Interventions for Children of Parents With Cancer From the Time of Cancer Diagnosis Through Bereavement: Two Systematic Reviews

OBJECTIVE

While there has been increasing attention on caring for children following a parent's cancer diagnosis or death, few studies include scalable evidence-based interventions to facilitate adjustment. The aim of this review was to summarize recent empirical studies that included interventions for minor children (0-18 years) with clear pre- and post-assessments of the child's psychological functioning from the time a parent is diagnosed with cancer through bereavement.

METHODS

Two separate systematic reviews were conducted for interventions during either a parent's illness or bereavement. We searched Ovid Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sociological Abstracts, and Social Services Abstracts for articles published in 2015 and beyond.

RESULTS

For the first review, 113 articles were reviewed at the full-text level. Of those, 11 met study inclusion criteria. All were published between 2015-2023 and the sample size ranged from 16-176, including 534 children in total, aged 4-18 years. Thirteen validated measures were used. For the second review, 49 articles were reviewed at the full text level, and only one met criteria. This study, published in 2023, included 20 children aged 7-12 years. Two validated measures were used. Quality assessment indicated a generally low risk of bias and high methodological quality for both reviews.

CONCLUSIONS

Evidence-based interventions for minor children whose parents have been diagnosed with cancer or who are bereaved during childhood are limited. To standardize and move the field forward, we propose a model to guide the development of interventions for children whose parents have been diagnosed with cancer through bereavement.

Behavioural interventions targeting the prevention and treatment of young children's mental health problems in low- and middle-income countries: a scoping review

Background

Globally, 10% of children and adolescents live with mental health problems and often lack high-quality care. Over 80% of people facing mental health issues reside in low- and middle-income countries (LMICs). Failing to address children's mental health may prolong these challenges into adulthood, impeding their chances for a healthy life. This scoping review aims to describe the types, implementation strategies, effectiveness, and gaps of existing interventions for preventing and treating mental health problems in early childhood (<10 years) in LMICs.

Methods

The study employed a scoping review of experimental studies published 2007-2023. Major databases including PubMed, Embase, Web of Science, and PsycINFO were searched using key terms related to the population (children), intervention (mental and/or behavioural health programmes), and outcome (mental health problems). Three authors independently conducted search strategy, article screening, data extraction, and quality assessment. The findings were presented using descriptive analysis and narrative synthesis.

Results

Of 39 499 identified articles, 33 were included in the study, covering 7629 children and published between 2009-2022. Seventeen studies (51.5%) were from upper-middle-income countries, 13 (39.4%) were from lower-middle-income, and three (9.1%) were from low-income countries. Enrolment was community-based in 23 studies and health-facility based in 10 studies; the majority (79%) focused on children aged 3-8 years old. Almost two-third (63.6%) of studies were conducted in urban settings. Programmes encompassed various interventions such as parenting programmes (33.3%). A majority of studies (57.5%) employed group therapy for delivering the programme, with mental health professionals (21.2%) acting as the primary intervention providers. Interventions were primarily received by children (39.4%), followed by mothers/caregivers (33.3%). Most studies explored disruptive disorders (20 studies), social and behavioural problems (16 studies), and anxiety disorders (12 studies). Statistically significant intervention effects on child mental health outcomes were reported for 90% of published studies.

Conclusions

Diverse behavioural programmes that improve the mental health of young children are available and effective in LMICs. Most interventions were delivered in urban settings and focus was on the use of health care professionals. Diverse intervention approaches, including parenting programmes and group therapy, were effective in addressing various mental health issues among young children.

Cancer and the family: Variations by sex and race/ethnicity

BACKGROUND

Cancer affects patients and their families, but few data are available on factors associated with diversity of family structures among patients with cancer. Family is a source of both support and responsibility that must be understood to support patients and their families.

METHODS

Pooled data (2004-2015) from the National Health Interview Study were used to compare characteristics of cancer survivors with and without minor children and differences by sex and race/ethnicity among survivors with minor children.

RESULTS

13.9% of cancer survivors have minor children in the household, and this experience is more likely for women and people who identify as other than non-Hispanic White.

CONCLUSION

There are considerable differences by sex and race/ethnicity in the characteristics of cancer survivors with minor children. Clinicians should make consideration of family circumstances a routine part of their history. Doing so will help to identify potential sources of support and responsibility that may affect adherence.

The Predictive Role of Body Image and Sexual Function in Quality of Life After Modified Radical Mastectomy Regarding the Mediating Role of Emotion; A Cross Sectional Study

Background: Mastectomy has negative effects on body image, sexual function, and quality of life (QOL). Additionally, maladaptive emotion regulation strategy is considered a trans-diagnostic mechanism underlying the psychiatric syndrome in these patients. Objectives: The predictive role of body image and sexual function in QOL regarding the mediating role of difficulty in emotion regulation has not been studied yet. Methods: In a correlational study, from March to December 2016, among patients undergoing modified radical mastectomy (MRM) at Early-stage Breast Cancer (BC), 90 patients were selected, using respondent-driven sampling (RDS). To collect the data, the Multidimensional Body-Self Relations Questionnaire (MBSRQ), the Persian language version of the Female Sexual Function Index (P-FSFI), QOL questionnaire, and Difficulties in Emotion Regulation Scales (DERS) were used. Data were analyzed through Pearson's correlation coefficient, regression analysis, and path analysis, using AMOS and SPSS software version 22 and the significance criterion was considered 0.05. Results: Data analysis showed a direct relationship between body image and sexual function with QOL, and it had an inverse relationship with difficulty in emotion regulation (P < 0.01). Also, body image, sexual function, and difficulty in emotion regulation were predictors of QOL (P < 0.01). Besides, in predicting QOL based on sexual function and body image, the difficulty in emotion regulation has a mediating role (P < 0.01). Conclusions: In patients with breast cancer under mastectomy, proper sexual function, sexual attraction depending on body image, and QOL were influenced by emotion regulation. Reducing the difficulty in emotion regulation through emotion-focused interventions can improve QOL in patients.

Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis

BACKGROUND

Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results.

METHODS

In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day.

RESULTS

A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found.

CONCLUSION

Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.