Mothers and fathers coping with their children's cancer: Individual and interpersonal processes

Quality of life of caregivers at the end of their child's pediatric cancer treatment: cancer-specific worry and material hardship

OBJECTIVE

Emerging research suggests that completion of pediatric cancer treatment can be challenging for caregivers given shifting roles and responsibilities. Lower caregiver quality of life (QOL) has been associated with cancer-related variables, higher cancer caregiving strain, and more household material hardship during pediatric cancer treatment. Caregiver QOL at the end of treatment has not been fully investigated but has implications for child and family well-being. Using a psycho-oncology framework, this study aimed to understand the cumulative burden of household material hardship and cancer-related factors on caregiver QOL at the end of treatment.

METHODS

Caregivers (N = 143) of children (Mage=10.51 years) within 1 year of ending active cancer treatment completed self-report questionnaires assessing their QOL, cancer-specific worry, and material hardship (e.g., housing, insurance). Total months of active cancer treatment were extracted from the medical record. Hierarchical linear regression was used to test the relative effects of length of treatment, material hardship, and cancer-specific worry on caregiver QOL.

RESULTS

Cancer-specific worry was significantly associated with and accounted for significant variance in caregiver QOL, above and beyond the length of treatment and material hardship. Caregivers who endorsed more cancer-specific worry had poorer QOL. Material hardship was also significantly associated with caregivers' QOL, but length of treatment was not.

CONCLUSIONS

Caregivers with sufficient resources and less worry about cancer have higher QOL. Findings highlight the importance of end-of-treatment screening of caregivers' subjective cancer-specific worry in addition to material hardship, irrespective of their cancer-related stressors, for ongoing psychosocial support.

Mental Health Care Utilization Among Parents of Children With Cancer

Importance

Caring for children diagnosed with cancer may adversely affect the mental health (MH) of parents.

Objective

To characterize utilization of MH services among parents of children with vs without cancer using nationwide commercial claims data.

Design, Setting, and Participants

For this cross-sectional study, the Merative MarketScan Commercial Claims Database was used to identify continuously insured families of children treated for cancer (aged ≤21 years at diagnosis) during 2010 to 2018, compared with families who matched eligibility criteria but did not have a child with a cancer history. Parents were assessed from 18 months before to 12 months after their child's cancer diagnosis. Analyses were conducted from February 2022 to September 2023.

Exposures

Children's cancer diagnosis.

Main Outcomes and Measures

Outcomes included parents' MH-related visits during the first year following their child's cancer diagnosis. Logistic regressions compared outcomes between families of children with vs without cancer, adjusting for sociodemographic and clinical factors.

Results

This study included 4837 families of children with cancer (4210 mothers and 4016 fathers) and 24 185 families of children without cancer (21 444 mothers and 19 591 fathers) with continuous insurance enrollment. Most household leads were aged 35 to 54 years (3700 [76.5%] in families of children with cancer vs 17 812 [73.6%] in families of children without cancer) and resided in urban areas (4252 [87.9%] vs 21 156 [87.5%]). The probabilities of parents having anxiety-related visits (10.6% vs 7.0%), depression-related visits (8.4% vs 6.1%), and any MH-related visits (18.1% vs 13.3%) were higher in families of children with vs without cancer. Adjusted analyses showed absolute increases of 3.2 percentage points (95% CI, 2.3 to 4.0; 45.7% relative increase), 2.2 percentage points (95% CI, 1.4 to 3.0; 36.1% relative increase), and 4.2 percentage points (95% CI, 3.1 to 5.3; 31.3% relative increase) in the probabilities of 1 or both parents having anxiety-related visits, depression-related visits, and any MH-related visits, respectively, among families of children with vs without cancer. Such differences were greater in magnitude among mothers than fathers.

Conclusions and Relevance

In this cohort study of privately insured parents, those caring for children with cancer had a higher likelihood of utilizing MH care than other parents. These findings underline the importance of interventions toward targeted counseling and support to better meet MH care needs among parents and caregivers of children with cancer.

Cancer-related stress in childhood cancer survivorship: Prevalence and associations with perceptions of health risks and quality of life

OBJECTIVE

Limited research has characterized cancer-related stress (CRS) among families of childhood cancer survivors. We examined the prevalence of CRS among survivors and caregivers, as well as its association with health risk perceptions (i.e., prognosis, risk for diminished quality of life) and views of survivor quality of life (QoL).

METHODS

At five years post-diagnosis or relapse, survivors (n = 100; Mage  = 15.84 years; 89% White), mothers (n = 127), and fathers (n = 59) reported their CRS. Perceived prognosis and risk for diminished QoL were rated on a 0%-100% visual analogue scale, while the PedsQL assessed QoL.

RESULTS

CRS was low (M = 1.6-1.8, scale: 1-4); mothers reported greater stress than survivors, p = 0.038, d = 0.25. There was an indirect effect of survivors' perceived prognosis on their QoL through CRS, CI = 0.04 to 0.25, R2  = 0.32. Among mothers, there was an indirect effect of perceived prognosis/risk for diminished QoL on their reports of survivor QoL through CRS, CI = 0.03 to 0.23 and -0.15 to -0.03, R2  = 0.28 and 0.32, respectively. There were no indirect effects among fathers.

CONCLUSIONS

CRS may be an important, modifiable factor that could improve survivors' QoL. Research is needed to examine how CRS changes over time to assess the utility of interventions among female survivors, mothers, and those with lower prognosis estimates.

Effectiveness of psychoeducation interventions in reducing negative psychological outcomes and improving coping skills in caregivers of children with cancer: A systematic review and meta-analysis

PURPOSE

Psychoeducation interventions (PEIs) have been used as an adjunct treatment for negative psychological outcomes in caregivers of children with cancer. This systematic review and meta-analysis aimed to evaluate the evidence on the effectiveness of PEIs in reducing anxiety and depressive symptoms and improving health-related quality of life (HRQoL) and coping skills in caregivers of children with cancer.

METHOD

Ten English databases were searched to identify studies on PEIs for caregivers of children with cancer. Studies inclusion criteria were as follows: (1) participants who were caregivers of children with cancer receiving treatment; (2) psychoeducational interventions assessing anxiety, depressive symptoms, HRQoL, and coping outcomes; and (3) usual care, waitlist, or active control as a control group. Meta-analysis and narrative synthesis were used to analyse data.

RESULTS

Fourteen randomised control trials were included. PEIs have a beneficial effect on anxiety levels (SMD: -0.59, 95% CI [-0.92, -0.25], p = 0.0007), quality of life (SMD: -0.31, 95% CI [-0.00, -0.61], p = 0.05) and depressive symptoms (SMD: -1.18, 95% CI [-2.08, -0.28], p = 0.01) immediately post-intervention. The effect of PEIs was maintained at long-term follow-up on depressive symptoms (SMD: -0.52, 95% CI [-1.54, -0.36], p = 0.0004). Similarly, the synthesised data suggest that PEIs are effective in improving coping skills.

CONCLUSION

The review provides evidence that PEIs effectively reduce negative psychological outcomes and improve coping skills in caregivers of children with cancer. However, due to methodological flaws and heterogeneity of the interventions evaluated, more research is needed to determine the most effective PEI design and improve the quality of evidence.

Empowering Parents of Pediatric Surgical Oncology Patients Through Collaborative Engagement with Surgeons

BACKGROUND

Ninety percent of parents of pediatric oncology patients report distressing, emotionally burdensome healthcare interactions. Assuring supportive, informative treatment discussions may limit parental distress. Here, we interview parents of pediatric surgical oncology patients to better understand parental preferences for surgical counseling.

METHODS

We interviewed 10 parents of children who underwent solid tumor resection at a university-based, tertiary children's hospital regarding their preferences for surgical discussions. Thematic content analysis of interview transcripts was performed using deductive and inductive methods.

RESULTS

Three main themes were identified: (1) the emotional burden of a pediatric cancer diagnosis; (2) complexities of treatment discussions; (3) collaborative engagement between parents and surgeons. Within the collaborative engagement theme, there were four sub-themes: (1) variable informational needs; (2) parents as advocates; (3) parents as gatekeepers of information delivery to their children, family, friends, and community; (4) parental receptivity to structured guidance to support treatment discussions. Two cross-cutting themes were identified: (1) perception that no treatment decision needed to be made regarding surgery and (2) reliance on diverse support resources.

CONCLUSIONS

Parents feel discussions with surgeons promote informed involvement in their child's care, but they recognize that there may be few decisions to make regarding surgery. Even when parents perceive that there are there are no decisions to make, they prioritize asking questions to advocate for their children. The emotional burden of a cancer diagnosis often prevents parents from knowing what questions to ask. Merging this data with our prior pediatric surgeon interviews will facilitate development of a novel decision support tool that can empower parents to ask meaningful questions.

LEVEL OF EVIDENCE

III.

The Association Between Caregiver Coping and Youth Clinic Attendance and Health-related Quality of Life in Pediatric Sickle Cell Disease

Caregivers of youth with sickle cell disease (SCD) influence the youth disease management and psychosocial outcomes. Effective caregiver coping is important for improving disease management and outcomes since caregivers often report high disease-related parenting stress. This study characterizes caregiver coping and examines its relation to youth clinic nonattendance and health-related quality of life (HRQOL). Participants were 63 youth with SCD and their caregivers. Caregivers completed the Responses to Stress Questionnaire-SCD module to assess primary control engagement (PCE; attempts to change stressors or reactions to stress), secondary control engagement (SCE; strategies to adapt to stress), and disengagement (avoidance) coping. Youth with SCD completed the Pediatric Quality of Life Inventory-SCD module. Medical records were reviewed for the hematology appointment nonattendance rates. Coping factors were significantly different ( F [1.837, 113.924]=86.071, P <0.001); caregivers reported more PCE ( M =2.75, SD =0.66) and SCE ( M =2.78, SD =0.66) than disengagement ( M =1.75, SD =0.54) coping. Responses to short-answer questions corroborated this pattern. Greater caregiver PCE coping was associated with lower youth nonattendance (β=-0.28, P =0.050), and greater caregiver SCE coping was related to higher youth HRQOL (β=0.28, P =0.045). Caregiver coping is related to improved clinic attendance and HRQOL in pediatric SCD. Providers should assess caregiver coping styles and consider encouraging engagement coping.

Profiles of Resilience, Distress, and Posttraumatic Growth in Parents of Children with Cancer and the Relation to Subsequent Parenting and Family Functioning

OBJECTIVE

The aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment.

METHODS

Participants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship.

RESULTS

Latent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning.

CONCLUSION

The majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.

Intrapersonal and Interpersonal Disengagement Coping: Associations with Emotions of Youth At-Risk for Huntington's Disease

BACKGROUND

Families in which a parent has Huntington's disease (HD) are faced with significant stressors that can contribute to difficulties in communicating together about illness-related concerns. Family members who use more disengagement coping strategies, including denial and avoidance, to deal with illness-related stressors may have the greatest challenges to effective communication.

OBJECTIVE

The current study examined the associations of intrapersonal and interpersonal disengagement coping responses with observed and reported emotions of adolescents and young adults (AYA) at genetic risk for HD.

METHODS

Families included 42 AYA (n = 26 females) ages 10 to 34 (M = 19 years, 11 months; SD = 7 years, 6 months) and their parent with HD (n = 22 females, M age = 46 years, 10 months; SD = 9 years, 2 months). Dyads participated in observations of communication and completed questionnaires about disengagement coping and internalizing symptoms.

RESULTS

Disengagement coping of AYA was unrelated to their observed and reported emotional difficulties (intrapersonal coping). However, there was evidence for the importance of interpersonal disengagement coping, as AYA's negative affect was observed and reported to be highest when both AYA and their parents reported using high levels of avoidance, denial, and wishful thinking to cope with HD-related stress.

CONCLUSION

The findings underscore the importance of a family-oriented approach to coping and communication in families affected by HD.

Dyadic Effect of Coping on the Perceived Impact of ASD of Children on Parental Quality of Life: Report from the ELENA Cohort

Autism spectrum disorder (ASD) has a significant impact on the quality of life (QoL) of families. This study aimed to examine, for parents of children with ASD, the dyadic effect of each parent's coping strategy on the perception of the impact of ASD on their QoL. In total, 164 couples completed self-report questionnaires, including the Par-DD-QoL, to evaluate the parental perception of QoL. Results from the actor-partner interdependence model showed that, in addition to the effect of the mothers' and fathers' emotion-focused coping on their own perception of QoL, the mothers' emotion-focused coping plays a key role in the fathers' perception of QoL. These findings suggest that both parents of children with ASD would benefit from couple-focused interventions.

'Like ships in the night': A qualitative investigation of the impact of childhood cancer on parents' emotional and sexual intimacy

BACKGROUND

Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy.

METHODS

We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis.

RESULTS

At interview, parents were on average 40.7 years old (SD = 5.5, range: 29-55 years), and had a child who had completed cancer treatment between 3 months and 10.8 years previously (M = 22.1 months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience.

CONCLUSIONS

Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.

'Torn in two': Experiences of Mothers Who Are Pregnant when Their Child Is Diagnosed With Cancer

Mothers of children diagnosed with cancer have been shown to experience high rates of psychological distress and poor physical health. Pregnancy further increases the healthcare needs of mothers due to the marked physiological changes and psychological adaptations. Our study aimed to explore the experiences of mothers who were pregnant and/or had a baby while their older child was receiving treatment for cancer. Our study employed a qualitative description methodology using semi-structured interviews. Participants were recruited from across Australia via notices on social media sites and the distribution of flyers. The sample comprised 13 mothers who were pregnant and/or had a baby and had a child diagnosed with cancer who was under 17 years old. Thematic analysis was used to analyse the data from which six themes were identified: (1) an impossible balancing act, (2) mother's health and well-being, (3) creating certainty: birthing plans, (4) a bit of sunshine and a time to rest, (5) challenges of caring for the baby and (6) an unenviable position: doing my best versus feeling guilty. Our study demonstrates the additional challenges faced by mothers who are pregnant while their child is receiving cancer treatment. There is a need for a comprehensive and coordinated program that provides pregnant mothers with practical and psychological support. The implementation of such a program has the potential to improve health outcomes for all family members, particularly the mother and their newborn.

CNS-Directed Cancer Treatment and Child Adjustment: Moderating Effects of Maternal Parenting

OBJECTIVE

The aim of this study was to examine whether maternal parenting behaviors (i.e., warmth, behavioral/psychological control) moderate the association between central nervous system (CNS)-directed treatment and adjustment among pediatric cancer survivors at 3 years post-diagnosis or relapse.

METHODS

Three years after their child's cancer diagnosis or relapse, mothers (N = 84) reported on their child's academic and social competence, as well as their internalizing and externalizing problems. Children (N = 84; Mage = 13.21 years, 52.4% male) reported on maternal parenting behaviors. Using medical chart data, children were separated into CNS (i.e., received cranial radiation, intrathecal chemotherapy, and/or neurosurgery; N = 45) or non-CNS-directed treatment (N = 39) groups. Twelve moderation models were tested when examining two-way interactions between CNS treatment group and maternal parenting behaviors.

RESULTS

Children in the CNS-directed treatment group demonstrated significantly worse academic and social competence. Moderation analyses revealed four significant two-way interactions between CNS treatment group and maternal parenting behaviors when predicting children's adjustment. High levels of maternal behavioral control buffered the negative impact of CNS-directed treatment on children's social competence. In addition, maternal warmth had a contrasting effect, as CNS-directed treatment was associated with worse academic competence at high levels of warmth. Analyses with psychological control revealed that low levels of this parenting style were not protective against internalizing or externalizing problems among those with CNS-directed treatment.

CONCLUSIONS

Children who receive CNS-directed treatment may benefit from a different pattern of parenting during early cancer survivorship. Findings highlight the importance of considering the broader family context when conceptualizing the impact of illness-related factors on adjustment among pediatric cancer survivors.

A qualitative examination of the benefits and challenges of a psychosocial screening intervention in pediatric oncology: "Support comes to us"

BACKGROUND

Pediatric cancer diagnosis and treatment can have detrimental mental health effects on parents (caregivers) and their children/adolescents (youth). Psychosocial screening and intervention have been recognized as standards of care in pediatric oncology. The most effective psychosocial interventions to support those in need post screening have not been determined.

AIMS

This qualitative study aimed to investigate the perceived benefits and challenges for caregiver and youth participants in the screening-intervention arm of an Enhanced Psychosocial Screening Intervention (EPSI) pilot study.

METHODS

EPSI consists of a psychosocial navigator (PSN) who shares screening results conducted near diagnosis (T1) and monthly for 1 year (T2) with treating teams and families. All 17 caregiver-youth dyads who had completed EPSI were invited to participate in a semi-structured interview.

RESULTS

Ten caregivers and nine youth participated. Identified themes were grouped into benefits and challenges of EPSI: feeling supported and cared for (support comes to us regularly, having someone to talk to); and feeling empowered through knowledge of resources and services were perceived as benefits. Caregivers were challenged by feeling overwhelmed, and youth by screening questions perceived as too repetitive.

CONCLUSIONS

Regular monthly contacts for a year by the PSN with screening results and recommendations were perceived as beneficial by youth newly diagnosed with cancer and their caregivers who participated in EPSI. Feeling that support came to them and they had someone to talk to was a critical component. While information about psychosocial resources was not always used right away, it did evoke feelings of being empowered.

Psychosocial functioning of caregivers of pediatric brain tumor survivors

BACKGROUND

Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth.

PROCEDURE

As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects.

RESULTS

Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden.

CONCLUSIONS

Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.

Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes

OBJECTIVE

Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories.

METHOD

Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors.

CONCLUSIONS

Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The impact of caregiver anxiety/depression symptoms and family functioning on child quality of life during pediatric cancer treatment: From diagnosis to 6 months

A pediatric cancer diagnosis can have a significant impact on the quality of life (QOL) of the child. Diagnosis and treatment impact caregiver anxiety/depression symptoms and family functioning, and these in turn may influence child QOL. However, there has been limited longitudinal examination of the impact of both caregiver anxiety/depression symptoms and family functioning on youth QOL at specific points during the early diagnosis and treatment period.

Ninety-six caregivers of youth (diagnosed with leukemia/lymphoma or a solid tumor) reported on their own anxiety/depression symptoms, family functioning, demographic and medical factors, and on their child's generic and cancer-specific QOL shortly after diagnosis (T1) and 6 months later (T2).

Caregiver anxiety/depression symptoms were associated with poorer cancer-specific and generic child QOL within and across time points. Family conflict was associated with youth cancer-related QOL at T1.

Attendance to caregiver anxiety/depression symptoms and family functioning, beginning early in the cancer trajectory, is an important aspect of family-centered care. Routine psychosocial screening and triage may help identify and intervene to support both caregiver and child psychosocial well-being.

Parents' Experiences of Childhood Cancer During the COVID-19 Pandemic: An Australian Perspective

Introduction

COVID-19 has had far-reaching impacts including changes in work, travel, social structures, education, and healthcare.

Objective

This study aimed to explore the experiences of parents of children receiving treatment for cancer during the COVID-19 pandemic.

Methods

Parents whose children were currently in treatment for childhood cancer or had completed treatment in the previous 12 months, participated in semi-structured interviews, face-to-face or via teleconferencing. Thematic analysis was used to analyze the data.

Results

The sample consisted of 34 participants (17 fathers and 17 mothers) from all states across Australia. Median age 37.5 years (range 29–51, years, SD = 6.3). Five main themes were identified: “Welcome to the Club”; “Remote Work and Study”; “Silver Linings”; “The Loneliest Experience” with three sub-themes “Immediate Family”; “Friends”; and “Overseas Family” and “Lack of Support” with two sub-themes: “Community Support” and “Organized Support.”

Conclusion

These findings revealed contrasting experiences of the impact of the COVID-19 pandemic. For parents whose children were neutropenic, the pandemic provided benefits in increased community understanding of infection control. Parents also reflected that the movement to remote work made it easier to earn an income. In contrast, some parents observed that restrictions on visitors and family intensified feelings of isolation. Parents also described how the COVID-19 reduced access to support services. These findings contribute to an understanding of the multifaceted impacts of the COVID-19 pandemic on families of children with cancer.

Coping with COVID-19 stress: Associations with depression and anxiety in a diverse sample of U.S. adults

The COVID-19 pandemic has brought unprecedented levels of stress to individuals in the U.S. and throughout the world. These high stress levels place individuals at risk for symptoms of anxiety, depression, and other psychiatric disorders. The current study applies a control-based model of coping to contribute to the development of evidence-based interventions to promote resilience. Data were collected online from April 22 through July 12, 2020. Data from two samples of U. S. community adults who completed an online battery of standardized questionnaires were combined (N = 709). More than a quarter reported moderate to severe levels of depression symptoms, and more than one-fifth reported moderate to severe levels of anxiety symptoms; symptom levels were higher among adults who reported more COVID-19-related stress. As hypothesized, multiple regression analyses indicated that greater use of primary and secondary control coping was associated with lower symptom levels, whereas greater use of disengagement coping was associated with higher symptom levels, above and beyond the association of stress with symptoms. Race and ethnicity emerged as important moderators of these associations, indicating that what constitutes adaptive coping varies according to characteristics of the individual. Implications for public health policy and clinical practice are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02444-6.

Psychological Impact of COVID-19 on Parents of Pediatric Cancer Patients

The changes and general alarm of the current COVID-19 pandemic have amplified the sense of precariousness and vulnerability for family members who, in addition to the emotional trauma of the cancer diagnosis, add the distress and fear of the risks associated with infection. The primary objectives of the present study were to investigate the psychological impact of the COVID-19 pandemic on the parents of pediatric cancer patients, and the level of stress, anxiety, and the child's quality of life perceived by the parents during the COVID-19 epidemic. The parents of 45 consecutive children with solid and hematological tumors were enrolled. Four questionnaires (Impact of Event Scale-Revised - IES-R; Perceived Stress Scale - PSS; Spielberger State - Trait Anxiety Inventory - STAI-Y; Pediatric Quality of Life Inventory - PedsQL) were administered to the parents at the beginning of the pandemic lockdown. A 75% of parents exhibited remarkable levels of anxiety, with 60 subjects in state scale and 45 subjects in trait scale having scores that reached and exceeded the STAI-Y cut off. The bivariate matrix of correlation found a significant positive correlation between the IES-R and PSS scores (r = 0.55, P < 0.001). There was a positive correlation between the PSS and PedsQL (emotional needs) scale (P < 0.001) and a negative correlation between IES-R and STAI-Y (P < 0.001). The results confirm that parents of pediatric cancer patients have a high psychological risk for post-traumatic symptoms, high stress levels, and the presence of clinically significant levels of anxiety.

Impact of central nervous system-directed treatment on competence and adjustment among children in early cancer survivorship

BACKGROUND

Central nervous system (CNS)-directed treatments can cause long-term academic, social, and emotional difficulties for children with cancer. However, limited research has examined the emergence of problems longitudinally and has often stratified risk by diagnosis alone. Therefore, this study compared competence and adjustment in children, who did and did not receive CNS-directed treatment, over the first 3 years following a cancer diagnosis.

PROCEDURE

Mothers, fathers, and children (ages 5-18 years at diagnosis) from 217 families reported on the child's competence (academic, social) and adjustment (anxious/depressed, withdrawn/depressed) near a new cancer diagnosis or relapse and 3 years later. Children were categorized into CNS-directed treatment (n = 112; including cranial radiation, intrathecal chemotherapy, and/or neurosurgery) and non-CNS-directed treatment (n = 105) groups.

RESULTS

At enrollment, there were few differences in competence and emotional adjustment among children based on treatment or diagnostic group. At 3 years, mothers and fathers reported poorer social competence for the CNS-directed treatment group, and fathers reported poorer school competence for the CNS-directed treatment group. Over time, father ratings of social competence increased for the non-CNS-directed treatment group, but not the CNS-directed treatment group. While father ratings of academic competence declined for the CNS-directed treatment group, mother ratings declined the most for children diagnosed with a brain tumor. All children demonstrated higher anxious/depressed scores over time.

CONCLUSIONS

CNS-directed treatment may be a valuable indicator to identify childhood cancer survivors at risk for poor competence during early survivorship. Follow-up screening and supportive services are recommended, as well as additional longitudinal research.

Effects of a Web-Based Pediatric Oncology Legacy Intervention on Parental Coping

OBJECTIVES

To examine the effects of a legacy intervention for children with advanced cancer and their parents on parental coping strategies.

SAMPLE & SETTING

The authors recruited 150 children with advanced cancer and their parents via Facebook.

METHODS & VARIABLES

Child-parent dyads were randomly assigned to the intervention or usual care. Children in the intervention group created electronic digital storyboards to assist in documenting their legacies. Parents completed the Responses to Stress Questionnaire at baseline/preintervention (T1) and postintervention (T2). Linear regressions were used to test for differences between the groups in the amount of change from T1 to T2 for each parent coping score.

RESULTS

Although not statistically significant, the legacy intervention showed trends toward increasing use of primary control and disengagement coping strategies in parents over time relative to usual care.

IMPLICATIONS FOR NURSING

Nurses can help to facilitate opportunities for parents to use adaptive coping strategies. More work is needed to determine how legacy interventions in pediatric oncology can facilitate adaptive coping strategies for parents of children with cancer.

Clinical Presentation and Treatment of Early-Onset Behavior Disorders: The Role of Parent Emotion Regulation, Emotion Socialization, and Family Income

Parent emotion regulation and socialization have been linked to various aspects of child functioning. In the case of early-onset behavior disorders in particular, parent emotion regulation may be an important correlate of the coercive cycle implicated in early-onset behavior disorders thus, symptom presentation at baseline. Further, emotion socialization may be complicated by a pattern of parent-child interactions in which both supportive or unsupportive parenting behaviors in response to behavioral dysregulation may increase vulnerability for problem behavior in the future. Some work suggests standard Behavioral Parent Training may impact parent emotion regulation and socialization. Still little is known, however, about how such processes may vary by family income, which is critical given the overrepresentation of low-income children in statistics on early-onset behavior disorders. This study explored parent emotion regulation, socialization, and family income in a sample of socioeconomically diverse treatment-seeking families of young (3–8 years old) children. Findings suggest relations between parental emotion regulation, socialization, and child behavior although the pattern of associations differed at baseline and post-treatment and varied by family income. Clinical implications and future directions are discussed.

Power of Religious Beliefs and Coping with Cancer: Opinions of Iranian Parents

Childhood cancer as a stressful event has many consequences for both the parents and their children. The aim of the study was to assess the coping strategies used by Iranian parents of children with cancer. The present study was conducted through convenience sampling with the participation of 205 parents with at least one child with cancer referred to the oncology ward, in the southeast of Iran. The Coping Health Inventory for Parents was used to measure parental coping strategies. Results showed that the highest and the lowest mean coping score belonged to the dimensions of social support and medical factors, respectively. Briefly, "Belief in God" and "Gratefulness for his Blessings" were the most helpful coping strategies among parents. Based on results of this study, it seems necessary for nurses to be aware of all aspects of human existence, including religion and spirituality as strong sources of power for parents to adapt with the illness of their child. Also, providing interventions to teach effective coping skills to parents may reduce their distress and improve their quality of life.

Parental Posttraumatic Growth After Pediatric Hematopoietic Stem Cell Transplant

Little is known about the development of posttraumatic growth among parents of children with serious advanced disease. The purpose of this study is to describe parental posttraumatic growth 100 days after pediatric stem cell transplant. This is a cross-sectional, descriptive study of 24 parents, approximately 100 days after their children received stem cell transplant. Participants reported environmental, personal, and disease characteristics and completed measures of distress, coping, rumination, and posttraumatic growth. Evidence of parental posttraumatic growth was described in each of 5 dimensions (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life). Posttraumatic growth was positively associated with parental distress, disengagement coping, and rumination measures (r = 0.44-0.47, P < .05). Appreciation of life demonstrated the strongest associations with distress and rumination (r = 0.53-0.61, P < .01). Curvilinear relationships were observed for the association of distress, disengagement coping, and involuntary engagement with posttraumatic growth (P < .05). Study results highlight opportunities for palliative care nurses and clinicians to facilitate opportunities to support parent posttraumatic growth during treatment for children's advanced disease.

Protocol for mapping psychosocial screening to resources in pediatric oncology: a pilot randomized controlled trial

Background

A pediatric cancer diagnosis and its treatment can have a detrimental effect on the mental health of children and their families. Screening to identify psychosocial risk in families has been recognized as a standard of care in pediatric oncology, but there has been limited clinical application of this standard thus far. A significant impediment to the implementation of psychosocial screening is the dearth of information on how to translate psychosocial screening to clinical practice, and specifically, how to follow-up from screening results. This manuscript aims to describe a protocol of a new intervention examining the feasibility and acceptability of mapping via a Psychosocial Navigator (PSN) psychosocial screening results to specific recommendations of resources for families based on measured risk for psychosocial distress and mental health symptoms.

Methods

The pilot randomized control trial (RCT) consists of dyads of youth (10–17 years) newly diagnosed with cancer and their primary caregiver. This RCT includes two arms (intervention and control group), with each group completing measurements near diagnosis and 1 year later. After the initial assessment, dyads in the intervention group receive monthly screening results and recommendations from the study PSN that are tailored to these results. The patient’s primary healthcare team (nurse, social worker, oncologist) also receive the risk, distress, and mental health results as well as the recommendations from the PSN.

Discussion

This study addresses a significant barrier to the implementation of psychosocial screening in pediatric oncology: specifically, the limited knowledge of how to follow-up from screening results. Findings from this pilot will inform a future definitive RCT to test the effectiveness of the intervention on patient and family mental health outcomes. This project has implications for enhancing clinical care in pediatric oncology, as well as other pediatric populations.

Strengths and limitations of this study

This is the first study of screening and follow-up using a psychosocial navigator.

This study involves both patient and caregiver report.

The small sample size necessitates a future larger study to investigate the effects of intervention.

Trial registration

NCT04132856, Registered 10 October 2019—retrospectively registered.

Development of a Structured Peer Mentoring Program for Support of Parents and Caregivers of Children with Cancer

BACKGROUND

Parents of children newly diagnosed with cancer have increased anxiety, depression, and numerous questions. Many of these concerns can only be answered by parents who have undergone a similar experience.

LOCAL PROBLEM

Our institution lacked a formal parent-to-parent mentoring program for parents of children newly diagnosed with cancer.

METHODS

The Parent Family Advisory Council (PFAC) recommended implementation of a formalized program that would promote a structured approach to mentoring, with a formal referral process and designated parent mentors who had been vetted, trained, and supported by the institution.

INTERVENTION

In 2010, a pilot parent-to-parent mentoring program was initiated.

RESULTS

Since the programs initiation, 4062 encounters have been documented. This represents an annual average of 72 mentees paired with 20 mentors, averaging 677 annual encounters. Parents view the mentoring relationship as positive and report that they feel understood, less anxious, and less isolated.

CONCLUSION

We show that a parent-to-parent mentoring program is feasible and sustainable over time. Our model is now transitioning from a staff referral to self-referral, as well as incorporating real-time mentoring into the new commons area for patients and their families. A formal volunteer mentoring program can assist parents in navigating the trajectory of childhood cancer, decreasing isolation.

Primary and secondary caregiver depressive symptoms and family functioning following a pediatric cancer diagnosis: an exploration of the buffering hypothesis

OBJECTIVE

After diagnosis, caregivers of children with cancer, particularly mothers or primary caregivers (PCs), often show elevated depressive symptoms which may negatively impact family functioning. We tested PC and secondary caregiver (SC) depressive symptoms as predictors of family, co-parenting, and marital functioning and whether having a non-depressed SC buffers against potential negative effects of PC depressive symptoms.

METHODS

Families (N = 137) were recruited from two major children's hospitals following a diagnosis of pediatric cancer. Caregivers completed self-report measures of depressive symptoms (Center for Epidemiological Studies-Depression Scale; Depression, Anxiety, and Stress Scale) and marital functioning (Dyadic Adjustment Scale) at 1-month post-diagnosis. A subset of families (n = 75) completed videotaped interaction tasks at approximately 3-months post-diagnosis that were coded for family and co-parenting interactions.

RESULTS

Higher PC depressive symptoms at 1-month post-diagnosis was associated with higher adaptability and lower conflict in family functioning. PC depressive symptoms were also associated lower dyadic consensus and lower dyadic satisfaction. SC depressive symptoms were not significantly associated with any family/co-parenting/marital functioning variables. Significant interaction analyses suggested that SC depressive symptoms moderated the effect of PC depressive symptoms on family cohesion, withdrawn parenting, and affective expression in the marriage, such that the relationship between PC depressive symptoms and poorer functioning was attenuated when SC depressive symptoms were at low or average levels.

CONCLUSIONS

Having a nondepressed SC buffered against negative effects of PC depressive symptoms on certain domains of family, coparenting, and marital functioning. SCs may play a protective role for families of children with cancer.

The association between parent stress, coping and mental health, and neurodevelopmental outcomes of infants with congenital heart disease

Caring for the complex needs of a child with congenital heart disease (CHD) can place significant burden on the family. Parent mental health and coping have important influences on resilience and neurodevelopmental outcomes in children with CHD. Objectives: To describe the uptake of a cardiac neurodevelopmental program (CNP), examine parent mental health and coping specific to parenting a child with CHD, and explore the relationship between parent mental health and child neurodevelopmental outcomes. Method: Implementation and uptake of the CNP was examined, and forty-four parents of children with CHD completed the DASS and RSQ-CHD. Results: The CNP showed significant uptake in follow-up and interventions offered including 100% completed brain MRIs of eligible patients, 35% increase in neonatal neurology consults, and 100% of families counselled on neurodevelopmental outcomes. A significant proportion of parents endorsed moderate/severe levels of anxiety (25%), depression (20%), and CHD-specific stress. Parents predominantly engaged in secondary control engagement coping (F(2,64)=75.04, p<.001, η_p²=.70). Secondary control engagement coping was associated with lower parent total stress (r=-.48, p=.006) and anxiety (r=-.47, p=.009). Higher parent stress was associated with higher anxiety (r=.45, p=.016), depression (r=.37, p=.05), more severe types of CHD (r=.35, p=.048), older child age (t(30)= -2.33, p=.03), and lower child cognitive scores (r=-.37, p=.045). More severe types of CHD were associated with lower language scores (F(3,35)=3.50, p=.03). Conclusions: This study highlights the relationship between parent mental health and early child cognitive outcomes in CHD and helps inform models of psychological care to reduce family burden and improve child outcomes.

The relationship between quality of life and coping strategies of children with EB and their parents

Background

Epidermolysis bullosa (EB) is a group of rare genetic skin disorders that primarily manifest as blisters and erosions following mild mechanical trauma. Despite the crucial role of the parents of children with EB in managing the disease, studies focusing on the parent–child relationship remain a gap in the literature. To address this gap, the current quantitative study, involving 55 children with all types of EB and 48 parents, assessed the relationship between their quality of life and coping strategies. Quality of life was measured with the Pediatric Quality of Life Inventory and TNO-AZL Questionnaire for Adult’s Health- related Quality of Life, and coping strategies were assessed with the Coping with a Disease Questionnaire. The majority of the analyses were descriptive and the results were interpreted qualitatively because of the small sample size.

Results

Overall, the quality of life of children with EB and that of their parents was somewhat lower compared with the quality of life of healthy children and adults. Children with EB who more frequently used emotional reactions and cognitive-palliative strategies to cope with the disease demonstrated lower levels of emotional and social functioning, while children who showed more acceptance and distancing showed higher levels of functioning on all domains. Parents who frequently demonstrated emotional reactions reported lower levels of social functioning and experienced more depressive emotions and anger. Parents who used more avoidance showed higher levels of positive emotions. Within parent–child dyads, acceptance, cognitive-palliative strategies and distancing were positively related. Children’s emotional and social functioning were negatively associated with their parents’ depressive emotions. Parents’ acceptance was linked to higher physical functioning in children, whereas children’s avoidance was linked to a lower level of anger in parents.

Conclusion

Children who are able to accept the disease or distance themselves from it appear to be better off in contrast to those who tend to engage in the cognitive-palliative strategies and expressing emotional reactions. Parents seem to be better off when they are able to use avoidance in contrast to those who tend to show emotional reactions. Further research is needed to substantiate these findings.

Psychological Distress in Parents of Children with Cancer: A Descriptive Correlational Study

Objective:

This study aimed to ascertain levels of distress and contributing factors among parent caregivers of pediatric cancer patients in Singapore.

Methods:

In this descriptive correlational study, parental caregivers were recruited via convenience sampling during their child's inpatient admission or outpatient appointment. They were asked to complete a self-administered demographic survey and the Distress Thermometer for Parents (DT-P) tool. Descriptive statistics, Chi-square tests, and correlation analyses were performed.

Results:

The mean DT-P score was 5.07 (standard deviation = 2.78), out of a maximum of 10. Distress was reported among 67.9% (n = 55) of caregivers. The cognitive domain of caregiving problems on the DT-P was found to correlate with distress. Parents most frequently reported cognitive problems (n = 21, 25.9%) and, least often, social problems (n = 6, 7.4%). Practical (P = 0.040), emotional (P = 0.001), physical (P = 0.026), and cognitive problems (P = 0.001) of caregiving were statistically significantly associated with distress.

Conclusions:

Notable levels of distress and proportions of distressed parents highlighted the heavy burden of caregiving. This may also be attributed to the differences in caregiving challenges. The psychological effects of parental caregiving highlight the need for supportive measures for pediatric cancer caregivers.

The Response to Stress Questionnaire for Parents Following Neonatal Brain Injury

OBJECTIVE

The Response to Stress Questionnaire-Brain Injury (RSQ-BI) was adapted utilizing a patient-oriented approach, exploring parental stress, coping, and associated mental health outcomes in parents of children with neonatal brain injury. The contributions of social risk, child adaptive functioning, and brain injury severity were also explored.

METHODS

Using a mixed-method design, this study explored adapted stressor items on the RSQ-BI. Parents and clinicians engaged in semistructured interviews to examine key stressors specific to being a parent of a child with neonatal brain injury. The adapted RSQ-BI was piloted in a parent sample (N = 77, child mean age 1 year 7 months) with established questionnaires of social risk, child adaptive functioning, severity of the child's injury, coping style, and parent mental health. Descriptive statistics and correlations examined parent stress, coping, and their association with parent mental health.

RESULTS

The final RSQ-BI questionnaire included 15 stressors. Factor analysis showed stressors loaded onto two factors related to (a) daily role stressors and (b) brain injury stressors. Using the RSQ-BI, parents reported brain injury stressors as more stressful than daily role stressors. When faced with these stressors, parents were most likely to engage in acceptance-based coping strategies and demonstrated lower symptoms of parent depression and anxiety.

CONCLUSIONS

The RSQ-BI provides a valuable adaptation to understand both stressors and coping specific to being a parent of a child with neonatal brain injury. Relevant interventions that promote similar coping techniques are discussed for future care and research.

Individual and Dyadic Coping and Fear of Progression in Mothers and Fathers of Children with Hematologic Cancer

This study investigated the association of individual and dyadic coping strategies with fear of progression (FoP) in mothers and fathers of children with hematologic cancer. Parental couples (N = 44) whose children had been diagnosed with hematologic cancer were recruited at a university hospital and a rehabilitation clinic in Germany between 03/2017 and 08/2017. Data included parents' self-report on FoP (Fear of Progression Questionnaire-parent version, FoP-Q-SF/PR), individual coping (Coping Health Inventory for Parents, CHIP-D), and dyadic coping (Dyadic Coping Inventory, DCI). Statistical analyses were carried out for mothers and fathers individually as well as for parental couples using dyadic data analyses (e.g., actor-partner interdependence model, APIM). Individual and dyadic coping strategies were significantly correlated with FoP in mothers, but not in fathers. Fathers' evaluation of the couple's dyadic coping significantly predicted mothers' FoP. The more frequent use of familial integration (CHIP-D FAM) and maintaining social support (CHIP-D SUP) as well as a better evaluation of their partners' dyadic coping was significantly associated with lower FoP in mothers. Differences in individual and dyadic coping in parental couples were not associated with FoP. Individual and dyadic coping strategies should be addressed in the psychosocial care of mothers and fathers of children with hematologic cancer. Study results support the benefits of involving fathers in psychosocial interventions, for example, in couple-based interventions that acknowledge interpersonal effects of coping on FoP. Future research should further explore coping strategies applied by fathers of children with hematologic cancer for the regulation of FoP.

Integrative Literature Review on Psychological Distress and Coping Strategies Among Survivors of Adolescent Cancer

PROBLEM IDENTIFICATION

Cancer survivors, particularly those diagnosed in adolescence, are faced with physical, mental, and emotional stressors associated with the disease and its treatment. These stressors add to the demand placed on survivors' already taxed coping skills. This article reviews the literature on psychological distress experienced by survivors diagnosed with cancer during adolescence and the coping strategies they employed.

LITERATURE SEARCH

Three electronic databases (CINAHL®, PsycINFO®, PubMed®) were searched, and 19 studies were selected. Garrard's matrix method guided this integrative review.

DATA EVALUATION

Gough's weight of evidence framework was used to evaluate each study.

SYNTHESIS

Analysis revealed important findings about the types of coping strategies used by adolescents during and after cancer treatment and the impact of each on levels of psychological distress.

IMPLICATIONS FOR PRACTICE

Healthcare providers, who regularly assess for negative thoughts and unmet needs among survivors, may identify symptoms of psychological distress, intervene early, and facilitate better outcomes for their patients. Patient-centered interventions aimed at coping with psychological distress are most helpful.

Post-Traumatic Stress Symptoms among Lithuanian Parents Raising Children with Cancer

Background and objectives: The study aims to evaluate post-traumatic stress symptom expression among Lithuanian parents raising children with cancer, including social, demographic, and medical factors, and to determine their significance for the risk of developing post-traumatic stress disorder. Materials and methods: The study was carried out in two major Lithuanian hospitals treating children with oncologic diseases. The cross-sectional study included 195 parents, out of which 151 were mothers (77.4%) and 44 were fathers (22.6%). Post-traumatic stress symptoms were assessed using the Impact of Event Scale-Revised. To collect the sociodemographic, childhood cancer, and treatment data, we developed a questionnaire that was completed by the parents. Main study results were obtained using multiple linear regression. Results: A total of 75.4% of parents caring for children with cancer had pronounced symptoms of post-traumatic stress disorder. The female gender (β = 0.83, p < 0.001) was associated with an increased manifestation of symptoms, whilst higher parental education (β = −0.21, p = 0.034) and the absence of relapse (β = −0.48, p < 0.001) of the child’s disease reduced post-traumatic stress symptom expression. Conclusions: Obtained results confirmed that experiencing a child’s cancer diagnosis and treatment is extremely stressful for many parents. This event may lead to impaired mental health and increased post-traumatic stress disorder (PTSD) risk; hence, it is necessary to provide better support and assistance to parents of children with cancer.

Efficacy of a Stress Management Intervention for Mothers of Children with Cancer

OBJECTIVE

Mothers of children with cancer confront life stress that can impact their psychological and physical health and, in turn, the health of the family. Recommendations advocate preemptive stress-management interventions; however, few studies have investigated their efficacy. Here, we report results of a parallel randomized pilot trial examining health benefits of a stress management intervention designed to teach coping skills.

METHODS

One hundred twenty mothers (age 36 ± 8 years) of children newly diagnosed with cancer were randomized to a 12-session stress management intervention (n = 60) or usual care (n = 60). Sessions took place in the inpatient or outpatient setting of a children's hospital. Primary outcome variables included psychological function and physical health assessed preintervention and postintervention and at 6-month follow-up (∼12 months postdiagnosis).

RESULTS

Enrollment, retention, and satisfaction data supported feasibility and acceptability. Latent change score models showed the intervention reduced perceived stress (d = -0.37, p = 0.03), anxiety symptoms (ds = -0.38 and -0.56, ps < .03) and, a nonsignificant effect for depressive symptoms (d = -0.29, p = .11) across the 6 months following diagnosis. Intervention participants also endorsed fewer depressive symptoms than controls ∼12 months after diagnosis. The intervention improved stress management skills, which associated with the psychological benefits of participation. There were no intervention-related changes in perceived health or markers of inflammation.

CONCLUSION

Intervention-related improvements in stress management skills may result in better psychological health in the face of caring for a child with cancer.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02022449.

“A mesa que encolheu”: a perspectiva alimentar das mães que perderam filhos

Resumo Este artigo descreve a relação de mães enlutadas com a alimentação, com base na fenomenologia existencial, considerando que o espaço familiar alimentar, protagonizado pela matriarca, pode ser perturbado com a perda de um filho. Foram realizadas entrevistas com quinze mães frequentadoras de Organizações Não Governamentais de apoio ao luto, com idade entre 40 e 61 anos. Da análise emergiram quatro eixos temáticos que indicam como a mãe enlutada se comporta no contexto da alimentação: a ausência de fome e do prazer em se alimentar; o ato de compartilhar refeições versus o luto materno; o confronto com a “cadeira vazia”; reações e sentimentos diante da culinária que simboliza a memória do filho. A influência que o luto exerce na relação das mães com a alimentação foi evidenciada de diversas maneiras, seja na ausência de fome, na alteração do peso e na falta do(a) filho(a) nas interações sociais durante as refeições compartilhadas, representando os desafios da mãe perante uma “mesa que encolheu”, exigindo das mesmas novas significações frente à alimentação. Compreende-se que a relação da enlutada com a alimentação é permeada de conflitos que a expõe a risco de desvios nutricionais e demanda apoio com profissionais sensíveis e esclarecidos sobre essa condição.

Long-term trajectories of depression symptoms in mothers of children with cancer

OBJECTIVE

To identify trajectories of depression symptoms in mothers of children with cancer from diagnosis/relapse through 5 years and examine maternal factors at diagnosis/relapse predicting membership in these trajectories.

METHOD

Mothers (n = 327; Mage = 37.6 years, SD = 7.7 years; 85.9% White) reported depression symptoms near the time of their child's diagnosis/relapse and then again at 1-, 3-, and 5-years postdiagnosis/relapse. Mothers also reported perceived stress, coping (primary control, secondary control, and disengagement coping), and spirituality near the time of diagnosis. Latent class growth analysis was used to identify latent trajectories of depression symptoms, and a 3-step multinomial logistic regression tested covariate predictors of membership in the trajectories.

RESULTS

Three trajectories were identified: "low depression symptoms" (63.3%), "moderate depression symptoms" (31.5%), and "high depression symptoms" (5.2%). Mothers who used more primary and secondary control coping were more likely to be in the low depression symptom trajectory as compared with the moderate (OR = 1.64, p = .024 and OR = 1.38, p = .013, respectively) or high trajectories (OR = 1.99, p = .008 and OR = 1.81, p = .001, respectively).

CONCLUSIONS

Although mothers of children with cancer generally displayed improved mental health further from diagnosis, mothers with more depression symptoms after diagnosis/relapse displayed substantial stability in depression symptoms over the 5 years. Mothers of children with cancer may benefit from early screening of mental health and coping strategies, as well as interventions to bolster effective coping for those with elevated depression symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Gender-specific differences in parental health-related quality of life in childhood cancer

BACKGROUND

Parents of children with cancer are at risk for impaired health-related quality of life (HRQoL). Most prior research has focused on the HRQoL of mothers. The aim of this study is to describe HRQoL in mothers and fathers, and determine the influence of sociodemographic, medical, and psychosocial factors.

PROCEDURE

In a cross-sectional study, both parents completed questionnaires on sociodemographics, distress, and HRQoL. Parental HRQoL was compared to healthy population values. Differences between mothers and fathers were evaluated with multilevel analysis. Gender-specific HRQoL determinants were assessed via multiple linear regression analysis.

RESULTS

Parents (202 mothers, 150 fathers; comprising 121 couples) of 231 children with different cancer diagnoses (mean time since diagnosis 3.3 ± 1.4 years, 90% posttreatment) participated. Compared to healthy women and men, mothers and fathers reported significantly impaired HRQoL on the following domains: cognitive functioning, sleep, daily activities, and vitality (Cohen's d = 0.3-0.9). Additionally, maternal HRQoL was reduced on the domains gross motor functioning, pain, social functioning, sexuality, and depressive emotions. Mothers scored worse than fathers on six of 12 domains. Risk factors for adverse outcomes in both parents were higher distress, emotional and parenting problems, little social support, medication use, and active treatment of the child. Other determinants in mothers were non-Dutch background and unemployment, while lower HRQoL in fathers was predicted by their child's diagnosis type, shorter time since diagnosis, and treatment intensity.

CONCLUSION

These outcomes illustrate the need for family-centered care. Future interventions aimed at improving parental functioning should take into account gender-specific differences in HRQoL to reach optimal efficacy.

A HYPNOSIS-BASED GROUP INTERVENTION TO IMPROVE QUALITY OF LIFE IN CHILDREN WITH CANCER AND THEIR PARENTS

Many children with cancer and their parents suffer from distress, fatigue, and relational difficulties. Hypnosis is often used to decrease children's procedure-related pain and distress in pediatric oncology and to improve the well-being of adults with cancer. This article describes a pilot study assessing the acceptability and feasibility of a group intervention combining self-care and hypnosis for children with cancer and their parents, and a quasi-experimental protocol aimed at assessing the efficacy of this intervention to improve quality of life, distress, fatigue, and coping. The pilot study showed that the intervention was feasible and perceived positively. Future research is needed to test the efficacy of group interventions combining self-care and hypnosis to improve quality of life for children with cancer and their families.

Longitudinal associations among maternal depressive symptoms, child emotional caretaking, and anxious/depressed symptoms in pediatric cancer

Research has shown that children experience increased emotional distress when engaging in emotional caretaking of a parent. The current study is the first to examine this process in families in which the source of the stress is the child's illness. Prospective associations were tested among mothers' depressive symptoms near the time of their child's cancer diagnosis, mothers' expressed distress and their child's emotional caretaking during an interaction task, and child anxious/depressed symptoms at 1 year postdiagnosis. Families (N = 78) were recruited from two pediatric hospitals soon after their child's (Ages 5-18) new diagnosis or relapse of cancer. Mothers reported on their own depressive symptoms and their child's anxious/depressed symptoms near the time of diagnosis or recurrence (Time 1) and 1 year later (Time 3). At Time 2 (4 months after Time 1), mother-child dyads completed a video-recorded discussion of their experience with cancer that was coded for observed maternal expressed distress (anxiety, sadness) and observed child emotional caretaking. Maternal expressed distress during the interaction was significantly related to more emotional caretaking behaviors by both boys and girls. Results of a moderated mediation model showed that child emotional caretaking at Time 2 significantly mediated the relation between maternal depressive symptoms at Time 1 and child anxious/depressed symptoms at Time 3 for girls but not for boys. The findings suggest that children's emotional caretaking behaviors contribute to subsequent anxious/depressed symptoms for girls, but not for boys, with cancer. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Psychosocial functioning of parents of children with heart disease-describing the landscape

The aim was to describe the psychological functioning of parents of school-age children with heart disease (HD) in a large-scale, transnational evaluation of parent dyads across the spectrum of cardiac diagnoses and a range of psychosocial domains. Parents of children with HD attending routine out-patient cardiology follow-up visits completed questionnaires assessing their mental health, coping, and family functioning. Parents (1197 mothers and 1053 fathers) of 1214 children (mean age: 12.6 years; S.D. 3.0 years; median time since last surgery: 8.9 years) with congenital or acquired HD from three centers each in the UK and the USA participated (80% response rate). Parents of children with milder HD demonstrated few differences from healthy norms and had significantly lower scores on measures of illness-related stress and post-traumatic stress than parents of children with single ventricle conditions or cardiomyopathy. Parents in these latter two diagnostic sub-groups had significantly higher levels of anxiety and depression than healthy norms but did not differ on other measures of family functioning and coping skills. There were few differences between parents from the UK and the USA. Agreement between mothers and fathers within a dyad was highest for the measure of frequency of illness-related stressors (ICC = 0.67) and lowest for anxiety (ICC = 0.12).Conclusion: Our results suggest two different pathways for the long-term psychological well-being of parents of children with HD: on the one hand, more complex HD is associated with poorer long-term psychosocial outcomes; in contrast, there are also grounds for optimism, particularly for parents of children with less complex conditions, with better psychological outcomes noted for some groups of parents compared to previously reported early psychosocial outcomes. Future work needs to identify factors other than disease severity which might explain poorer (or better) functioning in some parents of children with more complex HD. What is Known: • Parents of children with congenital heart disease report elevated levels of anxiety, depression, and stress after cardiac surgery in infancy. • Maternal mental health problems can have an adverse impact on the psychological adjustment of the child with congenital heart disease. What is New: • Parents of children with milder forms of heart disease do not differ from healthy norms in the longer term and psychological outcomes are better than might be expected from early findings. • More complex diagnoses, particularly functional single ventricle conditions and cardiomyopathy, are associated with poorer long-term psychosocial outcomes for parents.

Cancer-related effects on relationships, long-term psychological status and relationship satisfaction in couples whose child was treated for leukemia: A PETALE study

Objectives

Follow-up studies suggest that the psychosocial impact of pediatric cancer on parents often extends beyond the end of their child’s cancer treatments, and parents can continue to experience both individual and relationship effects. In a long-term study of parents of children who were treated for acute lymphoblastic leukemia (ALL), we aimed to: 1) describe parents’ adjustment (psychological distress, relationship satisfaction; 2) describe the perceived impact of cancer on couples’ relationship, and; 3) identify to what extent the perceived impact of cancer on the couple is related to both parents’ long-term adjustment.

Methods

Parents of childhood ALL survivors (n = 103 couples) were surveyed as part of a cohort recall (PETALE cohort). Both parents completed questionnaires exploring adjustment (Brief Symptom Inventory-18, Dyadic Adjustment Scale) and perceived impact of cancer on the relationship (Impact of Cancer on the Couple). Mothers’ and fathers’ scores were compared using MANOVAs. We also examined the degree to which a parent’s perceived changes in relationship dynamics following their child’s cancer were associated with their own current adjustment (actor effects), and their partner’s current adjustment (partner effects) using the Actor-Partner Interdependence Model (APIM).

Results

Frequencies of current distress were normative in parents (mothers/fathers): general distress (6.8/7.8%), anxiety (5.8/6.8%), depression (2.9/6.8%), somatization (13.6/9.7%), and relationship distress (21.4/20.4%). Mothers and fathers typically agreed on their reported relationship satisfaction, and the perceived nature of relationship changes following the illness. Dyadic analyses indicated that whereas mothers’ adjustment was related to their own perceived relationship changes, fathers’ adjustment was primarily related to their partner’s perceptions.

Conclusion

In long-term stable couples, mothers may act as an influential bridge connecting the illness experiences of survivors and fathers. This could explain why mothers’ perceptions of relationship changes were related to their partners’ long-term adjustment, which was not the case for fathers.

In good times and in bad: what strengthens or challenges a parental relationship during a child's cancer trajectory?

OBJECTIVES

To identify events during a child's cancer trajectory when parents perceived their marriage/partnership to be most strengthened and/or challenged.

RESEARCH APPROACH

Using a cross-sectional qualitative design, participants completed a self-administered questionnaire addressing changes in their relationship during their child's cancer trajectory, including events perceived to strengthen/challenge their relationship, and recommendations for other parents.

PARTICIPANTS

192 parents of pediatric oncology patients across three institutions. Data were analyzed using qualitative content analysis.

FINDINGS

Themes included relationship-specific, illness experience-related, and external supports/stressors that impacted the relationship. Dyadic strategies, empathic communication, and supportive behaviors strengthened the couple's relationship, whereas physical and emotional distance most commonly challenged the relationship. Recommendations to other parents included open communication, couple's connectedness, and use of external supports.

INTERPRETATION

Offering psychosocial support and helping parents anticipate when their relationship can be strengthened/challenged can be an important part of ongoing care. Implications for psychosocial providers: Teaching communication and dyadic coping strategies can help parents manage stress and build cohesion.

Trajectories of child and caregiver psychological adjustment in families of children with cancer

OBJECTIVE

To describe the trajectory of patient and caregiver mental health from diagnosis through the first year of treatment for pediatric cancer and assess whether rates of clinically relevant symptoms were elevated compared with norms. We examined mean levels of internalizing and externalizing symptoms and posttraumatic stress symptoms (PTSS) in children with cancer, and depression, anxiety, and PTSS in caregivers during the first year of treatment; the proportion of patients and caregivers that scored in the clinical range at each time point; and the typical trajectory of symptoms in patients and caregivers and whether trajectories differed between individuals.

METHOD

Families (N = 159) of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective study. Primary caregivers provided monthly reports of their own and their children's psychological adjustment.

RESULTS

On average, children were well-adjusted. However, compared with norms, there was a higher than expected proportion of children with clinically relevant internalizing symptoms around the time of diagnosis. On average children's symptoms declined over time, though variability was observed. Caregivers were less well-adjusted on average, with a high proportion reporting clinically relevant symptoms over time for depression and anxiety. Caregiver symptoms also declined over time, though considerable variability was observed.

CONCLUSION

Although most children remain well-adjusted during the first year of treatment, many caregivers experience clinically relevant symptoms of psychological distress. Implications for development of interventions targeting at-risk patients and caregivers are discussed. Identifying processes that predict between-family variability in trajectories of psychopathology is an important next step. (PsycINFO Database Record

Problem-solving skills, parent-adolescent communication, dyadic functioning, and distress among adolescents with cancer

Some adolescents with cancer report distress and unmet needs. Guided by the disability-stress-coping model, we evaluated associations among problem-solving skills, parent-adolescent cancer-related communication, parent-adolescent dyadic functioning, and distress in adolescents with cancer. Thirty-nine adolescent-parent dyads completed measures of these constructs. Adolescents were 14-20 years old on treatment or within 1 year of completing treatment. Better problem-solving skills were correlated with lower adolescent distress (r = -0.70, P < 0.001). Adolescent-reported cancer-related communication problems and dyadic functioning were not significantly related to adolescent distress (rs < 0.18). Future work should examine use of problem-solving interventions to decrease distress for adolescents with cancer.

Religious Coping in Iranian Mothers of Children With Cancer: A Qualitative Content Analysis

OBJECTIVE

Religious coping is one of the most frequently used coping methods in parents of children with cancer. This study aims to explain dimensions of religious coping in mothers of children with cancer in Iran.

METHODS

In this qualitative content analysis, using purposeful sampling, 8 mothers of children with cancer were selected and interviewed. When saturation was achieved, data were analyzed through directed content analysis. Primary and secondary codes were placed in prelabeled categories and subcategories based on Pargament's religious coping theory.

RESULTS

The participants of the study used coping methods in 4 of the 5 objectives of religious coping, that are meaning, control, comfort, and intimacy with others and closeness to God. Three of the most frequent used coping methods by the participants were "Punishing God Reappraisal," "Pleading for Direct Intercession," and "Benevolent Religious Reappraisal," respectively. None of the participants used religious coping methods for its function of "life transformation."

CONCLUSIONS

As suggested by Pargament's theory of religious coping, the dynamic, multidimensional process of religious coping has a culture-based pattern with unpredictable outcomes. Despite many similarities between religious coping in a Shia Muslim society and other studied ones, some differences are observed. Further studies are needed to show the potential evidence of the concept in relation to cultural diversity and religious differences.

The interdependence of posttraumatic stress symptoms in parental dyads during and after their child's treatment for cancer

BACKGROUND

Cancer in a child is highly distressing and some parents are at increased risk for developing posttraumatic stress symptoms (PTSS). However, the interdependence of PTSS in parental dyads has rarely been accounted for. The aim was to explore the dyadic relationship of PTSS in parents of children diagnosed with cancer.

MATERIAL AND METHODS

The sample includes 150 parents (75 dyads) of 75 children diagnosed with cancer in Sweden during 2002-2004, with follow-up until one year after end of treatment. Data on PTSS from six assessments were included. The first three assessments were carried out during treatment and the remaining after end of treatment. Actor-partner interdependence models were estimated using a structural equation modeling approach to explore the dyadic relationship of PTSS. Actor effects refer to intra-individual dependency over time, and partner effects refer to inter-individual dependency over time, i.e., how much an individual's symptom levels are affected by their partner's symptom levels at the previous assessment.

RESULTS

Results show both actor and partner effects during the child's treatment. Only an actor effect remained following end of treatment where level of PTSS at one assessment was associated with the level of PTSS at the subsequent assessment. The association between mothers' and fathers' PTSS did not remain after end of treatment.

CONCLUSIONS

Parents appear to react as an interdependent emotional system during the child's treatment but this effect disappears after end of treatment. Results suggest psychological interventions for parents during the child's cancer treatment should also be sensitive to and address the influence that distress in one partner may have on the other.

Family estimates of risk for neurocognitive late effects following pediatric cancer: From diagnosis through the first three years of survivorship

BACKGROUND

Families often express a need for additional information about neurocognitive late effects (NCLE) after a pediatric cancer diagnosis. Therefore, we examined: (i) differences in parent, child, and oncologist estimates of risk for NCLE; (ii) whether the estimates of parents and/or children change over time; and (iii) whether estimates are different for children treated with central nervous system (CNS) directed therapies.

PROCEDURE

Mothers, fathers, and children (initial age: 5-17, self-report: >10) from 258 families reported their perceived likelihood of the child developing "thinking/learning problems" on a visual analog scale (0-100%) at 2 months (T1), 1 year (T2), and 3 years (T3) following cancer diagnosis/relapse. Oncologists estimated the likelihood of NCLE at T1. Children were separated into groups based on CNS-directed treatment (n = 137; neurosurgery, intrathecal chemotherapy, and/or craniospinal radiation) or no CNS treatment.

RESULTS

Mother, father, and child estimates of risk for NCLE were similar to oncologists and to one another around diagnosis (T1). Although there were no significant mean differences, a considerable subset of family members either underestimated their child's risk for NCLE (>40%) or overestimated the risk for NCLE (20%) in comparison to oncologists. At T2 and T3, the estimates of mothers were significantly higher than children. Linear growth curves indicated that mothers' estimates for children with CNS-directed treatment significantly increased throughout the first 3 years of survivorship.

CONCLUSIONS

Considering that accurate understanding of NCLE is essential to seeking appropriate assessment and intervention, healthcare providers should focus on implementing family-based education early in treatment and throughout survivorship care.