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Hoag JA, Bingen K, Karst J, Palou A, Yan K, Zhang J. Playing With a Purpose: The Impact of Therapeutic Recreation During Hospitalization. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:6-14. [PMID: 35722870 DOI: 10.1177/27527530211059437] [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: 06/15/2023]
Abstract
Background: Youth undergoing cancer treatment and hematopoietic stem cell transplant (HSCT) spend significant time in the hospital, which is disruptive to their physical, social, and emotional development. Therapeutic recreation (TR) can help individuals with an illness maintain or improve their health, quality of life, and physical functioning. TR is an understudied intervention, particularly with youth in the hospital setting. Methods: Forty-nine children (median age = 12 years, interquartile range [IQR] 11-15 years) hospitalized for cancer treatment or HSCT were assigned to participate in either the historical control or TR intervention. Participants wore a Fitbit charge HR for three days to measure movement. At the end of the study participation, they completed self-report measures of mood, social connectedness, and health-related quality of life. Results: Compared with historical controls, the TR intervention group had improved positive affect and decreased mood disturbance (p = 0.03); had better sleep quality (p = 0.003); and was more satisfied with the leisure activities offered in the hospital (p = 0.01). There were no differences in the number of steps taken per day, somatic distress, cooperation with cares, or interaction with medical personnel or caregivers. Both groups reported poor availability and support of peer companions. Discussion: TR is one avenue to increase leisure activities and positively impact mood. More thought needs to be given to how TR programs can be leveraged to increase physical activity and social connectedness.
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Affiliation(s)
| | | | - Jeffrey Karst
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Akasha Palou
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ke Yan
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jian Zhang
- 5506Medical College of Wisconsin, Milwaukee, WI, USA
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2
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Deodhar J, Goswami SS, Sonkusare LN. A Retrospective Observational Study of Problems Faced by Children and Adolescents with Cancer: A 5-year Experience from a Pediatric Psycho-Oncology Service in India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1740069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Psychological concerns are common in children and adolescents with cancer, for which they require referral to specialist services. There is a dearth of pediatric psycho-oncology services in India. There are limited studies on emotional and related distress in children.
Objectives To evaluate the types of problems and associated factors in children and adolescents with cancer referred to the pediatric psycho-oncology service in a tertiary care oncology center in India.
Materials and Methods A retrospective analysis of all referrals to the institution's pediatric psycho-oncology service over 5 years was performed. Patients newly referred to the service, up to 18 years of age, with a cancer diagnosis, on active disease-modifying treatment or supportive care or following up within 2 years of completion of treatment were included. Patients not on any disease-modifying treatment and receiving the best supportive care only were excluded as needs and problems would differ in this group. Patients whose medical records were incomplete were excluded too. Descriptive measures and tests of association were performed for analysis.
Results Of the 278 children referred to the service in 5 years, 66.5% were males. The average age was 11 years (standard deviation [SD]: 4.5). Most children had hematolymphoid cancers (58.2%). All reported problems were mainly emotional/behavioral (59%), physical health-related (21%), and academic (14%). Male children, referred from outpatient clinics and undergoing treatment with palliative intent, had more emotional problems, but these factors were not statistically significant.
Conclusion Children and adolescents with cancer had different problems, most commonly emotional/behavioral and physical health-related. Age, gender, and treatment intent were factors associated with emotional problems. Psychosocial care services for children and adolescents with cancer are necessary for low-resource settings.
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Affiliation(s)
- Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Savita S. Goswami
- Psycho-oncology Unit, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Lekhika N. Sonkusare
- Psycho-oncology Unit, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
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3
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Morey A, Loades ME. Review: How has cognitive behaviour therapy been adapted for adolescents with comorbid depression and chronic illness? A scoping review. Child Adolesc Ment Health 2021; 26:252-264. [PMID: 32951336 DOI: 10.1111/camh.12421] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression becomes increasingly common in adolescence. Around 10%-20% of adolescents have a chronic illness, and they are more likely to experience depression. There is emerging evidence for cognitive behaviour therapy (CBT) interventions to treat depression in adolescents with chronic illnesses, yet no review has been undertaken of how these CBT interventions are delivered in practice. METHODS We conducted a scoping review to summarise how CBT has been delivered in adolescents with chronic illness and depression. We included studies that evaluated CBT aimed at treating depression/depressive symptoms in adolescents with chronic illness. Searches were carried out across Embase and PsycNET. RESULTS Twelve studies met our inclusion criteria. These included diabetes (n = 3), inflammatory bowel disease (n = 3), polycystic ovary syndrome (n = 2), chronic headache (n = 1), chronic pain (n = 1), chronic fatigue syndrome (n = 1) and Fanconi anaemia (n = 1). Adaptations made to the delivery of CBT included cognitive restructuring of illness-related thoughts, behavioural activation balancing illness-related and enjoyable activities, psychoeducation of the comorbidity and link between the chronic illness and depression, relationship building, skill building and parental or familial involvement. CBT was typically delivered by trained professionals with expertise in working with adolescents, who worked under supervision. CONCLUSIONS CBT for depression is commonly adapted for this population, and the nature of cognitions and behaviours targeted in CBT may typically depend on how the chronic illness presents. There is relatively little evidence to date, and a need for more research into the efficacy and effectiveness of treatments for adolescent depression in this vulnerable population specifically.
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Affiliation(s)
- Alice Morey
- Department of Psychology, University of Bath, Bath, UK
| | - Maria E Loades
- Department of Psychology, University of Bath, Bath, UK.,Bristol Medical School, University of Bristol, Bristol, UK
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4
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Berkman AM, Robert RS, Roth M, Askins MA. A review of psychological symptoms and post-traumatic growth among adolescent and young adult survivors of childhood cancer. J Health Psychol 2020; 27:990-1005. [PMID: 33153307 DOI: 10.1177/1359105320971706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The majority of childhood cancer patients survive well into adulthood, but remain at risk for psychological late effects that can impact overall health and quality of life. The current narrative review summarizes the literature on psychological late effects, including anxiety, depression, psychological distress, post-traumatic stress disorder, suicidality, psychoactive medication use, and post-traumatic growth in survivors of childhood cancers. While results were mixed, many studies demonstrated that psychological symptoms occurred at levels higher than would be expected in the general population. Treatment, environmental, and behavioral risk factors, as well as symptom onset and trajectory merit further investigation.
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Affiliation(s)
| | | | - Michael Roth
- The University of Texas MD Anderson Cancer Center, USA
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5
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Yardeni M, Abebe Campino G, Bursztyn S, Shamir A, Mekori-Domachevsky E, Toren A, Gothelf D. A three-tier process for screening depression and anxiety among children and adolescents with cancer. Psychooncology 2020; 29:2019-2027. [PMID: 32691478 DOI: 10.1002/pon.5494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To establish and to evaluate the effectiveness of a three-tier screening process of depressive and anxiety disorders among children and adolescents with cancer based on questionnaires (first tier), semistructured psychiatric interviews (second tier), and referral for psychiatric assessment and recommendations for treatment (third tier). We also aimed to determine the rates of depressive and anxiety disorders among participants. METHODS Participants and their parents completed the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety modules. Then, they were interviewed separately using the semistructured Affective and Anxiety Modules of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). PROMIS cutoff values for diagnosing depressive and anxiety disorders, based on the K-SADS, were calculated by receiver-operating characteristics (ROCs). RESULTS Of 91 participants 34 (37.4%) aged 7 to 21 years with cancer met the K-SADS criteria for depressive and/or anxiety disorders. The results of the ROC analyses were stronger for depressive disorders than for anxiety disorders and for more severe cases. The cutoff of 13 on the child-reported PROMIS for a major depressive episode had a sensitivity of 0.80 and a specificity of 0.82, and a cutoff of 14 on the parent-reported PROMIS for generalized anxiety disorder had a sensitivity of 0.78 and a specificity of 0.79. CONCLUSIONS Using the K-SADS, we found that anxiety and depressive disorders are very common in youngsters with cancer. The three-tier screening process we developed for depression and anxiety in this population provides practical cutoff values for identifying depressive and anxiety disorders in children with cancer.
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Affiliation(s)
- Maya Yardeni
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel
| | - Gadi Abebe Campino
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Bursztyn
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Mekori-Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Amos Toren
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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6
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Reed-Berendt R, Shafran R, Langdon D, Christie D, Hough R, Coughtrey A. Experiences of Low Mood in Young People With Cancer: A Qualitative Study. J Pediatr Oncol Nurs 2019; 36:424-435. [DOI: 10.1177/1043454219844232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Young people with cancer are at increased risk of psychological difficulty; yet there is little research on their experiences of low mood or depressive symptoms to help inform treatment interventions. This qualitative study explored experiences and opinions of low mood or depression in young people with cancer, how their mood related to developmental challenges, strategies used to cope, and how services could improve support. Nineteen young people diagnosed and treated for cancer completed semistructured interviews. Transcripts were thematically analyzed using the framework approach, and analysis produced eight themes, organized into three domains: “A Harder Time of Life,” “Interpersonal Impact of Cancer,” and “Learning to Understand and Describe Low Mood,” Participants interviewed experienced low mood during cancer and predominantly felt “low mood” was a helpful term to describe their emotions. There were similarities and variations in their reported mood compared with clinical depression. The developmental challenges of being a young person with cancer negatively affected their mood. Participants used a variety of different coping strategies to manage these challenges. Young people were clear that they would like others to help them understand negative emotions experienced through cancer are normal to feel and support for low mood to be accessible and available.
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Affiliation(s)
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | | | - Anna Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK
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7
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Graef DM, Crabtree VM, Srivastava DK, Li C, Pritchard M, Hinds PS, Mandrell B. Sleep and mood during hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma. Psychooncology 2018; 27:1847-1853. [PMID: 29663636 DOI: 10.1002/pon.4737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Disrupted sleep is common in pediatric cancer, which is associated with psychological distress and may impact neural recovery. Information regarding sleep during pediatric brain tumor treatment is limited. This study aimed to describe objective sleep-wake patterns and examine the sleep-mood relation in youth hospitalized for intensive chemotherapy and stem cell rescue. METHODS Participants included 37 patients (M age = 9.6 ± 4.2 years) enrolled on a medulloblastoma protocol (SJMB03) and their parents. Respondents completed a mood disturbance measure on 3 days, and patients wore an actigraph for 5 days as an objective estimate of sleep-wake patterns. General linear mixed models examined the relation between nocturnal sleep and next-day mood, as well as mood and that night's sleep. RESULTS Sleep duration was deficient, sleep efficiency was poor, and daytime napping was common, with large between-subjects variability. There were minimal mood concerns across all days. The sleep and next-day mood relationship was nonsignificant (P > .05). Greater parent-reported child mood disturbance on day 2 was associated with decreased same-night sleep (P < .001) and greater patient-reported mood disturbance was associated with greater same-night sleep latency (P = .036). CONCLUSIONS Patients with medulloblastoma are vulnerable to disturbed sleep during hospitalization, and mood may be an important correlate to consider. Sleep and mood are modifiable factors that may be targeted to maximize daytime functioning.
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Affiliation(s)
- Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Memphis, TN, USA.,Department of Pediatrics, George Washington University Washington, District of Columbia, Washington, DC, USA
| | - Belinda Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
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8
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Fisher PL, McNicol K, Cherry MG, Young B, Smith E, Abbey G, Salmon P. The association of metacognitive beliefs with emotional distress and trauma symptoms in adolescent and young adult survivors of cancer. J Psychosoc Oncol 2018; 36:545-556. [PMID: 29611779 DOI: 10.1080/07347332.2018.1440276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE/OBJECTIVES Adolescent and young adults who have survived cancer are at an increased risk of psychological distress. This study investigated whether metacognitive beliefs are associated with emotional distress and trauma symptoms in adolescent and young adult (AYA) survivors of cancer independent of known covariates, including current physical health difficulties. DESIGN Cross-sectional survey using multiple self-report measures. SAMPLE AND METHODS Eighty-seven AYA survivors of cancer were recruited from follow-up appointments at an oncology unit and completed self-report questionnaires measuring emotional distress, posttraumatic stress symptoms, metacognitive beliefs, demographic information, and current physical health difficulties. Data were analysed using correlational and hierarchical multiple regression analyses. FINDINGS Metacognitive beliefs explained an additional 50% and 41% of the variance in emotional distress and posttraumatic stress symptoms, respectively, after controlling for known covariate effects, including current physical health difficulties. Conclusions/Implications for Psychosocial Providers or Policy: The metacognitive model of psychopathology is potentially applicable to AYA survivors of cancer who present with elevated general distress and/or posttraumatic stress symptoms. Prospective studies are required to determine whether metacognitive beliefs and processes have a causal role in distress in AYA survivors of cancer.
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Affiliation(s)
- Peter L Fisher
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK.,b Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital , Liverpool , UK.,c Nidaros DPS, Division of Psychiatry, Ostmarka University Hospital , Trondheim , Norway
| | - Kirsten McNicol
- d Division of Clinical Psychology, University of Liverpool , Liverpool , UK
| | - Mary Gemma Cherry
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK.,b Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital , Liverpool , UK
| | - Bridget Young
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK
| | - Ed Smith
- e The Christie Hospital , Manchester , UK
| | - Gareth Abbey
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK
| | - Peter Salmon
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK.,b Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital , Liverpool , UK
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9
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Narendran G, Tomfohr L, Schulte F. Inflammatory cytokines and depression in children with cancer: A review of the literature. Pediatr Hematol Oncol 2018; 35:11-19. [PMID: 29648904 DOI: 10.1080/08880018.2018.1440335] [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] [Indexed: 10/17/2022]
Abstract
Compared to the general pediatric population, pediatric cancer patients are at increased risk of experiencing depressive symptoms during and after their treatment. Clinically, there exist few resources to guide health care professionals in the care of children with cancer who report depressive symptomatology. Pediatric cancer patients experience unique inflammatory changes secondary to their disease and accompanying treatments. It has been reported that inflammatory changes in the context of illness are related to cytokine dysregulation which in turn may influence the expression of depressive symptoms. In this review of current literature, we summarize the existing knowledge, relevant models and studies in progress with respect to this concept.
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Affiliation(s)
- Gaya Narendran
- a Division of Pediatric Oncology, Alberta Children's Hospital , Calgary , Alberta , Canada
| | - Lianne Tomfohr
- b Department of Psychology , Faculty of Arts, University of Calgary , Calgary , Alberta , Canada
| | - Fiona Schulte
- a Division of Pediatric Oncology, Alberta Children's Hospital , Calgary , Alberta , Canada
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10
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Turner-Sack AM, Menna R, Setchell SR, Maan C, Cataudella D. Psychological Functioning, Post-Traumatic Growth, and Coping in Parents and Siblings of Adolescent Cancer Survivors. Oncol Nurs Forum 2016; 43:48-56. [PMID: 26679444 DOI: 10.1188/16.onf.48-56] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine psychological functioning, post-traumatic growth (PTG), coping, and cancer-related characteristics of adolescent cancer survivors' parents and siblings.
. DESIGN Descriptive, correlational.
. SETTING Children's Hospital of Western Ontario in London, Ontario, Canada.
. SAMPLE Adolescents who finished cancer treatment 2-10 years prior (n = 31), as well as their parents (n = 30) and siblings (n = 18).
. METHODS Participants completed self-report measures of psychological distress, PTG, life satisfaction, coping, and cancer-related characteristics.
. MAIN RESEARCH VARIABLES Psychological functioning, PTG, and coping.
. FINDINGS Parents' and siblings' PTG levels were similar to survivors' PTG levels; however, parents reported higher PTG than siblings. Parents who used less avoidant coping, were younger, and had higher life satisfaction experienced less psychological distress. Parents whose survivor children used more active coping reported less psychological distress. Siblings who were older used more active coping, and the longer it had been since their brother or sister was diagnosed, the less avoidant coping they used.
. CONCLUSIONS Childhood and adolescent cancer affects survivors' siblings and parents in unique ways.
. IMPLICATIONS FOR NURSING Relationship to the survivor, use of coping strategies, life satisfaction, and time since diagnosis affect family members' postcancer experiences.
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Affiliation(s)
| | | | | | - Cathy Maan
- Children's Hospital London Health Science Center
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11
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Germann JN, Leonard D, Stuenzi TJ, Pop RB, Stewart SM, Leavey PJ. Hoping Is Coping: A Guiding Theoretical Framework for Promoting Coping and Adjustment Following Pediatric Cancer Diagnosis. J Pediatr Psychol 2015; 40:846-55. [PMID: 25842378 DOI: 10.1093/jpepsy/jsv027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/02/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the pattern of resilience and adjustment following pediatric cancer diagnosis and to evaluate hope as a mediator of adjustment. METHODS 61 participants with pediatric cancer completed measures of hope, depression, anxiety, and quality of life (QoL) within 4 weeks of cancer diagnosis and every 3 months for 1 year. RESULTS Participants showed high and increasing levels of hope and QoL, as well as low and decreasing levels of depression and anxiety. Linear mixed-effects regression analyses revealed changes in depression, anxiety, and hope to be significant predictors of changes in QoL. Changes in hope were found to partially mediate the effects of depression and anxiety on QoL. CONCLUSIONS While a variety of interventions are efficacious for treating anxiety and depression, hope theory provides a framework for choosing interventions that may more globally promote children's ability to maintain good functioning, adjustment, well-being, and QoL following cancer diagnosis.
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Affiliation(s)
- Julie N Germann
- Department of Psychiatry, Children's Health Children's Medical Center Dallas, University of Texas Southwestern Medical Center,
| | - David Leonard
- Department of Clinical Research, Children's Health Children's Medical Center Dallas
| | - Thomas J Stuenzi
- Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health Children's Medical Center Dallas, and
| | - Radu B Pop
- Department of Psychiatry, Children's Health Children's Medical Center Dallas
| | - Sunita M Stewart
- Department of Psychiatry, Children's Health Children's Medical Center Dallas, University of Texas Southwestern Medical Center
| | - Patrick J Leavey
- Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health Children's Medical Center Dallas, and Department of Pediatrics, University of Texas Southwestern Medical Center Dallas
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Ahomäki R, Gunn ME, Madanat-Harjuoja LM, Matomäki J, Malila N, Lähteenmäki PM. Late psychiatric morbidity in survivors of cancer at a young age: A nationwide registry-based study. Int J Cancer 2014; 137:183-92. [DOI: 10.1002/ijc.29371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/18/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Ritva Ahomäki
- Department of Pediatrics; Turku University Hospital; Turku Finland
| | - Mirja E. Gunn
- Department of Pediatrics; Turku University Hospital; Turku Finland
| | | | | | - Nea Malila
- Finnish Cancer Registry; Helsinki Finland
- School of Health Sciences; University of Tampere; Tampere Finland
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13
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Howard Sharp KM, Rowe AE, Russell K, Long A, Phipps S. Predictors of psychological functioning in children with cancer: disposition and cumulative life stressors. Psychooncology 2014; 24:779-86. [PMID: 25132111 DOI: 10.1002/pon.3643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study examined psychological functioning in children with a history of cancer and a matched sample of healthy peers, while exploring the roles of disposition and stressful life events. METHOD Participants were 255 children with a history of cancer and 101 demographically matched children (8-17 years). Children completed measures of depression, anxiety, and posttraumatic stress symptoms (PTSS); history of stressful life events; and dispositional factors, including optimism and a five-factor personality measure. RESULTS Children with cancer did not differ from peers with regard to depression and PTSS, but reported significantly lower anxiety. In hierarchical regressions, children's depression, anxiety, and PTSS scores were largely predicted by dispositional variables and, to a lesser extent, stressful life events, after controlling for demographics and health status. CONCLUSION Children's psychological functioning is predicted primarily by disposition, and secondarily by history of stressful life events, with health status (i.e., cancer versus control) accounting for minimal, and often non-significant variance in children's functioning. These findings further support that children with cancer are generally resilient, with factors predictive of their adjustment difficulties mirroring those of children without history of serious illness.
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Affiliation(s)
- Katianne M Howard Sharp
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Anjoli E Rowe
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathryn Russell
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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14
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Canning S, Bunton P, Talbot Robinson L. Psychological, demographic, illness and treatment risk factors for emotional distress amongst paediatric oncology patients prior to reaching 5-year survivorship status. Psychooncology 2014; 23:1283-91. [DOI: 10.1002/pon.3563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 03/23/2014] [Accepted: 04/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
- S. Canning
- Division of Clinical Psychology; University of Manchester, UK
| | - P. Bunton
- Division of Clinical Psychology; University of Manchester, UK
| | - L. Talbot Robinson
- Paediatric Psychosocial Service; Royal Manchester Children's Hospital; Harrington Building UK
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15
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Clerici CA, Ferrari A, Simonetti F, Massimino M. Psychotherapy and psychopharmacology for mental health in adolescents with cancer: what integration is possible? Expert Rev Anticancer Ther 2014; 11:1623-5. [DOI: 10.1586/era.11.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Relationships Among Therapy-Related Symptoms, Depressive Symptoms, and Quality of Life in Chinese Children Hospitalized With Cancer. Cancer Nurs 2013; 36:346-54. [DOI: 10.1097/ncc.0b013e31824062ec] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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17
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McNicol K, Salmon P, Young B, Fisher P. Alleviating Emotional Distress in a Young Adult Survivor of Adolescent Cancer. Clin Case Stud 2012. [DOI: 10.1177/1534650112461298] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A substantial proportion of adolescent and young adult cancer survivors experience persistent emotional distress, but little research has evaluated psychological interventions in this population. Metacognitive therapy (MCT), a transdiagnostic intervention, is an effective treatment for depression and a range of anxiety disorders in mental health settings, but its efficacy in cancer populations is unknown. This study used an AB design with 6-month follow-up to evaluate the potential efficacy of MCT for reducing symptoms of depression, anxiety, and posttraumatic stress in a young adult female survivor of adolescent leukemia. Clinician-rated and self-report measures demonstrated large, clinically meaningful, improvements on all outcome measures over seven treatment sessions, and these gains were maintained at 6-month follow-up. The case study demonstrates the potential applicability of MCT to treating emotional distress in young adult survivors of childhood cancer.
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Adduci A, Jankovic M, Strazzer S, Massimino M, Clerici C, Poggi G. Parent-child communication and psychological adjustment in children with a brain tumor. Pediatr Blood Cancer 2012; 59:290-4. [PMID: 22492656 DOI: 10.1002/pbc.24165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 03/19/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Internalizing problems, anxiety, depression, withdrawal, and consequent social problems are frequently observed in children with brain tumors. The objective of this work is to describe the relationship between these psychological problems and the type of parent-child communication established about the disease. PROCEDURES A group of 64 children surviving a brain tumor (aged 4-18 years) underwent psychological assessment by means of parent reports on the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS). A semi-structured interview with each child and their parents enabled us to classify the method of communication regarding the disease as "avoidance," "ineffective," and "effective." Demographic, clinical, and functional data relating to the disease were also collected. RESULTS A significant relationship between the onset of Internalizing problems, withdrawal, anxiety-depression, and social problems and the presence of avoidance or ineffective communication about the disease was observed (P = 0.001, P = 0.001, P = 0.001, and P = 0.01, respectively). These psychological problems did not prove to be associated to demographic or clinical variables; however, they were found to be related to the children's residual functional problems. By contrast, the method of communication proved to be unrelated to clinical or functional variables, but it was associated to demographic variables such as sex and age at assessment. CONCLUSIONS Effective (complete, truthful, consistent, comprehensible, gradual and continuous, and tailored) communication to the child about his/her condition proved to be associated with a better psychological outcome.
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Durualp E, Altay N. A Comparison of Emotional Indicators and Depressive Symptom Levels of School-Age Children With and Without Cancer. J Pediatr Oncol Nurs 2012; 29:232-9. [DOI: 10.1177/1043454212446616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to compare the emotional indicators and depressive symptom levels of 6- to 12-year-old children with and without cancer. The sample included 20 children with cancer and 20 healthy children of similar ages and gender. Data were collected by using the Child Introduction Form, Children’s Depression Inventory, the Human Figure Drawing test, and children’s drawings. The results showed that the depressive symptom levels of children with cancer were significantly higher than those of healthy children. Impulsivity, mistrust, and anger were observed significantly more in children with cancer ( P < .05). Although anxiety was equal in the two groups, shyness was observed more in the cancer group, though the difference was not significant ( P > .05). The emotional indicators of both groups of children did not have an effect on their depression scores.
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Turner-Sack AM, Menna R, Setchell SR, Maan C, Cataudella D. Posttraumatic growth, coping strategies, and psychological distress in adolescent survivors of cancer. J Pediatr Oncol Nurs 2012; 29:70-9. [PMID: 22422791 DOI: 10.1177/1043454212439472] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Only recently have researchers begun to empirically examine positive outcomes such as posttraumatic growth in adolescent cancer. This article examines associations between posttraumatic growth, coping strategies, and psychological distress in adolescent cancer survivors. Adolescents who finished cancer treatment 2 to 10 years prior (N = 31) completed self-report measures of posttraumatic growth, coping, symptomatology, and disease-related characteristics. Younger age at diagnosis and less use of avoidant coping strategies predicted lower levels of psychological distress. Adolescents' beliefs that they were more likely to relapse and the use of more acceptance coping strategies predicted higher levels of posttraumatic growth. Adolescent cancer survivors may be capable of experiencing posttraumatic growth. Those who believe they are more prone to relapse and use more acceptance coping strategies are likely to have higher levels of posttraumatic growth. As health care professionals encourage adolescent cancer survivors to use fewer avoidant coping strategies, they can also encourage survivors to use more acceptance coping strategies.
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Phipps S, Peasant C, Barrera M, Alderfer MA, Huang Q, Vannatta K. Resilience in children undergoing stem cell transplantation: results of a complementary intervention trial. Pediatrics 2012; 129:e762-70. [PMID: 22311995 PMCID: PMC3289525 DOI: 10.1542/peds.2011-1816] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Children undergoing stem cell transplantation (SCT) are thought to be at risk for increased distress, adjustment difficulties, and impaired health-related quality of life (HRQL). We report results of a multisite trial designed to improve psychological adjustment and HRQL in children undergoing SCT. METHODS A total of 171 patients and parents from 4 sites were randomized to receive a child-targeted intervention; a child and parent intervention; or standard care. The child intervention included massage and humor therapy; the parent intervention included massage and relaxation/imagery. Outcomes included symptoms of depression and posttraumatic stress, HRQL, and benefit finding. Assessments were conducted by patient and parent report at admission and SCT week+24. RESULTS Across the sample, significant improvements were seen on all outcomes from admission to week+24. Surprisingly, patients who had SCT reported low levels of adjustment difficulties at admission, and improved to normative or better than average levels of adjustment and HRQL at week+24. Benefit finding was high at admission and increased at week+24; however, there were no statistically significant differences between intervention arms for any of the measures. CONCLUSIONS Although the results do not support the benefits of these complementary interventions in pediatric SCT, this may be explained by the remarkably positive overall adjustment seen in this sample. Improvements in supportive care, and a tendency for patients to find benefit in the SCT experience, serve to promote positive outcomes in children undergoing this procedure, who appear particularly resilient to the challenge.
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Affiliation(s)
- Sean Phipps
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN 38105-3678, USA.
| | | | - Maru Barrera
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melissa A. Alderfer
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Qinlei Huang
- Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
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Phipps S, Buckholdt KE, Fernandez L, Wiener L, Kupst MJ, Madan-Swain A, Mullins L, Robert R, Sahler OJ, Vincent N, Noll RB. Pediatric oncologists' practices of prescribing selective serotonin reuptake inhibitors (SSRIs) for children and adolescents with cancer: a multi-site study. Pediatr Blood Cancer 2012; 58:210-5. [PMID: 21284076 DOI: 10.1002/pbc.22788] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 07/20/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To survey pediatric oncologists regarding prescription of selective serotonin reuptake inhibitors (SSRIs) and related medications for the treatment of depression and anxiety disorders in children with cancer. Specifically, we sought to determine (a) how frequently pediatric oncologists prescribed SSRIs and what were the most commonly prescribed agents; (b) how decisions were made to prescribe, particularly whether mental health professionals were consulted; (c) how patients were monitored while on the agents; and (d) how the FDA black box warning has affected prescribing practices. METHOD Oncologists from nine children's cancer centers (N = 151) from across the U.S. were surveyed, responding to either on-line or paper versions of a questionnaire developed for this study. RESULTS A majority of oncologists (71%) reported prescribing SSRIs for their patients. Oncologists reported difficulties differentiating symptoms of depression from aspects of cancer treatment. Mental health practitioners are consulted occasionally but not routinely, and oncologists reported a need for increased mental health resources. Approximately half of oncologists (51%) reported that the FDA black box warning had not affected their practice. In addition, only 28% reported monitoring patients on SSRIs at FDA recommended intervals, and only 9% indicated assessing for suicidality. CONCLUSIONS Prescription of SSRIs is a common practice of pediatric oncologists, often without consultation with mental health professionals. Post-prescription monitoring appears to be suboptimal, and does not follow FDA guidelines.
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Affiliation(s)
- Sean Phipps
- Department of Behavioral Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.
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김민희, 신윤정, 원성철, Chuhl Joo Lyu, Kyong-Mee Chung, 이명아. Discrepancy between Parent and Child Report on Quality of Life and Behavioral Problems in Child and Adolescent cancer survivors and Healthy Control Group. ACTA ACUST UNITED AC 2011. [DOI: 10.17315/kjhp.2011.16.3.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Li WHC, Chung JOK, Ho EKY, Chiu SY. Effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of Hong Kong Chinese children hospitalized with cancer. J SPEC PEDIATR NURS 2011; 16:190-8. [PMID: 21702879 DOI: 10.1111/j.1744-6155.2011.00288.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE. To examine the effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of children hospitalized with cancer. DESIGN AND METHODS. A nonequivalent control group design was employed. Children (8-16 years of age; n= 122) admitted to a pediatric oncology ward during a 14-month period were recruited. RESULTS. The results support the effectiveness and feasibility of using the computerized interactive virtual space in reducing depressive symptoms of children hospitalized with cancer. PRACTICE IMPLICATIONS. The results heighten the awareness in nurses of the importance of integrating play activities as an essential component of holistic and quality nursing care.
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Li WHC, Chung JOK, Ho EKY. The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. J Clin Nurs 2011; 20:2135-43. [DOI: 10.1111/j.1365-2702.2011.03733.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Williams NA, Allen MT, Phipps S. Adaptive style and physiological reactivity during a laboratory stress paradigm in children with cancer and healthy controls. J Behav Med 2011; 34:372-80. [DOI: 10.1007/s10865-011-9321-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 01/27/2011] [Indexed: 11/29/2022]
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Medical and Psychiatric Comorbidities in Children and Adolescents: A Guide to Issues and Treatment Approaches. Nurs Clin North Am 2010; 45:541-54, v. [DOI: 10.1016/j.cnur.2010.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Davis GL, Parra GR, Phipps S. Parental Posttraumatic Stress Symptoms Due to Childhood Cancer and Child Outcomes: Investigation of the Role of Child Anger Regulation. CHILDRENS HEALTH CARE 2010. [DOI: 10.1080/02739615.2010.493763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wolfe-Christensen C, Mullins LL, Stinnett TA, Carpentier MY, Fedele DA. Use of the Behavioral Assessment System for Children 2nd Edition: Parent Report Scale in Pediatric Cancer Populations. J Clin Psychol Med Settings 2009; 16:322-30. [DOI: 10.1007/s10880-009-9174-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moitra E, Armstrong CL. Tumor locus moderates anxiety symptoms in a pediatric neuro-oncologic sample. Child Neuropsychol 2009; 15:460-70. [PMID: 19177254 DOI: 10.1080/09297040802665769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite the prevalence of pediatric Central Nervous System (CNS) solid tumors, little is understood about patients' disease-related anxiety experience. Data from 25 remitted pediatric CNS tumor patients posttreatment were collected. Significant symptoms of anxiety were reported by 32% of patients. MRI studies showed all anxious patients had right cortical tumors or left cerebellar tumors. Confound analyses suggest these results are not better accounted for by demographic, disease, or treatment variables. These results evidence the risk some pediatric neuro-oncologic patients face for developing significant anxiety symptoms.
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Affiliation(s)
- Ethan Moitra
- Division of Neuro-oncology, Children's Hospital of Philadelphia, and Department of Psychology, Drexel University, Philadelphia, PA 19102, USA.
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Willingham Piersol L, Johnson A, Wetsel A, Holtzer K, Walker C. Decreasing psychological distress during the diagnosis and treatment of pediatric leukemia. J Pediatr Oncol Nurs 2008; 25:323-30. [PMID: 18780900 DOI: 10.1177/1043454208323293] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A literature review was performed to explore the experiences of parents during their child's diagnosis of leukemia. The findings revealed that anxiety is a major reaction to the diagnosis. Because of the parents' reactions, communication barriers and parental role changes are established between the parent and child. The lack of communication between the parent and child during diagnosis and treatment and parental role changes produce negative outcomes. Negative outcomes place the parent and child at risk for experiencing anxiety years after the illness is treated. This literature review describes positive outcomes that can be accomplished by decreasing the anxiety of parents, which leads to a decrease in communication barriers and parental role changes during the new diagnosis of leukemia. Interventions are provided to increase the support and resources of parents during this phase of the disease. Future research may focus on interventions to decrease anxiety, which will increase communication, produce positive outcomes for treatment, and decrease stress years after the disease is treated.
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Campbell LK, Scaduto M, Van Slyke D, Niarhos F, Whitlock JA, Compas BE. Executive function, coping, and behavior in survivors of childhood acute lymphocytic leukemia. J Pediatr Psychol 2008; 34:317-27. [PMID: 18667478 DOI: 10.1093/jpepsy/jsn080] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the role of executive function in coping and behavioral outcomes in childhood acute lymphocytic leukemia (ALL) survivors. METHODS We examined associations among several domains of executive function (working memory, behavioral inhibition, cognitive flexibility, and self-monitoring), coping, and emotional/behavioral problems in 30 children and adolescents ages 10- to 20-years old who completed treatment for ALL and 30 healthy controls matched on age and sex. RESULTS We found partial support for our hypothesis that performance on executive function measures is associated with strategies used to cope with stress, and emotional and behavioral problems in ALL survivors. CONCLUSIONS Findings suggest that executive function impairment may be associated with difficulties in coping and emotion regulation in a subgroup of children treated for ALL. Directions for future research on executive function deficits and coping skills in survivors of pediatric ALL are suggested.
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Affiliation(s)
- Laura K Campbell
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, P.O. Box 800223, Charlottesville, VA 22908-0223, USA.
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Abstract
We describe the first four cases of an open-label study investigating the response to citalopram in a depressed pediatric oncology population. Advice from the Committee for Safety of Medicines (CSM) in the United Kingdom warning against the use of serotonin-selective reuptake inhibitor (SSRI) antidepressants other than fluoxetine in this age group led to the discontinuation of the study. Advantages of citalopram over fluoxetine in a medical setting are discussed in terms of its favorable drug-interaction profile and shorter half-life. Citalopram was very well tolerated in these patients and preliminary data are presented that support its efficacy as an antidepressant agent in these patients.
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Affiliation(s)
- Margaret DeJong
- South West London and St. George's Mental Health NHS Trust and The Royal Marsden Hospital, Sutton, Surrey, United Kingdom, and McGill University, Montreal, Canada.
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