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Fernandez A, Guenegou L, Corcia P, Bailly N. The effect of social support on the emotional well-being of people with amyotrophic lateral sclerosis: Exploring the mediating role of spirituality. Palliat Support Care 2024:1-8. [PMID: 38745521 DOI: 10.1017/s1478951524000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that, so far, is considered always fatal. Treatments mainly consist in increasing survival and aim to improve the quality of life of people with ALS (pwALS). Social support and spirituality have been shown to play a key role in pwALS' quality of life. Our study explored it in depth by investigating the underlying mechanisms linking social support, spirituality, and emotional well-being. METHODS Thirty-six pwALS underwent a battery of tests evaluating emotional well-being (emotional well-being scale of the 40-item Amyotrophic Lateral Sclerosis Assessment Questionnaire), social support (6-item Social Support Questionnaire), and spiritual well-being (12-item Functional Assessment of Chronic Illness Therapy - Spiritual well-being). Our recruitment was web-based through the FILSLAN and the ARSLA websites as well as through Facebook® advertisements (ALS groups). Data were analyzed by Pearson correlation analysis and Process macro was used in an SPSS program to analyze the mediator variable effect. RESULTS Availability of social support, spiritual well-being, and 2 of its dimensions, i.e., meaning and peace, were positively correlated with emotional well-being. The mediational analyses showed that spiritual well-being, meaning, and peace act as mediators in the association between availability of social support and good emotional well-being. SIGNIFICANCE OF RESULTS Availability of social support and spirituality are essential for the emotional well-being of pwALS. Spirituality as a mediator between availability of social support and emotional well-being appears as real novel finding which could be explored further. Spiritual well-being, meaning, and peace appear as coping resources for pwALS. We provide practical guidance for professionals working with pwALS.
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Affiliation(s)
- Anne Fernandez
- Centre de Coordination des Centres de Référence Maladies Rares (CRMR) SLA, CHRU de Tours, France
| | - Léo Guenegou
- Laboratoire EA 2114 PAVeA (Psychologie des Ages de la Vie et Adaptation), Département de Psychologie, Université de Tours, France
| | - Philippe Corcia
- Centre de Coordination des Centres de Référence Maladies Rares (CRMR) SLA, CHRU de Tours, INSERM U1253, France
| | - Nathalie Bailly
- Laboratoire EA 2114 PAVeA (Psychologie des Ages de la Vie et Adaptation), Département de Psychologie, Université de Tours, France
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Stegenga K, Henley AK, Harman E, Robb SL. Shifting perspectives and transformative change: Parent perspectives of an active music engagement intervention for themselves and their child with cancer. Pediatr Blood Cancer 2024; 71:e30913. [PMID: 38337169 PMCID: PMC10959685 DOI: 10.1002/pbc.30913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress. PROCEDURE We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews. RESULTS The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief. CONCLUSIONS This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.
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Affiliation(s)
- Kristin Stegenga
- Children’s Mercy, Kansas City, Division of Hematology/Oncology/BMT, Kansas City, MO
| | - Amanda K. Henley
- Indiana University, Herron School of Art and Design, Indianapolis, IN
| | | | - Sheri L. Robb
- Indiana University, School of Nursing, Indianapolis, IN
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Klašnja S, Hausmeister IK, Kavčič M, Masten R, Kitanovski L. Paediatric Medical Traumatic Stress in Children with Cancer and their Parents: Difference in Stress Levels Due to Illness and Treatment Factors. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:579-587. [PMID: 37593054 PMCID: PMC10427565 DOI: 10.1007/s40653-023-00521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 08/19/2023]
Abstract
Pediatric medical traumatic stress (PMTS) is a set of children's and their parents' psychological and physiological responses to pain, injuries, serious illnesses, and other experiences with the medical environment. Pediatric cancer patients have the highest prevalence of PMTS as the illness its treatment involve a set of stressors that trigger many negative psychological reactions. The current study examined the difference in levels of traumatic stress in children with cancer and their parents due to medical factors (type of cancer, outcome, duration, and intensity of treatment, time since diagnosis, relapse, and hospitalization in ICU). The study involved 183 parents of 133 children and 62 children and adolescents who were treated between 2009 and 2019 at the Clinical Department of Pediatric Hematology and Oncology of University Children's Hospital in Ljubljana. We collected the data using The Intensity of Treatment Rating Scale 2.0 [IRT-2], PTSD Checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5]. Traumatic stress symptoms are frequently present in both children and their parents, regardless of the cancer type, treatment duration, and treatment outcome. Children with relapse, children with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post-cancer diagnosis. [Table: see text].
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Affiliation(s)
- Sandra Klašnja
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Ivana Kreft Hausmeister
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Marko Kavčič
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Robert Masten
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Lidija Kitanovski
- Division of Pediatrics, Departmant of Haematooncology, University Medical Center Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
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Robb SL, Stegenga K, Perkins SM, Stump TE, Moody KM, Henley AK, MacLean J, Jacob SA, Delgado D, Haut PR. Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer. Integr Cancer Ther 2023; 22:15347354231218266. [PMID: 38145309 PMCID: PMC10750508 DOI: 10.1177/15347354231218266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/03/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. METHODS Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. RESULTS No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. CONCLUSIONS AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.
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Affiliation(s)
| | | | | | | | | | - Amanda K. Henley
- Purdue School of Engineering and Technology, IUPUI, Indianapolis, IN, USA
| | | | | | - David Delgado
- Astellas Pharma Global Development, Inc, Northbrook, IL, USA
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Peng L, Hu X, Lan L, Xu C, Li M. The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen. Acta Psychol (Amst) 2022; 230:103741. [PMID: 36108447 DOI: 10.1016/j.actpsy.2022.103741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/27/2022] [Accepted: 09/04/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Psychological distress such as anxiety of medical students especially during the first-year has been widely acknowledged. However, many students could exhibit post-traumatic growth when experiencing anxiety. Previous study demonstrated that anxiety might have impacts on post-traumatic growth, but how anxiety affects post-traumatic growth is still undefined. This study sought to examine whether resilience has a moderating role between state and trait anxiety and post-traumatic growth when medical freshmen are experiencing stressful events. METHODS A total of 295 medical freshmen were administered the Post Traumatic Growth Inventory, the State-Trait Anxiety Inventory and the Connor-Davidson Resilience Scale. RESULTS Post-traumatic growth was negatively correlated with state anxiety and trait anxiety, with a correlation coefficient of -0.474 and -0.462 (p < 0.01), and positively correlated with resilience, with a correlation coefficient of 0.635 (p < 0.01). Resilience acted as a moderator for the indirect effect of state and trait anxiety on post-traumatic growth. CONCLUSIONS These findings demonstrated resilience could be of extreme importance for developing post-traumatic growth, and therapeutic interventions tailored to the medical freshmen to promote their resilience to adapt to life in college.
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Affiliation(s)
- Li Peng
- Department of Military Psychology, Army Medical University, Chongqing 400038, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Army Medical University, 400038, China
| | - Lan Lan
- Dujiangyan Special Service Nursing Center of Air Force, Chengdu 611800, China
| | - Chen Xu
- Department of Military Psychology, Army Medical University, Chongqing 400038, China
| | - Min Li
- Department of Military Psychology, Army Medical University, Chongqing 400038, China.
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Ben-Ari A, Ankri YLE, Aloni R, Buniak-Rojas O. The Effect of Parental Beliefs on Post-Traumatic Symptoms of the Parent and Child after the Child's Surgery. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1265. [PMID: 36010155 PMCID: PMC9406328 DOI: 10.3390/children9081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
In recent years, many studies have attempted to find the main predictors of the development of post-traumatic symptoms in children following medical procedures. Recent studies found a link between parental beliefs and children's post-traumatic symptoms in various medical contexts such as life-threatening illness, pain, and hospitalization. This study aims to examine the relationship between parental beleifs and post-traumatic symptoms in children and parents after surgical interventions of the children. The study was conducted among 149 children who underwent surgery and their parents. The children and parents were examined at 2 time points- during hospitalization, and 4 months after the hospitalization. Questionnaires were administered measuring parental beleifs pertaining to parental distress, and post-traumatic symptoms among children. results show a correlation between the factors. In addition, it was found that the parents' distress is a mediating relationship between the parents' perceptions and the child's level of distress. It has been found that there is a link between some of the parental beleifs and parental stress symptoms and post-traumatic symptoms in the children. Parental beliefs that were found to influence these variables were related to parental beliefs regarding children's suffering and pain during surgery. In addition, children of parents with higher levels of religious and spiritual beliefs were found to have fewer post-traumatic symptoms. This study sheds light on parental beliefs that may have the power to influence parental stress levels and children's post-traumatic symptoms after surgery.
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Affiliation(s)
- Amichai Ben-Ari
- Department of Behavioral Sciences, Ariel University, Ariel 4070000, Israel
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 9112001, Israel
| | - Yael L. E. Ankri
- Department of Behavioral Sciences, Ariel University, Ariel 4070000, Israel
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 9112001, Israel
| | - Roy Aloni
- Department of Behavioral Sciences, Ariel University, Ariel 4070000, Israel
| | - Orly Buniak-Rojas
- Department of Behavioral Sciences, Ariel University, Ariel 4070000, Israel
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Spiritual pain as part of the hospitalization experience of children and adolescents with acute lymphoblastic leukemia: A phenomenological study. Eur J Oncol Nurs 2022; 58:102141. [DOI: 10.1016/j.ejon.2022.102141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 02/07/2023]
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Koivula K, Isokääntä S, Tavast K, Toivonen I, Tuomainen I, Kokki M, Honkalampi K, Sankilampi U, Kokki H. Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study. J Clin Psychol Med Settings 2022; 29:453-465. [PMID: 35344125 PMCID: PMC9184431 DOI: 10.1007/s10880-022-09868-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 02/01/2023]
Abstract
We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.
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Affiliation(s)
- Krista Koivula
- Department of Pediatrics, Kuopio University Hospital (KYS), Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland.
| | - Siiri Isokääntä
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kati Tavast
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Iines Toivonen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Iina Tuomainen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Merja Kokki
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital (KYS), Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Yang Y, He X, Chen J, Tan X, Meng J, Cai R, Liang L, Shi L. Posttraumatic stress symptoms in Chinese children with ongoing cancer treatment and their parents: Are they elevated relative to healthy comparisons? Eur J Cancer Care (Engl) 2022; 31:e13554. [PMID: 35129840 DOI: 10.1111/ecc.13554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this work is to compare posttraumatic stress symptoms (PTSS) between families of children on cancer treatment and families of healthy children in China and to analyse the association among child PTSS, parent PTSS, and depression in the cancer group. METHODS Participants were children on cancer treatment (n = 91) and their parents (n = 91), and healthy children (n = 114) and their parents (n = 96). The children were asked to self-report PTSS, and the parents completed self-reported measures of PTSS and depression. RESULTS Although the prevalence of probable PTSD in children on cancer treatment was higher than that in comparisons (8.79% vs. 0.88%, P < 0.01), no statistic differences in PTSS levels were found between the two groups (P > 0.05). However, significant differences in PTSS levels and the prevalence of severe PTSS (21.98% vs. 1.04%) between parents of children with cancer and comparisons were observed (P < 0.001). Parent PTSS and depression were positively associated with child PTSS in the cancer group (P < 0.01). CONCLUSION The prevalence of probable PTSD in Chinese children with cancer was low, but PTSS was remarkably prevalent in their parents. Greater parent PTSS and depression were related to greater child PTSS. Results underline the importance to provide supportive psychological care for Chinese parents of children undergoing cancer treatment.
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Affiliation(s)
- Yiling Yang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaofeng He
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jinlu Chen
- PICU, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiangyi Tan
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Jiangnan Meng
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiqing Cai
- Department Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lichan Liang
- Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Shi
- School of Nursing, Southern Medical University, Guangzhou, China
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Golfenshtein N, Lisanti AJ, Cui N, Cooper BM. Predictors of Post-traumatic stress symptomology in parents of infants with Congenital Heart Disease post-surgery and after four months. J Pediatr Nurs 2022; 62:17-22. [PMID: 34839196 PMCID: PMC8942906 DOI: 10.1016/j.pedn.2021.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To identify predictors of post-traumatic stress symptomology among parents of infants with complex congenital heart defects at hospital discharge and after 4 months. DESIGN & METHODS A secondary analysis utilizing data from a larger RCT performed in three pediatric cardiac centers in North America. Analysis included 158 parent-infant dyads. Generalized Linear Modeling was used to identify predictors of parental post-traumatic symptomology at hospital discharge, and after 4 months. Considered predictors included demographics/SES, illness, and psychosocial parameters. RESULTS At discharge, parenting stress, education, and infant's medication number were linked to post-traumatic stress symptomology severity; Parenting stress, education, insurance type, and medications number predicted number of symptoms; Tube-assisted feeding predicted PTSD. At 4 months, parenting stress, ethnicity, and number of ED visits predicted PTSS severity; Parenting stress, ethnicity, and cardiologist visits predicted number of symptoms; Parenting stress, single ventricle physiology, and number of children predicted PTSD. CONCLUSIONS & PRACTICAL IMPLICATIONS Parental psychosocial factors, additionally to illness and sociodemographic indicators, can potentially risk parents to experience PTSS/PTSD. Nursing and other healthcare professionals can participate in early screening of such factors to determine familial risk. TRIAL REGISTRATION NCT01941667.
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Affiliation(s)
- Nadya Golfenshtein
- University of Haifa, Department of Nursing, Israel; School of Nursing, University of Pennsylvania, USA.
| | - Amy Jo Lisanti
- School of Nursing, University of Pennsylvania, USA; Children's Hospital of Philadelphia, USA
| | - Naixue Cui
- School of Nursing and Rehabilitation, Shandong University, China
| | - Barbara Medoff Cooper
- School of Nursing, University of Pennsylvania, USA; Children's Hospital of Philadelphia, USA
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Schulte FSM, Merz EL, Russell KB, Tromburg C, Cho S, Tran A, Reynolds K, Tomfohr-Madsen L. Social adjustment in survivors of acute lymphoblastic leukemia without cranial radiation therapy. Pediatr Blood Cancer 2022; 69:e29407. [PMID: 34665517 DOI: 10.1002/pbc.29407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate group differences in social adjustment in survivors of pediatric acute lymphoblastic leukemia (ALL) compared to survivor siblings and controls; identify disease-related predictors of social adjustment in survivors; and explore whether executive functioning explained differences in social adjustment across groups and between disease-related predictors. METHODS Survivors of pediatric ALL (n = 38, average age at diagnosis = 4.27 years [SD = 1.97]; average time off treatment = 4.83 years [SD = 1.52]), one sibling (if available, n = 20), and one parent from each family were recruited from a long-term survivor clinic. Healthy age- and sex-matched controls (n = 38) and one parent from each family were recruited from the community. Parents completed the Behavioral Assessment System for Children, Parent Rating Scale (BASC-3) Social Withdrawal subscale as a measure of social adjustment, and the Behavior Rating Inventory of Executive Functions (BRIEF-2) as a measure of executive function for each of their children. Multilevel modeling and mediation analysis were used to achieve the study aims. RESULTS Parents reported that survivors had significantly worse social adjustment compared to controls (b = 6.34, p = .004), but not survivor siblings. Among survivors, greater time off treatment (b = 2.06, p = .058) and poorer executive functioning (b = 0.42, p = .006) were associated with worse social adjustment. Executive function did not mediate differences in social withdrawal between survivors and controls or the relationship between time off treatment and social withdrawal among survivors. CONCLUSIONS Survivors of pediatric ALL presenting to follow-up programs should be screened for difficulties with social adjustment. Future research should examine treatment- and nontreatment-related factors contributing to poorer social outcomes.
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Affiliation(s)
- Fiona S M Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hematology, Oncology, and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Erin L Merz
- Department of Psychology, California State University, Carson, California, USA
| | - K Brooke Russell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Courtney Tromburg
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Cho
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Tran
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Reynolds
- Hematology, Oncology, and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
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Lewandowska A, Zych B, Papp K, Zrubcová D, Kadučáková H, Šupínová M, Apay SE, Nagórska M. Problems, Stressors and Needs of Children and Adolescents with Cancer. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121173. [PMID: 34943367 PMCID: PMC8700549 DOI: 10.3390/children8121173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cancer diseases in children and adolescents are considered to be one of the most serious health problems in the world. It is estimated that about 151,435 cases are diagnosed in children annually. Children with cancer experience many comorbid symptoms related to diagnosis and treatment that can profoundly affect their lives. They experience physical and emotional suffering, which affects their well-being and physical fitness, influencing the prognosis and deteriorating their physical, mental and social functioning. Given the limited data, an attempt was made to assess the problems of the biopsychosocial sphere of need and stressors among children and adolescents treated for cancer. Accurate symptom assessment is essential to ensure high-quality care and effective treatment. PATIENTS AND METHODS The qualitative study was conducted in pediatric oncology of hospitals in Poland. Children diagnosed with cancer were invited to participate in the study to assess their problems, stressors and needs. RESULTS The study included 520 people, where female sex constituted 48% and male 52%. The mean age of the children is 13.2 SD = 2.5. Negative experiences related to the disease are experienced by 82% of children. Among the surveyed children, the most experienced were anxiety (61%). The conducted research shows that as many as 69% of all respondents experienced states that indicate severe depression. The most common somatic problems reported by children were pain (58%). The most dominant areas of life that had a negative impact was body image (85%). CONCLUSIONS Children and adolescents diagnosed with neoplastic disease experience many problems and stressors in every sphere of life, which undoubtedly affects a high level of unmet needs. The main category of needs concerning the challenges faced by children with cancer was psychological and care problems. In the youth group, the needs were mainly related to education and social support.
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Affiliation(s)
- Anna Lewandowska
- Institute of Healthcare, State School of Technology and Economics, 37-500 Jaroslaw, Poland
- Correspondence: ; Tel.: +48-698-757-926
| | - Barbara Zych
- Institute of Health Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
| | - Katalin Papp
- Faculty of Health, University of Debrecen, 4400 Nyíregyháza, Hungary;
| | - Dana Zrubcová
- Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, 94974 Nitra, Slovakia;
| | - Helena Kadučáková
- Faculty of Health, Catholic University in Ružomberok, 03401 Ružomberok, Slovakia; (H.K.); (M.Š.)
| | - Mária Šupínová
- Faculty of Health, Catholic University in Ružomberok, 03401 Ružomberok, Slovakia; (H.K.); (M.Š.)
| | - Serap Ejder Apay
- Department of Midwifery, Faculty of Health Science, Ataturk University, Erzurum 25240, Turkey;
| | - Małgorzata Nagórska
- Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland;
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13
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White GE, Caterini JE, McCann V, Rendall K, Nathan PC, Rhind SG, Jones H, Wells GD. The Psychoneuroimmunology of Stress Regulation in Pediatric Cancer Patients. Cancers (Basel) 2021; 13:4684. [PMID: 34572911 PMCID: PMC8468382 DOI: 10.3390/cancers13184684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Stress is a ubiquitous experience that can be adaptive or maladaptive. Physiological stress regulation, or allostasis, can be disrupted at any point along the regulatory pathway resulting in adverse effects for the individual. Children with cancer exhibit significant changes to these pathways in line with stress dysregulation and long-term effects similar to those observed in other early-life stress populations, which are thought to be, in part, a result of cytotoxic cancer treatments. Children with cancer may have disruption to several steps in the stress-regulatory pathway including cognitive-affective function, neurological disruption to stress regulatory brain regions, altered adrenal and endocrine function, and disrupted tissue integrity, as well as lower engagement in positive coping behaviours such as physical activity and pro-social habits. To date, there has been minimal study of stress reactivity patterns in childhood illness populations. Nor has the role of stress regulation in long-term health and function been elucidated. We conclude that consideration of stress regulation in childhood cancer may be crucial in understanding and treating the disease.
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Affiliation(s)
- Gillian E. White
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
| | - Jessica E. Caterini
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
| | - Victoria McCann
- School of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Kate Rendall
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
| | - Paul C. Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.N.); (H.J.)
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON M3K 2C9, Canada;
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada
| | - Heather Jones
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.N.); (H.J.)
| | - Greg D. Wells
- Translational Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (G.E.W.); (J.E.C.); (K.R.)
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14
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Kamaladasa DS, Sansom-Daly UM, Hetherington K, McGill BC, Ellis SJ, Kelada L, Donoghoe MW, Evans H, Anazodo A, Patterson P, Cohn RJ, Wakefield CE. How Are Families Faring? Perceived Family Functioning Among Adolescent and Young Adult Cancer Survivors in Comparison to Their Peers. J Adolesc Young Adult Oncol 2021; 10:711-719. [PMID: 33960837 DOI: 10.1089/jayao.2020.0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) cancer survivors' families can face ongoing challenges into survivorship. Families' adjustment and functioning as a unit can subsequently impact AYAs' mental health and quality of life. This study examined AYA cancer survivors' perceived family functioning, compared with their peers, and investigated factors associated with family functioning. Methods: Eligible participants were aged between 15 and 40 years, fluent in English, and cancer survivors who had completed treatment. AYA cancer survivors were recruited from hospital clinics, and the comparison group from an affiliated university campus. Participants completed the McMaster Family Assessment Device, Kidcope, and the Depression, Anxiety and Stress Scale-Short Form. We analyzed between-group differences in family functioning using multivariate analysis of covariance and used partial correlations to investigate associations between demographic cancer-related psychological coping variables and family functioning. Results: Ninety-three AYA cancer survivors and 141 comparison peers participated (ages: 15-32 years). AYA cancer survivors reported significantly better family functioning (p = 0.029), lower depression (p = 0.016), and anxiety symptoms (p = 0.008) compared with the comparison group. Approximately one-third of AYA survivors (34.4%) reported clinically significant maladaptive family functioning; however, this was more prevalent in the comparison group (50.4%). After adjusting for covariates, poorer family functioning was associated with AYA survivors using more avoidant escape-oriented coping strategies (p = 0.010). Conclusions: Our cancer survivor cohort reported better family functioning and psychological outcomes compared with their peers. Interventions targeting avoidant coping behaviors may support improved family functioning in some survivors. Further research disentangling the relationship between coping mechanisms and family functioning among AYA cancer survivors is needed.
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Affiliation(s)
- Dinuli S Kamaladasa
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah J Ellis
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Lauren Kelada
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Mark W Donoghoe
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - Holly Evans
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,School of Psychology, UNSW Sydney, Kensington, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Pandora Patterson
- Canteen Australia, Newtown, Australia.,Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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15
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Holochwost SJ, Robb SL, Henley AK, Stegenga K, Perkins SM, Russ KA, Jacob SA, Delgado D, Haase JE, Krater CM. Active Music Engagement and Cortisol as an Acute Stress Biomarker in Young Hematopoietic Stem Cell Transplant Patients and Caregivers: Results of a Single Case Design Pilot Study. Front Psychol 2020; 11:587871. [PMID: 33224077 PMCID: PMC7667234 DOI: 10.3389/fpsyg.2020.587871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
This paper reports the results of a single case design pilot study of a music therapy intervention [the Active Music Engagement (AME)] for young children (age 3.51 to 4.53 years) undergoing hematopoietic stem cell transplantation (HCST) and their caregivers. The primary aims of the study were to determine feasibility/acceptability of the AME intervention protocol and data collection in the context of HCST. Secondary aims were to examine caregivers' perceptions of the benefit of AME and whether there were changes in child and caregiver cortisol levels relative to the AME intervention. Results indicated that the AME could be implemented in this context and that data could be collected, though the collection of salivary cortisol may constitute an additional burden for families. Nevertheless, data that were collected suggest that families derive benefit from the AME, which underscores the need for devising innovative methods to understand the neurophysiological impacts of the AME.
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Affiliation(s)
| | - Sheri L Robb
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Amanda K Henley
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | | | - Susan M Perkins
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Kristen A Russ
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Seethal A Jacob
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| | - David Delgado
- Astellas Pharma Global Development, Northbrook, IL, United States
| | - Joan E Haase
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Caitlin M Krater
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
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16
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Male and Female Sexual Dysfunction in Pediatric Cancer Survivors. J Sex Med 2020; 17:1715-1722. [PMID: 32622765 DOI: 10.1016/j.jsxm.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pediatric cancer survivors suffer indirect long-term effects of their disease; however, there is a paucity of data regarding the effect of pediatric cancer survivorship on sexual function. AIM To assess the prevalence and risk factors associated with sexual dysfunction among pediatric cancer survivors. METHODS Pediatric cancer survivors were recruited to complete an online survey using the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-5), both validated questionnaires to assess female sexual dysfunction (FSD) and erectile dysfunction (ED). Patient demographics, oncologic history, prior treatment, and sexual habits were also queried. Logistic regression was used to evaluate risk factors for sexual dysfunction, and Mann-Whitney U test was used to identify factors associated with individual domains of the FSFI. OUTCOMES The main outcome measures were FSFI and IIEF-5 score, which are used to diagnose FSD (FSFI<26.55) and ED (IIEF-5<22). RESULTS A total of 21 (72.4%) female respondents and 20 (71.4%) male respondents were sexually active and completed the survey and FSFI or IIEF-5 questionnaire, respectively. Mean (±SD) age was 23.7 (4.1) years, and average age at diagnosis was 9.1 (5.0), with no difference between genders. Overall, 25.0% (5/20) of male and 52.4% (11/21) of female pediatric cancer survivors reported sexual dysfunction (P = .11). Oncologic history and prior treatment were not associated with sexual function. Females who reported difficulty relaxing during intercourse in the last 6 months had higher odds of reporting sexual dysfunction (odds ratio: 13.6, 95% confidence interval: 1.2-151.2, P = .03). Subgroup analysis of FSFI domains found that previous radiation therapy was correlated with decreased lubrication and satisfaction during intercourse, whereas previous treatment to the pelvic region significantly reduced satisfaction and increased pain during intercourse. CLINICAL IMPLICATIONS Female pediatric cancer survivors have higher odds of reporting sexual dysfunction after treatment and should be screened appropriately to provide early intervention and to mitigate risk. STRENGTH & LIMITATIONS Our study includes validated questionnaires to assess FSD and ED and queries specific characteristics to assess their association with sexual dysfunction. However, the study is limited by sample size and its cross-sectional survey design. CONCLUSIONS The prevalence of female sexual dysfunction in this cohort is higher than that in the general population of equivalent-aged individuals, and clinicians should be aware of these potential long-term sequelae. Greenberg DR, Khandwala YS, Bhambhvani HP, et-al. Male and Female Sexual Dysfunction in Pediatric Cancer Survivors. J Sex Med 2020;17:1715-1722.
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17
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Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences. Seizure 2020; 80:169-174. [PMID: 32593140 DOI: 10.1016/j.seizure.2020.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate psychopathological reaction to traumatic stress, addressing in particular gender difference, in parental couples of children affected by epilepsy. METHODS 50 mothers and 50 fathers, paired for one's child, of children followed at the Pediatric Unit of a major Italian University Hospital with a diagnosis of epilepsy were enrolled, screened by means of the Semi-structured Clinical Interview for DSM-5 (SCID-5) and filled the Trauma and Loss Spectrum Self-Report (TALS-SR), an international instrument to evaluate post-traumatic stress symptomatology. RESULTS 25 % of the total sample presented a diagnosis of PTSD with a statistically higher prevalence of mothers (36 % and 14 %, respectively; p = .021). Furthermore, 44 % (48 % mothers and 40 % fathers) presented a partial PTSD. Important gender differences emerged also for all cluster dimensions of the TALS-SR except for the Avoidance. Finally, the analysis of the single items of the TALS-SR evidenced that in mothers subgroup prevail cognitive symptoms of fear and sadness as well as somatic manifestations. CONCLUSIONS Our results point out the differences between mothers and fathers in trauma response and underline the need to develop gender targeted models of healthcare prevention and assistance.
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18
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Pinquart M. Posttraumatic Stress Symptoms and Disorders in Children and Adolescents with Chronic Physical Illnesses: a Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:1-10. [PMID: 32318223 PMCID: PMC7163825 DOI: 10.1007/s40653-018-0222-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of the present meta-analysis was to compare levels of posttraumatic stress symptoms (PTSS) and the prevalence of posttraumatic stress disorders (PTSD) in individuals with and without pediatric chronic physical illnesses, and to analyze correlates of these symptoms. In total, 150 studies were identified that provided relevant data. On average, 11.5% of the participants with pediatric chronic physical illnesses met the criteria of PTSD (Odds Ratio 2.70). PTSS were also more common in this group than in control groups without chronic physical illnesses. While the PTSS levels did not differ across physical diseases, we found positive associations of PTSS with illness severity and duration/intensity of treatment, as well as negative associations with duration of illness, time since last treatment, treatment adherence, and family functioning. We conclude that individuals with pediatric chronic physical illnesses who experienced traumatic events should be screened for PTSS and receive psychological interventions when needed.
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Affiliation(s)
- Martin Pinquart
- Department of Psychology, Philipps University, Gutenbergstr. 18, D-35032 Marburg, Germany
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19
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Russ KA, Holochwost SJ, Perkins SM, Stegenga K, Jacob SA, Delgado D, Henley AK, Haase JE, Robb SL. Cortisol as an Acute Stress Biomarker in Young Hematopoietic Cell Transplant Patients/Caregivers: Active Music Engagement Protocol. J Altern Complement Med 2020; 26:424-434. [PMID: 32073877 PMCID: PMC7232696 DOI: 10.1089/acm.2019.0413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Primary aims of the proposed protocol are to determine the feasibility/acceptability of the active music engagement intervention protocol during hematopoietic stem cell transplantation (HSCT) and clinical feasibility/acceptability of the biological sample collection schedule. Design: The authors propose a single-case, alternating treatment design to compare levels of child and caregiver cortisol in blood and saliva collected on alternating days, when the dyad receives and does not receive AME sessions. Included are the scientific rationale for this design and detailed intervention and sample collection schedules based on transplant type. Setting/Location: Pediatric inpatient HSCT unit. Subjects: Eligible participants are dyads of children 3–8 years old, hospitalized for HSCT, and their caregiver. Children with malignant and nonmalignant conditions will be eligible, regardless of transplant type. Intervention: AME intervention is delivered by a board-certified music therapist who tailors music-based play experiences to encourage active engagement in, and independent use of, music play to manage the inter-related emotional distress experienced by children and their caregivers during HSCT. Dyads will receive two 45-min AME sessions each week during hospitalization. Outcome Measures: Eight collections of blood (child) and saliva (child/caregiver) will be performed for cortisol measurement. The authors will also collect self-report and caregiver proxy measures for dyad emotional distress, quality of life, and family function. At study conclusion, qualitative caregiver interviews will be conducted. Results: Planned analyses will be descriptive and evaluate the feasibility of participant recruitment, cortisol collection, planned evaluations, and AME delivery. Analysis of qualitative interviews will be used to gain an understanding about the ease/burden of biological sample collection and any perceived benefit of AME. Conclusions: Behavioral intervention studies examining biological mechanisms of action in pediatric transplant populations are rare. Findings will provide important information about the feasibility/acceptability of collecting cortisol samples during a high-intensity treatment and advance understanding about the use of active music interventions to mitigate child/caregiver distress during the transplant period.
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Affiliation(s)
- Kristen A Russ
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | | | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA.,Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | - Seethal A Jacob
- Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - David Delgado
- Astellas Pharma Global Development, Northbrook, IL, USA
| | | | - Joan E Haase
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Sheri L Robb
- Indiana University School of Nursing, Indianapolis, IN, USA
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20
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Harper FWK, Albrecht TL, Trentacosta CJ, Taub JW, Phipps S, Penner LA. Understanding differences in the long-term psychosocial adjustment of pediatric cancer patients and their parents: an individual differences resources model. Transl Behav Med 2020; 9:514-522. [PMID: 31094435 DOI: 10.1093/tbm/ibz025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The experience of childhood cancer is a major life stressor for children and their parents. There is substantial variability among pediatric cancer patients and their parents in their ability to cope with the cancer. Although other models typically focus on the psychological resources families use to broadly cope with a diagnosis of pediatric cancer, we present a model that focuses specifically how parents and children cope with the stress of invasive and often painful treatment episodes. Our resources model is further distinct with its focus on individual differences in personal (e.g., personality traits) and social (e.g., social support) resources and the role these differences may play in psychosocial adjustment of families confronting pediatric cancer. We use findings from the broader pediatric cancer research literature and our own 15-year program of research on individual differences in psychological resources and parents and children's responses to treatment episodes to provide empirical support for our model. Support was found for the six premises of the model: (a) parent resources influence their longer-term psychosocial adjustment, (b) parent resources influence children's responses to treatment episodes, (c) parent resources indirectly influence their longer-term psychosocial adjustment through their responses to treatment episodes, (d) children's personal resources influence how parent responses to treatment episodes, (e) children's resources influence their longer-term psychosocial adjustment, and (f) children's resources indirectly influence their longer-term psychosocial adjustment through their responses to treatment episodes. Understanding how the availability of resources influences parents and children confronting cancer provides a foundation for future research on individual differences in resources and offers other avenues through which clinicians can assess and treat families at risk for poor psychosocial adjustment during treatment and in their life beyond cancer treatments.
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Affiliation(s)
- Felicity W K Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Terrance L Albrecht
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Jeffrey W Taub
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Louis A Penner
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
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21
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Muscara F, McCarthy MC, Hearps SJC, Nicholson JM, Burke K, Dimovski A, Darling S, Rayner M, Anderson VA. Featured Article: Trajectories of Posttraumatic Stress Symptoms in Parents of Children With a Serious Childhood Illness or Injury. J Pediatr Psychol 2019; 43:1072-1082. [PMID: 29800298 DOI: 10.1093/jpepsy/jsy035] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Serious childhood illness is associated with significant parent psychological distress. This study aimed to (a) document acute and posttraumatic stress symptoms (PTSS) in parents of children with various life-threatening illnesses; (b) identify trajectory patterns of parental PTSS and recovery over 18 months; (c) determine psychosocial, demographic, and illness factors associated with trajectory group membership. Methods In total, 159 parents (115 mothers, 44 fathers) from 122 families participated in a prospective, longitudinal study that assessed parent psychological responses across four time points-at diagnosis, and 3, 6, and 18 months later. Children were admitted to the Cardiology, Oncology, and Pediatric Intensive Care Departments in a tertiary pediatric hospital. The primary outcome was parent PTSS. Results Three distinct parent recovery profiles were identified-"Resilient," "Recovery," and "Chronic." The "Resilient" class (33%) showed low distress responses across the trajectory period, whereas the "Recovery" class (52%) showed significantly higher levels of distress at the time of diagnosis that gradually declined over the first months following their child's illness. Both of these classes nevertheless remained within the normative range throughout. In contrast, the "Chronic" class (13%) was consistently high in severity, remaining within the clinical range across the entire period. Psychosocial factors such as mood, anxiety, and emotional responses predicted group membership, whereas demographic and illness factors did not. Conclusions Parents show considerable resilience in the face of children's life-threatening illnesses. Early assessment of parent psychosocial factors may aid identification of those who would benefit from early intervention.
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Affiliation(s)
- Frank Muscara
- Clinical Sciences, Murdoch Children's Research Institute.,Department of Pediatrics & School of Psychological Science, University of Melbourne.,Psychology Service, Royal Children's Hospital
| | - Maria C McCarthy
- Clinical Sciences, Murdoch Children's Research Institute.,Children's Cancer Centre, Royal Children's Hospital
| | | | | | - Kylie Burke
- Clinical Sciences, Murdoch Children's Research Institute.,Parenting and Family Support Centre, School of Psychology, The University of Queensland
| | - Anica Dimovski
- Clinical Sciences, Murdoch Children's Research Institute
| | - Simone Darling
- Clinical Sciences, Murdoch Children's Research Institute
| | | | - Vicki A Anderson
- Clinical Sciences, Murdoch Children's Research Institute.,Department of Pediatrics & School of Psychological Science, University of Melbourne.,Psychology Service, Royal Children's Hospital
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22
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van Warmerdam J, Sutradhar R, Kurdyak P, Lau C, Pole JD, Nathan PC, Gupta S. Long-Term Mental Health Outcomes in Mothers and Siblings of Children With Cancer: A Population-Based, Matched Cohort Study. J Clin Oncol 2019; 38:51-62. [PMID: 31714869 DOI: 10.1200/jco.19.01382] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although a diagnosis of childhood cancer can have a profound effect on the entire family unit, its impact on the long-term mental health of family members is not well characterized. METHODS A provincial childhood cancer registry in Ontario, Canada, was linked to birth records to identify separate population-based cohorts of mothers and siblings of children diagnosed with cancer between 1998 and 2014. The mother and sibling cohorts were matched to corresponding population controls and linked to health services data. The rate of mental health-related outpatient visits (family physician, psychiatrist) and the incidence of severe psychiatric events (psychiatric emergency department visit, psychiatric hospitalization, suicide) were compared between mothers and siblings and their controls. Possible predictors of mental health outcomes were examined, including demographics, characteristics of the cancer-affected child, and cancer treatment. RESULTS We identified 4,773 mothers and 7,897 siblings of children diagnosed with cancer during the study period. Compared with controls, both groups experienced elevated rates of outpatient visits (mothers: rate ratio [RR], 1.4; P < .0001; siblings: RR, 1.1; P < .0001). The risk of severe psychiatric events was not increased in either cohort. Mother and sibling demographic factors associated with increased risk of adverse mental health included younger maternal age at cancer diagnosis, low socioeconomic status, and rural residence among mothers and older sibling age among siblings. Treatment-related variables pertaining to the cancer-affected child were not associated with mental health outcomes. Mental health outcomes clustered within families. CONCLUSION Both mothers and siblings experience elevated and prolonged need for mental health-related health care as compared with the general population. Demographic risk factors predict subpopulations at highest risk. Increased psychosocial support for family members during and after cancer therapy is warranted.
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Affiliation(s)
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Jason D Pole
- ICES, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Paul C Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Sumit Gupta
- The Hospital for Sick Children, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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23
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Jankowska‐Polańska B, Sliwiński M, Świątoniowska N, Butrym A, Mazur G. Quality of life in children with acute lymphoblastic leukaemia. Scand J Caring Sci 2019; 34:380-389. [DOI: 10.1111/scs.12739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Beata Jankowska‐Polańska
- Faculty of Health Sciences, Department of Clinical Nursing Wroclaw Medical University Wroclaw Poland
| | - Maciej Sliwiński
- Student Scientific Societies of Clinical Nursing, Public Health Department Wroclaw Medical University Wroclaw Poland
| | - Natalia Świątoniowska
- Faculty of Health Sciences, Department of Clinical Nursing Wroclaw Medical University Wroclaw Poland
| | - Aleksandra Butrym
- Faculty of Medicine, Department of Cancer Prevention and Therapy Wroclaw Medical University Wroclaw Poland
| | - Grzegorz Mazur
- Faculty of Medicine, Department and Clinic of Internal and Occupational Diseases and Hypertension Wroclaw Medical University Wroclaw Poland
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Marusak HA, Harper FW, Taub JW, Rabinak CA. Pediatric cancer, posttraumatic stress and fear-related neural circuitry. Int J Hematol Oncol 2019; 8:IJH17. [PMID: 31467663 PMCID: PMC6714068 DOI: 10.2217/ijh-2019-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This review examines the neurobiological effects of pediatric cancer-related posttraumatic stress symptoms (PTSS). We first consider studies on prevalence and predictors of childhood cancer-related PTSS and compare these studies to those in typically developing (i.e., noncancer) populations. Then, we briefly introduce the brain regions implicated in PTSS and review neuroimaging studies examining the neural correlates of PTSS in noncancer populations. Next, we present a framework and recommendations for future research. In particular, concurrent evaluation of PTSS and neuroimaging, as well as sociodemographic, medical, family factors, and other life events, are needed to uncover mechanisms leading to cancer-related PTSS. We review findings from neuroimaging studies on childhood cancer and one recent study on cancer-related PTSS as a starting point in this line of research.
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Affiliation(s)
- Hilary A Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA.,Population Studies & Disparities Research Program, Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Felicity W Harper
- Population Studies & Disparities Research Program, Karmanos Cancer Institute, Detroit, MI 48201, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI 48201, USA.,Children's Hospital of Michigan, Detroit, MI 48201, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA.,Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA.,Department of Psychiatry & Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA
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Impact of a Child Life and Music Therapy Procedural Support Intervention on Parental Perception of Their Child's Distress During Intravenous Placement. Pediatr Emerg Care 2019; 35:498-505. [PMID: 28225375 DOI: 10.1097/pec.0000000000001065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Child life specialists and music therapists have a unique and integral role in providing psychosocial care to pediatric patients and families. These professionals are trained to provide clinical interventions that support coping and adjustment and reduce the risk of psychological trauma related to hospital visits and health care encounters. The researchers devised a multimodal approach using a combined child life and music therapy intervention to address procedure-related distress in patients receiving intravenous (IV) placement in the pediatric emergency department. The aim of this study was to investigate the efficacy of this collaborative intervention by evaluating parental perception of their child's distress. METHODS This study was a prospective analysis investigating the impact of a child life and music therapy intervention on children aged 4 to 11 years old receiving an IV placement in the pediatric emergency department. Efficacy was evaluated by comparing scores between a 4-question pretest and subsequent 4-question posttest that asked the child's parent to evaluate how they anticipated their child would respond to the procedure, and then to evaluate how they perceived their child to have responded after the procedure. Qualitative data were collected in the form of open-ended comments, which were accommodated at the end of the posttest. Data were analyzed by the Cochran-Mantel-Haenszel method for testing repeated ordinal responses and the PROC GENMOD procedure in the SAS system software. RESULTS A total of 41 participants were enrolled in this study. Results of the statistical analysis revealed significant differences between all pre- and posttest scores (P < 0.05), and significant likelihood that the patient would improve relative to the 4 questions, as a result of the child life and music therapy intervention. CONCLUSIONS Improvement was demonstrated across all 4 questions, suggesting that the child life and music therapy intervention supported healthy, adaptive coping and helped to minimize distress experienced by patients during IV placement. These results underscore the importance and potential clinical impact of child life psychological preparation and psychotherapy-based music therapy interventions in reducing distress in pediatric patients during common medical procedures.
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van Warmerdam J, Zabih V, Kurdyak P, Sutradhar R, Nathan PC, Gupta S. Prevalence of anxiety, depression, and posttraumatic stress disorder in parents of children with cancer: A meta-analysis. Pediatr Blood Cancer 2019; 66:e27677. [PMID: 30816008 DOI: 10.1002/pbc.27677] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND For parents, a diagnosis of cancer in their child is a traumatic experience. However, there is conflicting evidence about the risk of developing mental illness among parents following diagnosis. Our objective was to conduct a meta-analysis to determine the prevalence of mental illness in parents of children with cancer. METHODS Four databases were searched to identify articles describing the prevalence of anxiety, depression, or posttraumatic stress disorder (PTSD) in parents of pediatric cancer patients. Two reviewers independently screened and extracted data. Subgroup analyses by gender and phase of cancer experience were selected a priori. Studies were reviewed in accordance with PRISMA guidelines. RESULTS Of 11 394 articles identified, 58 met inclusion criteria. Reported prevalence was highly heterogeneous, ranging from 5% to 65% for anxiety (pooled prevalence 21% [95% CI, 13%-35%]), 7% to 91% for depression (pooled prevalence 28% [95% CI, 23%-35%]), and 4% to 75% for PTSD (pooled prevalence 26% [95% CI, 22%-32%]). Prevalence was consistently higher than noncancer parental controls. Heterogeneity was not explained by parental gender or child's cancer phase and was instead likely due to significant methodological differences in measurement tools and defined thresholds. CONCLUSIONS Parents of children with cancer have a higher prevalence of anxiety, depression, and PTSD compared with population controls. Yet, the reported prevalence of mental illness was highly variable, hampering any conclusive findings on absolute prevalence. To better understand the risk of long-term mental illness in this population and target interventions, future studies must adhere to standardized reporting and methods.
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Affiliation(s)
- Jacqui van Warmerdam
- The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, Toronto, Canada.,University of Toronto, Institute of Medical Sciences, Toronto, Canada
| | - Veda Zabih
- The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, Toronto, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health CAMH, Institute for Mental Health Policy Research, Toronto, Canada.,ICES, Cancer, Toronto, Canada
| | - Rinku Sutradhar
- ICES, Cancer, Toronto, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Canada
| | - Paul C Nathan
- The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, Toronto, Canada.,ICES, Cancer, Toronto, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Canada.,The Hospital for Sick Children, Division of Hematology/Oncology, Toronto, Canada
| | - Sumit Gupta
- The Hospital for Sick Children Research Institute, Child Health and Evaluative Sciences, Toronto, Canada.,ICES, Cancer, Toronto, Canada.,University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Canada.,The Hospital for Sick Children, Division of Hematology/Oncology, Toronto, Canada
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27
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Gallo A, Wertz C, Kairis S, Blavier A. Exploration of relationship between parental distress, family functioning and post-traumatic symptoms in children. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2019. [DOI: 10.1016/j.ejtd.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Development and validation of self- and caregiver-report of a distress screening tool for pediatric cancer survivors. Support Care Cancer 2019; 27:4179-4187. [PMID: 30805727 DOI: 10.1007/s00520-019-04708-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To develop and validate the Distress Screening Tool (DST) for child and adolescent cancer survivors. METHODS In part 1, items of the DST were generated through literature search and group interviews. Initially, the DST was tested on pediatric cancer survivors and their caregivers. In part 2, the modified version of the DST was retested with a different set of participants. Lastly, the psychometric properties and cutoff scores of the DST were evaluated on a separate set of survivors and caregivers. RESULTS In part 1, six items of the DST self- and caregiver-report versions were generated. The initial 6 DST items of both versions showed acceptable internal consistency, but low inter-item correlation. Following the item modification, both versions of the DST showed improved inter-item correlation. In part 2, the modified DST had acceptable internal consistency and convergent validity, with acceptable psychometric properties. Cutoff scores were also generated. CONCLUSIONS The DST could be a useful tool for pediatric cancer survivors.
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Marusak HA, Iadipaolo AS, Paulisin S, Harper FW, Taub JW, Dulay K, Elrahal F, Peters C, Sala-Hamrick K, Crespo LM, Rabinak CA. Emotion-related brain organization and behavioral responses to socioemotional stimuli in pediatric cancer survivors with posttraumatic stress symptoms. Pediatr Blood Cancer 2019; 66:e27470. [PMID: 30270517 PMCID: PMC6249085 DOI: 10.1002/pbc.27470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/06/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pediatric cancer is a life-changing, stressful experience for children and their families. Although most children adjust well, psychologically, a significant subset report posttraumatic stress symptoms (PTSS), with nearly 75% reexperiencing traumatic parts of cancer and/or its treatment. However, little research has examined the effects of pediatric cancer and related PTSS on emotional processing, and on functional properties of key emotional centers in the brain (e.g., amygdala). PROCEDURE We examined cancer-related PTSS, behavioral responses during an emotion-processing task, and resting-state functional connectivity of the amygdala in 17 pediatric cancer survivors (ages 6-11) and 17 age- and sex-matched controls. RESULTS Cancer survivors, relative to controls, were more likely to rate ambiguous (i.e., neutral) faces as negative (i.e., "negativity bias"). Higher reexperiencing PTSS was associated with faster responses to neutral faces. Although there were no group differences in amygdala centrality, within survivors, both higher reexperiencing PTSS and faster reaction times were associated with increased centrality of the amygdala-a functional property associated with hubs of information processing in the brain. In an exploratory mediation analysis, we found that amygdala centrality mediated the link between reaction time and PTSS, suggesting that changes in the brain may be a proximal marker of the expression of emotion-related symptomology. CONCLUSIONS Negativity bias in cancer survivors may reflect their stressful experiences with cancer and/or its treatment. This negativity bias may represent a susceptibility to changes in emotion-related brain functioning, which may, in turn, lead to PTSS.
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Affiliation(s)
- Hilary A. Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI;,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Allesandra S. Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Shelley Paulisin
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Felicity W. Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI;,Department of Oncology, School of Medicine, Wayne State University, Detroit, MI
| | - Jeffrey W. Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI,,Children’s Hospital of Michigan, Detroit, MI
| | | | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Craig Peters
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | | | - Laura M. Crespo
- Department of Psychology, Wayne State University, Detroit, MI
| | - Christine A. Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI;,Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI;,Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI
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Cousino MK, Hazen R, Josie KL, Laschinger K, de Blank P, Taylor HG. Childhood Cancer and Brain Tumor Late Effects: Relationships with Family Burden and Survivor Psychological Outcomes. J Clin Psychol Med Settings 2018; 24:279-288. [PMID: 29147881 DOI: 10.1007/s10880-017-9519-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study examines illness-specific family burden as a mediator of the association between late effects of childhood cancer and survivors' emotional and behavioral outcomes. Childhood cancer survivors (n = 65; ages 10-17) two or more years off-treatment completed measures assessing internalizing and PTSD symptoms. Parents reported on illness-specific family burden, late effects severity, and survivor internalizing/externalizing problems. Providers documented the number of late effects. Illness-specific family burden was correlated with provider-reported late effects (r = .29, p < .05) and parent report of severe late effects (r = .56, p < .01). Results supported an indirect effect of illness-specific family burden on number of late effects and parent-reported survivor internalizing problems, p < .05. Indirect effects were not found in models predicting PTSD and externalizing problems. Illness-specific family burden is an important intervention target for reducing internalizing problems in childhood cancer survivors with late effects.
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Affiliation(s)
- Melissa K Cousino
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA. .,Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA. .,Department of Pediatrics and Communicable Diseases at Michigan Medicine and the University of Michigan Transplant Center, Ann Arbor, MI, USA.
| | - Rebecca Hazen
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.,Division of Developmental/Behavioral Pediatrics & Psychology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | - Kelly Laschinger
- Division of Pediatric Hematology/Oncology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Peter de Blank
- Division of Oncology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - H Gerry Taylor
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.,Division of Developmental/Behavioral Pediatrics & Psychology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Parent's Perspectives on How They Cope With the Impact on Their Family of a Child With Heart Disease. J Pediatr Nurs 2018; 40:e9-e17. [PMID: 29396310 DOI: 10.1016/j.pedn.2018.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Studies of familial coping with a child's chronic condition have highlighted psychological distress; family functioning; and quality of life; as issues that demand coping strategies. There are conflicting findings on impact and coping and a paucity of information about the specific coping challenges for parents of a child with heart disease, with few qualitative studies in this area. The purpose of the study was to explore the way parents coped with their child's heart condition as it impacted on different domains of family functioning. DESIGN AND METHOD In this qualitative study, interviews were held with 17 parents attending a pediatric hospital-based family support program in 2015. Fifteen of the 17 children's conditions were classified as "major". Domains covered in the interviews included: coping challenges posed at different stages of the illness trajectory, parenting, condition management, transitions, psychological impact, social support and coping strategies. Interview transcripts were coded thematically. RESULTS Multiple points of stress and challenges to coping were identified: coping with the diagnosis, including consideration of termination; dealing with the challenges facing their child; coping with parenting including co-parenting issues; the role of social support in coping; and identification of adaptive and maladaptive coping behaviours. CONCLUSION A large range of positive coping strategies were identified, as was the need for coping-focused psychological support throughout the parents' and children's journey. PRACTICE IMPLICATIONS The strategies identified have formed the basis of a manualised intervention for these parents.
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Currie R, Anderson VA, McCarthy MC, Burke K, Hearps SJ, Muscara F. Parental distress in response to childhood medical trauma: A mediation model. J Health Psychol 2018; 25:1681-1691. [PMID: 29692208 DOI: 10.1177/1359105318770728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the relationship between individual and family-level risk in predicting longer-term parental distress following their child's unexpected diagnosis of serious illness. A mediation model was tested, whereby parents' pre-existing psychosocial risk predicts longer-term posttraumatic stress symptoms, indirectly through parents' acute stress response. One hundred and thirty-two parents of 104 children participated. Acute stress response partially mediated the relationship between psychosocial risk and posttraumatic stress symptoms, with a moderate indirect effect (r2 = .20, PM = .56, p < .001). Findings demonstrated that cumulative psychosocial risk factors predispose parents to acute stress and longer-term posttraumatic stress symptoms, highlighting the need for psychosocial screening in this population.
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Affiliation(s)
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Australia.,The University of Melbourne, Australia.,The Royal Children's Hospital Melbourne, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Australia.,The Royal Children's Hospital Melbourne, Australia
| | - Kylie Burke
- Parenting Research Centre, Australia.,The University of Queensland, Australia
| | | | - Frank Muscara
- Murdoch Children's Research Institute, Australia.,The University of Melbourne, Australia.,The Royal Children's Hospital Melbourne, Australia
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Jankovic M, Van Dongen-Melman JE, Vasilatou-Kosmidis H, Jenney ME. Improving the Quality of Life for Children with Cancer. TUMORI JOURNAL 2018; 85:273-9. [PMID: 10587031 DOI: 10.1177/030089169908500412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are now more than one million new cases of cancer every year in the European Community (EC) including the children to whom particular needs should be addressed. Besides the disease-free survival other outcomes reflecting the impact of treatment on the patient and their families must also be assessed and include their physical, psychological and social functioning throughout their care: during therapy, after completion of treatment or, for some, in the terminal phase of their illness. To provide optimal care and thus improve the quality of life for these children needs: a) an appropriately structured Paediatric Cancer Unit; b) well trained and permanent staff members: comprising doctors, nurses, psychologists, social workers and other health care professionals; c) facilities such as a specific out-patient clinic, a hospital school, a residence for parents; d) a well defined programme for the terminally ill children; e) a well defined programme for controlling the late effects of therapy.
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Affiliation(s)
- M Jankovic
- Department of Pediatrics, Ospedale San Gerardo, Monza, Italy
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Zheng DJ, Lu X, Schore RJ, Balsamo L, Devidas M, Winick NJ, Raetz EA, Loh ML, Carroll WL, Sung L, Hunger SP, Angiolillo A, Kadan-Lottick NS. Longitudinal analysis of quality-of-life outcomes in children during treatment for acute lymphoblastic leukemia: A report from the Children's Oncology Group AALL0932 trial. Cancer 2018; 124:571-579. [PMID: 29112230 PMCID: PMC5808870 DOI: 10.1002/cncr.31085] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/24/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children with average-risk acute lymphoblastic leukemia (AR-ALL) face many challenges that can adversely affect their quality of life (QOL). However, to the authors' knowledge, patterns and predictors of QOL impairment during therapy have not been well characterized to date. METHODS Patients with AR-ALL who were enrolled on the Children's Oncology Group AALL0932 trial were offered participation in this prospective cohort study if they were aged ≥4 years at the time of diagnosis and had an English-speaking parent. At approximately 2 months, 8 months, 17 months, 26 months, and 38 months (boys only) after diagnosis, parents completed the Pediatric Quality of Life Inventory Generic Core Scales Version 4.0 (PedsQL4.0) and McMaster Family Assessment Device instruments for QOL (physical, emotional, and social functioning) and family functioning, respectively. The proportions of individuals scoring in the impaired range (2 standard deviations below the population mean) were calculated at each time point. Longitudinal impairment patterns and predictors were examined. RESULTS A total of 594 participants with AR-ALL were diagnosed at a mean age of 6.0 years (standard deviation, 1.6 years). At 2 months, a substantial proportion of participants had impaired scores for physical (36.5%; 95% confidence interval [95% CI], 32.3%-40.8%) and emotional (26.2%; 95% CI, 22.5%-30.2%) functioning compared with population norms of 2.3%. These elevations persisted at 26 months. Emotional impairment at 2 months (odds ratio, 3.4; 95% CI, 1.5-7.7) was found to significantly predict emotional impairment at 26 months. In repeated measures analysis with multivariate modeling, unhealthy family functioning (odds ratio, 1.5; 95% CI, 1.1-2.1) significantly predicted emotional impairment controlling for age and sex. QOL outcomes were similar between sexes at the end of therapy (26 months for girls and 38 months for boys). CONCLUSIONS Many children with AR-ALL experience physical and emotional functioning impairment that begins early in treatment and persists. Early screening may identify high-risk patients who might benefit from family-based interventions. Cancer 2018;124:571-9. © 2017 American Cancer Society.
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Affiliation(s)
- Daniel J. Zheng
- Yale University School of Medicine, New Haven, CT
- Boston Children’s Hospital, Boston, MA
- Boston Medical Center, Boston, MA
| | | | | | - Lyn Balsamo
- Yale University School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | | | | | - Elizabeth A Raetz
- Primary Children’s Hospital, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
- University of Utah, Salt Lake City, UT
| | - Mignon L. Loh
- Benioff Children’s Hospital, San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
- University of California, San Francisco, San Francisco, CA
| | | | - Lillian Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen P. Hunger
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: A systematic review and meta-analysis. Psychooncology 2017; 27:1100-1109. [DOI: 10.1002/pon.4577] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/21/2017] [Accepted: 10/23/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Jasmin K. Turner
- School of Psychology; University of Adelaide; Adelaide South Australia Australia
| | - Amanda Hutchinson
- School of Psychology, Social Work & Social Policy; University of South Australia; Adelaide South Australia Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer; Flinders University; Bedford Park South Australia Australia
- Olivia Newton John Cancer Wellness and Research Centre; Heidelberg VIC Australia
- School of Psychology and Public Health; La Trobe University; Melbourne VIC Australia
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Berger C, Casagranda L, Faure-Conter C, Freycon C, Isfan F, Robles A, Trombert-Paviot B, Guichard I, Durieu I, Cathebras P. Long-Term Follow-up Consultation After Childhood Cancer in the Rhône-Alpes Region of France: Feedback From Adult Survivors and Their General Practitioners. J Adolesc Young Adult Oncol 2017; 6:524-534. [PMID: 28541785 DOI: 10.1089/jayao.2017.0019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We evaluated the satisfaction of adult survivors of childhood cancers and their general practitioners (GP) after a long-term consultation. METHODS The first Long-term Follow-up Study in Oncology (SALTO1) is a prospective cohort study of survivors of childhood cancers (except leukemia) diagnosed between 1987 and 1992 in the Rhône-Alpes and Auvergne regions of France. Of the 481 patients eligible for the study, 150 participated in a long-term consultation with a pediatric oncologist and an internist, after which survivors and their GPs received long-term plans and recommendations based on consultation findings. A year after the consultation, survivors and their GPs assessed their satisfaction with the process. RESULTS Of the 150 survivor participants in the long-term follow-up, 120 (80%) completed the satisfaction form, with 107 (89%) reporting satisfaction. Forty-eight (32%) expressed strengthening their follow-up as a consequence of the consultation. Of the 79 survivors sent recommendations, 76 (96%) reported reading them, most (n = 68; 86%) found them useful, and 56 (71%) followed recommendations. Of the 107 GPs of the survivors, 82 (77%) conceded having been poorly informed about long-term complications for their patients after chemotherapy, and 93 (88%) appreciated having a hospital contact available for these patients. CONCLUSION The long-term consultations ultimately enhanced medical follow-up of survivor participants, improving knowledge of both patients and family physicians regarding the patients' early disease, its treatments, and possible concerns, and offering consultative resources of medical specialists. The levels of participation of survivors and their physicians and reported satisfaction encourage the adoption of such consultations throughout France.
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Affiliation(s)
- Claire Berger
- 1 Department of Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne Cedex 02, France .,2 Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne Cedex 02, France .,3 Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne, France
| | - Léonie Casagranda
- 1 Department of Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne Cedex 02, France .,2 Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne Cedex 02, France .,3 Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne, France
| | | | - Claire Freycon
- 5 Department of Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble Cedex 9, France
| | - Florentina Isfan
- 6 Department of Pediatric Hematology and Oncology Unit, University Hospital Estaing of Clermont-Ferrand , Clermont-Ferrand, France
| | - Aurélie Robles
- 7 Department of Internal Medicine Unit, Hospital of Firminy , Firminy, France
| | - Béatrice Trombert-Paviot
- 3 Host Research Team EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University, University Hospital , Saint-Etienne, France .,8 Department of Public Health and Medical Informatics, University of Saint-Etienne , Saint-Etienne Cedex 02, France
| | - Isabelle Guichard
- 9 Department of Internal Medicine Unit, University Hospital of Saint-Etienne , Saint-Etienne Cedex 02, France
| | - Isabelle Durieu
- 10 Department of Internal Medicine and Vascular Pathology Unit, University Hospital of Lyon Sud , Pierre-Bénite, France
| | - Pascal Cathebras
- 9 Department of Internal Medicine Unit, University Hospital of Saint-Etienne , Saint-Etienne Cedex 02, France
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Fisher SD. Paternal Mental Health: Why Is It Relevant? Am J Lifestyle Med 2017; 11:200-211. [PMID: 30202331 PMCID: PMC6125083 DOI: 10.1177/1559827616629895] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/02/2015] [Accepted: 01/11/2016] [Indexed: 01/23/2023] Open
Abstract
Father's mental health is an emerging area of interest that is beginning to be recognized in research, and to a lesser extent in clinical practice and society. Fathers are part of a parenting dyad with 2 partners who are responsible for their children's emotional development. Similar to mothers, the risk for mental health problems increases once a male becomes a father, but there is limited research examining this issue. The purpose of this review is to present the available literature on father's mental health and its effect on child emotional health through various mechanisms. In general, father's mental health was found to be related to increased child internalizing and externalizing behaviors, but each disorder had different risk factors, and a unique effect on parenting behaviors and the child's emotional health. The most developed paternal mental health literature is focused on depression. However, key conceptual and methodological problems exist that may limit our understanding of paternal depression. Additionally, the focus on paternal depression may not accurately represent the largest risk for paternal psychopathology and the resultant child mental health outcomes because men have an increased likelihood of displaying externalizing behaviors. Implications for research, clinical practice, and policy are discussed.
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Affiliation(s)
- Sheehan D. Fisher
- Department of Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Predictors of Posttraumatic Stress and Posttraumatic Growth in Childhood Cancer Survivors. Cancers (Basel) 2017; 9:cancers9030026. [PMID: 28300764 PMCID: PMC5366821 DOI: 10.3390/cancers9030026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 11/16/2022] Open
Abstract
This longitudinal study aims to analyze predictors of posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among gender, age, objective factors of the disease and its treatment, family environment factors and negative emotionality. The sample consisted of 97 childhood cancer survivors (50 girls and 47 boys) aged 11-25 years who were in remission 1.7 to seven years at T1 and four to 12.5 years at T2. Survivors completed a set of questionnaires including the Benefit Finding Scale for Children and the University of California at Los Angeles Posttraumatic Stress Disorder Index. Regression and correlation analyses were performed. The relation between PTSS and PTG was not proven. A higher level of PTSS (T2) was associated with higher levels of negative emotionality (T1). A higher level of PTG (T2) was connected to a higher level of warmth in parenting (T1), female gender and older age at assessment. Medical variables such as the severity of late effects and the time from treatment completion did not play a significant role in the prediction of PTSS and PTG. PTG and PTSS are more influenced by factors of parenting and emotional well-being of childhood cancer survivors than by objective medical data.
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Straehla JP, Barton KS, Yi-Frazier JP, Wharton C, Baker KS, Bona K, Wolfe J, Rosenberg AR. The Benefits and Burdens of Cancer: A Prospective Longitudinal Cohort Study of Adolescents and Young Adults. J Palliat Med 2017; 20:494-501. [PMID: 28051888 DOI: 10.1089/jpm.2016.0369] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adolescents and early young adults (AYAs) with cancer are at high risk for poor outcomes. Positive psychological responses such as benefit-finding may buffer the negative impacts of cancer but are poorly understood in this population. OBJECTIVE We aimed to prospectively describe the content and trajectory of benefit- and burden-finding among AYAs to develop potential targets for future intervention. PATIENTS AND METHODS One-on-one semistructured interviews were conducted with English-speaking AYA patients (aged 14-25 years) within 60 days of diagnosis of a noncentral nervous system malignancy requiring chemotherapy, 6-12 and 12-18 months later. Interviews were coded using directed content analyses with a priori schema defined by existing theoretical frameworks, including changed sense of self, relationships, philosophy of life, and physical well-being. We compared the content, raw counts, and ratios of benefit-to-burden by patient and by time point. SETTING/SUBJECTS Seventeen participants at one tertiary academic medical center (mean age 17.1 years, SD = 2.7) with sarcoma (n = 8), acute leukemia (n = 6), and lymphoma (n = 3) completed 44 interviews with >100 hours of transcript-data. RESULTS Average benefit counts were higher than average burden counts at each time point; 68% of interviews had a benefit-to-burden ratio >1. Positive changed sense-of-self was the most common benefit across all time points (44% of all reported benefits); reports of physical distress were the most common burden (32%). Longitudinal analyses suggested perceptions evolved; participants tended to focus less on physical manifestations and more on personal strengths and life purpose. CONCLUSIONS AYAs with cancer identify more benefits than burdens throughout cancer treatment and demonstrate rapid maturation of perspectives. These findings not only inform communication practices with AYAs but also suggest opportunities for interventions to potentially improve outcomes.
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Affiliation(s)
- Joelle P Straehla
- 1 Department of Pediatric Hematology/Oncology, Harvard Medical School , Boston, Massachusetts.,2 Department of Pediatric Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Krysta S Barton
- 3 Cancer and Blood Disorders Center , Seattle Children's Hospital, Seattle, Washington.,4 Treuman Katz Center for Pediatric Bioethics , Seattle Children's Hospital, Seattle, Washington
| | - Joyce P Yi-Frazier
- 3 Cancer and Blood Disorders Center , Seattle Children's Hospital, Seattle, Washington.,5 Department of Pediatrics, University of Washington , Seattle, Washington
| | - Claire Wharton
- 3 Cancer and Blood Disorders Center , Seattle Children's Hospital, Seattle, Washington
| | - Kevin Scott Baker
- 3 Cancer and Blood Disorders Center , Seattle Children's Hospital, Seattle, Washington.,5 Department of Pediatrics, University of Washington , Seattle, Washington.,6 Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Kira Bona
- 1 Department of Pediatric Hematology/Oncology, Harvard Medical School , Boston, Massachusetts.,2 Department of Pediatric Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts.,7 Department of Medicine, Boston Children's Hospital , Boston, Massachusetts.,8 Division of Population Sciences, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Joanne Wolfe
- 1 Department of Pediatric Hematology/Oncology, Harvard Medical School , Boston, Massachusetts.,7 Department of Medicine, Boston Children's Hospital , Boston, Massachusetts.,8 Division of Population Sciences, Dana-Farber Cancer Institute , Boston, Massachusetts.,9 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Abby R Rosenberg
- 3 Cancer and Blood Disorders Center , Seattle Children's Hospital, Seattle, Washington.,4 Treuman Katz Center for Pediatric Bioethics , Seattle Children's Hospital, Seattle, Washington.,5 Department of Pediatrics, University of Washington , Seattle, Washington.,6 Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
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Prevalence and predictors of posttraumatic stress symptoms in parents of children with ongoing treatment for cancer in South China: a multi-centered cross-sectional study. Support Care Cancer 2016; 25:1159-1167. [PMID: 27966022 DOI: 10.1007/s00520-016-3506-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Parents of children with ongoing cancer treatment are exposed to risks of developing posttraumatic stress symptoms (PTSS), but little is known about the prevalence and predictors of PTSS among Chinese parents of children with cancer. This study aimed to examine the predictors of PTSS, and explored the correlation of depression, resilience, and family functions with severe PTSS. METHODS This cross-sectional survey was conducted from May 2014 to September 2015 among the parents of cancer children treated in four general hospitals in South China. PTSS in the parents were measured using post-traumatic stress checklist-civilian version (PCL-C). Multiple regression analyses were performed to evaluate the predictive values of depression, resilience, family functioning, and the demographic variables for severe PTSS. RESULTS A total of 279 parents (192 mothers and 87 fathers) participated in the survey. Severe PTSS, as defined by a PCL-C score ≥50, were reported in 32.97% (n = 92) of the total participants, 26.44% (23/87) in the fathers and 35.94% (69/192) in the mothers. The level of PTSS was positively correlated with depression (r = 0.782, P < 0.01) and a poor general family function (r = 0.325, P < 0.01) and negatively correlated with resilience (r = -0.236, P < 0.01). Multivariate analyses indicated that depression, general family function, gender, and education level were significant predictive factors of severe PTSS in the overall parents, accounting for 64.2% of the variance in the prediction of PTSS (R 2 = 0.642, F = 122.602, P = 0.000). For the mothers, depression and family function accounted for 66.5% of the variance in the prediction of PTSS (R 2 = 0.665, F = 187.451, P = 0.000); for the fathers, depression and educational level accounted for 58.8% of the variance in the prediction of PTSS (R 2 = 0.588, F = 59.829, P = 0.000). CONCLUSION Parents, especially the mothers, of children with ongoing treatment for cancer are at risk of developing PTSS. Supportive psychological interventions to attenuate the negative emotions of the parents and improve their family functions are important means to promote their natural protective mechanisms to cope with the stressful events.
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Eaton CK, Lee JL, Loiselle KA, Reed-Knight B, Mee LL, Gutierrez-Colina AM, Blount RL. Pretransplant patient, parent, and family psychosocial functioning varies by organ type and patient age. Pediatr Transplant 2016; 20:1137-1147. [PMID: 27670949 DOI: 10.1111/petr.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
The goal of this study was to compare pretransplant patient HRQOL, parent psychological functioning, and the impact of the patient's ongoing illness on the family between organ types (ie, kidney, liver, heart) and age-groups (ie, children, AYAs). The sample included 80 pediatric patients with end-stage organ disease who were evaluated for transplantation and their parents. Parents completed self- and proxy reports at patients' pretransplant evaluations. Results indicated that patients evaluated for heart transplants consistently had lower HRQOL and their parents had greater psychological distress compared to the kidney and liver groups. Within the heart group, parents and families of children (<12 years old) experienced significantly more distress and impact of the patient's illness on the family compared to those of AYAs (≥12 years old). Pediatric patients awaiting heart transplants, particularly younger children, and their parents and families may have greater psychosocial needs compared to patients awaiting kidney or liver transplants.
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Affiliation(s)
- Cyd K Eaton
- Psychology Department, University of Georgia, Athens, GA, USA
| | - Jennifer L Lee
- Children's Healthcare of Atlanta/Emory University School of Medicine, Athens, GA, USA
| | - Kristin A Loiselle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Athens, GA, USA
| | - Bonney Reed-Knight
- Children's Healthcare of Atlanta/Emory University School of Medicine, Athens, GA, USA
| | - Laura L Mee
- Children's Healthcare of Atlanta/Emory University School of Medicine, Athens, GA, USA
| | | | - Ronald L Blount
- Psychology Department, University of Georgia, Athens, GA, USA
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Gerhardt CA. Commentary: Dennis D. Drotar Distinguished Research Award: Academic and Personal Reflections on Childhood Cancer Research Across the Illness Spectrum. J Pediatr Psychol 2016; 41:1045-1052. [PMID: 27680081 PMCID: PMC5061976 DOI: 10.1093/jpepsy/jsw076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Department of Pediatrics and Psychology, The Ohio State University
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43
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Turner-Sack AM, Menna R, Setchell SR, Maan C, Cataudella D. Psychological Functioning, Post-Traumatic Growth, and Coping in Parents and Siblings of Adolescent Cancer Survivors. Oncol Nurs Forum 2016; 43:48-56. [PMID: 26679444 DOI: 10.1188/16.onf.48-56] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine psychological functioning, post-traumatic growth (PTG), coping, and cancer-related characteristics of adolescent cancer survivors' parents and siblings.
. DESIGN Descriptive, correlational.
. SETTING Children's Hospital of Western Ontario in London, Ontario, Canada.
. SAMPLE Adolescents who finished cancer treatment 2-10 years prior (n = 31), as well as their parents (n = 30) and siblings (n = 18).
. METHODS Participants completed self-report measures of psychological distress, PTG, life satisfaction, coping, and cancer-related characteristics.
. MAIN RESEARCH VARIABLES Psychological functioning, PTG, and coping.
. FINDINGS Parents' and siblings' PTG levels were similar to survivors' PTG levels; however, parents reported higher PTG than siblings. Parents who used less avoidant coping, were younger, and had higher life satisfaction experienced less psychological distress. Parents whose survivor children used more active coping reported less psychological distress. Siblings who were older used more active coping, and the longer it had been since their brother or sister was diagnosed, the less avoidant coping they used.
. CONCLUSIONS Childhood and adolescent cancer affects survivors' siblings and parents in unique ways.
. IMPLICATIONS FOR NURSING Relationship to the survivor, use of coping strategies, life satisfaction, and time since diagnosis affect family members' postcancer experiences.
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Affiliation(s)
| | | | | | - Cathy Maan
- Children's Hospital London Health Science Center
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44
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Van Schoors M, Caes L, Knoble NB, Goubert L, Verhofstadt LL, Alderfer MA. Systematic Review: Associations Between Family Functioning and Child Adjustment After Pediatric Cancer Diagnosis: A Meta-Analysis. J Pediatr Psychol 2016; 42:6-18. [DOI: 10.1093/jpepsy/jsw070] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 11/12/2022] Open
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Robaey P, Dobkin P, Leclerc JM, Cyr F, Sauerwein C, Théorêt Y. A comprehensive model of the development of mental handicap in children treated for acute lymphoblastic leukaemia: A synthesis of the literature. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016. [DOI: 10.1080/016502500383467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Most clinical studies addressing sequelae in children with leukaemia are not theory-driven. Nonetheless, the role of different mediating biological (e.g. cranial irradiation, chemotherapy) and psychosocial variables (e.g. family functioning) has been empirically acknowledged. In these studies, a cause-effect relationship between biological variables and cognitive deficits, sometimes complex due to multiple agents, has been hypothesised. As for the psychosocial consequences, adaptation to the cancer-related stress has been the main focus, at both the individual and family levels. In this paper, we advocate the use of a global model for the development of handicap, derived from the International Classification of Impairments, Disabilities and Handicaps (ICIDH) by the World Health Organisation. This revised model proposes that handicap is the result of complex interactions between the characteristics of a person’s impairment, disabilities, and the characteristics of the environment. At each of these levels, risk/resilience factors are defined. This means that depending on the environmental obstacles they face, persons with an impairment or a disability may or may not experience a situation creating a handicap which is no longer seen as a stable status resulting from a disease to which the individual must adapt. By reviewing animal and clinical studies, current knowledge pertaining to leukaemia sequelae are integrated into the different levels defined by the model: organic impairment, disabilities, environmental obstacles, and handicap situation. Practical implications for research, policies, and individual treatments, and comparisons with existing models, are also outlined.
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Affiliation(s)
- Philippe Robaey
- Centre de Recherche de l’Hôpital Sainte-Justine,
Montréal, Québec, Canada
| | - Patricia Dobkin
- Montreal General Hospital and McGill University, Montréal,
Québec, Canada
| | | | | | | | - Yves Théorêt
- Centre de Recherche de l’Hôpital Sainte-Justine,
Montréal, Québec, Canada
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46
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Kazak AE. Research Priorities for Family Assessment and Intervention in Pediatric Oncology. J Pediatr Oncol Nurs 2016; 21:141-4. [PMID: 15296042 DOI: 10.1177/1043454204264394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Four broad areas of research priority related to family assessment and intervention in pediatric oncology are outlined. The importance of a contextual, systemic approach is highlighted along with the value of systematic empirical assessment of psychosocial risk at diagnosis. Research to advance the development and application of standards of care during treatment is also advocated. The chapter concludes with opportunities for family-oriented research related to survivorship and end-of-life care.
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Affiliation(s)
- Anne E Kazak
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA 19103-4399, USA.
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Holley AL, Wilson AC, Noel M, Palermo TM. Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research. Eur J Pain 2016; 20:1371-83. [PMID: 27275585 DOI: 10.1002/ejp.879] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology. DATABASES AND DATA TREATMENT Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms 'child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder'. Studies were retrieved and reviewed based on relevance to the topic. RESULTS Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain. CONCLUSIONS Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs. WHAT DOES THIS REVIEW ADD?: This review presents relevant literature on pain and PTSS in youth and proposes a conceptual framework to examine factors salient during childhood that may be associated with symptom severity, comorbidity and mutual maintenance of chronic pain and PTSS in paediatric populations. We highlight dynamic factors that may change across children's development and provide recommendations to guide paediatric research examining potential associations among PTSS and chronic pain.
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Affiliation(s)
- A L Holley
- Division of Psychology, Oregon Health & Science University, Portland, USA.
| | - A C Wilson
- Division of Psychology, Oregon Health & Science University, Portland, USA
| | - M Noel
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, AB, Canada
| | - T M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children's Research Institute, USA
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Bitsko MJ, Cohen D, Dillon R, Harvey J, Krull K, Klosky JL. Psychosocial Late Effects in Pediatric Cancer Survivors: A Report From the Children's Oncology Group. Pediatr Blood Cancer 2016; 63:337-43. [PMID: 26488337 PMCID: PMC4715481 DOI: 10.1002/pbc.25773] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/31/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND This review was conducted to update the Children's Oncology Group (COG) Long-Term Follow-Up Guidelines (COG-LTFU Guidelines, version 4.0) regarding screening for psychosocial late effects of pediatric cancer. PROCEDURE Articles published between August 2009 and January 2011 that addressed psychosocial late effects of long-term survivors of pediatric cancer (n = 35) were reviewed by a multidisciplinary team of COG late effect experts. RESULTS The majority of studies in this time period indicate that survivors experience few psychosocial problems in long-term survivorship. A critical subset, however, is at increased risk for psychosocial late effects secondary to the treatment. Highlighted findings from this review include increased rates of suicidal ideation (SI), and health beliefs as robust predictors of SI, anxiety, and global distress. Survivors' health beliefs were associated with their perceptions of physical limitations, overall late effects, and cancer-related pain. While many survivorship studies continue to specify risk factors for anxiety and posttraumatic stress symptoms/posttraumatic stress disorder, others outcomes (e.g., developmental, interpersonal, and familial factors) appear to be emerging in importance. CONCLUSIONS Although the majority of childhood cancer survivors do not experience psychosocial problems, a subset will. The recent research findings have been included in the new COG-LTFU Guidelines that will assist in the targeted assessment and the treatment of survivors' psychosocial health.
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Affiliation(s)
- Matthew J. Bitsko
- Children’s Hospital of Richmond, Richmond, VA 23298, USA,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA,Correspondence to: Matthew J. Bitsko, PhD, Children’s Hospital of Richmond at VCU, Department of Pediatrics, PO Box 980440, Virginia Commonwealth University, Richmond, VA 23298-0440, Tel: 804-828-9048,
| | - Debra Cohen
- Children’s Hospital of Richmond, Richmond, VA 23298, USA,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Robyn Dillon
- Children’s Hospital of Richmond, Richmond, VA 23298, USA,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Jeanne Harvey
- Cardinal Glennon Children’s Medical Center, St. Louis, MO, USA
| | - Kevin Krull
- Departments of Epidemiology & Cancer Control and Psychology
| | - James L. Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis TN, USA
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Raz H, Tabak N, Kreitler S. Psychosocial Outcomes of Sharing a Diagnosis of Cancer with a Pediatric Patient. Front Pediatr 2016; 4:70. [PMID: 27489853 PMCID: PMC4951526 DOI: 10.3389/fped.2016.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This innovative pilot study was designed to provide research-based evidence on the variables to consider informing a child of his/her cancer diagnosis, so as to minimize the negative psychosocial effects of the cancer experience on survivors. The hypotheses of the study were that "good information" about cancer, will allow the child a better understanding way to cope with treatment and improve sociopsychological outcomes at adulthood. METHODS Ninety-one adult childhood cancer (CC) survivors got the questionnaires while waiting to their routine checkup at a grate CC medical center in center Israel. RESULTS To our surprise and not according to the hypothesis, there was a difference between children diagnosed up to 12 years of age and those diagnosed during adolescence. (Participants were divided into two groups according to their age at diagnosis: from birth to 12 years old and from age 12-18). In the group diagnosed at a younger age, those who had received "good information" were found to have better quality of life, lower mental pain, and higher mental pain tolerance than did those in the same group (diagnosed at a younger age) who received "not good information." By contrast, in the group diagnosed during adolescence, those who had received "not good information" scored higher on these measures than did their counterparts who had received "good information." CONCLUSION Given that information conveyed to children diagnosed with cancer can have a significant impact on survivors' quality of life, further research is needed to determine the precise information to be divulged to children at the time of diagnosis. In the meantime, extreme caution, sensitivity, and careful judgment are required. CLINICAL RELEVANCE Findings of the current study and of future studies can be used to formulate clear guidelines for assessing a child's readiness and the information to be divulged, so as to improve the quality of life of CC survivors.
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Affiliation(s)
- Haya Raz
- Nursing Department, Machon Tal, Jerusalem College of Technology , Jerusalem , Israel
| | - Nili Tabak
- Faculty of Nursing, School of Health Professions, Tel-Aviv University Medical School , Tel-Aviv , Israel
| | - Shulamith Kreitler
- Psychooncology Research Center, Sheba Medical Center, School of Psychological Sciences, Tel-Aviv University , Tel-Aviv , Israel
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50
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A review of supportive care interventions to manage distress in young children with cancer and parents. Cancer Nurs 2015; 37:E1-26. [PMID: 24936752 DOI: 10.1097/ncc.0000000000000095] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a positive relationship between parent and young child distress during cancer treatment. Dimensions of parent/child distress are multifaceted and associated with family function and quality of life outcomes. A critical examination of intervention research is needed to identify how dimensions of parent/child distress and related outcomes are being addressed. OBJECTIVE The aims of this study were to summarize and describe supportive care intervention research for young children with cancer and parents and to discuss implications for family-based intervention research. METHODS This systematic review examined supportive care intervention studies with randomized and nonrandomized designs for young children with cancer (aged 3-8 years) and/or their parents published between 1991 and 2011. Twenty-two studies that met specific inclusion criteria were reviewed to determine intervention type, intervention components, targeted outcomes and findings, and whether interventions addressed child, parent, or parent/child needs. RESULTS Most interventions focused primarily on procedural support, followed by parent education/counseling. Most studies targeted the child or the parent alone; very few targeted parent/child dyads. Outcomes focused primarily on child distress, anxiety, and pain. Quality of life and coping were rarely measured, and no studies examined family function. This body of research is emerging, with most interventions in the developmental pilot phase and few efficacy trials. CONCLUSIONS Findings confirm underrepresentation of young children in supportive care intervention research and the need for more complex, family-based interventions to advance young child intervention research beyond acute, procedural distress. IMPLICATIONS FOR PRACTICE The authors discuss the implications of review findings for clinical practice.
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