared with usual care. A mean absolute percentage improvement of 20.2% (SD = 7.2; range: 10-40%) was observed across studies. Heterogeneity was moderate (I² = 58%). Multi-component interventions combining reminders, incentives, and framing demonstrated greater effectiveness than single-strategy approaches.

This review provides the first comprehensive synthesis at the intersection of pediatric oncology, self-management, and behavioral economics, demonstrating that self-management behaviors are shaped by the interaction of developmental stage, caregiver involvement, and healthcare context. Of the behavioral economics constructs examined, present bias mitigation through reminder systems and short-term incentives, loss-framing communication, and choice architecture simplification through defaults and structured routines emerged as the most consistently effective strategies. The findings inform the development of evidence-based, developmentally appropriate interventions to enhance self-management and long-term outcomes for children with cancer.