Parental Sleep, Distress, and Quality of Life in Childhood Acute Lymphoblastic Leukemia: A Longitudinal Report from Diagnosis up to Three Years Later

Health-related quality of life in parents of long-term childhood cancer survivors: a report from the Swiss Childhood Cancer Survivor Study - Parents

PURPOSE

Having a child with cancer can profoundly impact parents' health-related quality of life (HRQOL). However, there is a lack of knowledge about the long-term effects of childhood cancer on parents' well-being. The current study aimed to (1) describe the HRQOL of parents of long-term childhood cancer survivors (CCS) and compare it with that of parents from the general population in Switzerland, and (2) investigate sociodemographic and cancer-related determinants of lower HRQOL in parents of CCS.

METHODS

In this cross-sectional study, a total of 751 parents of CCS (mean time since diagnosis = 23.7 years, SD = 6.7 years) and 454 parents from the general population reported their HRQOL by completing the Short Form-36 (SF-36v2). Sociodemographic and cancer-related characteristics were also collected.

RESULTS

Multilevel regression analyses showed that parents of CCS and parents from the general population had similar physical and mental HRQOL. When comparing mothers and fathers separately, there were no differences between the samples, except for higher HRQOL in the domain of physical functioning in mothers of CCS. Cancer-related characteristics were not associated with HRQOL in parents of CCS. Several sociodemographic characteristics such as being female, being from the French or Italian-speaking part of Switzerland, having a lower education, having a chronic condition, and having a migration background were associated with lower HRQOL.

CONCLUSION

Parents of CCS are doing well a long time after their child's cancer diagnosis. Nevertheless, tailored support should be provided for at-risk demographic groups.

The Effects of Biofeedback Intervention on Negative Emotions and Sleep Quality in Children With Leukemia Receiving Invasive Procedures and Their Caregivers: A Randomized Controlled Trial

OBJECTIVE

Children with leukemia and their caregivers have negative experiences such as pain, fear, and sleep disturbances when receiving invasive procedures. The purpose of this study was to evaluate the effects of a biofeedback intervention on negative emotions and sleep quality for children with leukemia receiving invasive procedures and their caregivers.

METHODS

A randomized controlled study involving 80 child-caregiver dyads was conducted, and dyads were randomly assigned to intervention (n = 40) and control (n = 40) groups. Both groups received health education, while the intervention group additionally received a 4-unit biofeedback intervention. Outcome measures compared at baseline (T0), post-intervention (T1), and 4-week follow-up (T2), included validated measures of pain, fear, worry, sleep quality in children, and anxiety, depression, and sleep quality in caregivers.

RESULTS

At T1 and T2, the scores of children's pain and fear in the intervention group were significantly lower than those in the control group (all p < 0.05). The significant group effects on children's pain (F = 6.064, p = 0.015) and fear (F = 15.532, p < 0.001) indicated that the intervention group had significantly lower scores in pain and fear compared to the control group. At T1 and T2, caregivers in the intervention group had significantly lower anxiety scores and significantly higher sleep quality than those in the control group (all p < 0.05). The significant group effects on anxiety (F = 10.124, p = 0.002) and sleep quality (F = 5.983, p = 0.015) suggested that the intervention group had significantly lower scores in anxiety and higher sleep quality in comparison to the control group.

CONCLUSIONS

The biofeedback intervention demonstrated significant efficacy in alleviating the pain, and fear experienced by children with leukemia during invasive procedures, concurrently relieving their caregivers' anxiety and improving sleep quality. This research furnishes compelling evidence substantiating the effectiveness of biofeedback interventions in alleviating negative emotions in children with leukemia undergoing invasive treatments, as well as in their caregivers.

TRIAL REGISTRATION

ChiCTR2300075306.

Parental Psychological Adjustment in Pediatric Acute Lymphoblastic Leukemia: The Mediating Role of Family Functioning and Resilience

Background/Objectives: Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with intense treatments affecting both children and their families. Limited information is available on parental distress and psychological well-being during the first treatment year, with most studies focusing on individuals rather than the family system. This study explores longitudinal changes in parental distress (psychological morbidity and traumatic stress symptoms), coping strategies, family resilience and functioning, and psychological well-being. The study also examines the mediating roles of family resilience, family functioning, and coping strategies in the relationships between parental distress and psychological well-being. Methods: A prospective study was conducted with 46 parents of children newly diagnosed with ALL, assessing parental distress, family functioning and resilience, coping, and psychological well-being across three treatment phases: consolidation (T0), delayed intensification (T1), and maintenance (T2). Results: Parental distress and family resilience significantly decreased from T0 to T2, while parental coping improved over time. Family functioning deteriorated from T0 to T1, stabilizing thereafter. Psychological well-being followed a non-linear trajectory, initially declining from T0 to T1 and improving from T1 to T2. Mediation analyses revealed that family resilience and family functioning partially mediated the relationships between parental distress and psychological well-being. Parental coping did not emerge as a mediator. Conclusions: Parental psychological adjustment in the context of ALL is dynamic and influenced by individual and family factors. Interventions that strengthen family functioning and resilience are crucial for supporting parental psychological well-being during treatment. A family-centered approach in healthcare delivery is essential to address individual and systemic challenges.

Factors Associated with Psychological Well-Being Among Children Under 18 Years Old with Cancer: A Scoping Review

Background

Cancer diagnosis and treatment can have severe psychological impacts on children that can affect various aspects of their emotional, social and cognitive functioning. Many children with cancer experience long-term psychological distresses. The psychological well-being (PWB) is a critical aspect of their overall health. Understanding the factors that influence their psychological state can help in developing effective interventions to support them.

Purpose

This scoping review aimed to identify and summarize the factors associated with PWB among children with cancer.

Methods

This study applied a scoping review using the guidelines outlined in the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A comprehensive literature search was conducted across multiple databases, including PubMed, CINAHL, Taylor and Francis, and Scopus. Inclusion criteria were included by keywords Psychological well-being OR Psychological AND Children OR Child OR Pediatric OR Childhood AND Adolescent OR Teenagers OR Youth AND Cancer OR Neoplasms OR Tumors OR Malignancy OR Cancer Survivors AND predictor OR factors OR determinant. Studies were included if they investigated psychological well-being in children (aged 0-18 years) with cancer. The Arksey and O'Malley framework for scoping reviews guided the methodology, including study selection, data extraction, and thematic analysis. The quality of the evidence was evaluated using the Joanna Briggs Institute (JBI) and the Mixed Methods Appraisal Tool (MMAT) critical appraisal checklist.

Results

12 articles met the inclusion criteria and were included in the review. The factors most frequently reported in several categories are age (sociodemographic), psychological function (individual factors), age at diagnosis (health and history), parent attachment and school status (environmental factors).

Conclusion

This review found several aspects that describe the PWB of the articles reviewed. These aspects consist of anxiety, depression, distress, well-being, and self-esteem. From these aspects, many predictors were obtained, which were classified into four categories of factors related to the PWB of children with cancer.

A 12-week WeChat education, relaxing, and care program relieves anxiety, depression, insomnia, and posttraumatic stress disorder in parents of childhood lymphoma patients

OBJECTIVES

In our previous study, we conducted a 6-month WeChat education and care program for parents of pediatric acute lymphoblastic leukemia patients, which was effectively alleviated anxiety, depression, and insomnia. This study implemented a 12-week WeChat education, relaxing, and care program (WERC) to investigate its effect on psychological disorders and insomnia in parents of childhood lymphoma patients.

METHODS

Totally, 112 parents of 56 childhood lymphoma patients were randomized at a 1:1 ratio into WERC (N = 56) or normal care (NC) (N = 56) groups to receive corresponding 12-week interventions. The self-rating anxiety/depression scale (SAS/SDS), Athens insomnia scale (AIS), and impact of events scale-revised (IES-R) scores were assessed at enrollment (W0) and 12 weeks after the initiation of the intervention (W12); score changes (W0-W12) were also calculated.

RESULTS

Scores of the scales at W0 did not differ between groups (all P > 0.05). The WERC group showed a lower SAS score at W12 (P = 0.045) and greater change in SAS score (P < 0.001) than the NC group. The SDS score at W12 was not different (P = 0.119), while SDS score change was numerically greater (P = 0.076) in the WERC group than the NC group. Compared with the NC group, the WERC group tended toward a decreased AIS score at W12 (P = 0.054) and a greater AIS score change (P < 0.001). The IES-R score at W12 was lower (P = 0.040), and the IES-R score change was greater (P = 0.013) in the WERC group than the NC group.

CONCLUSION

A 12-week WERC ameliorates psychological disorders and insomnia better than NC in parents of childhood lymphoma patients.

The influence of WeChat education and care program on anxiety, depression, insomnia, and general state of health in parents of pediatric acute lymphoblastic leukemia patients

PURPOSE

WeChat-based education and care program serves as a promising nursing method for relieving mental stress in parents of pediatric patients. This study purposed to explore the influence of the WeChat education and care program (WECP) on mental health, insomnia, and general state of health in parents of pediatric acute lymphoblastic leukemia (ALL) patients.

METHODS

Totally, 146 parents of 73 primary pediatric ALL patients were randomized into the WECP group (74 parents of 37 patients) and standard care (SC) group (72 parents of 36 patients) to receive a 6-month corresponding intervention. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), Athens insomnia scale (AIS), and 12-item general health questionnaire (GHQ-12) were assessed in parents of patients.

RESULTS

SAS scores at the third month (M3) (P = 0.041) and M6 (P = 0.032) were reduced in WECP group versus SC group. SAS-defined anxiety rate at M6 (P = 0.035) was declined in WECP group versus SC group. SDS score at M6 was descended in WECP group versus SC group (P = 0.024). However, there was no discrepancy in SDS-defined depression rate at any time point between groups (all P > 0.05). AIS scores at M1 (P = 0.015) and M6 (P = 0.021), as well as GHQ-12 scores at M3 (P = 0.007) and M6 (P = 0.001) were decreased in WECP group versus SC group. By subgroup analyses, WECP exhibited good effects at M6 in mothers, but not in fathers.

CONCLUSION

WECP is a feasible and efficacy intervention to improve mental stress and health status among parents of pediatric ALL patients, especially in mothers.

Parental experiences of the informed consent process in randomized clinical trials-A Nordic study

BACKGROUND

Randomized clinical trials (RCTs) are an essential part of improving acute lymphoblastic leukemia (ALL) treatment. This population-based questionnaire study investigated parents' experiences of the informed consent process in the RCTs within the Nordic NOPHO (Nordic Society of Paediatric Haematology and Oncology) ALL2008 trial.

PROCEDURE

Parents in Sweden, Denmark, and Finland whose child was alive and in first remission after end of therapy and who were asked to participate in any RCT in the ALL2008 protocol, were asked to complete 15 questions/items regarding their experience of the RCT consent process.

RESULTS

A total of 483 parents of 279 children met the inclusion criteria and answered the study questionnaire. Most (91%) agreed/strongly agreed to having received sufficient information to make a well-informed decision, felt confidence in the study design (86%), and thought that the process was satisfactory (86%). Those who did not consent reported a generally more negative experience of the process. More than a third of all parents and over half of parents who had refused participation felt that it was burdensome to decide. Most parents (66%) in general, and one-third of those with children 8 years or older, reported that their child was not involved in the process.

CONCLUSIONS

Parents were in general satisfied with the informed consent process, although many parents, particularly those who refused participation, reported it as burdensome to make the decision concerning RCT. Fewer than expected of the school-aged children were involved in the decision process, which calls for attention on how children are included in the consent procedure in clinical trials.

Internet-Based Self-Help Mindful Self-Compassion Intervention for Parents of Children With Cancer: A Pilot Study

BACKGROUND

Parents of children with cancer may experience persistent psychological distress and impaired physical health throughout their children's diagnosis and treatment.

OBJECTIVE

This study aimed to develop a mindful self-compassion program for parents of children with cancer and explore its effect.

METHODS

This pre-post-test study without a control group was conducted with 34 Chinese parents of children with cancer, using mixed methods. Participants received a 6-week internet-based self-help mindful self-compassion intervention. Self-compassion, post-traumatic stress symptoms, depression, and sleep quality were measured at baseline and at 10 weeks post-baseline. Semi-structured interviews were conducted with 9 completers within 10 days after the intervention was completed.

RESULTS

Significant differences were observed in self-compassion, re-experiencing, physical depressive symptoms, and sleep quality. Two participants reported feeling miserable or recalling distressing experiences, of which one withdrew from the study while the other completed the intervention.

CONCLUSION

The program could improve self-compassion, re-experiencing, physical depressive symptoms, and sleep quality in parents of children with cancer, which demonstrated the feasibility of delivering a self-help mindful self-compassion intervention through the internet. Increasing retention rates in future studies merits further discussion.

Health-related quality of life and its determinants during and after treatment for paediatric acute lymphoblastic leukaemia: a national, prospective, longitudinal study in the Netherlands

OBJECTIVES

Health-related quality of life (HRQoL) is impaired in paediatric patients with acute lymphoblastic leukaemia (ALL). Over the past decades, ALL treatment has successfully been adjusted to the risk of relapse, which is now reflected by the stratification of patients into three risk groups who receive treatment of differing intensities. This study is the first to evaluate the longitudinal course of HRQoL in light of these adjustments and identify determinants of HRQoL.

DESIGN

Two prospective, national cohort studies (add-on studies within the two most recent treatment protocols for children with ALL (ALL-10 and ALL-11)).

SETTING

Dutch paediatric oncology hospitals between October 2006 and October 2009 (ALL-10) and between August 2013 and July 2017 (ALL-11).

PARTICIPANTS

Patients with ALL (2-18 years) are treated according to the ALL-10 or ALL-11 treatment protocol. Patients treated according to the ALL-10 protocol only completed a cancer-specific QoL measure and patients treated according to the ALL-11 protocol completed both a cancer-specific and generic QoL measure (see below).

OUTCOME MEASURES

HRQoL, assessed with parent-proxy questionnaires (PedsQL Generic and Cancer module) within the first 5 months (T0), at 1 year (T1), 2 years (T2) and 3 years (T3) after diagnosis. The proportion of patients with clinically relevant generic HRQoL impairment was compared with healthy norm values. Multivariable mixed model analyses were used to evaluate the development of HRQoL over time and its medical and sociodemographic determinants (collected on enrolment).

RESULTS

Of the ALL-10 cohort, 132 families participated and of the ALL-11 cohort, 136 families participated (268 total). Thus, cancer-specific HRQoL assessments were available for 268 patients (median age 5.3 years (IQR 6.15), 56.0% boys, 69.0% medium-risk ALL), and generic HRQoL assessments for 136 patients (median age 4.8 years (IQR 6.13), 60.3% boys, 75.0% medium-risk ALL). Generic HRQoL improved between timepoints T0 and T3 (total score B 16.1, 95% CI 12.2 to 20.1, p<0.001), but did not restore to normal 1 year after the end of treatment: 28.0% of children remained impaired compared with 16% in the general population (p=0.003). Cancer-specific HRQoL generally improved from T0 to T2 (Pain B 11.3, 95% CI 7.1 to 15.5; Nausea B 11.7, 8.4 to 15.1; Procedural Anxiety B 19.1, 14.8 to 23.4; Treatment Anxiety B 12.8, 9.5 to 16.0; Worry B 3.5, 0.6 to 6.3; Communication B 8.5, 5.0 to 11.9; all p<0.001 except for Worry (p=0.02)), while Physical Appearance and Cognitive Functioning remained stable. Higher treatment intensity and experiencing pain or simultaneous chronic illness were associated with lower HRQoL over time for multiple subscales.

CONCLUSIONS

HRQoL impairment is prevalent during and after ALL treatment. Patients with standard-risk ALL and reduced treatment intensity have better HRQoL than patients in higher risk groups. Systematic monitoring of HRQoL is of utmost importance in order to provide timely psychosocial interventions and supportive care.

Insomnia Symptoms and Daytime Fatigue Co-Occurrence in Adolescent and Young Adult Childhood Cancer Patients in Follow-Up after Treatment: Prevalence and Associated Risk Factors

Insomnia symptoms and daytime fatigue commonly occur in pediatric oncology, which significantly impact physical and psychosocial health. This study evaluated the prevalence of insomnia only, daytime fatigue only, the co-occurrence of insomnia−daytime fatigue symptoms, and associated risk factors. Childhood cancer patients (n = 565, 12−26 years old, ≥6 months after treatment) participated in a national, cross-sectional questionnaire study, measuring insomnia symptoms (ISI; Insomnia Severity Index) and daytime fatigue (single item). Prevalence rates of insomnia and/or daytime fatigue subgroups and ISI severity ranges were calculated. Multinomial regression models were applied to assess risk factors. Most patients reported no insomnia symptoms or daytime fatigue (61.8%). In the 38.2% of patients who had symptoms, 48.1% reported insomnia and daytime fatigue, 34.7% insomnia only, and 17.1% daytime fatigue only. Insomnia scores were higher in patients with insomnia−daytime fatigue compared to insomnia only (p < 0.001). Risk factors that emerged were: female sex and co-morbidities (all), shorter time after treatment and bedtime gaming (insomnia only), young adulthood (insomnia−fatigue/fatigue only), needing someone else to fall asleep and inconsistent wake times (both insomnia groups), lower educational level and consistent bedtimes (insomnia−fatigue). Insomnia symptoms and daytime fatigue are common and often co-occur. While current fatigue guidelines do not include insomnia symptoms, healthcare providers should inquire about insomnia as this potentially provides additional options for treatment and prevention.