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Patterson V, Olsavsky A, Garcia D, Sutherland-Foggio M, Vannatta K, Prussien KV, Bemis H, Compas BE, Gerhardt CA. Impact of sociodemographic factors, stress, and communication on health-related quality of life in survivors of pediatric cancer. Pediatr Blood Cancer 2024:e31001. [PMID: 38644596 DOI: 10.1002/pbc.31001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND While most research has largely focused on medical risks associated with reduced health-related quality of life (HRQOL) in survivors, sociodemographic and family factors may also play a role. Thus, we longitudinally examined sociodemographic factors and family factors associated with survivor HRQOL, including adolescent's cancer-specific stress, mother's general stress, and mother-adolescent communication. METHODS Mothers (N = 80) and survivors (ages 10-23, N = 50) were assessed 5 years following initial diagnosis. Mothers completed measures regarding sociodemographic background adolescent's cancer-specific stress, mother's general stress, mother-adolescent communication, and adolescent HRQOL. Survivors also reported on their own HRQOL. Two hierarchical multiple regressions examined predictors of (a) mother's report of adolescent HRQOL, and (b) survivor's self-report of HRQOL. RESULTS The final model predicting mother-reported adolescent HRQOL was significant, F(5,74) = 21.18, p < .001, and explained 59% of the variance in HRQoL. Significant predictors included adolescent stress (β = -.37, p < .001), mothers' stress (β = -.42, p < .001), and communication (β = .19, p = .03). The final model predicting survivor-reported HRQOL was also significant, F(5,44) = 5.16, p < .01 and explained 24% of the variance in HRQOL. Significant predictors included adolescent stress (β = -.37, p = .01) and communication (β = -.31, p = .04). Sociodemographic factors were not a significant predictor of HRQOL in any model. CONCLUSION Family stress and communication offer potential points of intervention to improve HRQOL of pediatric cancer survivors from mother and survivor perspectives. While additional research is needed, healthcare professionals should encourage stress management and strong mother-child communication to enhance survivors' long-term HRQOL. Such interventions may be complimentary to efforts targeting the known sociodemographic factors that often affect health.
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Affiliation(s)
- Valdeoso Patterson
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Anna Olsavsky
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dana Garcia
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Kemar V Prussien
- Vanderbilt University, Nashville, Tennessee, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Bemis
- Vanderbilt University, Nashville, Tennessee, USA
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
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Desjardins L, Rodriguez E, Dunn M, Bemis H, Murphy L, Manring S, Winning A, Vannatta K, Gerhardt CA, Compas BE. Coping and Social Adjustment in Pediatric Oncology: From Diagnosis to 12 Months. J Pediatr Psychol 2020; 45:1199-1207. [PMID: 32930722 DOI: 10.1093/jpepsy/jsaa077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Children diagnosed with cancer experience stress associated with their diagnosis and treatment and are at heightened risk for problems in social adjustment. This study investigated the association between coping with cancer-related stress and problems in social adjustment across the first year after a pediatric cancer diagnosis. METHODS Mothers of children (ages 5-17 years) with cancer (N = 312) were recruited from two children's hospitals. Mother's reported on their child's social adjustment and coping near diagnosis (T1) and 12 months (T2). RESULTS Primary, secondary control, and disengagement coping were significantly associated with concurrent social adjustment at 12 months. The bivariate associations between baseline primary and secondary control coping and social problems 12 months later were no longer significant in a multivariate regression model. CONCLUSIONS These findings inform our understanding of the association between coping with cancer-related stress and social adjustment of children diagnosed with cancer. Interventions teaching primary and secondary control coping strategies for cancer-related stressors may offer some benefit to concurrent youth social adjustment. Further research is needed on how best to support social adjustment in this population over time.
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Affiliation(s)
| | | | | | | | | | | | - Adrien Winning
- The Research Institute at Nationwide Children's Hospital
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
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Murphy LK, Preacher KJ, Rights JD, Rodriguez EM, Bemis H, Desjardins L, Prussien K, Winning AM, Gerhardt CA, Vannatta K, Compas BE. Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress. J Pediatr Psychol 2019; 43:1114-1127. [PMID: 30016505 DOI: 10.1093/jpepsy/jsy054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 06/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.
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Affiliation(s)
- Lexa K Murphy
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Jason D Rights
- Department of Psychology & Human Development, Vanderbilt University
| | - Erin M Rodriguez
- Department of Psychology & Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Kemar Prussien
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University
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Yarboi J, Prussien KV, Bemis H, Williams E, Watson KH, McNally C, Henry L, King AA, DeBaun MR, Compas BE. Responsive Parenting Behaviors and Cognitive Function in Children With Sickle Cell Disease. J Pediatr Psychol 2019; 44:1234-1243. [PMID: 31579920 PMCID: PMC6823101 DOI: 10.1093/jpepsy/jsz065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Children with sickle cell disease (SCD) are at increased risk for cognitive impairment as a result in part from biological characteristics of the disease; however, limited research has explored possible social and contextual factors associated with risk for cognitive problems. The primary aim of the present study was to examine the relation between children's cognitive functioning and responsive parenting, a potentially important contextual factor in children with SCD, accounting for family socioeconomic disadvantage, child disease severity, and caregivers' perceived stress. METHODS Forty-eight children completed standardized cognitive assessments and caregivers provided self-reports of general and disease-related stress. Parent-child dyads completed a video recorded puzzle-solving task and observed parenting was quantified using two coding systems. Bivariate Pearson correlations were used to assess preliminary hypotheses, and linear multiple regression analyses were used to assess the primary hypothesis. RESULTS Results suggested that increased levels of parental stress were related to fewer observations of responsive parenting and provided evidence of an association between children's cognitive function and responsive parenting. Specifically, increased disease-related parent stress and reduced parental use of expansive language were associated with significantly lower cognitive functioning in children with SCD. CONCLUSIONS Findings suggest that social environmental factors along with disease characteristics are sources of risk for cognitive problems with children with SCD. Further, these findings highlight the need to develop targeted interventions for parents of children with SCD to decrease levels of stress and enhance parenting skills, with the aim improving cognitive functioning in youth.
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Affiliation(s)
- Janet Yarboi
- Department of Psychology of Human Development, Vanderbilt University
| | - Kemar V Prussien
- Department of Psychology of Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology of Human Development, Vanderbilt University
| | - Ellen Williams
- Department of Psychology of Human Development, Vanderbilt University
| | - Kelly H Watson
- Department of Psychology of Human Development, Vanderbilt University
| | - Collen McNally
- Department of Psychology of Human Development, Vanderbilt University
| | - Lauren Henry
- Department of Psychology of Human Development, Vanderbilt University
| | - Allison A King
- Department of Pediatrics, Washington University School of Medicine
| | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt University School of Medicine
| | - Bruce E Compas
- Department of Psychology of Human Development, Vanderbilt University
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Prussien KV, Salihu A, Abdullahi SU, Galadanci NA, Bulama K, Belonwu RO, Kirkham FJ, Yarboi J, Bemis H, DeBaun MR, Compas BE. Associations of transcranial doppler velocity, age, and gender with cognitive function in children with sickle cell anemia in Nigeria. Child Neuropsychol 2019; 25:705-720. [PMID: 30269648 PMCID: PMC6545195 DOI: 10.1080/09297049.2018.1526272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/12/2018] [Indexed: 12/16/2022]
Abstract
Children with sickle cell anemia (SCA) have elevated cerebral blood velocity relative to healthy peers. The primary aim of this study was to evaluate the association between cerebral blood velocity, measured by transcranial Doppler (TCD) ultrasound, age, and gender with cognitive function in children with SCA in Nigeria. Eighty-three children (Mage = 9.10, SD = 1.90 years; 55% female) with SCA in Nigeria completed cognitive assessments and a TCD ultrasound. The association between TCD velocity and measures of perceptual reasoning (Raven's Progressive Matrices), working memory (WISC-IV Digit Span), and executive planning (Tower of London, TOL) were assessed. Results showed that elevated TCD velocity significantly predicted lower scores on TOL Time Violations and Total Problem-Solving Time when controlling for BMI, hemoglobin level, and parent education, suggesting that TCD velocity is related to the efficiency of executive function. Further, age was negatively related to children's performance on the Ravens Matrices and TOL Total Correct, and boys showed greater deficits on the TOL Total Correct relative to girls. Moderation analyses for gender showed that there was a conditional negative association between TCD velocity and Digit Span for boys, but not for girls. Findings suggest that children with SCA in Nigeria with elevated TCD velocity are at risk for deficits in efficiency of executive planning, and boys with elevated TCD velocity are particularly at increased risk for deficits in auditory working memory. Implications of this study are important for interventions to reduce cerebral blood velocity and the use of TCD in this population.
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Affiliation(s)
- Kemar V. Prussien
- Department of Psychology & Human Development, Vanderbilt University, Nashville, TN, USA
| | - Auwal Salihu
- Department of Psychiatry, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Shehu U. Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Najibah A. Galadanci
- Department of Hematology and Blood Transfusion, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Khadija Bulama
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Raymond O. Belonwu
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fenella J. Kirkham
- Developmental Neurosciences Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Janet Yarboi
- Department of Psychology & Human Development, Vanderbilt University, Nashville, TN, USA
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University, Nashville, TN, USA
| | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce E. Compas
- Department of Psychology & Human Development, Vanderbilt University, Nashville, TN, USA
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Prussien KV, Murphy LK, Gerhardt CA, Vannatta K, Bemis H, Desjardins L, Ferrante AC, Shultz EL, Keim MC, Cole DA, Compas BE. Longitudinal associations among maternal depressive symptoms, child emotional caretaking, and anxious/depressed symptoms in pediatric cancer. J Fam Psychol 2018; 32:1087-1096. [PMID: 30211572 PMCID: PMC6289594 DOI: 10.1037/fam0000463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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).
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Prussien KV, DeBaun MR, Yarboi J, Bemis H, McNally C, Williams E, Compas BE. Cognitive Function, Coping, and Depressive Symptoms in Children and Adolescents with Sickle Cell Disease. J Pediatr Psychol 2018; 43:543-551. [PMID: 29155970 PMCID: PMC5961146 DOI: 10.1093/jpepsy/jsx141] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022] Open
Abstract
Objective The objective of this study was to investigate the association between cognitive functioning, coping, and depressive symptoms in children and adolescents with sickle cell disease (SCD). Method Forty-four children (M age = 9.30, SD = 3.08; 56.8% male) with SCD completed cognitive assessments measuring working memory (Wechsler Intelligence Scale for Children-Fourth Edition) and verbal comprehension (Wechsler Abbreviated Scale of Intelligence-Second Edition). Participants' primary caregivers completed questionnaires assessing their child's coping and depressive symptoms. Results Verbal comprehension was significantly positively associated with secondary control coping (cognitive reappraisal, acceptance, distraction), and both working memory and secondary control coping were negatively associated with depressive symptoms. In partial support of the primary study hypothesis, verbal comprehension had an indirect association with depressive symptoms through secondary control coping, whereas working memory had a direct association with depressive symptoms. Conclusions The results provide new evidence for the associations between cognitive function and coping, and the association of both of these processes with depressive symptoms in children with SCD. Findings provide potential implications for clinical practice, including interventions to improve children's cognitive functioning to attenuate depressive symptoms.
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Affiliation(s)
- Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University
| | | | - Janet Yarboi
- Department of Psychology and Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology and Human Development, Vanderbilt University
| | - Colleen McNally
- Department of Psychology and Human Development, Vanderbilt University
| | - Ellen Williams
- Department of Psychology and Human Development, Vanderbilt University
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University
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Rodriguez EM, Murphy L, Vannatta K, Gerhardt CA, Young-Saleme T, Saylor M, Bemis H, Desjardins L, Dunn MJ, Compas BE. Maternal Coping and Depressive Symptoms as Predictors of Mother-Child Communication About a Child's Cancer. J Pediatr Psychol 2015; 41:329-39. [PMID: 26609183 DOI: 10.1093/jpepsy/jsv106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/12/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE This study sought to identify possible associations between maternal coping and depression and subsequent mother-child communication about cancer following the child's diagnosis. METHOD Mothers (N = 100) reported on coping and depressive symptoms shortly after the child's diagnosis (M = 1.9 months). Subsequently, we observed children (age 5-17 years; M = 10.2 years; 48% female; 81% White) and mothers discussing cancer and coded maternal communication. RESULTS Higher primary and secondary control coping, and lower depressive symptoms, were generally correlated with more positive, and less harsh and withdrawn communication. In regression models, higher primary control coping (i.e., coping efforts to change the stressor or one's emotional reaction to the stressor) independently predicted less withdrawn communication, and depressive symptoms mediated relations between coping and harsh communication. CONCLUSIONS Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.
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Affiliation(s)
| | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, and The Ohio State University
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, and The Ohio State University
| | - Tammi Young-Saleme
- The Research Institute at Nationwide Children's Hospital, and The Ohio State University
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Murphy LK, Rodriguez EM, Schwartz L, Bemis H, Desjardins L, Gerhardt CA, Vannatta K, Saylor M, Compas BE. Longitudinal associations among maternal communication and adolescent posttraumatic stress symptoms after cancer diagnosis. Psychooncology 2015. [PMID: 26216475 DOI: 10.1002/pon.3918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to prospectively examine adolescent and maternal posttraumatic stress symptoms (PTSS) and maternal communication from time near cancer diagnosis to 12-month follow-up to identify potential risk factors for adolescent PTSS. METHODS Forty-one adolescents with cancer (10-17 years, 54% female) and their mothers self-reported PTSS at T1 (two months after cancer diagnosis) and T3 (1-year follow-up). At T2 (3 months after T1), mother-adolescent dyads were videotaped discussing cancer, and maternal communication was coded with macro (harsh and withdrawn) and micro (solicits and validations) systems. RESULTS Adolescent PTSS at T1 was associated with adolescent PTSS at T3. Greater maternal PTSS at T1 predicted greater harsh maternal communication at T2. There was an indirect effect of maternal PTSS at T1 on adolescent PTSS at T3 through maternal validations at T2. CONCLUSIONS Findings underscore the importance of maternal PTSS, maternal communication, and subsequent adolescent PTSS over the course of treatment of childhood cancer. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lexa K Murphy
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Erin M Rodriguez
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Laura Schwartz
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Heather Bemis
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Leandra Desjardins
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Cynthia A Gerhardt
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Kathryn Vannatta
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Megan Saylor
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
| | - Bruce E Compas
- Vanderbilt University, Department of Psychology and Human Development, Peabody 512, 230, Appleton Place, Nashville, TN, 37212, United States
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Compas BE, Desjardins L, Vannatta K, Young-Saleme T, Rodriguez EM, Dunn M, Bemis H, Snyder S, Gerhardt CA. Children and adolescents coping with cancer: self- and parent reports of coping and anxiety/depression. Health Psychol 2015; 33:853-61. [PMID: 25068455 DOI: 10.1037/hea0000083] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The diagnosis and treatment of cancer present children and adolescents with significant stress. However, research on the ways that children and adolescents cope with cancer-related stress has not yielded clear findings on the efficacy of different coping strategies, and has been limited by reliance primarily on self-reports of both coping and distress. To address this gap, the current study used a control-based model of coping to examine self- and parent reports of child/adolescent coping and symptoms of anxiety and depression in a sample of children with cancer. METHOD Children and adolescents (5 to 17 years old) and their parents were recruited near the time of a child's diagnosis or relapse of cancer (M = 1.30 months postdiagnosis). Child self-reports (n = 153), mother reports (n = 297), and father reports (n = 161) of children's coping and symptoms of anxiety/depression were obtained. RESULTS Bivariate correlations revealed significant associations for secondary control coping (efforts to adapt to source of stress; e.g., acceptance, cognitive reappraisal) and disengagement coping (e.g., avoidance, denial) with anxiety/depression within and across informants. Linear multiple regression analyses indicated that secondary control coping accounted for unique variance in symptoms of anxiety/depression both within and across informants. CONCLUSIONS Secondary control coping appears important for children and adolescents during early phases of treatment for cancer, and it may serve as an important target for future interventions to enhance adjustment in these children.
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Affiliation(s)
- Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Kathryn Vannatta
- Department of Pediatrics, The Research Institute at Nationwide Children's Hospital
| | - Tammi Young-Saleme
- Department of Pediatrics, The Research Institute at Nationwide Children's Hospital
| | - Erin M Rodriguez
- Department of Psychology & Human Development, Vanderbilt University
| | - Madeleine Dunn
- Department of Psychology & Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University
| | - Sarah Snyder
- Department of Pediatrics, The Research Institute at Nationwide Children's Hospital
| | - Cynthia A Gerhardt
- Department of Pediatrics, The Research Institute at Nationwide Children's Hospital
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Bemis H, Yarboi J, Gerhardt CA, Vannatta K, Desjardins L, Murphy LK, Rodriguez EM, Compas BE. Childhood Cancer in Context: Sociodemographic Factors, Stress, and Psychological Distress Among Mothers and Children. J Pediatr Psychol 2015; 40:733-43. [PMID: 25840446 DOI: 10.1093/jpepsy/jsv024] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine associations between sociodemographic factors (single parenthood, family income, education level, race), stress, and psychological distress among pediatric cancer patients and their mothers. METHODS Participants completed measures assessing sociodemographic variables, depressive symptoms, posttraumatic stress symptoms, general stress, and cancer-related stress within the first year of the child's (ages 5-17 years) cancer diagnosis or relapse. Mothers (N = 318) provided self-reports and parent report of their children; children aged 10-17 years (N = 151) completed self-reports. RESULTS Each sociodemographic variable demonstrated unique associations with mothers' and children's stress and distress in bivariate analyses. A cumulative sociodemographic risk measure was positively correlated with all stress and distress variables. In regression analyses predicting mothers' and children's distress, independent and cumulative sociodemographic measures were no longer significant when accounting for levels of stress. CONCLUSIONS Findings highlight the need to consider the ecological context of pediatric cancer, particularly the impact of sociodemographic disadvantage on stress and distress in this population.
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Affiliation(s)
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, and The Ohio State University
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, and The Ohio State University
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Compas BE, Bemis H, Gerhardt CA, Dunn MJ, Rodriguez EM, Desjardins L, Preacher KJ, Manring S, Vannatta K. Mothers and fathers coping with their children's cancer: Individual and interpersonal processes. Health Psychol 2015; 34:783-93. [PMID: 25622077 DOI: 10.1037/hea0000202] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine individual and interpersonal processes of coping and emotional distress in a sample of mothers and fathers of children with recently diagnosed cancer. METHOD A sample of 317 mothers and 166 fathers of 334 children were recruited near the time of the child's cancer diagnosis or relapse (M = 1.4 months, SD = 1.2). Mothers and fathers completed standardized measures of coping and depressive symptoms. RESULTS Analyses of individual coping responses revealed that, for both mothers and fathers, primary control coping (e.g., problem solving, emotional modulation) and secondary control coping (e.g., acceptance, cognitive reappraisal) were associated with lower depressive symptoms. Interpersonal analyses of coping and distress indicated that mothers' and fathers' coping as well as depressive symptoms were significantly correlated. Actor-partner interdependence model analyses indicated that mothers' coping was associated with fathers' depressive symptoms. Significant interactions also suggested that mothers' secondary control coping may have a compensatory effect against fathers' use of disengagement coping, both for themselves and their husbands. CONCLUSION Mothers' and fathers' adaptation to a child's cancer diagnosis and treatment are characterized by both individual and interpersonal processes, with secondary control coping playing a central role in both of these processes. Implications for interventions to enhance effective coping for parents of children with cancer are highlighted.
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Phillips CA, Hardcastle E, Desjardins L, Ruiz R, Bemis H, Arrington J, Feldman R, Murphy A, Compas B, Friedman DL. Psychosocial health in survivors of adult versus childhood cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9609 Background: The growing population of cancer survivors is characterized by two subgroups, those diagnosed as children and those diagnosed as adults. While psychosocial challenges are recognized in these survivors, little data exists comparing the psychosocial health between these two subgroups. Our objective is to compare adult and childhood cancer survivors for symptoms of depression, anxiety, somatic complaints, and post traumatic stress disorder (PTSD). Methods: At entry to the Vanderbilt Cancer Survivorship program, survivors of childhood and adult onset cancer, ages 15 – 55 years old, completed the Achenbach System of Empirically Based Assessment and the revised Impact of Event Scale. Using normalized T scores, independent sample t tests,and χ2 analyses, responses were compared to normative data for each group and responses of the two survivor groups were compared to one another. Results: There were 172 survivors of childhood cancer (M= 9 years old at diagnosis) and 125 survivors of adult cancer (M= 41 years old at diagnosis). Childhood cancer diagnoses included hematologic cancer (56%), sarcoma (17%), brain tumor (8%), and other (19%). Adult cancer diagnoses included breast cancer (45%), colon cancer (8%), hematologic cancer (14%), sarcoma (4%), and other (29%). After adjusting for age-related population norms, adult survivors were significantly more likely to have symptoms of depression (p=.011), anxiety (p=.029), somatic problems (p=.043), and PTSD (p=.004) compared to their childhood counterparts. Compared to age-expected norms, significantly more adult, but not child, survivors scored in the clinical range for depression (29%, p<.001; vs. 18% n.s) and somatic problems (23%, p=.013; vs. 12%; n.s.). Time elapsed from cancer diagnosis to completion of the questionnaires was not significantly correlated with any of the measures. Conclusions: Survivors of adult onset cancer face a significantly higher amount of psychologic distress, particularly depressive and somatic symptoms, compared to their childhood counterparts and age-expected norms. Analyses are ongoing to evaluate other demographic, disease, and treatment related risk factors that may contribute to this age-related phenomenon in order to develop interventions.
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Affiliation(s)
- Charles A Phillips
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Emily Hardcastle
- Department of Psychological Sciences,Vanderbilt University, Nashville, TN
| | - Leandra Desjardins
- Department of Psychological Sciences,Vanderbilt University, Nashville, TN
| | - Rachel Ruiz
- School of Medicine, Vanderbilt University, Nashville, TN
| | - Heather Bemis
- Department of Psychological Sciences,Vanderbilt University, Nashville, TN
| | | | | | - Alexandra Murphy
- Department of Psychological Sciences,Vanderbilt University, Nashville, TN
| | - Bruce Compas
- Department of Psychological Sciences,Vanderbilt University, Nashville, TN
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Greer JA, Traeger L, Bemis H, Solis J, Hendriksen ES, Park ER, Pirl WF, Temel JS, Prigerson HG, Safren SA. A pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal cancer. Oncologist 2012; 17:1337-45. [PMID: 22688670 DOI: 10.1634/theoncologist.2012-0041] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials.gov identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer. METHODS We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention. RESULTS We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of -5.41 (95% confidence interval: -10.78 to -0.04) and a large effect size for the intervention (Cohen's d = 0.80). CONCLUSION Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety.
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Affiliation(s)
- Joseph A Greer
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center, Yawkey Building, Suite 10B, 55 Fruit Street, Boston, Massachusetts 02114, USA.
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Pirl WF, Traeger L, Greer JA, Bemis H, Gallagher E, Lennes I, Sequist L, Heist R, Temel JS. Tumor epidermal growth factor receptor genotype and depression in stage IV non-small cell lung cancer. Oncologist 2011; 16:1299-306. [PMID: 21807767 DOI: 10.1634/theoncologist.2011-0116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Depression appears to be associated with worse survival from cancer, but underlying mechanisms for this association are unknown. In the present study, we explored the degree to which tumor genotype may be associated with depression in patients with non-small cell lung cancer (NSCLC). We examined differences in depression severity and rates of positive screens for major depressive disorder among newly diagnosed patients with stage IV NSCLC and known epidermal growth factor receptor (EGFR) genotype. METHODS Newly diagnosed patients (n = 53) with metastatic NSCLC attending an initial thoracic oncology consultation completed self-report questionnaires regarding demographics, smoking behavior, and depression before meeting with their oncologist. Biopsy samples were subsequently genotyped, including screening for EGFR mutations. We conducted a retrospective chart review to obtain clinical data, including tumor stage, performance status, and EGFR genotype. RESULTS Twelve patients (22.6%) tested positive for EGFR mutation. No EGFR mutation-positive cases met the screening criteria for major depressive disorder, in comparison with 29.3% of patients with wild-type EGFR (p = .03). Mutations of EGFR were also associated with lower depression severity than with wild-type EGFR, independent of gender, performance status, and smoking history (p < .05). This finding persisted for both the cognitive-affective and somatic domains of depression symptoms. CONCLUSIONS EGFR mutations were associated with lower depression severity and lower rates of probable major depressive disorder in patients with metastatic NSCLC, based on mood screening performed before results of genotyping were known. Findings support further work to explore the directionality of the associations and potential biological pathways to depression.
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Affiliation(s)
- William F Pirl
- M.P.H., Massachusetts General Hospital Cancer Center, Yawkey 9A, 55 Fruit Street, Boston, Massachusetts 02114. USA.
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Lennes IT, Temel JS, Greer JA, Jacobson JO, Park ER, Jackson VA, Gallagher ER, Bemis H, Pirl WF. ASCO Quality Oncology Practice Initiative (QOPI) quality measures for smoking cessation and survival in metastatic NSCLC. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pirl WF, Greer J, Bemis H, Heist RS, Gallagher E, Sequist LV, Engelman JA, Traeger L, Lennes IT, Temel JS. Depression and EGFR mutation status in stage IV non-small cell lung cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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