Post-traumatic stress symptoms in childhood brain tumour survivors and their parents

Longitudinal changes of psychological distress among childhood cancer survivors: The Swiss Childhood Cancer Survivor Study

BACKGROUND

Childhood cancer survivors may experience psychological distress due to the disease, cancer treatments, and potential late effects. Limited knowledge exists regarding longitudinal changes in psychological distress after childhood cancer. We aimed to determine changes in psychological distress over time and explore determinants of changes.

METHODS

The Swiss Childhood Cancer Survivor Study collected data at baseline (2007-2009) and follow-up (2010-2012). Psychological distress was measured using the Brief Symptom Inventory 18 (BSI-18), including three symptom scales (somatization, depression, anxiety) and an overall distress index (Global Severity Index, GSI). Sum-scores were T-standardized (mean = 50; standard deviation [SD] = 10). Survivors with a score ≥57 on the GSI or two symptom scales were classified as cases with distress. We used linear mixed effects regression to identify potential sociodemographic and clinical determinants of change in psychological distress.

RESULTS

We analyzed 696 survivors at baseline (mean age = 24 years [SD = 4], 49% females, mean time since diagnosis = 16 years [SD = 4]). On follow-up (2.4 years, SD = 1), 317 survivors were analyzed, including 302 participants with repeated measures. We found that 13% (39/302) were cases at baseline, and 25% (76/302) were cases on follow-up. Those older at study and longer since diagnosis, females, diagnosed with central nervous system (CNS) tumors, and those reporting late effects were more likely to experience higher levels of distress. Females and unemployed are at higher risk for developing or persisting psychological distress than males and those who are employed or in training.

CONCLUSION

We observed an increase in psychological distress score over time, with higher proportion of psychological distress on follow-up. Anticipatory guidance and screening should be implemented in regular follow-up care.

Risk of new onset and persistent psychopathology in children with long-term physical health conditions: a population-based cohort study

Children and young people (CYP) with long-term physical health conditions (pLTCs) have increased risk of psychopathology compared to physically healthier peers. We explored risk factors for new onset and persistent psychiatric disorders in CYP with pLTCs compared to CYP without pLTCs. This 3-year follow-up study involved a UK representative sample of CYP from the British Child and Adolescent Mental Health Surveys (N = 7804). We examined potential baseline predictors of new onset and persistent psychiatric disorders at follow-up in four groups of children based on the presence of any physical and/or any psychiatric conditions at baseline. Psychiatric disorders were assessed using standardised multi-informant diagnostic assessment. Separate multivariable binary logistic regressions were conducted for each group. In CYP with pLTCs, rented housing (aOR = 1.42, 95% CI  1.01 to 1.99), non-traditional family structure (aOR = 2.08, 95% CI  1.42 to 3.05), increased parental distress (aOR = 1.09, 95% CI  1.04 to 1.14), and greater peer relationship difficulties (aOR = 1.29, 95% CI  1.19 to 1.39) predicted future psychiatric disorder. Only peer relationship difficulties predicted persistent disorder (aOR = 1.27, 95% CI  1.17 to 1.38) in this group. A greater number of factors predicted the onset of psychiatric disorder in CYP with pLTCs compared to physically healthier peers and similarly, a higher number of factors predicted persistent disorder in CYP without pLTCs. CYP with pLTCs might comprise a group with different vulnerabilities, some of which are potentially tractable and may be useful indicators of patients who require preventable or management interventions.

Caregivers matter: Neurological vulnerability for pediatric brain tumor survivors

Background

Pediatric brain tumor survivors (PBTS) are at risk of worse quality of life (QOL) due to the impact of neurotoxic treatments on the developing nervous system. Parenting factors such as protectiveness have been linked to worse QOL in childhood cancer survivors generally, but have yet to be explored for PBTS. We examined whether parenting behaviors moderated the association between neurotoxic treatment and QOL for PBTS.

Methods

PBTS (n = 40; ages 10-25) and their caregivers (n = 47) completed measures of parenting behaviors including warmth (support/connectedness) and psychological control (protectiveness) and QOL. We divided the sample into moderate/high and low neurotoxicity groups based on chart review using the Pediatric Neuro-Oncology Rating of Treatment Intensity and examined moderator effects.

Results

Survivor-reported primary caregiver warmth moderated the relationship between neurotoxicity and caregiver-reported QOL. Moderate/high neurotoxicity was associated with lower caregiver-reported QOL only when survivor-reported primary caregiver warmth was low, P = .02. Similar results were found for survivor-reported QOL. Caregiver-reported psychological control moderated the association between neurotoxicity and caregiver-reported QOL such that neurotoxicity only affected QOL at high levels of psychological control, P = .01.

Conclusions

Heightened associations between parenting and QOL in the context of neurotoxic treatments underscore the need to better support PBTS. Findings are consistent with research suggesting that family factors may be particularly important for children with other neurological insults. Limitations include cross-sectional design and a small/heterogeneous clinical sample with low ethnic/racial diversity. Prospective studies are needed to refine evidence-based screening and develop psychosocial intervention strategies to optimize QOL for PBTS and their families.

Recognizing the psychological impact of a glioma diagnosis on mental and behavioral health: a systematic review of what neurosurgeons need to know

A cancer diagnosis is life altering and frequently associated with both acute and long-lasting psychosocial and behavioral distress for patients. The impact of a diffuse glioma diagnosis on mental health is an important aspect of the patient experience with their disease. This needs to be understood by neurosurgeons so these concerns can be appropriately addressed in a timely fashion and integrated into the multidisciplinary care of neuro-oncology patients. The relatively grave prognosis associated with diffuse gliomas, the morbidity associated with treatment, and the constant threat of developing a new neurological deficit all can negatively affect a patient's mental ability to cope and ultimately manifest in mental health disorders such as anxiety and depression. The objective of this systematic review was to describe the variety of behavioral health disorders patients may experience following a glioma diagnosis and discuss possible treatment options. The PubMed, Web of Science, Embase, and PsycINFO databases were searched through July 1, 2022, using broad search terms, which resulted in 5028 studies that were uploaded to Covidence systematic review software. Duplicates, non-English-language studies, and studies with irrelevant outcomes or incorrect design were removed (n = 3167). A total of 92 articles reporting behavioral health outcomes in brain tumor patients were categorized and extracted for associations with overall mental health, anxiety, depression, distress, stress, pharmacology, interventions, and mental health in caregivers. The authors identified numerous studies reporting the prevalence of mental health disorders and their negative influence in this population. However, there is a paucity of literature on therapeutic options for patients. Given the strong correlation between patient quality of life and mental well-being, there is a considerable need for early recognition and treatment of these behavioral health disorders to optimize everyday functioning for patients.

Social affective outcomes and brain injury in children and adolescents treated for brain tumours

In this Review we critically evaluate the empirical literature investigating the effect of paediatric brain tumours and their treatment on social affective function. We focus specifically on relations between social affective function and compromised brain structure and function associated with treatment for a paediatric brain tumour. We concentrate on emotion recognition and regulation, because these are core components of social affective function. First, we provide an overview of the literature in typically developing children and discuss the underlying brain networks thought to subserve emotion (ie, limbic system and supporting white matter microstructure). We then focus on how damage to brain structure and function after treatment for a paediatric brain tumour might be related to compromised emotion recognition and regulation-as well as broader social affective outcomes. On the basis of our review of the literature across typically developing children and those with a paediatric brain tumour, we suggest that structural changes to fronto-limbic tracts might interrupt social network neural communication in children and adolescents treated for brain tumours. A critical analysis of the reviewed literature suggests a relationship between social affective dysfunction and childhood-acquired injury to white matter microstructure. We argue that the knowledge synthesised regarding paediatric brain tumours could extend to other neurological disorders. Finally, we identify considerations for future investigation and recommend research practices to be adopted in forthcoming studies to establish causal links between brain structure and function to social affective processes.

Family functioning and adaptation following pediatric brain tumor: A systematic review

INTRODUCTION

Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS.

METHODS

We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions.

RESULTS

Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs.

CONCLUSIONS

Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.

Étude sur les inquiétudes parentales et ses facteurs associés dans le cadre de la rémission d’un cancer pédiatrique

Introduction : Les études sur les inquiétudes et la détresse des parents d’un enfant en rémission de cancer sont moins développées dans la littérature. L’objectif de l’étude est d’examiner l’intensité des inquiétudes ainsi que ses associations avec le facteur d’intolérance à l’incertitude (II) et les symptômes anxiodépressifs.

Méthodes : Soixante et un parents d’enfants en rémission de cancer (de quatre à six ans de rémission) ont participé à l’étude. Les parents ont rempli plusieurs questionnaires évaluant les inquiétudes, l’II et les symptômes anxiodépressifs.

Résultats : Les parents présentent majoritairement des symptômes anxieux et des inquiétudes intenses relatives à l’évolution de la santé de leur enfant en rémission de cancer. Le facteur d’II semble contribuer à expliquer l’intensité des inquiétudes parentales.

Conclusion : Des recommandations ont été publiées concernant la prise en charge des parents d’un enfant en rémission de cancer, mais des études longitudinales centrées sur le parent sont encore nécessaires afin d’améliorer les initiatives de prévention et de prise en charge de ces familles.

Examining the association of medical complications and posttraumatic stress symptoms in pediatric solid organ transplant patients and their caregivers

BACKGROUND

Post-traumatic stress symptoms (PTSS) have been reported by pediatric solid organ transplant (SOT) patients and their caregivers well after transplantation. This study examined the relationship between PTSS, medication adherence, and medical complications in SOT patients and their caregivers. A secondary aim examined the association between patient and caregiver-reported PTSS.

METHODS

Pediatric SOT patients (N = 69) and caregivers (N = 73) reported on PTSS by completing the Child PTSD Symptom Scale (patients 8-17 years) or the Impact of Events Scale-Revised (patients 18 years and older and caregivers). Patient medication adherence was assessed using the Medication Level Variability Index (MLVI). Patients were dichotomized as experiencing a post-transplant medical complication (ie, transplant-related hospital admission prior to the year completing measures of PTSS) or no complications.

RESULTS

Medication adherence was not significantly associated with patient or caregiver PTSS. A moderate effect size was found for elevated young adult and caregiver PTSS and the presence of a medical complication. Generally, the association between self-reported patient and caregiver PTSS was low.

CONCLUSIONS

The presence of elevated PTSS in young adult patients may be partially explained by the presence of proximal medical complications and more so by comorbid psychiatric diagnoses in child and adolescent patients (based on exploratory analyses). Caregivers of patients with medical complications within the past year reported higher levels of PTSS. Overall, transplantation and its associated impact on PTSS may be unique experience for patients versus caregivers. Qualitative research may further elucidate these experiences and inform future clinical interventions.

Post-traumatic stress symptoms in long-term disease-free cancer survivors and their family caregivers

Background

The experience of cancer is highly stressful and potentially traumatic. We assessed the presence of Post‐Traumatic Stress Symptoms (PTSS) in long‐term cancer survivors and their caregivers, while examining the association between PTSS and clinical, demographic and psychological variables in the long term.

Methods

In this cross‐sectional study 212 survivor‐family caregiver dyads completed measures of post‐traumatic stress symptoms (PTSS) (Impact of Event Scale), depression and anxiety (Hospital Anxiety Depression Scale). Coping strategies, fatigue, cognitive decline, stressful life events and psychopathological history were also assessed among survivors. Data were analyzed using mixed models, accounting both for individual and dyadic effects.

Results

Cancer survivors and their caregivers were assessed after a mean of 6 years after treatment. Twenty per cent of survivors and 35.5% of caregivers had possible posttraumatic stress disorder (PTSD), while 23 patients (11.0%) and 33 caregivers (15.6%) had probable PTSD. Among cancer patients, the severity of post‐traumatic symptoms was associated with an anxious coping style, previous psychopathology and depression (p < 0.001), whereas among caregivers it was associated with depression and having a closer relationship with patients (p < 0.001). Patients’ depression was associated with caregivers’ intrusion symptoms.

Conclusions

High levels of cancer‐related PTSS were still present several years after treatment in both survivors and caregivers. Psychopathology may derive from complex interactions among coping, previous disorders and between‐person dynamics.

Post-Traumatic Stress Reactions in Caregivers of Children and Adolescents/Young Adults with Severe Diseases: A Systematic Review of Risk and Protective Factors

Severe illnesses in children and adolescents/young adults (AYAs) may represent a complex burden for patients and their caregivers, including a wide range of mental disorders, particularly post-traumatic stress disorder (PTSD). Few events are as potentially traumatizing as having a son or a daughter diagnosed with a severe, life-threatening, or disabling disease. The presence of PTSD symptoms in caregivers may compromise their efficacy as caregivers and negatively affect the child’s well-being. This systematic review aims at outlining potential risk and protective factors for the development of PTSD symptoms in caregivers of children and AYAs affected by severe acute or chronic illnesses. Thirty-one studies on caregivers of children and AYAs affected by severe, acute, or chronic diseases were included. Socio-demographic and socio-economic characteristics, illness-related distress, psychiatric symptoms, support, and coping styles were found as potential risk/protective factors across studies. It is crucial to consider risk factors affecting caregivers of severely ill young patients, in order to plan focused interventions aimed at preventing an adverse clinical outcome in caregivers and at enhancing caregivers’ coping skills, in order to ultimately improve their quality of life.

A review of psychological symptoms and post-traumatic growth among adolescent and young adult survivors of childhood cancer

The majority of childhood cancer patients survive well into adulthood, but remain at risk for psychological late effects that can impact overall health and quality of life. The current narrative review summarizes the literature on psychological late effects, including anxiety, depression, psychological distress, post-traumatic stress disorder, suicidality, psychoactive medication use, and post-traumatic growth in survivors of childhood cancers. While results were mixed, many studies demonstrated that psychological symptoms occurred at levels higher than would be expected in the general population. Treatment, environmental, and behavioral risk factors, as well as symptom onset and trajectory merit further investigation.

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.

[The assessment of somatic symptoms and distress among parents of a childhood cancer survivor]

INTRODUCTION

Studies on somatic symptoms among parents of a childhood cancer survivor are less developed in the literature. The purpose of the study is to examine the somatic symptoms intensity (i.e. physical symptoms aggravated by emotional or psychological factors) and its associations with anxious and depressive symptoms and worries.

METHODS

Sixty-one parents of a childhood cancer survivor (since 4-years until 6-years of survivorship) participated in this transversal and quasi-experimental study. Parents filled in three clinical questionnaires assessing their anxious, depressive and somatic symptoms and their worries related to the child's health evolution.

RESULTS

Parents suffered mainly from a loss of energy and insomnia in the middle of the night. Significant correlations between somatic symptoms and anxious and depressive symptoms were observed. Lastly, depressive symptoms seem to be a significant factor to predict the level of somatic symptoms.

CONCLUSION

Recommendations for the management of parents of a childhood cancer survivor have been published. However, longitudinal studies focused on parents are still necessary to improve preventive initiatives and the management of these families.

Meaning Making and Religious Engagement Among Survivors of Childhood Brain Tumors and Their Caregivers

PURPOSE

To describe how adolescent and young adult survivors and their mother-caregivers ascribe meaning to their post-brain tumor survivorship experience, with a focus on sense making and benefit findings and intersections with religious engagement.

PARTICIPANTS & SETTING

Adolescent and young adult survivors of childhood brain tumors and their families, living in their community settings.

METHODOLOGIC APPROACH

Secondary analysis of simultaneous and separate individual, semistructured interviews of the 40 matched dyads (80 total interviews) occurred using conventional content analysis across and within dyads. Meaning is interpreted through narrative profiles of expectations for function and independence.

FINDINGS

Participants made sense of the brain tumor diagnosis by finding benefits and nonbenefits unique to their experiences. Meaning was framed in either nonreligious or religious terms.

IMPLICATIONS FOR NURSING

Acknowledging positive meaning alongside negative or neutral meaning could enhance interactions with survivors, caregivers, and their families. Exploring the meaning of their experiences may help them to reconstruct meaning and reframe post-tumor realities through being heard and validated.

Posttraumatic stress symptoms (PTSS) in patients with Cushing's disease before and after surgery: A prospective study

The aim of this study was to investigate the occurrence, correlated factors and prognosis of posttraumatic stress symptoms (PTSS) in patients with Cushing's disease (CD). A total of 49 patients who were newly diagnosed with CD and underwent transsphenoidal surgery in our hospital from April 2015 to August 2017 were asked to participate in this study. Another group of 49 age and sex matched healthy control participants were also included for comparison. PTSS (measured with Impact of Event Scale-Revised, IES-R), depression/anxiety (measured with Hospital Anxiety and Depression scale, HADS) and quality of life (QoL; measured with 36-item short-form, SF-36) were evaluated at pre-surgery, 6 months post-surgery and 12 months post-surgery. The results showed that at preoperative stage, 15 (30.6%) CD patients developed PTSS, and they had higher 24 h UFC, and presented worse levels of depression, anxiety and QoL compared with patients without PTSS. Although most of them recovered postoperatively, there were still 5/15 (33.3%) patients persisted with PTSS for over a year. Additionally, one patient with recurred CD developed PTSS between 6 and 12 months postoperatively. Among the whole group of CD patients, the PTSS severity showed consistent improvement after surgery, which was in accordance with the progressing trends of depression, anxiety and psychological aspects of SF-36. However, compared with healthy individuals, CD patients in remission still performed worse in physical/mental health. In conclusion, patients with CD can develop PTSS, and they may persist for over a year even after successful surgery. Combined psychological intervention is advised for these patients.

Aspectos psicosociales de la calidad de vida en supervivientes pediátricos de tumores en el sistema nervioso central

Introducción: Los supervivientes de tumores del sistema nervioso central (TSNC) presentan peor calidad de vida en relación a la salud (CVRS) que los supervivientes de otras neoplasias y la población normativa. El tipo y gravedad de las secuelas no parecen tener un impacto claro en la CVRS, pero la afectación del cociente intelectual (CI) sí podría modular la CVRS. Además, las estrategias de afrontamiento del paciente y de los progenitores y el malestar emocional parental podrían también actuar sobre la CVRS. Objetivo: Determinar si las estrategias de afrontamiento del adolescente y su CI, y las estrategias de afrontamiento, el estrés general y el malestar emocional parental, modulan las dimensiones psicosociales de la CVRS del superviviente. Método: Estudio transversal descriptivo-correlacional. Se reclutaron 37 adolescentes (12-19 años) que llevaban ≥1 año fuera de tratamiento oncológico y 44 progenitores. Resultados: En la CVRS valorada por los adolescentes, las dimensiones Relación con los Padres y Vida Familiar, Amigos y Apoyo Social, y Entorno Escolar dependen de la estrategia de afrontamiento de resolución del problema usada por el adolescente. La dimensión Aceptación Social depende del estilo de afrontamiento improductivo del adolescente y del estilo de búsqueda de ayuda social de los padres. La CVRS valorada por los padres depende de las secuelas, el CI del adolescente y, el tipo de tratamiento oncológico recibido. Discusión y conclusiones: Las estrategias de afrontamiento centradas en la resolución del problema, deben ser consideradas para valorar e intervenir en la mejora de la CVRS de los supervivientes TSNC.

A systematic review of factors related to children's quality of life and mental health after brain tumor

PURPOSE

Brain tumor has been found to have a major impact on children's quality of life (QOL); yet, the subjective impact of the illness is still not well understood. This review aimed to investigate factors related to children's subjective well-being (SWB), or self-reported QOL and mental health after brain tumor. A further aim was to determine the consistency between child and parent-proxy ratings of children's SWB and common factors associated with both child and parent-proxy ratings.

METHODS

A systematic search of PsycINFO, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and Scopus was conducted from 1980 to May 2018 to identify eligible studies. Methodological quality of these studies was assessed by 2 independent reviewers.

RESULTS

Twenty studies investigated factors related to children's self-reported mental health or QOL. Fourteen studies examined these factors from the perspectives of both children and their parents. Overall, risk factors for poor QOL included infratentorial tumors, radiation, hydrocephalus, lower IQ, and behavioral problems. Only 5 studies examined mental health outcomes, the findings of which were mixed. Relatively few studies examined psychosocial variables related to children's SWB.

CONCLUSIONS

Although several risk factors for poor QOL were identified, further research investigating mental health outcomes and the influence of psychosocial factors on children's SWB is needed to guide support interventions for pediatric brain tumor.

Experiences of posttraumatic growth in siblings of children with cancer

As survival rates continue to improve for children diagnosed with cancer, strides in achieving better psychosocial outcomes for both children with cancer and their families have been accentuated. The current study aimed to explore the experiences of siblings of children diagnosed with cancer and attempted to overcome some of the limitations described in previous research. Primarily, the study considered the theoretical framework of posttraumatic growth (PTG) in the project design and analysis. Semi-structured interviews were completed with six siblings. Thematic analysis was employed to identify themes within the data set as a whole. The data revealed that siblings experienced a range of difficult emotions throughout the cancer trajectory as well as experiencing remarkable changes in their lives. This included both positive and negative changes. These changes included increased empathy and resilience, improved family relationships, disrupted routine, increased responsibility and perceived changes in the ill child. Siblings described factors which they found helpful and unhelpful in adjusting to these changes. The report ends with a discussion of the themes and their clinical and theoretical implications. The report also highlights the research limitations and areas for future investigation.

Parental Post-Traumatic Stress Symptoms as Predictors of Psychosocial Problems in Children Treated for Cancer

The purpose of this study was to explore the association between psychosocial functioning of children treated for cancer and that of their parents. Factors associated with psychosocial functioning were also examined. The present study was a cross-sectional survey of 33 mothers and one father (mean age: 37.9), each of whom had a child that had been treated for cancer. The participants answered a package of questionnaires consisting of the Impact of Event Scale-Revised (IES-R), the Parent Experience of Child Illness (PECI), and the Child Behavior Checklist (CBCL). Information about the children's illnesses was collected from medical records. The CBCL total problems T score was correlated with the parental IES-R total scores. Intensity of treatment independently predicted the variance of parental long-term uncertainty. In conclusion, psychosocial problems of children with cancer were associated with parental post-traumatic stress symptoms (PTSS). Provision of early, adequate support to parents who are vulnerable to PTSS will help not only the parents, but also their children with cancer.

A systematic review on factors and consequences of parental distress as related to childhood cancer

The literature including correlates of parental distress as related to childhood cancer is abundant. It is important to identify predictive factors and outcomes of this distress in parents. The objective of this review was to update previous syntheses on factors of distress and to identify outcomes of parents' distress in the recent literature (2007-2012). We performed a systematic review to identify all quantitative studies including measures of parental distress and associated factors during the study period. We found 56 eligible studies, of which 43 had a Low risk of bias (Cochrane guidelines). Forty-two reports included potential predictive factors. Significant relationships were found with clinical history of the child, sex of the parent, coping response and personal resources, pre-diagnosis family functioning, but not education/income or marital status. Twenty-five reports studied potential consequences of distress and focused on psychological adjustment in parents and children. Compared to past periods, a higher proportion of studies included fathers. Measures used to evaluate distress were also more homogeneous in certain domains of distress. This review underscores the need for appropriate methods for selecting participants and reporting results in future studies. Appropriate methods should be used to demonstrate causality between factors/consequences and distress.

Assessing Suicidal Ideation and Behaviors Among Survivors of Childhood Brain Tumors and Their Mothers During Sociobehavioral Research

PURPOSE/OBJECTIVES

To describe the development and feasibility of a protocol for nonpsychiatric subspecialty research staff members to screen research participants who endorse suicidal ideations or behaviors during data collection
.

DESIGN

Descriptive protocol development.
.

SETTING

The Children's Hospital of Philadelphia and the University of Pennsylvania.
.

SAMPLE

186 mother caregivers and 134 adolescent or young adult survivors of childhood brain tumors, with the protocol implemented for 5 caregivers and 11 survivors.

METHODS

During telephone- and home-based interviews, the interviewer assessed the participant using the Columbia-Suicide Severity Rating Scale (C-SSRS).

MAIN RESEARCH VARIABLES

Expressed suicidal ideation or behavior
.

FINDINGS

Implementation of the C-SSRS by nonpsychiatric subspecialty staff members was feasible and valid. Interviewers' conclusions based on this instrument matched those of the mental health professional who followed up with participants. Process notes contained themes about the participants, including anger and sadness in survivors and the physical and emotional demands of the survivor in caregivers. Progress notes for the interviewer included a reiteration of events, whether the assessment was successful, and whether the recommendation of the interviewer was in agreement with that of the mental health professional
.

CONCLUSIONS

The protocol based on the C-SSRS was useful and feasible for nonpsychiatric subspecialty staff members to use in the collection of data from survivors of childhood brain tumors and their caregivers.

IMPLICATIONS FOR NURSING

Survivors of childhood brain tumors and their caregivers may experience psychosocial distress. Nurses, as research assistants or in other roles, can use tools such as the C-SSRS to assist in front-line assessments. 
.

Mother-caregiver expectations for function among survivors of childhood brain tumors

PURPOSE

Children diagnosed with brain tumors increasingly survive to adulthood, although they do so with needs often requiring continued parental caregiving. We sought to describe the nature of caregivers' expectations about survivors' function and how expectations connect to ongoing management and decision-making.

METHODS

Forty-five qualitative interviews with mother-caregivers were conducted and coded for themes related to expectations for their adolescent/young adult children living post-childhood brain tumors.

RESULTS

Five main themes emerged as integral to mother-caregiver expectations: realizing a difference in the survivor, noticing limitations to independence in the survivor, memories of learning about clinical prognoses as understood from consent meetings and education, managing these realizations, and acknowledging unresolved challenges.

CONCLUSIONS

Caregiver expectations are influenced by both initial clinical interactions and contemporary family dynamics and require individual- and family-specific survivorship planning. As caregiver expectations can influence management behaviors that impact outcomes and possibly independence, implications for clinician-caregiver shared decision-making are substantial.

Expectations for function and independence by childhood brain tumors survivors and their mothers

Survivors of childhood brain tumors face many obstacles to living independently as adults. Causes for lack of independence are multifactorial and generally are investigated in terms of physical, cognitive, and psychosocial treatment-related sequelae. Little is known, however, about the role of expectation for survivors' function. From a mixed-methods study including qualitative interviews and quantitative measures from 40 caregiver-survivor dyads, we compared the data within and across dyads, identifying four distinct narrative profiles: (A) convergent expectations about an optimistic future, (B) convergent expectations about a less optimistic future, (C) non-convergent expectations about a less optimistic future, and (D) non-convergent expectations about an unclear future. Dyads both do well and/or struggle in systematically different manners in each profile. These profiles may inform the design of interventions to be tested in future research and help clinicians to assist families in defining, (re-)negotiating, and reaching their expectations of function and independence.

Late morbidity in long-term survivors of childhood brain tumors: a nationwide registry-based study in Finland

BACKGROUND

The population of long-term survivors of childhood brain tumors (BTs) is growing. The aim of our study was to evaluate late-appearing morbidity in BT survivors.

METHODS

Patients diagnosed with a BT at the age of 0-15 years between 1970 and 2004, and surviving at least 5 years, were identified from the Finnish Cancer Registry (n = 740). Their late new morbidity ≥ 5 years after cancer diagnosis was assessed using the Hospital Discharge Registry containing hospitalizations and outpatient visits in specialized health care settings. The morbidity of BT survivors was compared with that of the sibling cohort (n = 3615).

RESULTS

The 5-year survivors had a significantly increased hazard ratio (HR) for endocrine diseases (HR, 14.7), psychiatric disorders (HR, 1.8), cognitive and developmental disorders (HR, 16.6), neurological diseases (HR, 9.8), disorders of vision and hearing (HR, 10.5), and diseases of the circulatory system (HR, 2.7) compared with the sibling cohort. The HRs for disorders of musculoskeletal system (HR, 1.4) and diseases of the kidney (HR, 2.1) were not significantly increased. Radiation treatment did not explain all of the excess morbidity. Female survivors had a higher risk for disorders of vision and hearing (P = .046). Age at diagnosis did not show an effect on HRs. The HRs for endocrine diseases and disorders of vision or hearing loss were highest for survivors treated in the 1980s or later.

CONCLUSIONS

Pediatric BT survivors had significant neurocognitive consequences. This, together with the considerable risk for endocrine morbidity, will motivate us to organize systematic follow-up procedures for pediatric BT survivors.

The involvement of secondary neuronal damage in the development of neuropsychiatric disorders following brain insults

Neuropsychiatric disorders are one of the leading causes of disability worldwide and affect the health of billions of people. Previous publications have demonstrated that neuropsychiatric disorders can cause histomorphological damage in particular regions of the brain. By using a clinical symptom-comparing approach, 55 neuropsychiatric signs or symptoms related usually to 14 types of acute and chronic brain insults were identified and categorized in the present study. Forty percent of the 55 neuropsychiatric signs and symptoms have been found to be commonly shared by the 14 brain insults. A meta-analysis supports existence of the same neuropsychiatric signs or symptoms in all brain insults. The results suggest that neuronal damage might be occurring in the same or similar regions or structures of the brain. Neuronal cell death, neural loss, and axonal degeneration in some parts of the brain (the limbic system, basal ganglia system, brainstem, cerebellum, and cerebral cortex) might be the histomorphological basis that is responsible for the neuropsychiatric symptom clusters. These morphological alterations may be the result of secondary neuronal damage (a cascade of progressive neural injury and neuronal cell death that is triggered by the initial insult). Secondary neuronal damage causes neuronal cell death and neural injury in not only the initial injured site but also remote brain regions. It may be a major contributor to subsequent neuropsychiatric disorders following brain insults.

Concordance of parent proxy report and child self-report of posttraumatic stress in children with cancer and healthy children: influence of parental posttraumatic stress

OBJECTIVE

This study examined the relationships between parental posttraumatic stress symptoms (PTSS), child PTSS, and parent-child concordance for child PTSS.

METHOD

Participants were children with cancer (n = 199), and healthy children (n = 108) and their parents. Children self-reported on PTSS and parents completed measures of child and parent PTSS.

RESULTS

In the cancer group, child and parent reports of child PTSS were significantly correlated with no mean differences between reporters. In contrast, correlations were non-significant in the control group, and parents reported significantly lower levels of child PTSS than children. Increased parental PTSS was associated with better concordance in the cancer group but not in the control group. In fact, in the cancer group, parent-child concordance was strongest at the highest level of parental PTSS.

CONCLUSIONS

Parents of children with cancer were found to be accurate reporters of their children's distress, even with high levels of reported personal distress. In contrast, parents of healthy children appear primarily influenced by personal distress when reporting child PTSS. Although multiple informant assessments are always desirable, it appears that utilization of a single informant may be reasonable in the cancer setting when access to informants is limited.

Suicide ideation in pediatric and adult survivors of childhood brain tumors

Survivors of pediatric brain tumors are at risk for long-term psychological morbidities. The current study investigated the prevalence and predictors of suicide ideation (SI) in a clinical sample of youth and adult survivors. Retrospective chart reviews were completed for 319 survivors of pediatric brain tumors who were assessed via clinical interview during routine neuro-oncology clinic visits between 2003 and 2007. Survivors were, on average, 18.0 years of age (SD = 4.9) and 10 years from diagnosis (SD = 5.0) at their most recent follow-up. The most common diagnosis was low-grade glioma (n = 162) followed by embryonal tumors (PNET/medulloblastoma; n = 64). Multivariable logistic regression was used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for SI. Nearly 12 % of survivors (11.7 %, n = 37) reported SI. Five survivors (1.5 %) had documented suicide attempts, though none were fatal. In a multivariable model, adjusting for sex and age, history of depression (OR = 20.6, 95 % CI = 4.2-101.1), psychoactive medication treatment (OR = 4.5, 95 % CI = 1.8-11.2), observation or surgery only treatment (OR = 3.7, 95 % CI = 1.5-9.1), and seizures (OR = 3.6, 95 % CI = 1.1-11.1) were significantly associated with SI in survivors. Survivors of pediatric brain tumors appear to be at risk for experiencing SI. Our results underscore the importance of a multidisciplinary approach to providing follow-up care for childhood brain tumor survivors, including routine psychological screenings.

Impact of a parent-based interdisciplinary intervention for mothers on adjustment in children newly diagnosed with cancer

OBJECTIVE

To determine if maternal distress predicts child adjustment outcomes or if child adjustment outcomes predict maternal distress among children newly diagnosed with cancer, and if a parent-focused intervention has downstream effects on child adjustment.

METHODS

Mothers (n = 52) were randomly assigned to a clinic-based, interdisciplinary intervention for parents of children newly diagnosed with cancer. Measures of maternal distress and child adjustment were collected at baseline, posttreatment, and follow-up.

RESULTS

A lagged relationship was identified between maternal distress and child internalizing symptoms, but not externalizing symptoms. The parent intervention reduced child internalizing and externalizing symptoms at follow-up. Only the child internalizing symptoms effect was mediated by reduced maternal distress. The child externalizing symptoms effect was mediated by unobserved parent factors.

CONCLUSIONS

This study provides support for illness adjustment and coping models that emphasize the role of parent factors in driving child adjustment outcomes and is encouraging for future parent-focused intervention research.