Concerns underlying treatment preferences of advanced cancer patients with children

Cancer parents' experiences of parenting concerns about minor children: A meta-synthesis of qualitative studies

Background

Some cancer patients not only endure physical and mental distress due to the disease and treatment but also shoulder the responsibility of raising their children. This situation significantly impacts the patients' quality of life. While there is a growing body of qualitative research focusing on parenting concerns among cancer patients, there remains a lack of comprehensive qualitative evidence.

Objective

This study aims to conduct a systematic review and synthesis of qualitative research evidence, investigating the experiences of cancer patients in raising minor children.

Design

Systematic review and synthesis of qualitative studies.

Settings

Through a screening process employing inclusion/exclusion criteria, qualitative studies specifically addressing cancer patients raising minor children were identified.

Participants

Participants: A total of 669 participants from 40 studies were included in the review.

Methods

Four English (Pubmed, Web of Science, Embase and Cochrane Library) and three Chinese (CNKI, Wanfang and Sinomed) databases were searched for qualitative studies of the real-life experiences of raising children in cancer patients from the establishment of the library to January 2024. The methodological quality of the included literature was assessed using the Critical Appraisal Skill Program (CSAP). Qualitative data were extracted, summarized, and meta-synthesized.

Results

A total of 26 studies were included in this meta-synthesis, encompassing 11 different countries. 160 themes were extracted from these included literatures, which were combined into ten categories, ultimately forming four themes: the impact of parents' disease on their children, the challenges of parenting, coping strategies, and multifaceted parenting needs. Based on the Confidence in the Output of Qualitative research synthesis (ConQual) approach, the confidence level of the synthesized findings ranged from moderate to low.

Conclusions

Cancer patients experience significant psychological stress while raising children, which can lead to a reduction in their quality of life and influence treatment decisions. These findings elucidate the parenting concerns experienced by cancer patients, allowing medical staff to understand their emotions and treatment preferences. Additionally, healthcare professionals should pay attention to the special needs of this group and develop targeted interventions to support and reduce patients' psychological stress and burden.

Patients with advanced cancer and their spouses parenting minor children: The role of the relationship context in parenting concerns

OBJECTIVE

Patients with advanced cancer who parent minor children report parenting concerns and increased psychological distress. This cross-sectional study seeks to understand parenting-related issues in patients and spousal caregivers from a relationship perspective.

METHODS

Patients with a metastatic solid malignancy and their spouses independently completed cross-sectional assessments of psychological distress (Hospital Anxiety and Depression Scale), parenting concerns (Parenting Concern Questionnaire) and efficacy (Cancer-Related Parenting Self-Efficacy Scale), and relationship measures (DAS-7, Couples' Illness Communication Scale, and Family Relationship Index).

RESULTS

Of the 51 patients (57% female, 49% NHW, mean age 42 years) and spouses (43% female, 43% NHW, mean age of 42 years), approximately 50% couples endorsed psychological distress and were at risk for family dysfunction. Spouses reported significantly higher levels of parenting-related concerns (t = -2.0, p < 0.05) and anxiety (t = -2.8, p < 0.001) than patients. Parenting concerns were significantly associated with illness communication (r = -0.56, p < 0.001) and family function (r = -0.38, p < 0.001). Although the expected interactions between parenting concerns and relationship variables (i.e., illness communication, dyadic adjustment, and family function) were significant for depressive symptoms at p < 0.05, the associations were not in the expected direction. Relationship function buffered against depressive symptoms for those with low rather than high parenting concerns.

CONCLUSIONS

Not only patients but also spouses report cancer-related parenting concerns. The associations between parenting concerns and distress were stronger for spouses than patients. Dual caregiving appears to be a particularly stressful role. Because relationship function was associated with parenting concerns, we suggest that parent support programs that are couple-based and include both parenting-specific and relationship-specific content may be most effective in reducing distress for this vulnerable population.

Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies

Indices of aggressive or supportive end-of-life (EOL) care are used to evaluate health services quality. Disparities according to sex were previously described, with studies showing that male sex is associated with aggressive EOL care. This is a secondary analysis of 69,983 patients who died of a GI malignancy in Ontario between 2006 and 2018. Quality indices from the last 14-30 days of life and aggregate measures for aggressive and supportive EOL care were derived from administrative data. Hospitalizations, emergency department use, intensive care unit admissions, and receipt of chemotherapy were considered indices of aggressive care, while physician house call and palliative home care were considered indices of supportive care. Overall, a smaller proportion of females experienced aggressive care at EOL (14.3% vs. 19.0%, standardized difference = 0.13, where ≥0.1 is a meaningful difference). Over time, rates of aggressive care were stable, while rates of supportive care increased for both sexes. Logistic regression showed that younger females (ages 18-39) had increased odds of experiencing aggressive EOL care (OR 1.71, 95% CI 1.30-2.25), but there was no such association for males. Quality of EOL care varies according to sex, with a smaller proportion of females experiencing aggressive EOL care.

Caring for Children in Relation to Financial Hardship, Advance Care Planning, and Genetic Testing Among Adolescent and Young Adults with Cancer

Purpose: When a cancer diagnosis coincides with caring for children, it may influence the financial impacts of cancer and decisions to pursue advance care planning (ACP) or genetic testing. We examined associations between caring for children and financial hardship, ACP, and genetic testing among female adolescent and young adult (AYA) cancer survivors in North Carolina and California. Methods: Participants were diagnosed at ages 15-39 years with breast, melanoma, gynecologic, lymphoma, or thyroid cancer during 2004-2016. We estimated adjusted prevalence differences (aPDs) and ratios (aPRs) for each outcome by child caring status using marginal structural binomial regression models. Results: Among 1595 women ages 19-54 years at survey (median = 7 years since diagnosis), 819 (51.3%) reported that they were caring for children at diagnosis. Women caring for children had a higher prevalence of material financial hardship (e.g., medical debt; 30% vs. 21.9%; aPD = 9%, 95% confidence interval [CI]: 3 to 14; aPR = 1.39, 95% CI: 1.12 to 1.72) but similar levels of psychological financial hardship compared to noncaregivers. Women caring for children were more likely to complete ACPs (42.2% vs. 30.7%; aPD = 9%, 95% CI: 3 to 16; aPR = 1.30, 95% CI: 1.08 to 1.57). Among the 723 survivors of breast, endometrial, and ovarian cancer, the prevalence of genetic testing was higher among women caring for children (89%) than noncaregivers (81%); this difference was not statistically significant. Conclusion: Women caring for children at diagnosis may be at elevated risk for adverse financial outcomes and may benefit from additional financial navigation support. Childcare responsibilities may further complicate health decision-making for AYAs diagnosed with cancer.

Experiences of being a severely ill parent of dependent children receiving care at home: Hopes and challenges

OBJECTIVES

Multiple studies have focused on severely ill patients in the role as parents of dependent children, yet few have explored the thoughts and feelings within this group during palliative home care.

METHODS

This qualitative study derives from a pilot intervention study, the Family Talk Intervention (FTI), in specialized palliative home care. The FTI is a support program with the main goal to increase family communication about illness-related topics. The study is based on field notes from 104 sessions with 20 parents taken by an interventionist during intervention delivery. The field notes were analyzed using the principles of qualitative content analysis.

RESULTS

The field notes revealed several challenging situations for parents with severe illness. A major issue was how to find ways to talk to their children about their illness and prognosis. The parents expressed guilt for being unable to fulfill their roles as parents and partners. Existing family conflicts had escalated with the illness, according to some parents. Despite being affected by illness, parents tried to have hope, if only for small things - such as a period of ordinary family life.

SIGNIFICANCE OF RESULTS

Severely ill parents in specialized palliative home care seek support regarding how to communicate and stay connected to their roles in the family, which is a struggle when a parent is cared for at home, while it in contrast may promote normality and hope. Communication with children is vital and needs to be brought to the attention of health-care professionals. A family-centered focus, involving both parents and children, should be embraced.

Pediatric Oncology Hospice: A Comprehensive Review

Pediatric hospice is a new terminology in current medical literature. Implementation of pediatric hospice care in oncology setting is a vast but subspecialized field of research and practice. However, it is accompanied by substantial uncertainties, shortages and unexplored sections. The lack of globally established definitions, principles, and guidelines in this field has adversely impacted the quality of end-of-life experiences for children with hospice needs worldwide. To address this gap, we conducted a comprehensive review of scientific literature, extracting and compiling the available but sparse data on pediatric oncology hospice from the PubMed database. Our systematic approach led to development of a well-organized structure introducing the foundational elements, highlighting complications, and uncovering hidden gaps in this critical area. This structured framework comprises nine major categories including general ideology, population specifications, role of parents and family, psychosocial issues, financial complications, service locations, involved specialties, regulations, and quality improvement. This platform can serve as a valuable resource in establishing a scientifically reliable foundation for future experiments and practices in pediatric oncology hospice.

Exploring the perspectives of cancer patients parenting minor children: A qualitative study on family-centered cancer care experiences

OBJECTIVES

Parents with cancer experience not only disease-related burden but also child- and family-related concerns. According to the German guidelines, all professionals working in oncology are responsible for addressing these burdens and needs and for involving the patient's relatives. This study aims to explore patients' perspectives on their experiences regarding family-centeredness in cancer care.

METHODS

We conducted interviews with 18 cancer patients parenting at least one minor child (< 18). The interviews were audio-recorded, transcribed verbatim and analyzed using qualitative content analysis.

RESULTS

Most parents reported that their healthcare professionals (HCPs) rarely or not routinely discussed family issues. There was a wide range of ways in which HCPs communicated about family issues. Parents often felt unsure about professionals' responsibilities and many of them expressed a desire for more proactive communication.

CONCLUSIONS

The findings suggest that the majority of patients have unmet needs related to comprehensive care as parents.

PRACTICE IMPLICATIONS

HCPs need to be sensitized to identify parents facing additional burdens and needs. It is essential that HCPs clarify parents' preferences regarding the extent of involvement of family issues in cancer care.

Understanding Dying Concerns in Parents With Advanced Cancer With Dependent Children for Their Coparent: A Phenomenological Study

Parents with advanced cancer and their dependent children experience high psychological distress, decreased quality of life, and decreased family functioning due to cancer-related concerns. Dying concerns are defined as fluctuating thoughts or feelings that are conscious or unconscious about an anticipated and approaching death that is attributed to a palliative/terminal diagnosis. This study used Gadamer's phenomenological approach to gain a shared understanding of the perspectives of the parents with advanced cancer about dying concerns, family life before and after advanced cancer diagnosis, and family resources to manage the crisis of advanced cancer for the coparent. The sample consisted of 4 patients from a Midwestern cancer hospital. Data were collected through 2 virtual semistructured interviews and were qualitatively analyzed using the hermeneutic rule and the theoretical concepts from McCubbin and McCubbin's Family Resiliency Model. Four major themes emerged: "Uncertainty in End-of-Life Decisions," "Effectless Communication," "Parental Skepticism," and "Psychological Well-being." The results showed that parents with advanced cancer have concerns for their coparent outside their parental role. Understanding dying concerns from all family members may increase nurse-initiated communication to improve family outcomes.

The Impact of Cancer on the Mental Health of Patients Parenting Minor Children: A Systematic Review of Quantitative Evidence

OBJECTIVE

To provide an overview of quantitative data on the impact of cancer on the mental health of patients parenting minor children. We focused on mental health outcomes, their levels and prevalence and applied measurement tools.

METHODS

MEDLINE, CINAHL, PsycInfo and Web of Science were searched up to March 2021. We included quantitative studies, published in a peer-reviewed journal and reporting outcomes on the mental health (e.g., depression, anxiety) of cancer patients parenting minor children (≤ 21 years). Study quality was assessed based on the NIH assessment tool for observational studies. This study is registered on PROSPERO (CRD42019141954).

RESULTS

A total of 54 articles based on 36 different studies were included in this systematic review. Studies differ markedly regarding study and sample characteristics (e.g., outcome measures, sample size, parental health status). Depression and anxiety levels range from normal to abnormal, according to applied measurement tools. 7%-83% of parents with cancer have depression scores indicating probable depression and 19%-88% have anxiety scores indicating anxiety disorder.

CONCLUSIONS

This review reveals the dimension of mental burden affecting cancer patients parenting minor children. To identify, address and timely treat potentially arising mental health problems and support needs, affected parents should be closely monitored by healthcare professionals and referred to specialized support offers, if necessary. In the context of a comprehensive patient- and family-oriented care, it is highly relevant to integrate mental health (including parental) issues routinely into oncological care by proactively asking for the patient's psychosocial situation and the family status. This article is protected by copyright. All rights reserved.

How parents of dependent children reason about their partner's impending death due to cancer

This paper explores how bereaved parents with dependent children reasoned about their partner's impending death due to cancer. Questionnaires were used to collect data from 42 cancer-bereaved parents of dependent children in Sweden. The results showed that most of the parents had thought, at least once, that death would be best for their partner's own sake. A few parents had also thought that it would be best for everyone if their partner died. Many parents had a wish to keep up hope, no matter what. However, living with a partner with advanced illness and dependent children was described as extremely stressful.

Family Cohesiveness: A Dying Concern for the Coparent in Families With Parents With Advanced Cancer With Dependent Children: A Pilot Study

BACKGROUND

Dying concerns are thoughts expressed by a person diagnosed with a terminal illness or by an individual coping with the impending death of a loved one. Little is known about the dying concerns of parents with advanced cancer (PWACs) with dependent children, and even less is known about the dying concerns of the coparent. Understanding the PWACs' dying concerns for the coparent can contribute to the overall health of the family when faced with the death of a loved one.

OBJECTIVE

The aim of this pilot descriptive study was to explore the PWACs' perspective of their dying concerns for their coparent.

METHODS

Four PWACs were recruited from 2 oncology inpatient units from an urban community hospital within the same hospital system. Semistructured interviews were conducted, audio-recorded, and transcribed with 4 participants. Data analysis used directed content analysis.

RESULTS

Parents with advanced cancer expressed concern about the repercussions of advanced cancer on family cohesiveness. Three subthemes within this general structure were "My Weakest Link," "If I'm Not There, Where Do They Go?" and "Putting Up a Front."

CONCLUSIONS

Parents with advanced cancer have concerns beyond their role as a parent could make a difference in the overall health of the PWACs, but also the family unit. The PWACs' concerns are present but may be covered over by use of protective mechanisms to maintain family cohesiveness.

IMPLICATIONS FOR PRACTICE

Understanding dying concerns may enhance nurse-initiated communications between family members and healthcare providers to improve psychological distress and enhance family functioning.

Dying concerns in young parents with advanced cancer (PWAC): A scoping review

BACKGROUND

Advanced cancer in young parents (PWAC) can increase dying concerns, the fluctuating thoughts, or feelings, conscious, or unconscious, about an approaching death by a person facing a terminal illness or a family member coping with the impending death of a loved one. However, limited research has been conducted to identify dying concerns in an ill parent as the research has focused on older adults.

OBJECTIVE

Our goal was to identify dying concerns that PWAC are expressing and to understand how these concerns affect measurable outcomes.

METHOD

CINHAL, MEDLINE, PsychARTICLES, PsycINFO, Social Work Abstracts, Health Source: Nursing/Academic Edition, and Psychology and Behavioral Sciences Collection were searched. Articles included were samples of PWAC, peer-reviewed, and published within the last 10 years. Elderly or pediatric populations, PWAC with adult children, and early-stage cancer were excluded. The initial search resulted in 1,526 articles, 18 were identified as potentially relevant. Fourteen articles were identified and reviewed.

RESULTS

PWAC expressed concerns for their children (n = 11), concerns for their co-parent (n = 4), and personal concerns (n = 11). Additionally, PWAC have decreased quality of life, have significant emotional and psychological distress, and have increased family dysfunction in relation to their concerns. Samples limit the generalizability of the findings. Majority of the articles consisted of White, upper, middle-class (n = 8) women (n = 7) diagnosed with breast cancer (n = 11) within nuclear families (n = 11).

SIGNIFICANCE OF RESULTS

Dying concerns are described in the literature from a fairly narrow sample of PWAC. Future research should focus on recruiting participants from diverse backgrounds, genders, diagnosis types, and non-nuclear families. Identifying concerns for the co-parent would also add to the understanding of dying concerns.

Experiences of adults as parents with cancer: a systematic review and thematic synthesis of qualitative studies

PROBLEM IDENTIFICATION

This thematic synthesis is aimed at providing an overview of qualitative studies on parenting experiences during cancer and focuses on the investigation of the challenges parents face and the strategies they use to adapt to a new situation.

LITERATURE SEARCH

A search of five electronic databases was conducted, specifying publication dates between 1993 and 2020. Qualitative studies, which focused on parenting experiences of cancer patients with minor children from an ill parent perspective, were included in the review. Thematic synthesis was undertaken to examine the included studies by referring to a theoretical model of family resilience by Froma Walsh.

DATA EVALUATION

12,345 articles were discovered and, after assessment for eligibility, 27 studies were included in the review. The thematic synthesis involved line by line coding of the findings of the primary studies and the development of descriptive and analytical themes.

CONCLUSIONS

This review showed that parenting is a process that requires restructuring in the face of cancer. After cancer diagnosis, requirements connected to the illness and its treatments are imposed on previous family life duties.

An exploration of the perceptions, experience and practice of cancer clinicians in caring for patients with cancer who are also parents of dependent-age children

BACKGROUND

Being a parent alongside a cancer diagnosis presents unique challenges. It is unclear to what degree parenting considerations feature in routine care and how doctors approach treatment decision discussions.

OBJECTIVE

To explore doctor perspectives regarding patients with cancer who have dependent children.

METHODOLOGY

Focus groups and interviews conducted to ascertain doctor views. Responses were audio-recorded, transcribed and thematically analysed.

RESULTS

Twenty-eight doctors participated: medical oncology (7), haematology (10), palliative care (8), and psycho-oncology (3). Participants observed cancer impacted upon parenting across several domains: psycho-social, practical, and family implications. Having dependent children was perceived to influence the patient experience and decision-making by patients and clinicians. Participants identified this cohort as emotionally demanding to care for with a range of psychological effects identified for doctors, particularly in highly challenging circumstances (single-parent and non-English speaking families, scenarios involving communication difficulties).

CONCLUSION

Participants recognised the presence of dependent children to profoundly influence the experience of being both a parent and a patient with cancer. Identifying patients with parental responsibilities was noted as relevant for management at diagnosis through to death. Greater understanding of doctors' experiences providing care for this cohort may inform the development of resources to assist doctors and their patients.

Parents With Advanced Cancer: Worries About Their Children's Unspoken Concerns

BACKGROUND

Parents with advanced cancer struggle initiating conversations with their children about the cancer. When parents do not have the tools to talk with their children, they silently watch their children attempt to navigate their illness but can only wonder but not know what their children are thinking. The objective of the current study is to describe, from parents living with advanced cancer, the worries and concerns parents wonder their child holds, but has not spoken, about the parent's cancer.

METHODS

Twenty-seven parents with incurable cancer enrolled in a 5 session telephone intervention pilot study during which they were asked, "What questions do you have about what your child is thinking or feeling about the cancer?" Data were transcribed and inductively coded using content analysis methods adapted from grounded theory.

RESULTS

Analysis yielded 14 categories of parent concerns organized into 6 larger conceptual domains: Being Concerned and Scared about My Cancer; Worrying about Me; Changing How We Talk and Live Day-to-Day; Not Knowing What Will Happen; Having Unanswered Questions about My Cancer; and Understanding My Disease Is Terminal.

CONCLUSIONS

Study results add to our understanding of the magnitude of the emotional burden parents with advanced cancer carry as they struggle to balance their diagnosis and treatment and their life as parents.

Australian Hospital-Based Parenting Support for Adults with Incurable End-Stage Cancer: Parent Perspectives

Parenting support needs of patients diagnosed with incurable end-stage cancer (IESC) with young families are not addressed as part of routine hospital health care. Their support needs and experiences of hospital-based parenting support are largely unknown. The study aims to explore hospital-based parenting support delivery from patient and co-parent perspectives in context to their parenting experience and support needs. Exploratory, prospective, cross-sectional qualitative design. Semi-structured in-depth interviews with eight adult patients with IESC and four co-parents purposively recruited from a tertiary hospital in Melbourne, Australia. Findings were thematically analyzed. Parents desire support with challenging multidimensional parenting issues. Organization, health professionals (HP), and parental-based factors hinder and facilitate optimal service provision. Responsibility rests with HP to initiate parenting support. Interdisciplinary family-focused support offered throughout IESC health-care journey is key. Patient-centered family-focused support is warranted. Surmountable challenges lie with management and HPs to address barriers affecting optimal service delivery.

Patients' preferences for postmenopausal hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer treatments in Japan

Background

This study aimed to identify factors affecting patients’ preferences for postmenopausal hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer treatments, their relative importance, and impact of sociodemographic/clinical characteristics.

Methods

Japanese postmenopausal patients with HR+ breast cancer chose between 2 hypothetical treatments for HR+/HER2− advanced breast cancer using an online discrete choice experiment, defined by different levels of 5 attributes: progression-free survival (PFS), incidence of diarrhea (IOD), frequency of loose stools of grade 1–3 severity (FOS), duration of diarrhea (DOD), and route/frequency of administration (RFA). Conditional logit modeling identified relative preferences for each attribute. Subgroup analyses, based on sociodemographic characteristics (age, employment status, age of youngest child, marital status) and clinical characteristics (relapse/metastasis, hormone sensitivity), identified factors affecting preferences.

Results

Of 896 participants screened, 258 eligible participants were included in analyses. Patient preferences, when the potential frequency of diarrhea was grade 2, were (strongest to weakest): PFS, DOD, FOS, IOD, RFA; however, when the potential frequency of diarrhea was grade 3, FOS became most important. Sociodemographic/clinical characteristics tended to affect preferences.

Conclusions

Japanese postmenopausal patients with HR+ breast cancer preferred treatments that extend PFS despite potential grade 2 diarrhea. However, when diarrhea severity increased to grade 3, patients were more willing to sacrifice PFS to avoid more frequent diarrhea. Prevention or limitation of diarrhea to grade ≤ 2 is important for maintaining patients’ motivation for treatment that can extend PFS. Additionally, patient characteristics (age, family context, therapeutic experience) should be considered during treatment choice.

Electronic supplementary material

The online version of this article (10.1007/s12282-019-00965-4) contains supplementary material, which is available to authorized users.

Disrupted biographies and balancing identities: A qualitative study of cancer patients' communication with healthcare professionals about dependent children

OBJECTIVE

About 14% of cancer patients live with dependent children. Healthcare professionals are well placed to help patients support their children as part of a patient-centred practice. Children tend to appreciate open communication during the course of illness, but patients often find this difficult. However, research is unclear about patients' preferences and their willingness to talk with healthcare professionals about their dependent children.

METHODS

We conducted 15 in-depth interviews with patients from haematological (N = 11) and gynaecological oncology (N = 4). The interviews and subsequent analysis focused on patients' communicative preferences, taking the theoretical framework of "biographical disruption" as a starting point and using Jenkins' concept of identity as a social, relational and dynamic process.

RESULTS

We identified two overall identities at stake for seriously ill patients with parental responsibility: "patient identity" and "parent identity." As "patients," patients were ambivalent about relating to their children, but as "parents" they wanted healthcare professionals to talk about their children.

CONCLUSION

In order to be patient-centred, clinicians should, we suggest, acknowledge that patients have these conflicting perspectives and identities, which surface at various times and situations throughout their illness trajectories. Research is needed to further explore these findings in different illness groups and cultures.

Parenting with a Life-Limiting Illness

Parents with life-threatening illness face unique challenges in their dual roles as patients and parents. They are at risk for depression, parenting stress, and impaired family functioning, and their children are at risk for adjustment difficulties. In addition to treatment of depression and other mental health issues, patients may also benefit from evidence-informed guidance addressing the challenges of parenting while ill. Consultations should be tailored to each family, with consideration of children's developmental stage and temperament. Clinical recommendations for communication about a parent's anticipated death, helping children spend meaningful time with an ill parent, and legacy leaving are provided.

Understanding health-related quality of life in adult women with metastatic cancer who have dependent children

BACKGROUND

Cancer is a leading cause of death among women of parenting age in the United States. Women living with advanced or incurable cancer who have dependent children experience high rates of depression and anxiety as well as unique parenting challenges. To the authors' knowledge, few studies to date have examined the parenting factors associated with health-related quality of life (HRQOL) in women with advanced cancer.

METHODS

The authors conducted a cross-sectional, Web-based survey of the psychosocial concerns of 224 women with a tumor-node-metastasis staging system of the AJCC stage IV solid tumor malignancy who had at least 1 child aged <18 years. Participants completed validated measures of HRQOL (Functional Assessment of Cancer Therapy-General [FACT-G]); depression and anxiety symptom severity; functional status; parenting concerns; and investigator-designed questions to assess demographic, communication, and parenting characteristics. Multiple linear regression models were estimated to identify factors associated with FACT-G total and subscale scores.

RESULTS

The mean FACT-G score was 66 (standard deviation, 16). The mean Emotional Well-Being subscale scores were particularly low (13; standard deviation, 5). In multivariable linear regression models, parenting variables explained nearly 40% of the HRQOL model variance. In the fully adjusted model, parenting concerns and the absence of parental prognostic communication with children both were found to be significantly associated with HRQOL scores. For each 1-point increase in parenting concern severity, FACT-G scores decreased by 4 points (P = .003).

CONCLUSIONS

Women with metastatic cancer who are parents of dependent children are at risk of high psychological distress and low HRQOL. Parenting factors may have a negative influence on HRQOL in this patient population. Cancer 2018;124:2629-36. © 2018 American Cancer Society.

Psychometric Analysis of the Parenting Concerns Questionnaire in Women With Metastatic Cancer

CONTEXT

Parenting concerns are a major source of distress for patients with advanced cancer. However, validated tools to measure this construct in advanced cancer patients are lacking.

OBJECTIVES

The Parenting Concerns Questionnaire (PCQ) is the only tool available to assess parenting concerns in cancer patients, yet its psychometric properties have not been fully evaluated.

METHODS

This cross-sectional Web-based survey of the psychosocial concerns included 211 women with Stage IV solid tumor malignancy who had at least one minor child in the home. Participants completed a battery of questionnaires assessing parenting concerns, health-related quality of life (HRQOL), depression and anxiety symptoms, and sociodemographic and clinical characteristics. Internal consistency was assessed by computing Cronbach's alpha. Convergent validity was evaluated using correlations of the PCQ with anxiety and depression symptom severity and HRQOL. We examined the PCQ's underlying dimensions with confirmatory factor analysis.

RESULTS

The mean total PCQ score for the sample was 2.2 (SD, 0.7), corresponding to "a little bit concerned." Internal consistency was 0.82. The PCQ demonstrated adequate convergent validity with expected correlations with anxiety (r = 0.49) and depression (r = 0.56) symptom severity, and HRQOL (r = -0.61). The original three-factor structure was not fully supported by confirmatory factor analysis.

CONCLUSION

The PCQ assesses a unique aspect of psychological distress in cancer patients. It demonstrated adequate reliability and convergent validity, but its original three-factor structure was not supported in a population of patients with metastatic cancer. The PCQ would benefit from further testing and refinement to enhance its representation of parenting concerns in metastatic cancer.