Childhood cancer--a family crisis 2: coping with diagnosis

The psychobiology of depression and resilience to stress: implications for prevention and treatment

This review discusses neurobiological and psychosocial factors associated with stress-induced depression and compares these factors with those believed to characterize stress resilience. Neurobiological factors that are discussed and contrasted include serotonin, the 5-HT1A receptor, polymorphisms of the 5-HT transporter gene, norepinephrine, alpha-2 adrenergic receptors, neuropeptide Y, polymorphisms of the alpha-2 adrenergic gene, dopamine, corticotropin-releasing hormone (CRH), dehydroepiandrosterone (DHEA), cortisol, and CRH receptors. These factors are described in the context of brain regions believed to be involved in stress, depression, and resilience to stress. Psychosocial factors associated with depression and/or stress resilience include positive emotions and optimism, humor, cognitive flexibility, cognitive explanatory style and reappraisal, acceptance, religion/spirituality, altruism, social support, role models, coping style, exercise, capacity to recover from negative events, and stress inoculation. The review concludes with potential psychological, social, spiritual, and neurobiological approaches to enhancing stress resilience, decreasing the likelihood of developing stress-induced depression/anxiety, and treating stress-induced psychopathology.

The qualitative experience of Chinese parents with children diagnosed of cancer

AIM

The present study aimed to describe the coping experiences of Chinese parents with children diagnosed as having cancer during the treatment stage.

BACKGROUND

Cancer is the second major cause of death among children in Hong Kong, it claims the lives of 60-70 children per year. Childhood cancer has tremendous impact on the family, especially the parents. It is, therefore, important to understand parents' psychological functioning and coping experience.

METHODS

A phenomenological approach was used. Data were collected by qualitative interviews and analysed following Colaizzi's phenomenological methodology. A purposive sample of nine parents whose children were diagnosed of having childhood cancer was recruited from a regional hospital in Hong Kong.

RESULTS

Four themes emerged describing parents' coping experiences: shock and denial, establishing the meaning or the situation, confronting the reality and establishing a new perspective. The initial reactions of the parents to the diagnosis were shock, denial and worry. However, they quickly accepted the reality and regarded their child's illness as their 'fate' that they had to accept. They were committed to the care of the sick child and seek informational and emotional support to cope with the situation. All of them were able to identify positive aspects from the illness experience and establish hope for the future. Chinese cultural beliefs might help the parents cope positively and avoid negative emotions.

CONCLUSION

This study found some commonalities of coping experience in both Western and Chinese culture. It adds knowledge to the coping experience of Chinese parents at the treatment phase of their children's illness and highlighted the need for emotional and information support for parents.

RELEVANCE TO CLINICAL PRACTICE

Education programme and mutual support group would be helpful to parents. Nurses have to learn how different cultural groups and subcultural groups in the society cope to provide competent cultural care.

Transition: a conceptual analysis in the context of siblings of children with cancer

Transition has been described by many disciplines. However, the concept of transition has yet to be applied to the sibling experience of childhood cancer. Understanding the transitions that siblings encounter is important because it will offer nurses new possibilities for enhancing siblings' outcomes. Accordingly, the purpose of this article is to provide a conceptual framework that will assist nurses in their efforts to promote healthy transitions in siblings of children with cancer. The method of concept analysis developed by Walker and Avant [Walker, L., & Avant, K. (1995). Concept analysis. In Strategies for theory construction in nursing (3rd ed.) (pp. 37-54). Norwalk, CT: Appleton and Lane.] is employed. The result is a definition of transition that is relevant and useful for research and clinical practice in pediatric oncology.

Coping and the course of mother's depressive symptoms during and after pediatric bone marrow transplantation

OBJECTIVE

To evaluate the role of maternal coping strategies in depressive symptoms experienced by mothers of children undergoing bone marrow transplantation (BMT).

METHOD

A total of 207 mothers completed measures of coping and depressive symptoms at the time of the child's BMT, 3 and 6 months post-BMT. The sample was collected between 1998 and 2002. The acceptance rate was 73%. The contribution of demographic, illness and treatment parameters, and mothers' concerns about the child were also evaluated. Growth curve modeling was used to evaluate the role of coping in the course of depressive symptoms. Both main effects and interactions of coping strategies with time of assessment were evaluated.

RESULTS

Acceptance and humor were associated with reductions in maternal depressive symptoms, and planning and alcohol/substance use were associated with increases in maternal depressive symptoms. Positive reframing, use of emotional support, and use of religion were associated with the course of depressive symptoms, but the magnitude of associations differed depending on the use of the coping strategies at the time of transplantation. Mothers' fears about the child also predicted depressive symptoms.

CONCLUSIONS

Acceptance and humor may be targets for behavioral interventions to reduce mothers' depressive symptoms during and after pediatric BMT hospitalization.

The psychological effect of childhood cancer on families

The diagnosis of childhood cancer has a devastating effect on the family because of its life threatening nature requiring major shifts in lifestyle and psychological reality. An awareness of the developmental and cognitive levels of the child at the time of diagnosis, and the psychological and situational status of the family is crucial to providing appropriate interventions. The pre-diagnostic and diagnostic stages of the illness provide an opportunity to assist the child and family in developing healthy adjustment strategies for both acute and long-term issues. The child and the family need to develop new coping skills, make use of outside support and resources, and receive specific interventions in order to maximize their adjustment. Continuing improvements in outcomes of cancer therapy and in psychotherapeutic treatment will reduce the psychological impact and assist in the child and family's adjustment to childhood cancer.