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Irestorm E, Schouten-van Meeteren AYN, van Gorp M, Twisk JWR, van Santen HM, Partanen M, Grootenhuis MA, van Litsenburg RRL. The development of fatigue after treatment for pediatric brain tumors does not differ between tumor locations. Pediatr Blood Cancer 2024; 71:e31028. [PMID: 38698502 DOI: 10.1002/pbc.31028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Children and adolescents treated for a brain tumor suffer from more fatigue than survivors of other types of childhood cancer. As tumor location might be predictive of fatigue, our aim was to investigate the longitudinal development of fatigue in children with brain tumors and risk factors for fatigue separately for different tumor locations. METHODS Fatigue was assessed 1235 times for 425 participants. Self-report versions of PedsQL Multidimensional Fatigue Scale were used to repeatedly assess fatigue from the end of treatment up to 8 years later. Mixed models were used to analyze fatigue over time and determinants separately for infratentorial (N = 205), supratentorial hemispheric (N = 91), and supratentorial midline tumors (N = 129). RESULTS Cognitive fatigue worsened with time, while sleep-rest and general fatigue first decreased and then increased. There was no difference in fatigue between the tumor locations, but the risk factors differed when stratified by location. Radiotherapy was associated with more fatigue for infratentorial tumors, and centralization of care was associated with less fatigue for the supratentorial midline tumors. For supratentorial hemispheric tumors, female sex was associated with more fatigue. Higher parental education was associated with less fatigue regardless of tumor location. CONCLUSIONS The development of fatigue seems to be more related to sociodemographic and treatment variables than to tumor location. Healthcare providers need to be aware that fatigue may develop in the years following end of treatment, and that patients with a low/middle educational family background might be more vulnerable and in need of targeted support.
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Affiliation(s)
- Elin Irestorm
- Faculty of Medicine, Department of Paediatrics, Lund University, Lund, Sweden
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Marloes van Gorp
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, Utrecht, The Netherlands
| | - Marita Partanen
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martha A Grootenhuis
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Raphaele R L van Litsenburg
- Department of Pediatric Endocrinology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Fisher AP, Patronick J, Moscato EL, Gerhardt CA, Treble-Barna A, Radonovich K, Wade SL. Barriers to Care and Perceived Need for Mental Health Services Among Adolescent and Emerging Adult Survivors of Pediatric Brain Tumors. J Adolesc Young Adult Oncol 2024; 13:469-480. [PMID: 38100322 DOI: 10.1089/jayao.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Purpose: Pediatric brain tumor survivors (PBTS) commonly experience mental health challenges, which can be exacerbated during adolescence and emerging adulthood (AEA). We examined survivors and caregivers' perceived need for mental health services and barriers to receiving mental health care. Methods: Families completed surveys to assess perceived need for mental health services, socioemotional impairment, and barriers to mental health services. Survivors were between 13 and 25 years of age and were at least 5 years from diagnosis. Results: Sixty-nine caregiver-PBTS dyads participated, as well as 18 survivors and 20 caregivers who participated individually. Approximately half of survivors were male (n = 57, 52.3%), 85% (n = 93) were White, and their average age was 19.31. Most caregivers (n = 63, 70.8%) and survivors (n = 55, 63.2%) endorsed need for services for the survivors. Adolescents endorsed more barriers related to perceived helpfulness, t(18) = 2.3, p = 0.03, d = 0.54, and effects of services, t(18) = 3.8, p < 0.001, d = 0.88, than their caregivers. Emerging adults, t(34) = 2.4, p = 0.02, d = 0.41, endorsed more content barriers than their caregivers.. Discussion: Both survivors and their caregivers reported obstacles to accessing mental health services such as perceived lack of need, concerns regarding the effectiveness and usefulness of services, and limited knowledge about the content of services. Psychoeducation and psychosocial screening can support families in understanding survivors' need for mental health services.
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Affiliation(s)
- Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jamie Patronick
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily L Moscato
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Department of Pediatrics and Psychology, The Abigail Wexner Research Institute, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Amery Treble-Barna
- Neurodevelopmental Center, WVU Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - Krestin Radonovich
- Physical Medicine and Rehabilitation and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Sebastian T, Close A, DeVeau C, Fessenden C, Braunreiter C. Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative. J Adolesc Young Adult Oncol 2024. [PMID: 38708692 DOI: 10.1089/jayao.2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.
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Affiliation(s)
- Tara Sebastian
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Allison Close
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
- Division of Pediatric Hematology and Oncology, Helen DeVos Children's Hospital at Corewell Health, Grand Rapids, Michigan, USA
| | - Clare DeVeau
- Division of Pediatric Hematology and Oncology, Helen DeVos Children's Hospital at Corewell Health, Grand Rapids, Michigan, USA
| | - Chad Fessenden
- Division of Pediatric Hematology and Oncology, Helen DeVos Children's Hospital at Corewell Health, Grand Rapids, Michigan, USA
| | - Chi Braunreiter
- Division of Pediatric Hematology and Oncology, Helen DeVos Children's Hospital at Corewell Health, Grand Rapids, Michigan, USA
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Robichaud LA, Felipe J, Duval M, Michon B, Olivier-D’Avignon M, Perreault S, Tyo-Gomez M, Marquis MA, Sultan S. Quality-of-Life Assessment in Pediatric Advanced Cancer: Development of the Patient-Reported Outcome Measure Advance QoL. Curr Oncol 2024; 31:2289-2304. [PMID: 38668073 PMCID: PMC11049209 DOI: 10.3390/curroncol31040170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
A recent measure was developed to assess the Quality of Life (QoL) of young people with advanced cancer and is available for parents and professionals (Advance QoL). The present study aimed to elaborate self-reported versions for children and adolescents with advanced cancer. We adopted a four-phase research plan: (1) to elaborate the Advance QoL questionnaire for youth (8-12 and 13-18 years old) with a team of young research partners; (2) to evaluate the understandability of these versions in a sample of 12 young patients from the target population using cognitive interviews; (3) to assess social validity in the same group using a questionnaire and the content validity index (CVI); and (4) to refine the questionnaires according to these results. Four major themes were identified: (1) issues affecting the understanding of the tool; (2) issues that did not affect the understanding of the tool; (3) modifications to improve the tool; and (4) positive features of the tool. Advance QoL was well received, and feedback was positive. Adjustments were made according to young people's comments and two self-reported versions are now available. It is essential to measure the key domains of QoL in advanced cancer. Advance QoL self-report versions will help target the specific needs of young people with this condition and their families.
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Affiliation(s)
- Lye-Ann Robichaud
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada; (L.-A.R.); (J.F.)
- Azrieli Research Centre, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
| | - Julie Felipe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada; (L.-A.R.); (J.F.)
| | - Michel Duval
- Department of Pediatrics, Université de Montréal, Montréal, QC H3C 3J7, Canada; (M.D.); (M.-A.M.)
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Bruno Michon
- Centre Mère-Enfant Soleil, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada;
| | | | - Sébastien Perreault
- Azrieli Research Centre, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
- Department of Neurology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Mathias Tyo-Gomez
- Psycho-Oncology Center (CPO), CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada;
| | - Marc-Antoine Marquis
- Department of Pediatrics, Université de Montréal, Montréal, QC H3C 3J7, Canada; (M.D.); (M.-A.M.)
- Department of General Pediatrics, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada; (L.-A.R.); (J.F.)
- Azrieli Research Centre, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
- Department of Pediatrics, Université de Montréal, Montréal, QC H3C 3J7, Canada; (M.D.); (M.-A.M.)
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Arvidsson S, Brobeck E, Nygren JM, Jarfelt M, Aili K, Olsson M. Adult survivors' perceptions of their childhood and the influences of being treated for acute lymphoblastic leukaemia with allogeneic hematopoietic stem cell transplantation as a child: A phenomenographic study. Eur J Oncol Nurs 2024; 70:102592. [PMID: 38669953 DOI: 10.1016/j.ejon.2024.102592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Adults who had acute lymphoblastic leukaemia (ALL) as children and were treated with allogeneic hematopoietic stem cell transplantation (aHSCT) may have been affected in their lives due to several long-term complications. From a clinical point of view, it is of interest to study how survivors describe their perceptions of their childhood today. The aim was therefore to describe how adults perceived their childhood and the influences of being treated for ALL with aHSCT as a child. METHOD Semi-structured telephone interviews were undertaken with 18 adults who had been treated for childhood ALL with aHSCT and were included in a national cohort of childhood ALL survivors, diagnosed between 1985 and 2007 at an age between 0 and 17 years. A phenomenographic analysis was used. RESULTS Three categories emerged: Feeling different, Feeling security and Feeling guilty. The informants felt that they had been different from other children but had felt security with the healthcare professionals and in care. They felt guilty because both their siblings' and parents' lives had been affected, but at the same time many perceived that they and their family members had become closer to one another. CONCLUSIONS The results emphasised that adults who had been treated for childhood ALL with aHSCT were affected both in negative and positive ways during their childhood. This indicates the importance for early psychosocial care interventions directed to children during their treatment, but also the need for person-centred psychological care in long-term outpatient clinics.
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Affiliation(s)
- Susann Arvidsson
- School of Health and Welfare, Halmstad University, P.O. Box 823, SE-301 18 Halmstad, Sweden.
| | - Elisabeth Brobeck
- Department of Research and Development, Region Halland, Lasarettsvägen, SE-302 33 Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, P.O. Box 823, SE-301 18 Halmstad, Sweden
| | - Marianne Jarfelt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 426, SE-405 30 Gothenburg, Sweden; The Long-term follow-up for Adult Childhood Cancer Survivors, Oncology Department Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Katarina Aili
- School of Health and Welfare, Halmstad University, P.O. Box 823, SE-301 18 Halmstad, Sweden
| | - Maria Olsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 426, SE-405 30 Gothenburg, Sweden; The Long-term follow-up for Adult Childhood Cancer Survivors, Oncology Department Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Hosseinchi P, Ghalibaf E, Kamyab G, Eghbali A, Khatibi A. Health anxiety and the negative interpretation of children's bodily symptoms in mothers of cancer patients. J Cancer Surviv 2024; 18:157-164. [PMID: 37470950 PMCID: PMC10866749 DOI: 10.1007/s11764-023-01431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Fear of progression (FoP) is a substantial concern for family caregivers of cancer survivors and is related to a number of adverse outcomes, including increased mental distress and worse quality of life. Previous research has revealed that health anxiety (HA) contributes to fear of relapse, but cognitive factors underlying establishing and maintaining FoP in mothers of cancer patients have not been examined. In this study, we were looking to investigate this association. METHODS We used the computerized interpretation bias (IB) assessment to investigate the biased interpretation of ambiguous bodily information and its association with FoP through HA among 69 mothers of cancer patients and 42 mothers of healthy kids. RESULTS Mothers of cancer patients interpreted more negatively ambiguous bodily symptoms than mothers of healthy kids. Moreover, they had higher levels of HA and FoP and lower quality of life than the healthy group. Also, among mothers of cancer patients, the relationship between negative IB and FoP is mediated by their HA. CONCLUSIONS The findings of this study imply that negative IB may contribute to increased HA, which in turn contributes to higher levels of FoP among the mothers of cancer patients, which may reduce the quality of life of their children. IMPLICATIONS FOR CANCER SURVIVORS From these findings, we propose that changing HA through modification of IB might lower the FoP in mothers of kids with cancer and improve the mother and child's quality of life.
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Affiliation(s)
| | | | - Golnoosh Kamyab
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
| | - Aziz Eghbali
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
- Ali-Asghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
- Institute for Mental Health, University of Birmingham, Birmingham, UK.
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7
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Hughes K, Blackett L, Jacobson CEH, Henley SMD, Carr E. A Systematic Review of the Psychosocial Measures Used in Teenage and Young Adult Cancer. J Adolesc Young Adult Oncol 2024; 13:30-39. [PMID: 37477895 DOI: 10.1089/jayao.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background: Teenagers and young adults (TYAs; ages 16-24 in the United Kingdom) with cancer have specific needs and experience worse physiological and psychological outcomes compared with pediatric and adult cancer. In the United Kingdom, psychosocial screening is a mandatory part of TYA care. However, there is a lack of age-appropriate and acceptable psychosocial measures for this population. This review aimed to (1) identify the psychosocial measures utilized and available for TYA cancer and (2) describe their psychometric properties. Methods: We searched five databases for studies meeting the eligibility criteria. We extracted data relevant to the review and assessed study quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and the Hughes Quality Assessment Tool developed by the research team. Results: We identified 40 studies that included 105 psychosocial measures. The main constructs measured were distress, depression, and anxiety. The TYA age range varied widely. Reporting of psychosocial measures and their psychometric properties was poor, and most measures were not validated or developed for TYA cancer populations. Discussion: There is an urgent need for psychosocial measures that are designed for and validated in TYA cancer populations. Appropriate measures would enable clinicians to reliably identify and effectively support the psychosocial challenges faced by TYAs. The use of validated psychosocial measures enables earlier detection of difficulties, fosters patient-centered care, and is cost-effective since resources can be allocated to those most in need.
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Affiliation(s)
- Kathryn Hughes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Laura Blackett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Susie M D Henley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, King's College London, London, United Kingdom
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Gandy K, Hall L, Krull KR, Esbensen AJ, Rubnitz J, Jacola LM. Neurocognitive and psychosocial outcomes in survivors of childhood leukemia with Down syndrome. Cancer Med 2024; 13:e6842. [PMID: 38240104 PMCID: PMC10905531 DOI: 10.1002/cam4.6842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE The primary aim of this study was to assess the feasibility of a developmentally tailored neurocognitive assessment in survivors of childhood acute leukemia with Down syndrome (DS-leukemia). A secondary aim was to compare outcomes in the DS-leukemia group to a historical comparison group of individuals with DS and no history of childhood cancer. METHODS Survivors of DS-leukemia (n = 43; 56% male, mean [SD] age at diagnosis = 4.3 [4.5] years; age at evaluation = 15 [7.9] years) completed a neurocognitive assessment battery that included direct measures of attention, executive function, and processing speed, and proxy ratings of attention problems and executive dysfunction. Direct assessment outcomes were compared to a historical comparison cohort of individuals with DS and no history of childhood cancer (DS-control; n = 117; 56% male, mean [SD] age at evaluation = 12.7 [3.4] years). RESULTS Rates of valid task completion ranged from 54% to 95%, suggesting feasibility for most direct assessment measures. Compared to the DS-control group, the DS-leukemia group had significantly lower completion rates on measures of executive function (p = 0.008) and processing speed (p = 0.018) compared to the DS-control group. There were no other significant group differences in completion rates. Compared to the DS-control group, the DS-leukemia group had significantly more accurate performance on two measures of executive function (p = 0.032; p = 0.005). Compared to the DS-control group, the DS-leukemia group had significantly more problems with executive function as identified on proxy ratings (6.5% vs. 32.6%, p = <0.001). CONCLUSION Children with Down syndrome (DS) are at increased risk for developing acute leukemia compared to the general population but are systematically excluded from neurocognitive outcome studies among leukemia survivors. This study demonstrated the feasibility of evaluating neurocognitive late effects in leukemia survivors with DS using novel measures appropriate for populations with intellectual developmental disorder.
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Affiliation(s)
- Kellen Gandy
- Department of Psychology and Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Social SciencesUniversity of Houston DowntownHoustonTexasUSA
| | - Lacey Hall
- Department of Psychology and Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Kevin R. Krull
- Department of Psychology and Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Anna J. Esbensen
- Division of Developmental and Behavioral PediatricsCincinnati Children's Hospital Medical Center & University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jeffrey Rubnitz
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lisa M. Jacola
- Department of Psychology and Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
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Perez MN, Deatrick JA, Barakat LP. Caregiver condition management and family functioning after pediatric cancer treatment: Moderation by race and ethnicity. Psychooncology 2024; 33:e6263. [PMID: 38040486 DOI: 10.1002/pon.6263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE End of pediatric cancer treatment requires family adjustment. Caregivers who struggle to incorporate the child's condition into family life have poorer family outcomes. To better understand factors that contribute to successful transition off active childhood cancer treatment, we sought to examine caregiver perceived management ability of the youth's condition and family functioning as predictors of caregiver distress, evaluate family functioning as a mediator between perceived ability and distress, and explore race and ethnicity as a moderator between perceived ability and family functioning. METHODS Caregivers (N = 141) completed measures assessing family management (condition management ability; CMA), family functioning, and distress as part of a clinical education and screening program within 1 year of the end of treatment. Bias-corrected bootstrap regression analyses examined mediation and moderated mediation models with patient race and ethnicity as the moderator. RESULTS The overall mediation model was statistically significant for CMA→family functioning→distress. Race and ethnicity moderated the relationship between CMA and family functioning, but the full model was not significant. CMA was related to family functioning for caregivers of non-Hispanic white youth, but not caregivers of Hispanic youth. Family functioning was related to distress for all caregivers. CONCLUSIONS Family functioning serves as an initial intervention target to reduce caregiver distress. Caregiver perceived management ability of their child's condition is a meaningful predictor of family functioning and distress for caregivers of non-Hispanic white youth, yet CMA may be limited as a screener of family management patterns for diverse populations, and other family management dimension may be more applicable.
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Affiliation(s)
- Megan N Perez
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janet A Deatrick
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Young K, Cashion C, Ekberg S, Hassall T, Bradford N. Quality of life and family functioning soon after paediatric brain tumour diagnosis: A cross-sectional observational study. Eur J Oncol Nurs 2023; 67:102463. [PMID: 37951071 DOI: 10.1016/j.ejon.2023.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE There is scant scholarly exploration of quality of life in families with a child who has a brain tumour early after diagnosis, despite this being a pivotal point in their illness trajectory. We aimed to describe quality of life in children and their parents, and family functioning, within six months of diagnosis; and to examine if this differed for various subpopulations. METHOD This is a cross-sectional analysis of baseline data of an ongoing longitudinal survey. Parents/carers of a child who had a diagnosis of a malignant or non-malignant brain tumour and were receiving care at the Queensland Children's Hospital were invited to complete an electronic survey. Univariate analyses were conducted with potential covariates and each dependent variable (child quality of life, caregiver quality of life, family functioning). Potential relationships between the outcome variables were explored through Pearson's correlation coefficient. RESULTS Seventy-nine diverse families completed the survey between August 2020 and September 2022. Caregiver quality of life did not differ by the child's tumour risk grade. It was lowest for those with a child who had undergone chemotherapy and/or radiation compared to surgery only, and for those with a child who had been diagnosed 6 months prior to survey completion compared to more recent diagnoses. A third of families reported problematic family functioning. Lower levels of problematic family functioning were associated with higher caregiver quality of life (r = -.49, p < .001). CONCLUSIONS Our findings suggest caregivers need greater psychosocial support early after diagnosis, and supports the need for family-centred care that fosters communication and cohesiveness.
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Affiliation(s)
- Kate Young
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, 515 Ring Rd, Kelvin Grove, QLD, 4059, Australia; Children's Brain Cancer Centre at the Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Government, 62 Graham St, South Brisbane, QLD, 4101, Australia.
| | - Christine Cashion
- Children's Brain Cancer Centre at the Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Government, 62 Graham St, South Brisbane, QLD, 4101, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland Government, 501 Stanley St, South Brisbane, QLD, 4101, Australia
| | - Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, 515 Ring Rd, Kelvin Grove, QLD, 4059, Australia; Children's Brain Cancer Centre at the Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Government, 62 Graham St, South Brisbane, QLD, 4101, Australia; School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, O Block, Ring Road, Kelvin Grove, QLD, 4059, Australia
| | - Timothy Hassall
- Children's Brain Cancer Centre at the Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Government, 62 Graham St, South Brisbane, QLD, 4101, Australia; Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland Government, 501 Stanley St, South Brisbane, QLD, 4101, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre, Centre for Healthcare Transformation, School of Nursing, Faculty of Health, Queensland University of Technology, 515 Ring Rd, Kelvin Grove, QLD, 4059, Australia; Children's Brain Cancer Centre at the Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland Government, 62 Graham St, South Brisbane, QLD, 4101, Australia
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11
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Schneider NM, Rossell N, Khan MS. Psychosocial services for pediatric oncology patients in low- and middle-income countries from health care providers' perspectives: A survey-based report from the SIOP Global Health Network Psychosocial Working Group. Psychooncology 2023; 32:1710-1717. [PMID: 37795966 DOI: 10.1002/pon.6222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES While pediatric cancer survival rates have improved in high-income countries, they remain much lower in low- and middle-income countries (L/MICs). While much focus in recent years has been on remediating the survivorship gap, less is known about the psychosocial needs and availability of psychosocial services for this population. METHODS A questionnaire was created by the SIOP Global Health Network Psychosocial Working Group to assess psychosocial needs and services in L/MIC. The questionnaire was distributed to pediatric oncology professionals, both in-person at the SIOP Annual Congress in Lyon (2019) conference and then electronically. Individuals not part of SIOP were also invited to participate via social media posts. RESULTS Sixty-six respondents from 31 countries completed the questionnaire. The majority of participants were physicians, followed by nurses. Participants from low- and lower-middle-income countries (L/LMICs) perceived patients as having higher rates of anxiety and caregivers as having higher rates of depression as compared to those in upper-middle-income countries (UMICs). Across all L/MICs represented, 85% of physicians reported that psychosocial issues sometimes, frequently, or always affect their clinical obligations. Participants reflected on the availability of professionals who treat mental health concerns; the availability of social workers, psychologists, and non-professional volunteers differed significantly between L/LMICs and UMICs. Treatment abandonment and myths/disinformation were highlighted as the most pressing psychosocial priorities. CONCLUSION Our study highlights pediatric oncology providers' perceptions of psychosocial concerns. Based on responses, proposals for minimum standards of care are made, as well as the importance of training existing providers and funding additional psychosocially-focused professionals.
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Affiliation(s)
- Nicole M Schneider
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawarrah, Saudi Arabia
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12
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Malaval CI, Cabanillas Stanchi KM, Werle D, Thiel S, Gansel M, Lang P, Handgretinger R, Svaldi J, Döring M. Application of the National Comprehensive Cancer Network-distress thermometer in pediatric patients during autologous and allogeneic hematopoietic stem cell transplantation and relationship to blood parameters of the stress axis. J Cancer Res Clin Oncol 2023; 149:15899-15909. [PMID: 37676266 PMCID: PMC10620269 DOI: 10.1007/s00432-023-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. METHODS In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The patients were aged 10-18 years. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. RESULTS After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of their children. There was a significant difference in the parents' stress levels on the day of HSCT, as compared to their stress levels on other days. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. CONCLUSIONS In summary, a significantly increased stress level is shown for both the patients and their parents. This is reflected for the patients both in the DT scores and in the increased cortisol values. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry.
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Affiliation(s)
- Carmen Isolde Malaval
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Stefanie Thiel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Melanie Gansel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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13
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Umaretiya PJ, Koch VB, Flamand Y, Aziz-Bose R, Ilcisin L, Valenzuela A, Cole PD, Gennarini LM, Kahn JM, Kelly KM, Tran TH, Michon B, Welch JJG, Wolfe J, Silverman LB, Bona K. Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia. J Natl Cancer Inst 2023; 115:1179-1187. [PMID: 37261858 PMCID: PMC10560600 DOI: 10.1093/jnci/djad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Parent psychological distress during childhood cancer treatment has short- and long-term implications for parent, child, and family well-being. Identifying targetable predictors of parental distress is essential to inform interventions. We investigated the association between household material hardship (HMH), a modifiable poverty-exposure defined as housing, food, or utility insecurity, and severe psychological distress among parents of children aged 1-17 years with acute lymphoblastic leukemia (ALL) enrolled on the multicenter Dana-Farber ALL Consortium Trial 16-001. METHODS This was a secondary analysis of parent-reported data. Parents completed an HMH survey within 32 days of clinical trial enrollment (T0) and again at 6 months into therapy (T1). The primary exposure was HMH at T0 and primary outcome was severe parental distress at T0 and T1, defined as a score greater than or equal to 13 on the Kessler-6 Psychological Distress Scale. Multivariable models were adjusted for ALL risk group and single parent status. RESULTS Among 375 evaluable parents, one-third (32%; n = 120/375) reported HMH at T0. In multivariable analyses, T0 HMH was associated with over twice the odds of severe psychological distress at T0 and T1 HMH was associated with over 5 times the odds of severe distress at T1. CONCLUSIONS Despite uniform clinical trial treatment of their children at well-resourced pediatric centers, HMH-exposed parents-compared with unexposed parents-experienced statistically significantly increased odds of severe psychological distress at the time of their child's leukemia diagnosis, which worsened 6 months into therapy. These data identify a high-risk parental population who may benefit from early psychosocial and HMH-targeted interventions to mitigate disparities in well-being.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Victoria B Koch
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rahela Aziz-Bose
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lenka Ilcisin
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Ariana Valenzuela
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Justine M Kahn
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia, University Medical Center, New York, NY, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Thai Hoa Tran
- Division of Pediatric Hematology Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Bruno Michon
- Centre Hospitalier Universitaire de Quebec, Saint-Foy, QC, Canada
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children’s Hospital, Brown University, Providence, RI, USA
| | - Joanne Wolfe
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lewis B Silverman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
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14
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Irestorm E, van Gorp M, Twisk J, Nijhof S, de Bont J, Grootenhuis M, van Litsenburg R. Longitudinal development of fatigue after treatment for childhood cancer: a national cohort study. Acta Oncol 2023; 62:1309-1321. [PMID: 37676687 DOI: 10.1080/0284186x.2023.2254477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Fatigue is a distressing and prevalent long-term sequela of treatment for childhood cancer, and there is a need for longitudinal studies to investigate the development of fatigue over time. The objective of this study was to calculate growth-curves for the longitudinal development of fatigue after treatment for childhood cancer, and to investigate the effects of biopsychosocial predictors. MATERIALS AND METHODS Participants were recruited from a patient monitoring program and data extracted from medical records. Parent-proxy and self-report versions of PedsQLTM Multidimensional Fatigue Scale were used to repeatedly assess fatigue up to 5 years after the end of treatment for childhood cancer. Fatigue was assessed 2440 times for 761 participants (median:3) with proxy-reports (age 2-8 years) and 2657 times for 990 participants with self-reports (above 8 years) (median:2). Mixed models were used to establish growth-curves and to analyze the effect of predictors separately for participants with solid tumors (ST), hemato-oncological malignancies and central nervous system-tumors (CNS). RESULTS CNS-tumors were associated with more cognitive fatigue than ST at the end of treatment, for both proxy-reports (-11.30, p<.001) and self-reports (-6.78, p=.002), and for proxy-reports of general fatigue (-6.78, p=.002). The only significant difference in change over time was for self-reports of sleep-rest fatigue. The raw scores for the CNS-group decreased with -0.87 per year (95% CI -1.64; -0.81, p=.031) compared to the ST-group. Parental distress was overall the variable most associated with increased fatigue, while immunotherapy was the most frequent medical predictor. National centralization of childhood cancer care decreased fatigue for the CNS-group, but not for other diagnoses. DISCUSSION Children and adolescents treated for CNS-tumors reported more fatigue than other participants after the end of treatment, and this difference remained over time. Results from this study may help to facilitate the early recognition of children with insufficient recovery of fatigue symptoms.
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Affiliation(s)
- Elin Irestorm
- Department of Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marloes van Gorp
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jos Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sanne Nijhof
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith de Bont
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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15
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Crowder SL, Foster RH, Buro AW, Dillon R, Godder K, Stern M. Mediators of Social Acceptance Among Emerging Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2023; 12:644-652. [PMID: 36795980 PMCID: PMC10611963 DOI: 10.1089/jayao.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Purpose: Examine associations of social developmental factors (e.g., peer/parent social attachment, romantic relationships) and perceptions of social acceptance among emerging adult survivors of childhood cancer. Methods: A cross-sectional, within-group design was used. Questionnaires included the Multidimensional Body-Self Relations Questionnaire, Inventory of Parent and Peer Attachment, Adolescent Social Self-Efficacy Scale, Personal Evaluation Inventory, Self-Perception Profile for Adolescents, and demographics. Correlations were utilized to determine associations between general demographic, cancer-specific, and the psychosocial outcome variables. Peer and romantic relationship self-efficacy were assessed as potential mediators of social acceptance in three mediation models. Relationships between perceived physical attractiveness, peer attachment, parental attachment, and social acceptance were assessed. Results: Data were collected from N = 52 adult participants (Mage = 21.38 years, standard deviation = 3.11 years) diagnosed with cancer as a child. The first mediation model demonstrated a significant direct effect of perceived physical attraction on perceived social acceptance and retained significance after adjusting for indirect effects of the mediators. The second model demonstrated a significant direct effect of peer attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer relationship self-efficacy. The third model demonstrated a significant direct effect of parent attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer self-efficacy. Conclusion: Relationships between social developmental factors (e.g., parental and peer attachment) and perceived social acceptance are likely mediated by peer relationship self-efficacy in emerging adult survivors of childhood cancer.
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Affiliation(s)
- Sylvia L. Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa Florida, USA
| | - Rebecca H. Foster
- Department of Psychology, St. Louis Children's Hospital, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Acadia W. Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa Florida, USA
| | - Robyn Dillon
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kamar Godder
- Division of Hematology Malignancies, Oncology Center of Excellence, Silver Spring, Maryland, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Marilyn Stern
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa Florida, USA
- Department of Child and Family Studies, University of South Florida, Tampa, Florida, USA
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16
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van Gorp M, Irestorm E, Twisk JWR, Dors N, Mavinkurve-Groothuis A, Meeteren AYNSV, de Bont J, van den Bergh EMM, van der Meer WVDP, Beek LR, Aarsen FK, Streefkerk N, van Litsenburg RRL, Grootenhuis MA. The course of health-related quality of life after the diagnosis of childhood cancer: a national cohort study. BMC Cancer 2023; 23:855. [PMID: 37697253 PMCID: PMC10496372 DOI: 10.1186/s12885-023-11379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Comprehensive insight in the longitudinal development of health-related quality of life (HRQOL) after childhood cancer diagnosis could improve quality of care. Thus, we aimed to study the course and biopsychosocial determinants of HRQOL in a unique national cohort of children with cancer. METHODS HRQOL of 2154 children with cancer was longitudinally reported (median: 3 reports) between diagnosis and 5 years after, using the pediatric quality of life inventory generic core scales (PedsQL). HRQOL was modelled over time since diagnosis using mixed model analysis for children 2-7 years (caregiver-reports) and ≥ 8 years (self-reports). Differences in the course between hematological, solid and central nervous system malignancies were studied. Additional associations of demographics, disease characteristics (age at diagnosis, relapse, diagnosis after the national centralization of childhood cancer care and treatment components) and caregiver distress (Distress thermometer) were studied. RESULTS Overall, HRQOL improved with time since diagnosis, mostly in the first years. The course of HRQOL differed between diagnostic groups. In children aged 2-7 years, children with a solid tumor had most favorable HRQOL. In children aged ≥ 8 years, those with a hematological malignancy had lower HRQOL around diagnosis, but stronger improvement over time than the other diagnostic groups. In both age-groups, the course of HRQOL of children with a CNS tumor showed little or no improvement. Small to moderate associations (β: 0.18 to 0.67, p < 0.05) with disease characteristics were found. Centralized care related to better HRQOL (β: 0.25 to 0.44, p < 0.05). Caregiver distress was most consistently associated with worse HRQOL (β: - 0.13 to - 0.48, p < 0.01). CONCLUSIONS The HRQOL course presented can aid in identifying children who have not fully recovered their HRQOL following cancer diagnosis, enabling early recognition of the issue. Future research should focus on ways to support children, especially those with a CNS tumor, for example by decreasing distress in their caregivers.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Elin Irestorm
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
- Faculty of Medicine, Department of Paediatrics, Lund University, Lund, Sweden
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Judith de Bont
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | | | | | - Laura R Beek
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Femke K Aarsen
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
| | - Nienke Streefkerk
- Princess Máxima Center for pediatric Oncology, Utrecht, The Netherlands
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17
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Lai JS, Jensen SE, Peipert JD, Mitchell SA, Garcia SF, Cella D, Goldman S, Lenzen A. Using IT to Improve Outcomes for Children Living With Cancer (SyMon-SAYS): Protocol for a Single-Institution Waitlist Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50993. [PMID: 37682593 PMCID: PMC10517385 DOI: 10.2196/50993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Children and adolescents with cancer may experience multiple disease- and treatment-related symptoms that negatively affect health-related quality of life. Routine symptom surveillance thus constitutes an important component of supportive care in pediatric oncology. The Symptom Monitoring and Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) system will administer, score, interpret, and display the results of symptom assessments captured weekly using patient-reported outcomes presented via the electronic health record (EHR) portal between clinic visits in oncology ambulatory settings, when patients are likely to be more symptomatic. This study is testing a digital system for routine symptom surveillance that includes EHR-based reports to clinicians and alerts for severe symptoms. OBJECTIVE In this randomized trial, we are examining the effects of the SyMon-SAYS system on perceived barriers to symptom management, self-efficacy, and symptom severity. Better self-management and timely clinical intervention to address symptoms promote adherence to treatment plans, strengthen child and parent self-efficacy, improve interactions between children, parents, and their clinical providers, and optimize clinical outcomes. METHODS The SyMon-SAYS system is integrated into the EHR to streamline the presentation of symptom scores and delivery of alerts for severe symptoms to clinicians using EHR (Epic) messaging functionalities. Children (aged 8 to 17 years) complete the weekly symptom assessment and review the symptom report by logging into the patient portal (Epic MyChart). This single-institution waitlist randomized controlled trial is recruiting 200 children (aged 8-17 years) with cancer and their parents, guardians, or caregivers. Participating dyads are randomly assigned to receive the intervention over 16 weeks (Group A: 16-week SyMon-SAYS intervention; Group B: 8-week usual care and then an 8-week SyMon-SAYS intervention). Analyses will (1) evaluate the efficacy of SyMon-SAYS at week 8 and the maintenance of those effects at week 16; (2) evaluate factors associated with those efficacy outcomes, including contextual factors, adherence to the SyMon-SAYS intervention, demographic characteristics, and clinical factors; and (3) evaluate predictors of adherence to the SyMon-SAYS intervention and preference of SyMon-SAYS versus usual care. RESULTS Data collection is currently in progress. We hypothesize that at 8 weeks, those receiving the SyMon-SAYS intervention will report decreased parent-perceived barriers to managing their children's symptoms, increased parent and child self-efficacy, decreased child symptom burden, and ultimately better child health-related quality of life, compared to waitlist controls. Feasibility, acceptability, and engagement from the perspectives of the children with cancer, their parents, and their clinicians will be examined using mixed methods. CONCLUSIONS We anticipate that this system will facilitate prompt identification of problematic symptoms. Additionally, we hypothesize that with the availability of graphical symptom reports over time, and timely provider responses, children or parents will become better informed and take an active role in managing their symptoms, which will further improve clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04789720; https://clinicaltrials.gov/study/NCT04789720. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50993.
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Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sally E Jensen
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - John Devin Peipert
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Sofia F Garcia
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - David Cella
- Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Stewart Goldman
- Department of Child Health, College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, United States
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Alicia Lenzen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
- Division of Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, United States
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18
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Shenoi S, Edison SE, Haynes S, Patten J. Implementation of an embedded behavioral health care model in a pediatric rheumatology subspecialty juvenile myositis clinic. Front Psychiatry 2023; 14:1192711. [PMID: 37636819 PMCID: PMC10447969 DOI: 10.3389/fpsyt.2023.1192711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Youth with chronic medical illness, such as juvenile myositis (JM), require specialized behavioral health care. However, access to such care is challenging due to the youth mental health crisis, which impacts accessibility of mental health services in the community, as well as challenges accessing behavioral health care above and beyond the demands of care related to their JM management. In this paper we describe an embedded behavioral health care model, including the establishment and implementation of such a model, at a pediatric hospital where youth with JM receive medical care in a Center of Excellence (CoE). We describe a unique partnership with a philanthropic organization; the challenges and benefits of delivering care within this model; as well as recommendations for maximizing its effectiveness. Ultimately, we provide an example of a successful embedded behavioral health care program for youth with rare disease, which may be applied to other institutions providing similar care.
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Affiliation(s)
- Susan Shenoi
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
| | - Suzanne E. Edison
- Mental Health Coordinator, Cure JM Foundation, Leesburg, VA, United States
| | - Stacey Haynes
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
| | - Joanna Patten
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
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19
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Rosenberg AR, Muriel AC. Poor Mental Health Among Survivors of Childhood Cancer-Risk Factors and a Call for Intervention. JAMA Pediatr 2023; 177:758-759. [PMID: 37345507 DOI: 10.1001/jamapediatrics.2023.2162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
- Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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20
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Ananth P, Lindsay M, Mun S, McCollum S, Shabanova V, de Oliveira S, Pitafi S, Kirch R, Ma X, Gross CP, Boyden JY, Feudtner C, Wolfe J. Parent Priorities in End-of-Life Care for Children With Cancer. JAMA Netw Open 2023; 6:e2313503. [PMID: 37184834 PMCID: PMC10878399 DOI: 10.1001/jamanetworkopen.2023.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Importance Robust quality measures to benchmark end-of-life care for children with cancer do not currently exist; 28 candidate patient-centered quality measures were previously developed. Objective To prioritize quality measures among parents who lost a child to cancer. Design, Setting, and Participants This survey study was conducted using an electronic, cross-sectional discrete choice experiment (DCE) with maximum difference scaling from January to June 2021 in the US. In each of 21 questions in the DCE, participants were presented with a set of 4 quality measures and were asked to select the most and least important measures within each set. All 28 quality measures were presented an equal number of times in different permutations. In the volunteer sample, 69 eligible bereaved parents enrolled in the study; 61 parents completed the DCE (participation rate, 88.4%). Main Outcomes and Measures Using choices participants made, a hierarchical bayesian multinomial logistic regression was fit to derive mean importance scores with 95% credible intervals (95% Crs) for each quality measure, representing the overall probability of a quality measure being selected as most important. Importance scores were rescaled proportionally from 0 to 100, with the sum of scores for all quality measures adding up to 100. This enabled interpretation of scores as the relative importance of quality measures. Results Participants included 61 bereaved parents (median [range] age, 48 [24-74] years; 55 individuals self-identified as women [90.2%]; 1 American Indian or Alaska Native [1.6%], 1 Asian [1.6%], 2 Black or African American [3.3%], 1 Native Hawaiian or Pacific Islander, and 58 White [91.8%]; 58 not Hispanic or Latinx [95.1%]). Highest-priority quality measures by mean importance score included having a child's symptoms treated well (9.25 [95% Cr, 9.06-9.45]), feeling that a child's needs were heard by the health care team (8.39 [95% Cr, 8.05-8.73]), and having a goal-concordant end-of-life experience (7.45 [95% Cr, 6.84-8.05]). Lowest-priority quality measures included avoiding chemotherapy (0.33 [95% Cr, 0.21-0.45]), provision of psychosocial support for parents (1.01 [95% Cr, 0.57-1.45]), and avoiding the intensive care unit (1.09 [95% Cr, 0.74-1.43]). Rank-ordering measures by mean importance revealed that symptom management was 9 times more important to parents than psychosocial support for themselves. Conclusions and Relevance This study found that bereaved parents prioritized end-of-life quality measures focused on symptom management and goal-concordant care while characterizing quality measures assessing their own psychosocial support and their child's hospital resource use as substantially less important. These findings suggest that future research should explore innovative strategies to measure care attributes that matter most to families of children with advanced cancer.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| | - Meghan Lindsay
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Sarah McCollum
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Sarah Pitafi
- University College London, London, United Kingdom
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington, District of Columbia
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jackelyn Y Boyden
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia
- Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Departments of Pediatrics, Medical Ethics, and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston
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21
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Rodgers-Melnick SN, Bartolovich M, Desai NJ, Vasanna SH, Rivard RL, Owusu-Ansah A, Ahuja SP, Dusek JA, Miller DW. Massage therapy for children, adolescents, and young adults: Clinical delivery and effectiveness in hematology and oncology. Pediatr Blood Cancer 2023; 70:e30243. [PMID: 36726036 DOI: 10.1002/pbc.30243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Children, adolescents, and young adults with hematologic and/or oncologic conditions experience multiple, significant symptoms (e.g., pain, stress, and anxiety), which may be addressed by nonpharmacologic approaches such as massage therapy (MT). The purpose of this study was to describe the clinical delivery of MT provided by a certified pediatric massage therapist and assess effectiveness in two patient groups: those with sickle cell disease (SCD) or hematologic and/or oncologic conditions excluding SCD (HemOnc). METHODS Investigators conducted a retrospective review of MT sessions provided to patients 0-39 years with hematologic and/or oncologic conditions at a large pediatric academic medical center. RESULTS Between October 2019 and December 2021, 3015 MT sessions were provided to 243 patients (171 HemOnc; 72 SCD) and documented in the electronic health record. Patients (mean age: 12.21 ± 7.19 years) were generally White (49.4%) or Black/African American (43.2%), non-Hispanic (94.2%), and 52.3% female. Patients in the SCD group (vs. patients in the HemOnc group) reported significantly higher (p < .05) pretreatment pain (6.95 vs. 4.46), stress (6.47 vs. 4.58), and anxiety (6.67 vs. 4.59). All patients reported clinically and statistically significant (p < .001) mean reductions in pain (-2.25 ± 1.87), stress (-2.50 ± 1.73), and anxiety (-2.52 ± 1.69), with patients in the HemOnc group reporting greater mean pain change (-2.54 vs. -1.87) than patients in the SCD group. CONCLUSIONS This study supports the clinical effectiveness of MT for addressing acute pain, stress, and anxiety among youth with hematologic and/or oncologic conditions. Future research is needed to identify optimal MT utilization.
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Affiliation(s)
- Samuel N Rodgers-Melnick
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mandy Bartolovich
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA.,Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Neha J Desai
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Smitha Hosahalli Vasanna
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Rachael L Rivard
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA.,Center for Survey and Evaluation Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Amma Owusu-Ansah
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Sanjay P Ahuja
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - David W Miller
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of General Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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22
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Melesse TG, Chau JPC, Li WHC, Choi KC, Yimer MA, Gidey AMS. Translation and evaluation of psychometric properties of the Amharic pediatric quality of life inventory 4.0 generic core scale for children with cancer. Health Qual Life Outcomes 2023; 21:10. [PMID: 36717868 PMCID: PMC9887904 DOI: 10.1186/s12955-022-02077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/02/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Childhood cancer negatively impacts a child's physical, mental, and behavioural health and significantly affects their health-related quality of life. The Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL™ 4.0 GCS) is one of the most commonly used measures of the quality of life in children. However, the Amharic version of PedsQL™ 4.0 GCS has not been validated in a paediatric oncology population. This study aimed to translate and evaluate the psychometric properties of the Amharic PedsQL™ 4.0 GCS (PedsQL™ 4.0 GCS (A)) for Ethiopian children with cancer. METHODS A descriptive cross-sectional study was conducted among children aged 8-18 years with any type of cancer across the cancer trajectory. Cronbach's alpha and intraclass correlation coefficient were computed to determine the internal consistency and test-retest reliability of the scale. The convergent validity was established by examining the correlation of the PedsQL™ 4.0 GCS (A) with the Amharic version of the Revised Child Anxiety and Depression Scale (RCADS-25(A)). Factorial validity was evaluated by conducting a confirmatory factor analysis. RESULTS The study included 142 participants with childhood cancer. PedsQL™ 4.0 GCS (A) had good validity and reliability. It demonstrated high internal consistency with a Cronbach's alpha of 0.96 for the scale and 0.82-0.95 for the subscales. The intraclass correlation coefficient for the scale was 0.9 and that for the subscales was 0.76-0.90. The PedsQL™ 4.0 GCS (A) was highly correlated with RCADS-25 (A) (r = - 0.97, p < 0.001), supporting its convergent validity. The four-factor structure of the model fitted the data satisfactorily (χ2/df = 1.28; CFI = 0.97; TLI = 0.97; RMSEA = 0.05; SRMR = 0.05), supporting the factorial validity of the PedsQL™ 4.0 GCS (A). CONCLUSION The PedsQL™ 4.0 GCS (A) demonstrates desirable psychometric properties for assessing quality of life among Ethiopian children with cancer. The scale can be used in clinical settings for assessing and evaluating quality of life in children with cancer. The use of parent-report versions and studies in those with different health conditions and healthy populations are necessary to further establish the psychometric properties of the PedsQL™ 4.0 GCS (A).
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Affiliation(s)
- Tenaw Gualu Melesse
- grid.10784.3a0000 0004 1937 0482Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR ,grid.449044.90000 0004 0480 6730Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Janita Pak Chun Chau
- grid.10784.3a0000 0004 1937 0482Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - William Ho Cheung Li
- grid.10784.3a0000 0004 1937 0482Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kai Chow Choi
- grid.10784.3a0000 0004 1937 0482Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Mulugeta Ayalew Yimer
- grid.59547.3a0000 0000 8539 4635Pediatric Hematology-Oncology Unit, Department of Pediatrics and Child Health, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Abdulkadir Mohamed Said Gidey
- grid.7123.70000 0001 1250 5688Pediatric Hematology-Oncology Division, Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Ullán AM, Herreros P, Belver MH, Jerez C. The Best and the Worst Things About the Hospital for Children with Cancer: A Qualitative, Interview-Based Study in a Spanish Hospital. J Patient Exp 2023; 10:23743735221149499. [PMID: 36687164 PMCID: PMC9850125 DOI: 10.1177/23743735221149499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The comprehensive psychosocial assessment of children with cancer requires listening to them and understanding their point of view. The objective of this work was to know what the participating children with cancer thought about the hospital, which they considered to be the best and worst aspects of their experience. We conducted a qualitative study using semi-structured interviews with 27 children with cancer. The interviewer asked the participating children what they considered to be the best thing about the hospital and what they considered to be the worst. These conversations with them were recorded and transcribed, and a thematic analysis of these transcripts was conducted. Among the aspects of the hospital that the children rated most highly was the treatment they received from the health care staff. Among what the children considered the worst aspect of their experience was pain, particularly pain caused by medical procedures such as injections. The obtained results lead us to conclude that children have a complex view of the hospital and are capable of a detailed analysis that must be taken into account.
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Affiliation(s)
- Ana M Ullán
- Department of Social Psychology, University of
Salamanca, Salamanca, Spain,Ana M Ullán, Facultad de Ciencias Sociales,
Campus Miguel de Unamuno, 37007 Salamanca, Spain.
| | - Pilar Herreros
- Patient Care Service, Niño Jesús
Hospital, Madrid, Spain
| | - Manuel H Belver
- Department of Art Education, Complutense University, Madrid,
Spain
| | - Carmen Jerez
- Educational Campus Sant Joan de
Déu, University of Barcelona, Barcelona,
Spain
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24
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van Gorp M, Grootenhuis MA, Darlington AS, Wakeling S, Jenney M, Merks JHM, Hjalgrim LL, Adams M. Patient Reported Outcomes and Measures in Children with Rhabdomyosarcoma. Cancers (Basel) 2023; 15:cancers15020420. [PMID: 36672371 PMCID: PMC9856469 DOI: 10.3390/cancers15020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
In addition to optimising survival of children with rhabdomyosarcoma (RMS), more attention is now focused on improving their quality of life (QOL) and reducing symptoms during treatment, palliative care or into long-term survivorship. QOL and ongoing symptoms related to the disease and its treatment are outcomes that should ideally be patient-reported (patient-reported outcomes, PROs) and can be assessed using patient-reported outcome measures (PROMS). This commentary aims to encourage PRO and PROM use in RMS by informing professionals in the field of available PROMs for utilisation in paediatric RMS and provide considerations for future use in research and clinical practice. Despite the importance of using PROMs in research and practice, PROMs have been reported scarcely in paediatric RMS literature so far. Available literature suggests lower QOL of children with RMS compared to general populations and occurrence of disease-specific symptoms, but a lack of an RMS-specific PROM. Ongoing developments in the field include the development of PROMs targeted at children with RMS specifically and expansion of PROM evaluation within clinical trials.
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Affiliation(s)
- Marloes van Gorp
- Princes Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | | | - Sara Wakeling
- Founder, Alice’s Arc, Rhabdomyosarcoma Children’s Cancer Charity, London E4 7RW, UK
| | | | | | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Madeleine Adams
- Children’s Hospital for Wales, Cardiff CF14 4XW, UK
- Correspondence:
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25
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Perez MN, Halada S, Isaza A, Sisko L, Mostoufi-Moab S, Bauer AJ, Barakat LP. Health-Related Quality of Life at Diagnosis for Pediatric Thyroid Cancer Patients. J Clin Endocrinol Metab 2022; 108:e169-e177. [PMID: 36330655 DOI: 10.1210/clinem/dgac648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/01/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Pediatric thyroid cancer (TC) incidence rates are increasing, yet TC has one of the highest survival rates. Despite increased prevalence, little is known about youth adjustment to TC, particularly compared to other pediatric cancers. OBJECTIVE The current study sought to describe health-related quality of life (HRQoL) in pediatric TC patients early after diagnosis compared to other pediatric cancer patients and healthy youth and examine predictors of HRQoL. DESIGN Patients completed psychosocial questionnaires as part of a clinic-based screening program around time of surgery. TC HRQoL was compared to other pediatric cancer and healthy youth reported norms. Clinical and demographic data extracted from the medical record were examined for predictors of HRQoL. SETTING Pediatric Thyroid Center. PATIENTS AND OTHER PARTICIPANTS Pediatric TC patients (ages 8.5-23.4 years) and their caregivers. MAIN OUTCOME MEASURES Pediatric Quality of Life Inventory (HRQoL) and distress thermometer. RESULTS Findings evidenced significantly higher HRQoL for TC patients than other pediatric cancers for all but emotional and school functioning. Compared to healthy youth, TC patients reported significantly lower functioning, except comparable social functioning. No significant differences in HRQoL were identified based on disease severity, thyroid disease history, or treatment. Patient distress was associated with HRQoL. CONCLUSIONS The findings suggest general resilience in TC patients compared to youth with other cancers, yet worse HRQoL than peers. Early universal screening is warranted due to a short TC treatment regimen. If administrative barriers preclude comprehensive screening, the single-item distress thermometer may identify patients for further comprehensive screening.
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Affiliation(s)
- Megan N Perez
- Cancer Center, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; USA
| | - Stephen Halada
- Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA; USA
| | - Amber Isaza
- Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA; USA
| | - Lindsay Sisko
- Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA; USA
| | - Sogol Mostoufi-Moab
- Cancer Center, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; USA
| | - Andrew J Bauer
- Thyroid Center, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA; USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; USA
| | - Lamia P Barakat
- Cancer Center, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; USA
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26
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Gandy K, Chambers T, Raghubar KP, Fatih Okcu M, Chintagumpala M, Taylor O, Mahajan A, Kahalley LS, Chan W, Grosshans DR, Brown AL, Douglas Ris M. A Prospective Evaluation of Fatigue in Pediatric Brain Tumor Patients Treated With Radiation Therapy. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:358-365. [PMID: 36285825 DOI: 10.1177/275275302110560011068754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Fatigue is a well-established consequence of cranial radiotherapy in survivors of pediatric brain tumor, but less is known about acute fatigue during radiotherapy treatment. This study aimed to longitudinally evaluate fatigue in newly diagnosed pediatric patients with brain tumors during treatment. Methods: Primary caregivers of pediatric patients with brain tumors completed the proxy-reported Parent Fatigue Scale assessments prior to radiotherapy and weekly during radiotherapy treatment. The association between clinical factors and fatigue at each assessment was evaluated with multiple linear regressions. A comparison of fatigue between radiation modalities was also analyzed. Results: A total of 33 caregivers completed pre-radiation fatigue assessments, with 29 reporting fatigue during radiotherapy. Patients were aged 3 to 16 years (M = 8.32) at diagnosis and diagnosed with medulloblastoma (n = 23), primitive neuroectodermal tumor (n = 2), ependymoma (n = 1), germ cell tumor (n = 1), pineoblastoma (n = 1), atypical teratoid rhabdoid (n = 1), and other unspecific tumors (n = 3). Moderate-to-severe fatigue was reported for the majority of patients (31/33; 94%) during treatment. Craniospinal irradiation dose was the only significant predictor of fatigue (p < .05), but this association was restricted to the first week of therapy and was attenuated by therapy completion. Discussion: Although fatigue is often considered a long-term consequence of cranial radiotherapy, this pilot study demonstrates that moderate-to-severe fatigue is pervasive prior to radiotherapy and persists throughout treatment in pediatric patients with brain tumors, regardless of radiation modality or clinical factors. Additional research is warranted to establish a link between acute and long-term fatigue and develop interventions to mitigate this adverse outcome.
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Affiliation(s)
- Kellen Gandy
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tiffany Chambers
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Murali Chintagumpala
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Olga Taylor
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa S Kahalley
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Austin L Brown
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Martin Douglas Ris
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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27
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Hetherington K, Wakefield CE, Kunalan KPK, Donoghoe MW, McGill BC, Fardell JE, Daly R, Deyell RJ, Ziegler DS. Quality of Life (QoL) of Children and Adolescents Participating in a Precision Medicine Trial for High-Risk Childhood Cancer. Cancers (Basel) 2022; 14:5310. [PMID: 36358729 PMCID: PMC9656810 DOI: 10.3390/cancers14215310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2023] Open
Abstract
Precision medicine is changing the treatment of childhood cancer globally, however little is known about quality of life (QoL) in children and adolescents participating in precision medicine trials. We examined QoL among patients enrolled in PRISM, the Zero Childhood Cancer Program's precision medicine trial for high-risk childhood cancer. We assessed patient QoL via self-report (aged 12-17 years) and parent-proxy (aged 4-17 years) completion of the EQ-5D-Y. We analysed data using descriptive statistics and regression models. Patients (n = 23) and parents (n = 136) provided data after trial enrolment and following receipt of trial results and treatment recommendations (n = 8 patients, n = 84 parents). At enrolment, most patients were experiencing at least some difficulty across more than one QoL domain (81% patient self-report, 83% parent report). We did not find strong evidence of a change in QoL between timepoints, or of demographic or disease factors that predicted parent-reported patient QoL (EQ-VAS) at enrolment. There was strong evidence that receiving a treatment recommendation but not a change in cancer therapy was associated with poorer parent-reported patient QoL (EQ-VAS; Mdiff = -22.5, 95% CI: -36.5 to -8.5, p = 0.006). Future research needs to better understand the relationship between treatment decisions and QoL and would benefit from integrating assessment of QoL into routine clinical care.
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Affiliation(s)
- Kate Hetherington
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Kavitha P. K. Kunalan
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Mark W. Donoghoe
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Brittany C. McGill
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Joanna E. Fardell
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Western Sydney Youth Cancer Service, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Rebecca Daly
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | | | - David S. Ziegler
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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28
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Analysis of the Correlation between the Level of Posttraumatic Growth and Social Support among Caregivers of Children with Acute Leukemia. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7456284. [PMID: 36128176 PMCID: PMC9473918 DOI: 10.1155/2022/7456284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
We investigate the current situation of stress burden and quality of life of primary caregivers of children with leukemia and analyze the correlation between their stress burden and quality of life, using the phenomenological research method in qualitative research. The posttraumatic growth experiences of the parents of children with leukemia included life perceptions (appreciation of life, change in priority of important things in life, and adjustment of self to reality); personal empowerment (increased sense of self-reliance and increased sense of self-achievement); and improvement of interpersonal relationships (increased family harmony, valuing parent-child bonding, benefiting from professional support from other parents and medical staff, and increased sense of empathy and altruism). The posttraumatic growth experiences of parents of children with leukemia are based on their roles (parenting) and responsibilities and can be used as an important basis for future trauma interventions, as well as an entry point for exploring the posttraumatic growth potential of parents of children with leukemia and ultimately improving the posttraumatic growth of parents of children with leukemia.
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Long KA, Davis KA, Pariseau E, Murie AC, Kazak AE, Alderfer MA. Initial Validation of a New Psychosocial Screener for Siblings of Youth with Cancer The Psychosocial Assessment Tool (PAT) Sibling Modules. Psychooncology 2022; 31:1774-1781. [PMID: 36029137 DOI: 10.1002/pon.6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Psychosocial screening can facilitate the identification of families who have difficulty adjusting to and managing serious pediatric illness. Despite siblings' roles within the family and increased psychosocial risk, a systematic approach to screening siblings of youth with cancer remains rare. One barrier to systematic sibling screening is the lack of a validated screener. We aimed to establish initial validity of the new parent-reported Psychosocial Assessment Tool (PAT) Sibling Modules for siblings ages 0-2, 3-4, 5-9, and 10+. METHODS Families (N=64) completed the PAT Sibling Modules and the Strengths and Difficulties Questionnaire (SDQ) regarding siblings' functioning at cancer diagnosis (13-23 items, depending on age version) and 6-months later (17-42 items). Cross-sectional and longitudinal analyses examined internal consistency and convergent and predictive validity of the PAT Sibling Modules. RESULTS Baseline and follow-up versions of the modules have strong internal consistency (Kuder-Richardson 20 range: 0.82-0.93) and convergent validity at diagnosis (r-values ≥0.4, p-values <0.01) and follow-up (r-values >0.4, p-values <0.05). Predictive validity was supported by significant correlations between baseline PAT Sibling Module scores and 6-month SDQ scores (r=0.86, p<0.001). CONCLUSIONS Findings provide initial evidence that the PAT Sibling Modules are valid measures of sibling psychosocial risk. Availability of a validated screener is a first step toward addressing siblings' unmet psychosocial needs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | - Melissa A Alderfer
- Nemours Children's Hospital, Delaware, Boston, United States.,Sidney Kimmel Medical College at Thomas Jefferson University, Boston, United States
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Patient-reported outcomes are under-utilised in evaluating supportive therapies in paediatric oncology - A systematic review of clinical trial registries. Crit Rev Oncol Hematol 2022; 176:103755. [PMID: 35803454 DOI: 10.1016/j.critrevonc.2022.103755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Children with cancer suffer from numerous symptoms and side-effects, making supportive interventions indispensable to improve their quality of life. The gold standard for evaluating the latter is patient-reported outcome (PRO) assessment. This systematic review investigates the current practice of clinical outcome assessment (COA) in clinical trials on supportive interventions. METHODS ClinicalTrials.gov and EudraCT were searched for trials including children and adolescents (≤21 years) with cancer receiving supportive care registered 2007-2020. The use of different types of COAs was analysed, focusing on PRO assessment and the domains measured with PRO measures (PROMs). Associations with trial characteristics were investigated using univariate and multivariable analyses. RESULTS Of 4789 identified trials, 229 were included. Among them, 44.1 % relied on PROMs, the most commonly used COA. The proportion of trials using PROMs did not significantly differ over time. In the multivariable analysis, intervention type (higher PROM use in behavioural vs. medical interventional trials) and cancer type (higher PROM use in mixed and solid tumour samples vs. haematological samples) were significant predictors of PROM use. The majority of trials using PROMs (59.6 %) measured more than one health domain. 'Physical health' was the most frequently assessed domain (92.6 %). CONCLUSION Less than half of registered clinical trials investigating supportive interventions for children with cancer used PROMs. This result is striking since supportive care explicitly focuses on patients' quality of life, which is best assessed using PROMs. Our systematic review underlines the need to identify barriers for PROM implementation and to improve PRO research in paediatric oncology.
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Manikowski A, Williamson Lewis R, Bennett T, Miller H, Mertens A, Wasilewski-Masker K, Escoffery C, Gilleland Marchak J. Implementation of Electronic Psychosocial Screening Among Caregivers in Pediatric Oncology. JCO Oncol Pract 2022; 18:e1198-e1208. [DOI: 10.1200/op.21.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: This study aimed to evaluate the reach and implementation of an electronic psychosocial screening program among caregivers of pediatric oncology patients, as well as characterize caregiver distress. METHODS: Participants (N = 2,013) included caregivers of patients age 0-17.99 years presenting across 9,280 outpatient oncology visits (median = 2; range = 1-52) from September 2018 to June 2019. At check-ins, caregivers electronically completed the pediatric distress thermometer via a patient-facing electronic health record (EHR) application. Caregiver distress ratings ≥ 8 triggered electronic alerts to medical teams to refer for social work support at point of care. Patient clinical and demographic differences in reach and fidelity were evaluated using univariate chi-square and t-tests. Caregivers reporting high distress were compared with caregivers without reports of high distress using univariate and multivariable logistic regression. RESULTS: The e-screening program was able to reach a caregiver for nearly all children seen during the study period, with 95.5% (1,923/2,013) of patients having a caregiver-completed pediatric distress thermometer. On screeners where caregivers reported high distress, medical teams made appropriate referrals to social work 95.5% (471/493) of the time. Overall, 16.9% (325/1,923) of caregivers ever indicated high distress (score ≥ 8), with caregivers of newly diagnosed (odds ratio = 3.16; 95% CI, 2.12 to 4.71) and on-therapy (odds ratio = 2.81; 95% CI, 2.11 to 3.76) patients being more likely to report high distress, compared with those who were off-treatment for the entire study. CONCLUSION: Leveraging EHR technology to provide evidence-based psychosocial screening can aid in successfully reaching a significant proportion of caregivers of pediatric oncology patients to identify and respond to ongoing psychosocial distress.
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Affiliation(s)
- Alison Manikowski
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | | | - Tonya Bennett
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | | | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | - Karen Wasilewski-Masker
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
| | - Cam Escoffery
- Emory University Rollins School of Public Health, Atlanta, GA
| | - Jordan Gilleland Marchak
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Atlanta, GA
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Deatrick JA, Kazak AE, Scialla MA, Madden RE, McDonnell GA, Okonak K, Barakat LP. Advancing health equity in pediatric cancer through implementation of universal family psychosocial risk screening. Psychooncology 2022; 31:1483-1490. [PMID: 35726382 DOI: 10.1002/pon.5978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/29/2022] [Accepted: 06/08/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Unaddressed psychosocial risks may contribute to disparities in cancer care outcomes and may be addressed by early psychosocial risk screening. In a study implementing universal family psychosocial risk screening in 18 children's cancer programs in the United States, parents, clinicians, and organizational leaders described the importance of universal screening to health equity. PURPOSES The purposes of this study were to (1) describe the perspectives of parents, clinicians, and organizational leaders regarding the importance of universal family psychosocial risk screening in childhood cancer care and (2) identify barriers and facilitators to improving health equity and decreasing health disparities in childhood cancer through universal family psychosocial screening. METHODS Nineteen participants (parent advocates, clinicians, leaders in professional organizations and healthcare policy) were interviewed. Directed content analysis was used to identify thematic descriptions. RESULTS Theme 1: Personal (individual child and family) and systemic barriers to health care contribute to health disparities and can be identified by universal family psychosocial risk screening in pediatric cancer. Theme 2: Universal family psychosocial risk screening in pediatric cancer creates the opportunity for health equity through personalized psychosocial care. Theme 3: Recognition of health inequities and guidance from the Standards of Psychosocial Care for Children with Cancer and their Families suggest that clinicians and healthcare systems are ethically obligated to screen, provide resources, and advocate for services to meet identified needs. CONCLUSIONS Universal family psychosocial risk screening in pediatric oncology creates the opportunity to support efforts for health equity by guiding delivery of personalized psychosocial care. TRIAL REGISTRATION NCT04446728 23 June 2020.
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Affiliation(s)
- Janet A Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science of Nemours Children's Health, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michele A Scialla
- Nemours Center for Healthcare Delivery Science of Nemours Children's Health, Wilmington, Delaware, USA
| | - Rebecca E Madden
- Divison of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Glynnis A McDonnell
- Nemours Center for Healthcare Delivery Science of Nemours Children's Health, Wilmington, Delaware, USA
| | - Katherine Okonak
- Nemours Center for Healthcare Delivery Science of Nemours Children's Health, Wilmington, Delaware, USA
| | - Lamia P Barakat
- Divison of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Fladeboe KM, Scott S, Comiskey L, Zhou C, Yi-Frazier JP, Rosenberg AR. The Promoting Resilience in Stress Management (PRISM) intervention for adolescents and young adults receiving hematopoietic cell transplantation: a randomized controlled trial protocol. BMC Palliat Care 2022; 21:82. [PMID: 35585525 PMCID: PMC9117082 DOI: 10.1186/s12904-022-00966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Psychological distress is prevalent among adolescents and young adults (AYAs) receiving hematopoietic cell transplantation (HCT). The Promoting Resilience in Stress Management (PRISM) intervention is a resilience-coaching program that has been shown to mitigate distress and improve quality of life among AYAs receiving chemotherapy for newly diagnosed or advanced cancer. This article describes the protocol of an ongoing randomized-controlled trial (RCT) examining the efficacy of PRISM among AYAs receiving HCT for cancer and/or blood disorders. Methods/design The goal of this multi-site, parallel, RCT is to evaluate the effect of PRISM compared to psychosocial usual care (UC) among AYAs receiving HCT. Our primary hypothesis is that AYAs who receive PRISM will report lower depression and anxiety 6-months following enrollment compared to those who receive UC. The PRISM program includes four scripted coaching sessions targeting skills in stress-management, goal setting, cognitive-restructuring, and meaning-making, followed by a facilitated family meeting. Sessions are delivered one on one, 1–2 weeks apart, in-person or via videoconference. We aim to recruit 90 AYAs from 4 US pediatric AYA oncology centers. Eligible AYAs are aged 12–24 years; receiving HCT for malignancy or a bone marrow failure syndrome associated with cancer predisposition; < 4 weeks from their HCT date; able to speak English and read in English or Spanish; and cognitively able to complete sessions. Enrolled AYAs are randomized 1:1 within each site to receive PRISM+UC or UC alone. AYAs on both study-arms complete patient-reported outcome surveys at baseline, 3- and 6-months. Age-valid instruments assess depression and anxiety, overall and cancer-specific health-related quality of life, symptom burden, resilience, and hope. Covariate-adjusted regression models will compare AYA-reported depression and anxiety at 6-months in the PRISM versus UC groups. Secondary and exploratory objectives include assessments of PRISM’s cost-effectiveness and its impact on (i) parent and caregiver quality of life and mental health, (ii) pharmaco-adherence to oral graft-versus-host disease (GVHD) prophylaxis, (iii) biologic outcomes such as transplant engraftment and graft-versus-host disease, and (iv) biomarkers of stress such as heart rate variability and the Conserved Transcriptional Response to Adversity (CTRA) gene expression profile. Discussion If successful, this study has the potential to address a critical gap in whole-patient care for AYAs receiving HCT. Trial registration ClinicalTrials.gov Identifier NCT03640325, August 21, 2018.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, USA.,Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Samantha Scott
- Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA.,Department of Psychology, University of Denver, Denver, CO, USA
| | - Liam Comiskey
- Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Chuan Zhou
- Department of Pediatrics, Division of General Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, USA. .,Palliative Care and Resilience Lab, Center for Clinical & Translational Research, Seattle Children's Research Institute, M/S CURE-4, PO Box 5371, Seattle, WA, 98145-5005, USA. .,Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, USA.
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Hancock K, Barrera M, Prasad S, Desjardins L, Shama W, Alexander S, Szatmari P. A qualitative examination of the benefits and challenges of a psychosocial screening intervention in pediatric oncology: "Support comes to us". Pediatr Blood Cancer 2022; 69:e29578. [PMID: 35084106 DOI: 10.1002/pbc.29578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric cancer diagnosis and treatment can have detrimental mental health effects on parents (caregivers) and their children/adolescents (youth). Psychosocial screening and intervention have been recognized as standards of care in pediatric oncology. The most effective psychosocial interventions to support those in need post screening have not been determined. AIMS This qualitative study aimed to investigate the perceived benefits and challenges for caregiver and youth participants in the screening-intervention arm of an Enhanced Psychosocial Screening Intervention (EPSI) pilot study. METHODS EPSI consists of a psychosocial navigator (PSN) who shares screening results conducted near diagnosis (T1) and monthly for 1 year (T2) with treating teams and families. All 17 caregiver-youth dyads who had completed EPSI were invited to participate in a semi-structured interview. RESULTS Ten caregivers and nine youth participated. Identified themes were grouped into benefits and challenges of EPSI: feeling supported and cared for (support comes to us regularly, having someone to talk to); and feeling empowered through knowledge of resources and services were perceived as benefits. Caregivers were challenged by feeling overwhelmed, and youth by screening questions perceived as too repetitive. CONCLUSIONS Regular monthly contacts for a year by the PSN with screening results and recommendations were perceived as beneficial by youth newly diagnosed with cancer and their caregivers who participated in EPSI. Feeling that support came to them and they had someone to talk to was a critical component. While information about psychosocial resources was not always used right away, it did evoke feelings of being empowered.
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Affiliation(s)
- Kelly Hancock
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Soni Prasad
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leandra Desjardins
- Research Centre, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Wendy Shama
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Alexander
- Division of Haematology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Sudnawa KK, Yeepae J, Photia A, Rujkijyanont P, Traivaree C, Monsereenusorn C. The Reliability of the Thai version of Health-Related Quality of Life Questionnaire: PedsQL 3.0 Cancer Module. Glob Pediatr Health 2022; 9:2333794X221092738. [PMID: 35521436 PMCID: PMC9067036 DOI: 10.1177/2333794x221092738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/20/2022] [Indexed: 11/15/2022] Open
Abstract
Assessing the health-related quality of life (HRQOL) is highly recommended as a standard of care for children with cancer in conjunction with medical treatment. The Pediatric Quality of Life Inventory (PedsQL) Cancer Module is a standard tool designed to assess the HRQOL among pediatric oncology patients. This study aimed to evaluate the reliability and correlation of the PedsQL 3.0 Cancer Module in Thai version between child and parent reports. A cross-sectional study was conducted on 85 Thai children with cancer and their families. Excellent internal consistency of the PedsQL 3.0 Cancer Module of the Thai version was addressed among child and parent reports (0.92 and 0.94, respectively). Overall positive correlations were also found between child and parent reports ( r = 0.61, P < .001). However, the statistically significant differences of HRQOL scores between child and parent reports were determined on procedural anxiety (70.05 ± 26.67 vs 60.03 ± 25.6, P = .003), treatment anxiety (88.15 ± 17.37 vs 76.82 ± 26.7, P = .001), worry (66.67 ± 25.59 vs 55.34 ± 30.37, P = .003) and the total score (74.37 ± 15.7 vs 70.42 ± 17.15, P = .034). This study demonstrated desirable internal reliability with positive correlations between child and parent reports of the PedsQL 3.0 Cancer Module in Thai version, although possible differences between child and parent HRQOL scores should be considered.
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Affiliation(s)
- Khemika Khemakanok Sudnawa
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Apichat Photia
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Piya Rujkijyanont
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chanchai Traivaree
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chalinee Monsereenusorn
- Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
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Benini F, Avagnina I, Giacomelli L, Papa S, Mercante A, Perilongo G. Pediatric Palliative Care in Oncology: Basic Principles. Cancers (Basel) 2022; 14:cancers14081972. [PMID: 35454879 PMCID: PMC9031296 DOI: 10.3390/cancers14081972] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary About 4 million children with an oncological disease worldwide require palliative care due to the nature of their condition. The WHO defines pediatric palliative care (PPC) as the prevention and relief of suffering in patients with life-threatening or life-limiting disease and their families. PPC relies on the comprehensive and multidisciplinary management of the child and the family’s physical, psychological, spiritual, and social needs. Importantly, PPC begins at the diagnosis of incurability, or supposed incurability, and continues regardless of whether the patient receives any oncological treatment. As such, PPC is a general approach continuing over the entire disease trajectory, which includes, but is not limited to, end-of-life care. This review addresses the value of integrating PPC in treating children with cancer, focusing on the basic principles of PPC and its application in pediatric oncology. Abstract About 4 million children with an oncological disease worldwide require pediatric palliative care (PPC) due to the nature of their condition. PPC is not limited to end-of-life care; it is a general approach continuing over the entire disease trajectory, regardless of whether the patient receives any oncological treatment. This review addresses the value of integrating PPC in treating children with cancer, focusing on the basic principles of PPC and its application in pediatric oncology. Moreover, models for PPC implementation in oncology, end-of-life care, and advanced care planning are discussed.
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Affiliation(s)
- Franca Benini
- Paediatric Palliative Care, Pain Service, Department of Women’s and Children’s Health, University of Padua, 35127 Padua, Italy;
- Correspondence:
| | - Irene Avagnina
- Paediatric Palliative Care, Pain Service, Department of Women’s and Children’s Health, University of Padua, 35127 Padua, Italy;
| | | | | | - Anna Mercante
- Pediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University of Padua, 35127 Padua, Italy; (A.M.); (G.P.)
| | - Giorgio Perilongo
- Pediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University of Padua, 35127 Padua, Italy; (A.M.); (G.P.)
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McGrady ME, Mara CA, Beal SJ, Chan SF, Sorge CE, Pai ALH. Development and Preliminary Validation of a Multidimensional Psychosocial Assessment Strategy for Young Adults With Cancer. J Pediatr Psychol 2022; 47:952-963. [PMID: 35380687 DOI: 10.1093/jpepsy/jsac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Regular psychosocial assessment is a best-practice guideline for young adult oncology care, but multipurpose, multidimensional, developmentally appropriate patient-reported outcome measurement strategies for young adults with cancer are lacking. This study reported on the development and preliminary validation of the Young Adult Psychosocial Assessment Strategy (YA-PAS), a tool designed to meet this clinical need. METHODS The YA-PAS was developed based on the literature and clinician feedback. 20 young adults with cancer participated in cognitive interviews to provide feedback on complexity, readability, and applicability to inform measure refinement. Following refinements, 100 young adults with a history of cancer participated in an observational study including a preliminary evaluation of YA-PAS factor structure, internal consistency, test-retest reliability, construct and criterion validity, feasibility, and acceptability. RESULTS Cognitive interviews and psychometric evaluation informed modifications and resulted in a measure with 9 domains (anxiety, depression, cognitive functioning, post-traumatic stress, family stressors, support, social isolation, self-efficacy for symptom management, and self-efficacy for medication management) and nonscoring items assessing substance use, life stressors, resources, educational/vocational status, and relationship status. 8 of 9 domains demonstrated acceptable internal consistency (Cronbach's α ≥ 0.70), substantial (r = 0.61-0.80) or almost perfect (r > 0.80) test-retest reliability, and evidence of domain and cut-point validity. 89% of participants were able to complete the YA-PAS within 20 min and 87% were satisfied with the measure. CONCLUSIONS The YA-PAS demonstrated promising psychometric properties, feasibility, and acceptability. Clinical implications and research recommendations are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Constance A Mara
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Sarah J Beal
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Sherilynn F Chan
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Caryn E Sorge
- Department of Pediatrics, Division of Hematology Oncology, University of Kentucky, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
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Bates CR, Fairclough D, Noll RB, Barrera ME, Kupst MJ, Egan AM, Gartstein MA, Ach EL, Gerhardt CA, Vannatta KA. Psychosocial functioning of caregivers of pediatric brain tumor survivors. Pediatr Blood Cancer 2022; 69:e29565. [PMID: 35044078 PMCID: PMC8860870 DOI: 10.1002/pbc.29565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.
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Affiliation(s)
- Carolyn R. Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Diane Fairclough
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Maru E. Barrera
- Division of Hematology/Oncology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anna M. Egan
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO,University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Emily L. Ach
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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van Gorp M, Maurice-Stam H, Teunissen LC, Kilsdonk E, van Dijk J, Sulkers M, Tissing WJE, van Litsenburg RRL, Grootenhuis MA. Psychosocial function of Dutch children with cancer and their caregivers during different phases of the COVID-19 pandemic. Pediatr Blood Cancer 2022; 69:e29535. [PMID: 35107873 DOI: 10.1002/pbc.29535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/01/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022]
Abstract
We compared psychosocial functioning of children with cancer and their caregivers in several phases of the coronavirus disease 2019 (COVID-19) pandemic to before COVID-19. One or more questionnaires on health-related quality of life (HRQoL) or fatigue of children or distress of their caregivers was available from 1644 families. In children with cancer, HRQoL was stable throughout the COVID-19 pandemic. Fatigue was slightly lower and sleep somewhat better during the pandemic than before. Caregiver distress was lower in the first pandemic phase, but increased to pre-COVID-19 levels in later phases, indicating that the length and consequences of the pandemic may be weighing on them.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Layla C Teunissen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ellen Kilsdonk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jennifer van Dijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Mirjam Sulkers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Marchak JG, Christen S, Mulder RL, Baust K, Blom JMC, Brinkman TM, Elens I, Harju E, Kadan-Lottick NS, Khor JWT, Lemiere J, Recklitis CJ, Wakefield CE, Wiener L, Constine LS, Hudson MM, Kremer LCM, Skinner R, Vetsch J, Lee JL, Michel G. Recommendations for the surveillance of mental health problems in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2022; 23:e184-e196. [PMID: 35358467 PMCID: PMC9639707 DOI: 10.1016/s1470-2045(21)00750-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022]
Abstract
Survivors of childhood, adolescent, and young adult (diagnosed when <25 years of age) cancer are at risk of mental health problems. The aim of this clinical practice guideline is to harmonise international recommendations for mental health surveillance in survivors of childhood, adolescent, and young adult cancer. This guideline was developed by a multidisciplinary panel of experts under the sponsorship of the International Guideline Harmonization Group. We evaluated concordance among existing survivorship clinical practice guidelines and conducted a systematic review following evidence-based methods. Of 7249 studies identified, 76 articles from 12 countries met the inclusion criteria. Recommendations were formulated on the basis of identified evidence in combination with clinical considerations. This international clinical practice guideline strongly recommends mental health surveillance for all survivors of childhood, adolescent, and young adult cancers at every follow-up visit and prompt referral to mental health specialists when problems are identified. Overall, the recommendations reflect the necessity of mental health surveillance as part of comprehensive survivor-focused health care.
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41
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Bradford N, Cashion C, Holland L, Henney R, Walker R. Coping with cancer: A qualitative study of adolescent and young adult perspectives. PATIENT EDUCATION AND COUNSELING 2022; 105:974-981. [PMID: 34334263 DOI: 10.1016/j.pec.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Cancer can have long-term biopsychological impacts for young people that persist for years. To promote adjustment, it is essential to understand how young people cope, yet this is relatively understudied. METHODS This study explored the coping strategies using semi-structured interviews with 16 young people with cancer aged 15-24 years. Eligible participants were diagnosed within the previous 24 months and recruited through Australian Youth Cancer Services. Transcribed interviews were analysed using content analysis. RESULTS Coping strategies included: seeking support; controlling the focus; avoiding negatives and staying positive; meaning making and; changes with time. During treatment, seeking support, focussing on the present, distraction and avoidance were commonly applied. Following treatment, planning for the future, avoidance of re-traumatising situations and meaning making were used. CONCLUSION Findings support the concept of coping as a dynamic process where different strategies are used depending on the stressor, available resources and previous experiences. PRACTICE IMPLICATIONS Comprehensive, developmentally appropriate psychosocial assessments, open communication, education and information provision, as well as appropriate referral for support are essential, particularly for young cancer survivors identified at risk.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, School of Nursing, Brisbane, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Brisbane, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia.
| | | | - Lucy Holland
- Queensland University of Technology, School of Nursing, Brisbane, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rosyln Henney
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rick Walker
- Queensland Children's Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia; The University of Queensland, School of Medicine, Queensland, Australia
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42
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Etkin-Spigelman L, Hancock K, Nathan PC, Barrera M. Sharing psychosocial risk screening information with pediatric oncology healthcare providers: Service utilization and related factors. Pediatr Blood Cancer 2022; 69:e29456. [PMID: 34854538 DOI: 10.1002/pbc.29456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Psychosocial morbidity in pediatric oncology patients and their caregivers is widely recognized. Although routine systematic psychosocial screening has been proposed as a standard of care, screening is still limited. The present study assessed whether supplying the patient's treating team of healthcare providers with psychosocial risk screening information near diagnosis would increase the rate of documented psychosocial contacts, particularly for patients/families with elevated risk. The effect of demographic and clinical factors was also examined. PROCEDURES Ninety-three families with a child/youth newly diagnosed with cancer participated. Families were randomly assigned to a care as usual control group (n = 44) or an intervention group (n = 49) where the treating team was provided with a summary of family psychosocial risk, measured by the Psychosocial Assessment Tool (PAT). The PAT was completed by the primary caregiver, who also provided demographic information. The number of psychosocial intervention contacts documented in the medical charts was examined. RESULTS The rate of psychosocial intervention did not significantly differ between the groups (P > 0.05). The intensity of the child's cancer treatment was found to be the only significant predictor of the number of documented psychosocial intervention contacts (β = 0.396, P < 0.001). CONCLUSIONS Clinical factors appear to be more predictive of the rate of psychosocial intervention provided to pediatric oncology patients and their families than informing the treating team of family psychosocial risk. Additional research is required to address the gap between psychosocial risk screening, psychosocial intervention, and family outcomes.
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Affiliation(s)
| | - Kelly Hancock
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, Ontario, Canada
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43
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Moscato E, Patronick J, Wade SL. Family functioning and adaptation following pediatric brain tumor: A systematic review. Pediatr Blood Cancer 2022; 69:e29470. [PMID: 34842339 DOI: 10.1002/pbc.29470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Emily Moscato
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jamie Patronick
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L Wade
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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44
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Jones AM, Browne EK, Adams K, Potter BS, McLaughlin Crabtree V, Jurbergs N, Heidelberg RE, Webster RT. The Toll of Transition: Caregiver Perceptions of Family Adjustment During the Transition off Pediatric Cancer Therapy. Psychooncology 2022; 31:985-994. [PMID: 35083824 DOI: 10.1002/pon.5888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The role of transition-focused psychology appointments in managing the transition off therapy is unclear. The objective of this research was to explore caregiver perceived familial distress and the role of psychology in preparing families for transition. METHODS Fifty-seven caregivers of youth, who finished treatment, completed an online questionnaire through a quality improvement project on experiences of families at transition. Twenty-two percent of caregivers had children who completed a transition-focused psychology consult and 63% completed a cognitive assessment at transition. Retrospective analyses were conducted assessing the association of psychology visits on caregiver perceptions of being informed of and prepared to manage transition-related challenges. RESULTS Most caregivers reported experiencing adjustment concerns for family members. Caregivers of children completing a transition-focused psychology consult or cognitive assessment reported feeling more informed and greater preparedness to manage difficulties. Although decreased distress was not associated with the visit, those who felt more informed and prepared reported lower distress. CONCLUSIONS Caregivers perceive transitioning off therapy as stressful for their family, though they experience decreased familial distress when informed of and prepared to manage transition-related challenges. These findings highlight the importance of psychosocial support at transition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna M Jones
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Emily K Browne
- Transition Program, St. Jude Children's Research Hospital, Memphis, TN
| | - Kristen Adams
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Brian S Potter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.,St. Jude Graduate School of Biomedical Sciences, Memphis, TN
| | - Niki Jurbergs
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - R Elyse Heidelberg
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rachel Tillery Webster
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.,Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN
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45
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Enlow PT, Lewis AM, Scialla MA, Hwang WT, Kazak AE. Validating the Factor Structure of the Psychosocial Assessment Tool Using Internet-Based Data. J Pediatr Psychol 2022; 47:215-224. [PMID: 35026020 DOI: 10.1093/jpepsy/jsab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The Psychosocial Assessment Tool (PAT) is a well-validated, brief screener of family psychosocial risk. Since 2014 a web-based version of the PAT (WebPAT) has been available for use by clinicians and researchers, but the psychometric properties have not been examined. The objective of this article was to examine the factor structure and internal consistency of the WebPAT, which was administered to caregivers of youth with cancer. METHODS The WebPAT was administered to 1,252 caregivers of youth with cancer across 29 institutions. Confirmatory factor analysis (CFA) was used to examine the factor structure of the WebPAT. Internal consistencies of the total and subscale scores were examined via the Kuder-Richardson 20 coefficient. The distribution of total PAT score across the three risk categories of the Pediatric Psychosocial Preventative Health Model (PPPHM) was also examined. RESULTS The CFA supported the original seven-factor structure of the PAT (Family Structure, Social Support, Child Problems, Sibling Problems, Family Problems, Stress Reactions, and Family Beliefs). Internal consistencies were strong for the total PAT score and four subscales (Social Support, Child Problems, Sibling Problems, and Family Problems). The distribution of total PAT scores across PPPHM risk categories was consistent with prior research. CONCLUSIONS The WebPAT is a psychometrically sound screener of psychosocial risk in families of youth with cancer. Healthcare providers can use the WebPAT to assess families' psychosocial risk and guide the provision of psychosocial care. Future research should evaluate the implementation of the PAT and identify barriers and facilitators to implementation.
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Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children's Health, USA
| | - Michele A Scialla
- Center for Healthcare Delivery Science, Nemours Children's Health, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health, USA.,Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, USA
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46
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Desjardins L, Solomon A, Shama W, Mills D, Chung J, Hancock K, Barrera M. The impact of caregiver anxiety/depression symptoms and family functioning on child quality of life during pediatric cancer treatment: From diagnosis to 6 months. J Psychosoc Oncol 2022; 40:790-807. [PMID: 35016592 DOI: 10.1080/07347332.2021.2015646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A pediatric cancer diagnosis can have a significant impact on the quality of life (QOL) of the child. Diagnosis and treatment impact caregiver anxiety/depression symptoms and family functioning, and these in turn may influence child QOL. However, there has been limited longitudinal examination of the impact of both caregiver anxiety/depression symptoms and family functioning on youth QOL at specific points during the early diagnosis and treatment period. Ninety-six caregivers of youth (diagnosed with leukemia/lymphoma or a solid tumor) reported on their own anxiety/depression symptoms, family functioning, demographic and medical factors, and on their child's generic and cancer-specific QOL shortly after diagnosis (T1) and 6 months later (T2). Caregiver anxiety/depression symptoms were associated with poorer cancer-specific and generic child QOL within and across time points. Family conflict was associated with youth cancer-related QOL at T1. Attendance to caregiver anxiety/depression symptoms and family functioning, beginning early in the cancer trajectory, is an important aspect of family-centered care. Routine psychosocial screening and triage may help identify and intervene to support both caregiver and child psychosocial well-being.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada.,Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Aden Solomon
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Shama
- Department of Social Work, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Denise Mills
- Department of Nursing, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Joanna Chung
- Department of Psychology, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Kelly Hancock
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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47
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Cuffe R, Norman C, Haeems G, Spicer L, Mohammed K, Rodger M, Edwards L. Age-stratified distress thermometers with Worry and Learning problem domains for the paediatric oncology population: Development and validation. Psychooncology 2022; 31:832-839. [PMID: 34981598 DOI: 10.1002/pon.5870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The long-term psychological/neuro-psychological sequalae for a minority of survivors of childhood cancer are considerable. This project aims to develop and validate a psychosocial and memory/learning distress thermometer (DT) for paediatric/young adult cancer patients. METHODS Pilot/Development Age-appropriate versions of the DT were developed. A pilot study tested acceptability, usability, and design. VALIDATION Seven collaborating paediatric-oncology centres with 549 participants validated the DT against Strengths and difficulties questionnaire (SDQ) and Hospital Anxiety and depression scale (HADS) for psychological issues, Utilities Index Mark 2 (HUI2) for memory/learning issues, PedsQL and SF-8 measured quality of life. RESULTS Using a cut-off of four, sensitivity against SDQ for under 18 was 75.8%, 18plus against HADS was 94.1%. The specificity was 53.3% against the SDQ for the 18plus specificity against the HADS was 47.1%. The sensitivity against the HUI2 for all age groups was 89.0% specificity was 70.3%. CONCLUSION The DT is a valid and reliable measure screening instrument. It can be used to identify early on those experiencing psychological distress and memory problems.
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Affiliation(s)
- Ray Cuffe
- Paediatric and Teenage Psychological Support Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Catherine Norman
- Southampton Children's Hospital, Southampton General, Southampton, UK
| | - Gabriella Haeems
- Paediatric and Teenage Psychological Support Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Lucy Spicer
- Paediatric and Teenage Psychological Support Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Kabir Mohammed
- Paediatric and Teenage Psychological Support Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Melanie Rodger
- Paediatric and Teenage Psychological Support Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Lesley Edwards
- Paediatric and Teenage Psychological Support Service, The Royal Marsden NHS Foundation Trust, London, UK
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48
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Wechsler AM, Bragado-Álvarez C, Hernández-Lloreda MJ, Lopes LF, Perina EM. Psychological Adjustment of Children with Cancer: Relapse and Survival Perspectives. PSICO-USF 2022. [DOI: 10.1590/1413-82712022270101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract In Brazil, few studies have investigated the psychological aspects of childhood cancer. The aim of this article was to compare the psychological adjustment of children with cancer from different survival perspectives with that of children without cancer, besides examining potential risk factors. The sample consisted of 179 participants (6-14 years-old) recruited in two Brazilian public hospitals and three schools, and divided in three groups (relapsed, survivors and control). Children answered orally the self-reported Behavior Assessment Scale for Children, the Revised Children’s Manifest Anxiety Scale and Piers-Harris’ Self-Concept Scale. No differences were found between groups regarding school and clinical maladjustment, personal adjustment, emotional symptoms and self-concept. Findings also showed positive associations between psychological maladjustment and gender, younger age, lower household income, single parenthood and lower levels of parental education. Conclusions indicate that children with cancer adapt well to the disease and do not present more psychological problems than controls.
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49
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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis. Eur J Psychotraumatol 2022; 13:2116825. [PMID: 36186160 PMCID: PMC9518403 DOI: 10.1080/20008066.2022.2116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families' psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. OBJECTIVES Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. METHODS Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. RESULTS The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. CONCLUSION Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.,Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-aviv, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel.,Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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50
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Canter KS, McIntyre R, Babb R, Ramirez AP, Vega G, Lewis A, Bottrell C, Lawlor C, Kazak AE. A community-based trial of a psychosocial eHealth intervention for parents of children with cancer. Pediatr Blood Cancer 2022; 69:e29352. [PMID: 34532970 DOI: 10.1002/pbc.29352] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Electronic Surviving Cancer Competently Intervention Program (eSCCIP), a psychosocial eHealth intervention for parents and caregivers of children with cancer (parents), was delivered in a community-based psychosocial oncology center. Primary endpoints were intervention acceptability, feasibility, and accessibility, with a secondary exploratory focus on psychosocial outcomes. PROCEDURE Oncology therapists in a psychosocial oncology center were trained in eSCCIP delivery. Participants were eligible for participation if they were the primary caregiver of a child with cancer between the ages 0 and 17, could read and write in English, and had reliable internet access to complete eSCCIP. Surveys were administered electronically at baseline and post intervention to evaluate study endpoints. Effect sizes (Cohen's d) were computed for exploratory psychosocial outcomes. Nineteen parents completed the intervention. RESULTS Parents rated eSCCIP as highly acceptable, feasible, and accessible. A large clinical effect was detected for acute distress (d = 0.79). Moderate clinical effects were reported for overall posttraumatic stress disorder (PTSD) symptoms (d = 0.37), negative mood/cognitions (d = 0.59), and symptoms of anxiety (d = 0.48). CONCLUSIONS Results indicate that eSCCIP is an acceptable, feasible, and accessible psychosocial intervention for parents. Exploratory analyses suggest that participation in eSCCIP may contribute to decreases in acute distress, symptoms of anxiety, and symptoms of PTSD.
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Affiliation(s)
- Kimberly S Canter
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rebecca McIntyre
- Inova Schar Cancer Institute, Life with Cancer, Fairfax, Virginia, USA
| | - Rebecca Babb
- Inova Schar Cancer Institute, Life with Cancer, Fairfax, Virginia, USA.,Department of Pediatric Hematology/Oncology, Inova Children's Hospital, Fairfax, Virginia, USA
| | | | - Gabriela Vega
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA
| | - Amanda Lewis
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA
| | - Cathy Bottrell
- Inova Schar Cancer Institute, Life with Cancer, Fairfax, Virginia, USA.,Center for Cancer and Blood Disorders, Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Christopher Lawlor
- Center for Cancer and Blood Disorders, Pediatric Specialists of Virginia, Fairfax, Virginia, USA.,Department of Pediatrics, George Washington University, Washington, District of Columbia, USA.,Department of Oncology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Anne E Kazak
- Nemours Center for Healthcare Delivery Science, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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