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Søby AKH, Moos CM, Andersen AH, Ravn SL, Andersen CM, Roessler KK. Adolescents' needs for information and psychosocial support during their mother's breast cancer trajectory: A systematic review. Psychooncology 2023; 32:1163-1172. [PMID: 37271880 DOI: 10.1002/pon.6172] [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: 02/16/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer diagnosis among women. The acute crisis and uncertainty that often follow diagnosis put the family at risk of exhaustion and dysfunction. Adolescents have been identified as a particularly vulnerable group of relatives. To investigate how to prevent distress in this group, we systematically reviewed research on adolescents' (11-21 years) needs for information and psycho-social support during their mothers' breast cancer trajectory. METHOD Systematic searches were conducted in five bibliometric databases. Peer-reviewed, original research of adolescents aged 11-21 with a mother diagnosed with breast cancer was included. Two researchers conducted screening, quality assessment, and data extraction independently. Thematic synthesis was applied to the included studies. RESULTS A total of 8066 studies were screened, and five quantitative and six qualitative studies were included. The results indicated that adolescents' information and psycho-social support needs were poorly met. Many were reluctant to share feelings with family and peers and experienced abandonment during the crisis. Adolescents who were not well informed experienced distress. Poor family functioning increased the level of adolescents' distress. CONCLUSIONS Despite limitations regarding heterogeneity among the studies, eligibility criteria, and quality assessment, this review provides clear clinical implications. Encounter groups may support adolescents during their mother's breast cancer trajectory. Furthermore, healthcare professionals could provide more indirect support to adolescents by providing support and clearer guidelines to parents. Finally, adolescents from poor-functioning families need extra attention.
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Affiliation(s)
| | - Caroline M Moos
- Department of Clinical Research, Hospital Sønderjylland, Aabenraa, Denmark
| | | | - Sophie Lykkegaard Ravn
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Specialized Hospital for Polio and Accident Victims, Rødovre, Denmark
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Oshiro R, Tanabe M, Tada K, Takei J, Yamauchi H, Warita Y, Kamibeppu K. Post-traumatic growth and cancer-related communication among adolescents having mothers with breast cancer. Support Care Cancer 2023; 31:446. [PMID: 37414957 DOI: 10.1007/s00520-023-07915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE This study aimed to clarify the characteristics of post-traumatic growth (PTG) among adolescents having mothers diagnosed with breast cancer and the relationship between PTG and cancer-related communication with breast cancer survivors. METHODS A cross-sectional study was conducted using anonymous self-report questionnaires with breast cancer survivors and adolescent children. PTG in adolescents was measured using the Japanese version of the revised PTG Inventory for Children (PTGI-C-R-J). Furthermore, hierarchical multiple regression analysis was implemented. To evaluate the impact of cancer-related communication on each subscale, the total score of cancer-related communication was switched with other subscales individually within the constructed model. RESULTS A total of 97 breast cancer survivors and their adolescent children were included. The mean scores of the total PTGI-C-R-J and subscale scores for "personal strength," "new possibilities," "relating to others," "appreciation of life," and "spiritual change" were 9.0, 1.7, 1.8, 2.3, 2.4, and 0.9, respectively. The connection between PTG and cancer-related communication was partially clarified. The PTGI-C-R-J score was higher when adolescents shared more information regarding breast cancer with their mothers and lower when adolescents expressed more negative feelings toward their mothers. Communication regarding relationships with mothers was not correlated with PTG. CONCLUSIONS Of all PTG domains, "relating to others" and "appreciation of life" were comparatively higher in adolescents. Health professionals should support breast cancer survivors to ensure that they convey appropriate information regarding their treatment plans and side effects to their adolescent children. Health professionals should help adolescent children express their negative feelings calmly and clearly.
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Affiliation(s)
- Rei Oshiro
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Nursing, School of Nursing, Hyogo Medical University, 1-3-6 Minatojima, Chuo-Ku, Kobe, 650-8530, Japan.
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiichiro Tada
- Department of Breast and Endocrine Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Junko Takei
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Youko Warita
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate Programs in Family Nursing, International University of Health and Welfare, Tokyo, Japan
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3
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Campbell KD, Howell KH, Napier TR, Maye C, Thurston IB. Strengths-Based Factors Related to Post-Traumatic Stress Problems in Black Youth with High Body Weights. J Pediatr Psychol 2023; 48:514-522. [PMID: 37335870 PMCID: PMC10544731 DOI: 10.1093/jpepsy/jsad030] [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: 02/16/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Black youth with high body weights [BYHW; Body Mass Index (BMI)≥95th percentile] endure unique stressors (e.g., exposure to discrimination due to race and size) that may contribute to psychopathology. Factors that decrease mental health problems associated with these stressors have been underexamined in BYHW. The current study assessed how multisystemic resilience, weight-related quality of life (QOL), and discrimination were associated with post-traumatic stress problems in BYHW from the perspective of youth and their caregivers. METHODS A total of 93 BYHW and one of their primary caregivers were recruited from a Midsouth children's hospital. Youth ranged in age from 11 to 17 years (Mage=13.94, SD = 1.89), were mostly girls (61.3%), and had CDC-defined BMI scores above the 95th percentile. Nearly all caregivers were mothers (91.4%; Mage=41.73 years, SD = 8.08). Youth and their caregivers completed measures of resilience, discrimination, weight-related QOL, and post-traumatic stress problems. RESULTS Utilizing linear regression modeling, the youth model was significant [F(3, 89)=31.63, p<.001, Adj. R2=.50], with higher resilience (β=-.23; p=.01) and lower discrimination (β=.52; p<.001) associated with fewer post-traumatic stress problems. The caregiver regression model was also significant [F(2, 90)=10.45, p<.001, Adj. R2=.17], with higher weight-related QOL associated with lower post-traumatic stress problems (β=-.37; p<.001). CONCLUSIONS Findings illustrate differences in youth and caregiver perceptions of factors related to post-traumatic stress problems in BYHW. Youth emphasized both internal and external contributors to stress, while caregivers focused on internal variables. Such knowledge could be harnessed to develop strengths-based interventions that address health and well-being among BYHW.
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Affiliation(s)
- Kaytryn D Campbell
- Department of Psychological Sciences, University of Missouri—St. Louis, USA
| | | | | | - Caitlyn Maye
- Department of Psychological & Brain Sciences, Texas A&M University, USA
| | - Idia B Thurston
- Department of Psychological & Brain Sciences, Texas A&M University, USA
- Department of Health Behavior, Texas A&M Health, USA
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Geertz W, Frerichs W, Inhestern L, Bergelt C. Supportive and psychosocial peer-group interventions for children and adolescents of parents with cancer: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 114:107844. [PMID: 37331281 DOI: 10.1016/j.pec.2023.107844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Children and adolescents are highly affected by their parents` cancer disease. This review aims to summarize peer-group interventions for children and adolescents of cancer patients, where those affected have the opportunity to exchange and normalize their feelings among equals. METHODS A systematic review searching four different databases (MEDLINE, PsycInfo, CINAHL and Web of Science) was conducted. We included studies investigating psychosocial peer-group interventions for offspring of cancer patients. A narrative synthesis summarised the characteristics of the interventions and the findings on effects and evaluation. RESULTS Ten articles on seven different peer-group interventions were analysed. Research designs and intervention concepts were heterogeneous. Overall, high acceptance, feasibility and positive effects of peer-group support were reported. Significant effects were found in six studies, e.g. in relation to psychological well-being, quality of life and coping skills. CONCLUSION Peer-group interventions are an accepted and helpful form of support. Providing children and adolescents of cancer patients for example with psychoeducation, community and coping strategies, thereby impacting on psychological well-being. PRACTICE IMPLICATIONS For comprehensive care, it seems to be important to offer support throughout the parent's cancer journey and to offer support flexibly as needed through group services as well as individual sessions.
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Affiliation(s)
- Wiebke Geertz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Medical Psychology, University Medicine Greifswald, Germany
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Communication between mothers with breast cancer and minor children: a qualitative systematic review and meta-synthesis. Support Care Cancer 2023; 31:169. [PMID: 36786856 DOI: 10.1007/s00520-023-07630-9] [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: 05/18/2022] [Accepted: 02/05/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Both women with breast cancer and their minor children were affected by a breast cancer diagnosis. The purpose of this review was to synthesize the evidence from qualitative studies on illness-related communication between mothers with breast cancer and their minor children from mothers' perspectives. METHODS A thorough systematic review and meta-synthesis of qualitative studies was conducted. English articles published prior to 6 November 2021 were searched from five databases, including PubMed/ MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO. After screening the titles, abstracts, and full texts, seven articles were finally included in the quality appraisal and meta-aggregation. RESULTS Four synthesized findings were derived from seven articles, including disclosure dilemma, factors impacting disclosure, methods of communication, and information needs. CONCLUSIONS This systematic review offered insight into the communication between mothers with breast cancer and their minor children. Various factors influenced the decision-making process on illness-related disclosure, as well as the methods and contents of the communication. Future studies should be undertaken to explore the common model shared by mothers and children who have had comparable experiences, as well as to completely analyze the differences between different cultures in this topic.
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Maternal Cancer and Perception of Child Psychological Adjustment: The Role of Mother's Anxiety, Depression, and Parenting Stress. Cancers (Basel) 2023; 15:cancers15030910. [PMID: 36765868 PMCID: PMC9913337 DOI: 10.3390/cancers15030910] [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: 12/12/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
A mother's cancer diagnosis may have consequences for all family members, particularly for children, since it makes a parent less physically and emotionally available, with effects on the relationship with the child and his/her development. The main aim of this study was to analyze children's psychological adjustment in the context of maternal cancer by considering factors related to the child (i.e., age and sex), the mother (psychological adjustment), and cancer (i.e., time elapsed from the diagnosis and current oncological treatment). Self-report questionnaires investigating mothers' parenting stress, depression, anxiety, and children's emotional and behavioral problems were administered to 124 mothers (mean age = 44.52 years; SD = 7.22) diagnosed with cancer. A hierarchical regression analysis highlighted that time since diagnosis and mothers' anxiety and parenting stress accounted for almost 44% of the variance of the children's difficulties. Maternal depression, current oncological treatment, and the child's age and sex were not statistically significant. Higher mothers' parenting stress and anxiety and a longer time elapsed since the first diagnosis predicted higher levels of children's emotional and behavioral problems. These findings highlight the need to identify precursors of childhood distress in the context of maternal cancer and to develop structured programs to support both mothers and children.
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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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Zamir O, Bentley G, He Y. A Promotive Process of Resource Gain Against Harsh and Inconsistent Discipline in Mothers Coping With Breast Cancer: A Serial Mediation Model. Front Psychiatry 2022; 13:859604. [PMID: 35782420 PMCID: PMC9243754 DOI: 10.3389/fpsyt.2022.859604] [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] [Received: 01/21/2022] [Accepted: 04/27/2022] [Indexed: 12/09/2022] Open
Abstract
Breast cancer is a life-threatening disease and a source of enduring stress. The Family Stress Model posits that psychological distress provoked by stressful conditions may spill over and intensify harsh and inconsistent parental discipline. However, the Conservation of Resources theory posits that having more resources may lead to further resource gain, which may promote adaptive coping with adversities. Therefore, this study examined a serial mediation model in which financial resources (income) are predicted to be associated with more interpersonal resources (paternal involvement). The latter is expected to be linked with less maternal post-traumatic stress symptoms, which, in turn, should be associated with less harsh and inconsistent discipline in mothers coping with breast cancer. A sample of 100 Israeli mothers receiving breast cancer treatments was recruited through social media. The participants completed online self-report questionnaires. Structural Equation Modeling indicated significant serial mediation, in which a greater income level was associated with more paternal involvement, which was linked to a lower level of maternal post-traumatic symptoms. The latter, in turn, was associated with less harsh and inconsistent maternal discipline practices. We controlled for illness severity and the time since diagnosis, which did not predict maternal discipline practices. The study suggests that although breast cancer is a stressful condition for any family, having more financial resources can be a significant promotive factor predicting a cascading process by which paternal functioning facilitates better mental health of mothers, and, in turn, better maternal parenting practices.
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Affiliation(s)
- Osnat Zamir
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriella Bentley
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaliu He
- Social Work & Marriage and Family Therapy Department, Iona College, New Rochelle, NY, United States
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Illness unpredictability and psychosocial adjustment of adolescent and young adults impacted by parental cancer: the mediating role of unmet needs. Support Care Cancer 2021; 30:145-155. [PMID: 34241699 PMCID: PMC8636435 DOI: 10.1007/s00520-021-06379-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/19/2021] [Indexed: 11/14/2022]
Abstract
Purpose Given the large number of adolescents and young adults (AYAs) impacted by parental cancer and the potential for negative psychosocial outcomes in this vulnerable population, this study examined the mediating role of offspring unmet needs with regard to parental cancer and the relation between AYAs psychosocial adjustment and perceived illness unpredictability. Methods A total of 113 AYAs (aged 11–24 years) living with a parent diagnosed with cancer completed a questionnaire assessing illness unpredictability, offspring unmet needs, and psychosocial adjustment (i.e., health-related quality of life and internalizing problems). Results Higher offspring unmet needs were associated with lower health-related quality of life (r = –0.24**) and higher internalizing problems (r = 0.21*). Offspring unmet needs mediated the relation between illness unpredictability and health-related quality of life (standardized indirect effect = –0.100* [–0.183, –0.018]) but not internalizing problems (standardized indirect effect = 0.067 [–0.015, 0.148]). In particular, higher illness unpredictability was related to higher unmet needs (β = 0.351**) which, in turn, predicted lower health-related quality of life (β = –0.286**). Conclusion These findings identify offspring unmet needs and illness unpredictability as implicated in AYAs positive psychosocial adjustment to parental cancer. Given that AYAs are at greater risk of elevated psychosocial difficulties, interventions should target offspring unmet needs and perception of illness unpredictability to mitigate the adverse effects of parental cancer.
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Recognition of Insufficient Competence-Nurses' Experiences in Direct Involvement With Adolescent Children of Cancer Patients. Cancer Nurs 2020; 43:32-44. [PMID: 30299419 DOI: 10.1097/ncc.0000000000000646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A parent's cancer may have disruptive impact on his/her adolescent children. Currently, nurses have been regarded as central actors in direct involvement with patients' minor children. Development of an extended nursing role has become a pertinent issue. OBJECTIVE Adolescents' needs tend to be overlooked by nurses because of inexperience with this population. The aim of this study was to explore nurses' experiences of direct involvement with these adolescents, to get a deeper understanding about this phenomenon. METHODS Using a constructivist grounded theory approach, 12 interviews were conducted among Norwegian nurses within the cancer care context. The category insufficient competence was explored through analyzing participants' experiences of direct involvements with adolescents. RESULTS The recognition of insufficient competence became visible as nurses experienced being involved with a population about whom they held inadequate and limited knowledge. Adolescents were perceived as unpredictable and rejecting nurses' approaches. Consequently, nurses feared involvement and experienced failing on their assignments. After completing more or less failed attempts to establish good relationships with adolescents, the nurses request for more knowledge and experience in order to support this group. CONCLUSIONS Nurses are recognizing insufficient competence in direct involvement with adolescents, which calls for extended competence. Because nurses are not the only responsible actors performing in this field, building competence requires a broadened attention at both an individual and organizational level, across several healthcare disciplines, as well as through user participation. IMPLICATIONS FOR PRACTICE Competence building should be considered in light of organizational frameworks, collective learning possibilities across disciplines, and opportunities for involving adolescents/young adults as user participants.
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Rodríguez L. An exploration of resilience in adolescents facing maternal cancer. Cancer Rep (Hoboken) 2020; 3:e1208. [PMID: 32672001 DOI: 10.1002/cnr2.1208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Research findings on the impact of parental cancer on adolescents are inconsistent, some studies identifying negative psychosocial impact but others identifying positive impact; however, there is not enough understanding on the underlying factors that may lead to differences in outcomes. Research has found that resilience has a role in adolescents' adaptation to maternal cancer; however, the nature of this requires further exploration. AIMS This analysis will help understand resilience in adolescents that experience maternal cancer by exploring the nature of resilience and the individual, family, and environmental risk and protective factors that determine resilience in adolescent lived experiences of maternal cancer that enable positive outcomes. METHODS This study is part of a larger investigation focused on understanding adolescent adjustment to maternal cancer and the psychosocial factors that promote adjustment. Original adolescent interview transcripts (n = 15) were subject to a secondary thematic analysis. RESULTS The analysis yielded four themes: the first theme, The Journey of Maternal Cancer, describes adolescent experiences of maternal cancer over time; the second theme is a detailed description of adolescent Protective Factors and how these supported the adolescents; the third theme describes the Risk Factors that adolescents faced; and the fourth theme summarizes the Positive Outcomes that adolescents self-identified. CONCLUSION This study found resilience as dynamic, as it changes over time. These changes are a result of the course of maternal illness and its treatment over time. Adolescents can adapt to change, but this capacity is shaped by protective factors and risk factors as well as challenges that are unique to having a mother diagnosed with cancer. Most adolescents managed to navigate successfully and identified positive outcomes from a difficult and life-changing experience. The study suggests the need to provide long-term supports for adolescents and carry out longitudinal research to further understand the trajectories of resilience in adolescents who experience maternal cancer.
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Affiliation(s)
- Leonor Rodríguez
- UNESCO Child and Family Research Centre NUI Galway, Galway, Ireland
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Chan A, Lomma C, Chih H, Arto C, McDonald F, Patterson P, Willsher P, Reid C. Psychosocial consequences in offspring of women with breast cancer. Psychooncology 2019; 29:517-524. [PMID: 31733016 DOI: 10.1002/pon.5294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 11/14/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Breast cancer (BC) accounts for 24% of female cancers, with approximately one quarter of women likely to have offspring aged less than 25 years. Recent publications demonstrate negative psychosocial well-being in these offspring. We prospectively assessed for psychological distress and unmet needs in offspring of BC patients. METHODS Eligible offspring aged 14 to 24 years were consented and completed the Kessler-10 Questionnaire and Offspring Cancer Needs Instrument. Demographic and BC details were obtained. RESULTS Over a 7-month period, 120 offspring from 74 BC patients were included. Fifty-nine mothers had nonmetastatic BC (nMBC), and 27 had metastatic BC (MBC) with median time from diagnosis of 27.6 and 36.1 months, respectively. The prevalence of high/very high distress was 31%, with significantly higher scores reported by female offspring (P = .017). Unmet needs were reported by more than 50% of offspring with the majority of needs relating to information about their mother's cancer. Greater unmet needs were seen in female offspring and offspring with none or one sibling for several domains (practical assistance, time-out, dealing with feelings, and support from friends; P < .05). Greater unmet needs were seen in regard to feelings for MBC patients' offspring compared with nMBC but were similar for other unmet needs. CONCLUSIONS Our study confirms high levels of psychological distress in offspring of BC patients, with female offspring reporting significantly higher emotional distress and unmet needs. More than 50% of respondents reported unmet needs in areas that can potentially be supported, including greater information provision, improving practical issues, and enabling sufficient recreational time.
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Affiliation(s)
- Arlene Chan
- Breast Cancer Research Centre-WA, Medical Oncology, Nedlands, Western Australia, Australia.,School of Medicine, Curtin University, Bentley, Perth, Western Australia, Australia
| | - Christopher Lomma
- Breast Cancer Research Centre-WA, Medical Oncology, Nedlands, Western Australia, Australia
| | - HuiJun Chih
- School of Public Health, Curtin University, Bentley, Perth, Western Australia, Australia
| | - Carmelo Arto
- Breast Cancer Research Centre-WA, Medical Oncology, Nedlands, Western Australia, Australia
| | - Fiona McDonald
- CanTeen Australia, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, University of Sydney, Sydney, New South Wales, Australia
| | - Pandora Patterson
- CanTeen Australia, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Willsher
- Breast Cancer Research Centre-WA, Medical Oncology, Nedlands, Western Australia, Australia
| | - Christopher Reid
- School of Public Health, Curtin University, Bentley, Perth, Western Australia, Australia
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Langlois CM, Bradbury A, Wood EM, Roberts JS, Kim SYH, Riviere ME, Liu F, Reiman EM, Tariot PN, Karlawish J, Langbaum JB. Alzheimer's Prevention Initiative Generation Program: Development of an APOE genetic counseling and disclosure process in the context of clinical trials. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2019; 5:705-716. [PMID: 31921963 PMCID: PMC6944715 DOI: 10.1016/j.trci.2019.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction As the number of Alzheimer's disease (AD) prevention studies grows, many individuals will need to learn their genetic and/or biomarker risk for the disease to determine trial eligibility. An alternative to traditional models of genetic counseling and disclosure is needed to provide comprehensive standardized counseling and disclosure of apolipoprotein E (APOE) results efficiently, safely, and effectively in the context of AD prevention trials. Methods A multidisciplinary Genetic Testing, Counseling, and Disclosure Committee was established and charged with operationalizing the Alzheimer's Prevention Initiative (API) Genetic Counseling and Disclosure Process for use in the API Generation Program trials. The objective was to provide consistent information to research participants before and during the APOE counseling and disclosure session using standardized educational and session materials. Results The Genetic Testing, Counseling, and Disclosure Committee created a process consisting of eight components: requirements of APOE testing and reports, psychological readiness assessment, determination of AD risk estimates, guidance for identifying providers of disclosure, predisclosure education, APOE counseling and disclosure session materials, APOE counseling and disclosure session flow, and assessing APOE disclosure impact. Discussion The API Genetic Counseling and Disclosure Process provides a framework for large-scale disclosure of APOE genotype results to study participants and serves as a model for disclosure of biomarker results. The process provides education to participants about the meaning and implication(s) of their APOE results while also incorporating a comprehensive assessment of disclosure impact. Data assessing participant safety and psychological well-being before and after APOE disclosure are still being collected and will be presented in a future publication. Participants may need to learn their risk for Alzheimer's disease to enroll in studies. Alternatives to traditional models of apolipoprotein E counseling and disclosure are needed. An alternative process was developed by the Alzheimer's Prevention Initiative. This process has been implemented by the Alzheimer's Prevention Initiative Generation Program.
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Affiliation(s)
| | - Angela Bradbury
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Elisabeth M Wood
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | - Fonda Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Eric M Reiman
- Banner Alzheimer's Institute, Phoenix, AZ, USA.,Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, USA.,Department of Psychiatry, University of Arizona School of Medicine - Phoenix, Phoenix, AZ, USA.,Department of Psychiatry, University of Arizona, Tucson, AZ, USA.,Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA.,Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | | | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Birgisdóttir D, Bylund Grenklo T, Nyberg T, Kreicbergs U, Steineck G, Fürst CJ. Losing a parent to cancer as a teenager: Family cohesion in childhood, teenage, and young adulthood as perceived by bereaved and non-bereaved youths. Psychooncology 2019; 28:1845-1853. [PMID: 31250504 PMCID: PMC6771813 DOI: 10.1002/pon.5163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to investigate levels of perceived family cohesion during childhood, teenage years, and young adulthood in cancer‐bereaved youths compared with non‐bereaved peers. Methods In this nationwide, population‐based study, 622 (73%) young adults (aged 18‐26) who had lost a parent to cancer 6 to 9 years previously, when they were teenagers (aged 13–16), and 330 (78%) non‐bereaved peers from a matched random sample answered a study‐specific questionnaire. Associations were assessed using multivariable logistic regression. Results Compared with non‐bereaved youths, the cancer‐bereaved participants were more likely to report poor family cohesion during teenage years (odds ratio [OR] 1.6, 95% CI, 1.0‐2.4, and 2.3, 95% CI, 1.5‐3.5, for paternally and maternally bereaved youths, respectively). This was also seen in young adulthood among maternally bereaved participants (OR 2.5; 95% CI, 1.6‐4.1), while there was no difference between paternally bereaved and non‐bereaved youths. After controlling for a number of covariates (eg, year of birth, number of siblings, and depression), the adjusted ORs for poor family cohesion remained statistically significant. In a further analysis stratified for gender, this difference in perceived poor family cohesion was only noted in females. Conclusion Teenage loss of a parent to cancer was associated with perceived poor family cohesion during teenage years. This was also noted in young adulthood among the maternally bereaved. Females were more likely to report poor family cohesion. Our results indicate a need for increased awareness of family cohesion in bereaved‐to‐be families with teenage offspring, with special attention to gender roles.
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Affiliation(s)
- Dröfn Birgisdóttir
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lunds University, Lund, Sweden
| | - Tove Bylund Grenklo
- Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Tommy Nyberg
- Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Caring Sciences, Palliative Research Center, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Gunnar Steineck
- The Sahlgrenska Academy, Department of Oncology, Division of Clinical Cancer Epidemiology, University of Gothenburg Institute of Clinical Sciences, Gothenburg, Sweden
| | - Carl J Fürst
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lunds University, Lund, Sweden
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15
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Dalton L, Rapa E, Ziebland S, Rochat T, Kelly B, Hanington L, Bland R, Yousafzai A, Stein A. Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent. Lancet 2019; 393:1164-1176. [PMID: 30894272 DOI: 10.1016/s0140-6736(18)33202-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Abstract
Many adults diagnosed with a life-threatening condition have children living at home; they and their partners face the dual challenge of coping with the diagnosis while trying to maintain a parenting role. Parents are often uncertain about how, when, and what to tell their children about the condition, and are fearful of the effect on their family. There is evidence that children are often aware that something is seriously wrong and want honest information. Health-care professionals have a key role in supporting and guiding parents and caregivers to communicate with their children about the diagnosis. However, the practical and emotional challenges of communicating with families are compounded by a scarcity of evidence-based guidelines. This Review considers children's awareness and understanding of their parents' condition, the effect of communication around parental life-threatening condition on their wellbeing, factors that influence communication, and the challenges to achieving effective communication. Children's and parents' preferences about communication are outlined. An expert workshop was convened to generate principles for health-care professionals, intended as practical guidance in the current absence of empirically derived guidelines.
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Affiliation(s)
- Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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16
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Koita K, Long D, Hessler D, Benson M, Daley K, Bucci M, Thakur N, Burke Harris N. Development and implementation of a pediatric adverse childhood experiences (ACEs) and other determinants of health questionnaire in the pediatric medical home: A pilot study. PLoS One 2018; 13:e0208088. [PMID: 30540843 PMCID: PMC6291095 DOI: 10.1371/journal.pone.0208088] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/12/2018] [Indexed: 01/24/2023] Open
Abstract
Adverse Childhood Experiences (ACEs) are associated with poor health outcomes, underlining the significance of early identification and intervention. Currently, there is no validated tool to screen for ACEs exposure in childhood. To fill this gap, we designed and implemented a pediatric ACEs questionnaire in an urban pediatric Primary Care Clinic. Questionnaire items were selected and modified based on literature review of existing childhood adversity tools. Children twelve years and under were screened via caregiver report, using the developed instrument. Cognitive interviews were conducted with caregivers, health providers, and clinic staff to assess item interpretation, clarity, and English/Spanish language equivalency. Using a rapid cycle assessment, information gained from the interviews were used to iteratively change the instrument. Additional questions assessed acceptability of screening within primary care and preferences around administration. Twenty-eight (28) caregivers were administered the questionnaire. Cognitive interviews conducted among caregivers and among 16 health providers and clinic staff resulted in the changes in wording and addition of examples in the items to increase face validity. In the final instrument, no new items were added; however, two items were merged and one item was split into three separate items. While there was a high level of acceptability of the overall questionnaire, some caregivers reported discomfort with the sexual abuse, separation from caregiver, and community violence items. Preference for methods of administration were split between tablet and paper formats. The final Pediatric ACE and other Determinants of Health Questionnaire is a 17-item instrument with high face validity and acceptability for use within primary care settings. Further evaluation on the reliability and construct validity of the instrument is being conducted prior to wide implementation in pediatric practice.
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Affiliation(s)
- Kadiatou Koita
- The Center for Youth Wellness, San Francisco, California, United States of America
| | - Dayna Long
- Benioff Children’s Hospital Oakland, Oakland (BCHO), University of California San Francisco, Oakland, California, United States of America
| | - Danielle Hessler
- Department of Family Community Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Mindy Benson
- Benioff Children’s Hospital Oakland, Oakland (BCHO), University of California San Francisco, Oakland, California, United States of America
| | - Karen Daley
- Benioff Children’s Hospital Oakland, Oakland (BCHO), University of California San Francisco, Oakland, California, United States of America
| | - Monica Bucci
- The Center for Youth Wellness, San Francisco, California, United States of America
| | - Neeta Thakur
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Nadine Burke Harris
- The Center for Youth Wellness, San Francisco, California, United States of America
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17
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Majeed MH, Khokhar MA, Abid M, Raza A, Qaisar MN, Ali AA, Waqas A. Frequency and correlates of symptoms of anxiety and depression among young caregivers of cancer patients: a pilot study. BMC Res Notes 2018; 11:631. [PMID: 30170625 PMCID: PMC6119268 DOI: 10.1186/s13104-018-3740-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
Objectives To determine the frequency of symptoms of anxiety and depression among the young caregivers of family members with cancer and their correlation with role of gender, age and socio-economic status. Results A total of 87.8% of caregivers were between 11 and 16 years of age, with 94.6% reported having support from another caregiver. At least 95% of caregivers reported symptoms of anxiety with a higher predisposition among females. Around 73% of caregivers had low monthly incomes followed by (22.9%) middle and (4.1%) high monthly incomes. Care givers belonging to low income groups were more likely to report anxiety and depressive symptoms (70%). Young adults 17–18 years of age reported fewer symptoms of anxiety (10.9%) than their younger counterparts. Reported symptoms of anxiety and depression decreased when the number of care givers increased—2 (67.5%), 3 (16.2%), 4 (5.4%). Increased hospital stay was associated with increased frequency of symptoms, but not beyond 5 weeks. Electronic supplementary material The online version of this article (10.1186/s13104-018-3740-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Muhammad Abbas Khokhar
- Department of Oncology and Radiotherapy, King Edward Medical University, Lahore, Pakistan.
| | - Maryam Abid
- Department of Oncology and Radiotherapy, King Edward Medical University, Lahore, Pakistan
| | - Awais Raza
- King Edward Medical University, Lahore, Pakistan
| | - Muhammad Nawaz Qaisar
- Faculty of Management Sciences, Hamdard University, Islamabad Campus, Islamabad, Pakistan
| | - Ali Ahsan Ali
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ahmed Waqas
- CMH Lahore Medical College & Institute of Dentistry, Lahore Cantt, Pakistan.,Human Development Research Foundation, Rawalpindi, Pakistan
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18
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Faccio F, Ferrari F, Pravettoni G. When a parent has cancer: How does it impact on children's psychosocial functioning? A systematic review. Eur J Cancer Care (Engl) 2018; 27:e12895. [DOI: 10.1111/ecc.12895] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/21/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Flavia Faccio
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
- Applied Research Division for Cognitive and Psychological Science; European Institute of Oncology; Milan Italy
| | - Federica Ferrari
- Applied Research Division for Cognitive and Psychological Science; European Institute of Oncology; Milan Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
- Applied Research Division for Cognitive and Psychological Science; European Institute of Oncology; Milan Italy
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19
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Stefanou K, Zografos E, Zografos GC, Vaslamatzis G, Zografos CG, Kolaitis G. Emotional and behavioural problems in children dealing with maternal breast cancer: a literature review. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2018. [DOI: 10.1080/03069885.2018.1487530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Kalliopi Stefanou
- 1st Department of Propaedeutic Surgery, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
- Transfusion Medicine and Blood Bank Department, General Hospital of Nea Ionia “Konstantopouleio-Patision”, Athens, Greece
| | - Eleni Zografos
- 1st Department of Propaedeutic Surgery, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios C. Zografos
- 1st Department of Propaedeutic Surgery, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Grigoris Vaslamatzis
- 1st Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Constantine G. Zografos
- 1st Department of Propaedeutic Surgery, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
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20
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Mat Saat SA, Hepworth M, Jackson T. “She looked like an Alien”. ASLIB J INFORM MANAG 2018. [DOI: 10.1108/ajim-06-2017-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore the Malay children’s information needs from their experience with parental cancer using information behaviour techniques to elicit sensitive information that provided an indication of what children were thinking.
Design/methodology/approach
Data collection adapted the participatory action research method and used participatory-based techniques that included drawings, essays and interviews. Data explication used an interpretative phenomenological analysis approach. Social constructionism, learning theory and cognitive theory were used to analyse the data. In total, 32 participants took part, ten mothers with breast cancer at different stages of their cancer journey, and 32 children between 6 and 18 years old.
Findings
There are shortcomings in the provision of cancer information for Malay children. Unlike verbose and difficult to digest medical definitions and descriptions about cancer and its treatment, the Malay children defined cancer as having components made from their experiences and observations about how cancer affected their parent. The findings explain the relationship between children participants’ reaction to a health situation and the subsequent processes they undergo to resolve their state of information need.
Originality/value
It highlights the importance of determining information needs and the combined methods used to gain and interpret the experience children face with a parental cancer diagnosis. The findings about ethnic-based information problems, needs and provision for dependent children of cancer patients are one of the original contributions of this research. To the best of the authors’ knowledge, this research is believed to be the first in-depth qualitative and highly participative study of the implications of cancer for dependent children of Malay cancer patients.
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21
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Holst-Hansson A, Idvall E, Bolmsjö I, Wennick A. Hoping to reach a safe haven - Swedish families' lived experience when a family member is diagnosed with breast cancer. Eur J Oncol Nurs 2017; 31:52-58. [DOI: 10.1016/j.ejon.2017.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
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22
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Walczak A, McDonald F, Patterson P, Dobinson K, Allison K. How does parental cancer affect adolescent and young adult offspring? A systematic review. Int J Nurs Stud 2017; 77:54-80. [PMID: 29035733 DOI: 10.1016/j.ijnurstu.2017.08.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To i) identify and synthesise evidence published since 2007 regarding the impact of parental cancer on adolescent and young adult offspring, ii) identify methodological and evidence gaps addressed during this period and iii) highlight those requiring further attention. DESIGN A systematic review and thematic synthesis of peer reviewed literature regarding the impact of parental cancer upon AYA offspring. DATA SOURCES Online searches of CINAHL, Embase, Medline, PsychInfo and Scopus databases were conducted. Reference lists of included articles were screened and additional searches by prominent authors were performed. REVIEW METHODS Study selection, data extraction and quality analysis was undertaken by three independent researchers. Extracted study data was iteratively reviewed and discussed to achieve consensus regarding thematic synthesis of included studies. RESULTS Database and hand-searching yielded 1730 articles, 54 of which were included in the final synthesis. Included studies are discussed with respect to the following themes: i) study design and quality; ii) measurement and sampling; iii) positive and negative aspects of parental cancer; iv) needs; v) communication and information; vi) coping strategies; vii) interventions; and viii) family functioning and other predictors. Twenty-nine studies reported negative impacts related to parental cancer, while eight identified positive outcomes related to post-traumatic growth. Five returned null or mixed findings. Unmet needs were frequently explored and a new validated measure developed. Communication and information were particularly important for offspring, though these needs were often unmet and parents wanted guidance regarding discussions with their children. Offspring may adopt a variety of coping strategies, some of which appear maladaptive, and may cycle between different approaches. Few evaluations of interventions were identified, and further work in this area is needed. Further evidence has emerged that poorer family functioning and other family and illness-related factors predict worse psychosocial outcomes for offspring, however evidence for other predictors such as age and gender remain mixed. CONCLUSIONS Additional evidence for the negative psychosocial impact of parental cancer on adolescent and young adult offspring, their needs, and factors predicting psychosocial outcomes has emerged in the last decade. However, substantial gaps and methodological issues remain and evidence for the development, efficacy or implementation of interventions for this population is very limited. There is also a clear need for greater focus on bereaved and young adult offspring and those from non-western cultural groups, who remain under-represented in research conducted to date.
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Affiliation(s)
| | - Fiona McDonald
- Canteen Australia, NSW, Australia; Cancer Nursing Research Unit, University of Sydney, NSW, Australia
| | - Pandora Patterson
- Canteen Australia, NSW, Australia; Cancer Nursing Research Unit, University of Sydney, NSW, Australia
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23
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Tavares R, Brandão T, Matos PM. Mothers with breast cancer: A mixed-method systematic review on the impact on the parent-child relationship. Psychooncology 2017; 27:367-375. [PMID: 28477374 DOI: 10.1002/pon.4451] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/26/2017] [Accepted: 04/29/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To systematically review and integrate the findings from quantitative and qualitative studies on parenting and parent-child relationships in families where mothers had breast cancer (BC). METHODS Ten different databases were searched from inception to January 2016. All authors assessed these data independently. Full-text, peer-reviewed articles exploring parenting and/or mother-child relationships in families where the mother had BC, regardless of cancer stage, were considered for inclusion. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS From 116 studies, 23 were deemed eligible for inclusion. Five of them were quantitative, 15 were qualitative, and 1 study used a mixed-method approach. Most studies analysed the mother's perceptions about the experience of having BC in parenting and in the parent-child relationship. The majority of studies explored experiences and perspectives on the parent-child relationship in mothers with minor children, although a minority of studies included adult children. Additionally, a few studies (17%) addressed perceptions and experiences of women with advanced stage cancer. Three main themes were found: priorities and concerns of patients, decision-making processes about sharing the diagnosis with their children, and mother-child relationship and parenting after mother's diagnosis. CONCLUSIONS Findings indicated that the diagnosis of BC is accompanied by an array of challenges that affect parental roles and parenting. Further studies are needed to explore these issues more sensitively. For now, however, the evidence suggests that the families of women with BC, and particularly the women themselves, may benefit from informal and formal support aimed at helping them cope effectively with this challenging life event.
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Affiliation(s)
- Rita Tavares
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Tânia Brandão
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
| | - Paula Mena Matos
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
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24
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Beierlein V, Bultmann JC, Möller B, von Klitzing K, Flechtner HH, Resch F, Herzog W, Brähler E, Führer D, Romer G, Koch U, Bergelt C. Measuring family functioning in families with parental cancer: Reliability and validity of the German adaptation of the Family Assessment Device (FAD). J Psychosom Res 2017; 93:110-117. [PMID: 28107886 DOI: 10.1016/j.jpsychores.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The concept of family functioning is gaining importance in psycho-oncology research and health care services. The Family Assessment Device (FAD) is a well-established measure of family functioning. Psychometric properties inherent in the German 51-item adaptation of the FAD are examined in different samples of families with parental cancer. METHODS Acceptance, reliability, and validity of FAD scales are analysed in samples from different study settings (N=1701 cancer patients, N=261 partners, N=158 dependent adolescent children 11 to 18years old). RESULTS Missing items in the FAD scales (acceptance) are rare for adults (<1.1%) and adolescent children (<4.4%). In samples of adults and older adolescents (15 to 18years), all FAD scales except for the Roles scale are significantly reliable (0.75≤Cronbach's α≤0.88). The scales correlate highly (0.46≤Pearson's r≤0.59) with the criterion satisfaction with family life (convergent validity), and have smaller correlations (0.16≤r≤0.49) with measures of emotional distress and subjective well-being (divergent validity). In most FAD scales, adults seeking family counselling report worse family functioning (0.24≤Cohen's d≤0.59) than adults in other samples with parental cancer (discriminative validity). CONCLUSION Overall, the German 51-item adaptation of the FAD reveals good acceptance, reliability, and validity for cancer patients and their relatives. Particularly the scale General Functioning shows excellent psychometric properties. The FAD is suitable in the assessment of families with parental cancer for adults and adolescents older than 11years.
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Affiliation(s)
- Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
| | | | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Muenster, Germany.
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Hospital, Germany.
| | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke-University, Magdeburg, Germany.
| | - Franz Resch
- Department of Child and Adolescent Psychiatry; Heidelberg University Hospital, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany.
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Leipzig University Hospital, Germany; Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Germany.
| | - Daniel Führer
- Department of Child and Adolescent Psychiatry, Psychosomatic s and Psychotherapy, Charité University Medicine Berlin, Germany.
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Muenster, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
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25
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Psychological distress of cancer patients with children under 18 years and their partners-a longitudinal study of family relationships using dyadic data analysis. Support Care Cancer 2016; 25:255-264. [PMID: 27624466 DOI: 10.1007/s00520-016-3411-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE With increasing age at pregnancy, the likelihood of cancer affecting a family with children under 18 is rising and the issue of parents with cancer is gaining importance. Here, we examined the level of anxiety and depression, social support, and partnership satisfaction of cancer patients with children under 18 years and their partners as well as the dyadic patient-partner relationship concerning psychological distress and predictor variables. METHODS We used a longitudinal survey, recruiting patients with children under legal age and their partners (t1 = post therapy, t2 = 6 months after t1, t3 = 12 months after t1). Patients and partners completed the Hospital Anxiety and Depression Scale (HADS), the Oslo 3-item Social Support Scale (OSS-3), and the Abbreviated Dyadic Adjustment Scale (ADAS). We surveyed 161 cancer patients and 115 partners by mail (t1). Anxiety and depression were compared to German normative data. Dyadic relationships of three variables (social support, partnership satisfaction, and employment) and the psychological distress of 81 patient-partner dyads were analyzed with a structural equation model to estimate the actor-partner interdependence model. RESULTS After cancer therapy, 28.3 % of the patients and 46.2 % of their partners had moderate to high levels of anxiety and 17.9 % and 23.1 % had moderate to high levels of depression, respectively. Partners' levels of anxiety (p = 0.002) and depression (p = 0.018) had decreased significantly over the 1-year period post therapy. We found no changes in patients' anxiety (p = 0.444) and depression (p = 0.636) over time. Anxiety and depression did not differ on pair level (p = 0.120-0.928). The level of anxiety in patients and partners was significantly higher than that in the general population (p < 0.001-0.006). The analyses of the dyadic relationships showed a positive effect of social support on psychological distress of the patient (beta = -0.206, p < 0.2). Social support (beta = -0.448, p < 0.001), employment (beta = -0.509, p < 0.01), and satisfaction with partnership (beta = -0.448, p < 0.001) showed a positive impact on psychological well-being of the partner. CONCLUSIONS A cancer experience within a family is a large burden for both patients and partners, highlighting the high incidence of anxiety. The results indicate that couples coping with cancer tend to react as an emotional system rather than as individuals. Patients' reintegration in employment is as important as encouraging partners in their working activities. The findings underline the importance of continuing social support for patients and their partners.
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26
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Bradbury AR, Patrick-Miller L, Schwartz LA, Egleston BL, Henry-Moss D, Domchek SM, Daly MB, Tuchman L, Moore C, Rauch PK, Shorter R, Karpink K, Sands CB. Psychosocial Adjustment and Perceived Risk Among Adolescent Girls From Families With BRCA1/2 or Breast Cancer History. J Clin Oncol 2016; 34:3409-16. [PMID: 27551110 DOI: 10.1200/jco.2015.66.3450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To evaluate the impact of breast cancer family history and maternal BRCA1/2 mutation on the psychosocial adjustment and perceived risk in girls age 11 to 19 years old. MATERIALS AND METHODS Girls age 11 to 19 years old with one or more relatives with breast cancer or a familial BRCA1/2 mutation (breast cancer family history [BCFH] positive, n = 208; n = 69 with BRCA1/2-positive mother), peers (BCFH negative, n = 112), and their mothers completed assessments of psychosocial adjustment, breast cancer-specific distress, and perceived risk of breast cancer. RESULTS General psychosocial adjustment did not differ significantly between BCFH-positive and BCFH-negative girls, either by self-report or mother report, except for higher self-esteem among BCFH-positive girls (P = .01). BCFH-positive girls had higher breast cancer-specific distress than BCFH-negative girls (P < .001), but girls from BRCA1/2-positive families did not differ from other BCFH-positive peers. BCFH-positive girls were more likely to report themselves at increased self-risk for breast cancer in adulthood than BCFH-negative peers (74% v 33%, respectively; P ≤ .001). Girls from BRCA1/2-positive families were more likely than other BCFH-positive and BCFH-negative peers to report themselves at increased risk (P < .001). In all groups, perceived risk of breast cancer was associated with older age. Higher breast cancer-specific distress among adolescent girls was associated with higher self-perceived risk of breast cancer and higher maternal breast cancer-specific distress. CONCLUSION Adolescent girls from BRCA1/2-positive and breast cancer families have higher self-esteem and do not have poorer psychosocial adjustment than peers. However, they do experience greater breast cancer-specific distress and perceived risk of breast cancer, particularly among older girls. Understanding the impact is important to optimize responses to growing up in families at familial and genetic risk for breast cancer, particularly given the debate over the genetic testing of children for cancer susceptibility in adulthood.
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Affiliation(s)
- Angela R Bradbury
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA.
| | - Linda Patrick-Miller
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Lisa A Schwartz
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Brian L Egleston
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Dare Henry-Moss
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Susan M Domchek
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Mary B Daly
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Lisa Tuchman
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Cynthia Moore
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Paula K Rauch
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Rebecca Shorter
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Kelsey Karpink
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
| | - Colleen Burke Sands
- Angela R. Bradbury, Lisa A. Schwartz, Dare Henry-Moss, Susan M. Domchek, Rebecca Shorter, Kelsey Karpink, and Colleen Burke Sands, The Perelman School of Medicine of the University of Pennsylvania; Lisa A. Schwartz, The Children's Hospital of Philadelphia; Brian L. Egleston and Mary B. Daly, Fox Chase Cancer Center, Temple University Health System; Susan M. Domchek, The Basser Research Center for BRCA in the Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Linda Patrick-Miller, The University of Chicago, Chicago, IL; Lisa Tuchman, Children's National Medical Center, Washington, DC; and Cynthia Moore and Paula K. Rauch, Massachusetts General Hospital, Boston, MA
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Teixeira RJ, Pereira MG. Posttraumatic Stress Disorder Symptoms and Family Functioning in Adult Children Facing Parental Cancer: A Comparison Study. Res Theory Nurs Pract 2016; 30:212-228. [PMID: 28304267 DOI: 10.1891/1541-6577.30.3.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study analyzed posttraumatic stress disorder (PTSD) symptoms and family functioning in a sample of adult children caregivers of cancer patients and in a group of adult children of nonchronically ill parents. Participants completed measures of family functioning and PTSD symptoms. The parental cancer group was subdivided into PTSD subgroups, and significant differences, on family functioning, were found. In the parental cancer group, the predictors of PTSD symptoms were being a woman and having an enmeshed or chaotic family functioning. Chaotic functioning mediated the relationship between family communication/satisfaction and PTSD symptoms, in the parental cancer group. Finally, there was a higher prevalence of PTSD symptoms in the parental cancer group, and participants with a probable PTSD diagnosis showed higher levels of family imbalance. This study shows that adult children facing parental cancer, who have a poorer family balance, may benefit from interventions that target family functioning.
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Purc-Stephenson R, Lyseng A. How are the kids holding up? A systematic review and meta-analysis on the psychosocial impact of maternal breast cancer on children. Cancer Treat Rev 2016; 49:45-56. [PMID: 27497342 DOI: 10.1016/j.ctrv.2016.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Having a mother diagnosed with breast cancer can be a distressing time for a child. This review examines the impact maternal breast cancer has on the psychosocial functioning of children and what factors possibly moderate this relationship. METHODS Using PRISMA guidelines, five electronic databases were systematically searched for published studies examining maternal breast cancer and the psychosocial functioning of children. RESULTS A total of 15 studies contributed to the analysis. Results from a random effects meta-analysis show that children experience marginally elevated internalizing problems (standardized mean difference=.14, 95% CI .00, .28), significantly fewer total problem behaviors (standardized mean difference=-.13, 95% CI -.23, -.03), and no changes in externalizing problems (standardized mean difference=-.07, 95% CI -.19, .05) relative to comparison groups. Consistent with this, the narrative review suggests the children may experience elevated depression, anxiety and mental distress yet show more social competence and little aggressive or disruptive behavior. Significant moderating variables included informant type (i.e., self-ratings vs mother's ratings vs other's ratings) and comparison group used (i.e., controls vs normative data). There is also evidence that illness severity and maternal mental health may impact the results. CONCLUSIONS The results suggest that children may be at risk for internalizing-type problems, especially when their mother experiences depression and has serious medical complications. Research using larger and more diverse samples is needed to fully understand how maternal breast cancer impacts children.
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Affiliation(s)
- Rebecca Purc-Stephenson
- Department of Social Sciences, Augustana Faculty, University of Alberta, 4901-46 Ave., Camrose, AB T4V2R3, Canada.
| | - Annelise Lyseng
- Department of Educational Psychology, Faculty of Education, University of Alberta, 11210-87 Ave., Edmonton, AB T6G 2R3, Canada.
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29
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Shallcross AJ, Visvanathan PD, McCauley R, Clay A, van Dernoot PR. The effects of the CLIMB® program on psychobehavioral functioning and emotion regulation in children with a parent or caregiver with cancer: A pilot study. J Psychosoc Oncol 2016; 34:259-73. [PMID: 27355243 DOI: 10.1080/07347332.2016.1191577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study evaluated the psychobehavioral benefits of the Children's Lives Include Moments of Bravery (CLIMB®) intervention in 45 children (aged 6-11) with a parent/caregiver with cancer. Parent/caregiver reports of psychobehavioral functioning indicated signi-ficant decreases in children's emotional symptoms and marginally significant reductions in conduct problems. Child reports of emotion regulation indicated significant increases in emotion awareness, significant decreases in emotion suppression, and nonsignificant increases in emotion-focused coping and dysregulated expression. Parents/caregivers and children reported high satisfaction with CLIMB®. Results suggest CLIMB® is a promising intervention for improving psychobehavioral functioning and emotion regulation in children with a parent/caregiver with cancer.
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Affiliation(s)
| | | | | | - Alex Clay
- b OMNI Institute , Denver , CO , USA
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30
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The well-being of children impacted by a parent with cancer: an integrative review. Support Care Cancer 2016; 24:3235-51. [PMID: 27079580 DOI: 10.1007/s00520-016-3214-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This paper reviewed the peer-reviewed scientific literature on well-being of children impacted by a parent with cancer. METHOD An integrative review of peer-reviewed literature between 2000 and 2015 regarding parental cancer and its impact on families was conducted by searching relevant databases using predefined key search terms. A thematic analysis was undertaken on literature that met inclusion criteria. RESULTS Forty-nine studies met the criteria for this review, and five major themes were established: impact of cancer, communication, coping strategies, parenting factors mediating impact, and support services. There was considerable variability in study design, methodological approaches, and findings. In the majority of studies, children were significantly impacted by the parent's cancer diagnosis and exhibited distress. Daughters appeared to experience worsened mental health, and sons experienced a greater totality of internalizing and externalizing problems. Children of all ages were impacted by their parent's cancer diagnosis and initiated a number of coping strategies in response. Despite this, a significant number of studies revealed that parents underestimated the impact that their cancer had on their children. Family functioning, as well as the ill parents' gender, coping strategies, cancer severity, and mental and physical health mediated their children's well-being. Parent-child communication was a key element in supporting children. CONCLUSION Parental cancer may impact children's long-term well-being. Further investigations are needed in this area. Additionally, review of support programs and interventions are warranted in terms of their uptake and impact on families affected by a parent's cancer.
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31
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Phillips F, Prezio EA. Wonders & Worries: evaluation of a child centered psychosocial intervention for families who have a parent/primary caregiver with cancer. Psychooncology 2016; 26:1006-1012. [PMID: 26954773 DOI: 10.1002/pon.4120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Scant evidence exists to guide interventions for children who have a parent with cancer. This study evaluated the outcomes of a community based psychosocial intervention targeted to children dealing with parental or primary caregiver cancer. This curriculum provided an age-appropriate understanding of the illness, facilitated the expression of feelings, identified individual coping skills to help ease feelings related to parent's cancer, and enhanced the family's ability to communicate about the disease. METHODS Families whose children participated in the six-week curriculum-based intervention completed a questionnaire that included demographic information, a five-item assessment of changes in parenting abilities, and a nine-item assessment of changes in children's behavioral issues. The prevalence of each reported item was determined through a secondary analyses of cross-sectional data derived from a multi-year sample of these survey results. RESULTS A sample of 156 families responded to the survey between 2009 and 2014. A majority of families described improvement in all five areas of parenting abilities assessed including communication skills and confidence in parenting. Amelioration of multiple children's issues was reported including improved communication skills (87%), reduced anxiety (84%), increased feeling of security at home (90%), and improved school performance (73%). CONCLUSIONS The results reported here suggest that this child centered psychosocial intervention promoted positive adaptation by actively supporting families and children while a parent/primary caregiver coped with a cancer diagnosis. Future research is planned utilizing a randomized controlled study design to formally evaluate the effectiveness and preventative impact of this manualized six-week curriculum. Copyright © 2016 John Wiley & Sons, Ltd.
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32
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Bradbury AR, Patrick-Miller L, Schwartz L, Egleston B, Sands CB, Chung WK, Glendon G, McDonald JA, Moore C, Rauch P, Tuchman L, Andrulis IL, Buys SS, Frost CJ, Keegan TH, Knight JA, Terry MB, John EM, Daly MB. Psychosocial Adjustment in School-age Girls With a Family History of Breast Cancer. Pediatrics 2015; 136:927-37. [PMID: 26482668 PMCID: PMC4972044 DOI: 10.1542/peds.2015-0498] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Understanding how young girls respond to growing up with breast cancer family histories is critical given expansion of genetic testing and breast cancer messaging. We examined the impact of breast cancer family history on psychosocial adjustment and health behaviors among >800 girls in the multicenter LEGACY Girls Study. METHODS Girls aged 6 to 13 years with a family history of breast cancer or familial BRCA1/2 mutation (BCFH+), peers without a family history (BCFH-), and their biological mothers completed assessments of psychosocial adjustment (maternal report for 6- to 13-year-olds, self-report for 10- to 13-year-olds), breast cancer-specific distress, perceived risk of breast cancer, and health behaviors (10- to 13-year-olds). RESULTS BCFH+ girls had better general psychosocial adjustment than BCFH- peers by maternal report. Psychosocial adjustment and health behaviors did not differ significantly by self-report among 10- to 13-year-old girls. BCFH+ girls reported higher breast cancer-specific distress (P = .001) and were more likely to report themselves at increased breast cancer risk than BCFH- peers (38.4% vs 13.7%, P < .001), although many girls were unsure of their risk. In multivariable analyses, higher daughter anxiety was associated with higher maternal anxiety and poorer family communication. Higher daughter breast cancer-specific distress was associated with higher maternal breast cancer-specific distress. CONCLUSIONS Although growing up in a family at risk for breast cancer does not negatively affect general psychosocial adjustment among preadolescent girls, those from breast cancer risk families experience greater breast cancer-specific distress. Interventions to address daughter and mother breast cancer concerns and responses to genetic or familial risk might improve psychosocial outcomes of teen daughters.
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Affiliation(s)
- Angela R. Bradbury
- Division of Hematology/Oncology, Department of Medicine, and,Department of Medical Ethics and Health Policy, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania;,Address correspondence to Angela R. Bradbury, MD, Perelman School of Medicine at the University of Pennsylvania, 3 West Perelman Center, 3400 Civic Center Blvd, Philadelphia, PA 19104. E-mail:
| | - Linda Patrick-Miller
- Division of Hematology-Oncology, Department of Medicine, and the Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois
| | - Lisa Schwartz
- Department of Pediatrics, Division of Oncology, The Children’s Hospital of Philadelphia and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Jasmine A. McDonald
- Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Cynthia Moore
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Paula Rauch
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Lisa Tuchman
- Department of Adolescent Medicine, Children’s National Medical Center, Washington, District of Columbia
| | - Irene L. Andrulis
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada;,Departments of Molecular Genetics and Laboratory Medicine, and
| | - Saundra S. Buys
- Department of Medicine, Division of Oncology, The University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Caren J. Frost
- College of Social Work, The University of Utah, Salt Lake City, Utah
| | - Theresa H.M. Keegan
- Cancer Prevention Institute of California, Fremont, California; and,Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, and Stanford Cancer Institute, Stanford, California
| | - Julia A. Knight
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada;,Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center, and,Mailman School of Public Health, Columbia University Medical Center, New York, New York
| | - Esther M. John
- Cancer Prevention Institute of California, Fremont, California; and,Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, and Stanford Cancer Institute, Stanford, California
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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McDonald FEJ, Patterson P, White KJ, Butow PN, Costa DSJ, Kerridge I. Correlates of unmet needs and psychological distress in adolescent and young adults who have a parent diagnosed with cancer. Psychooncology 2015; 25:447-54. [DOI: 10.1002/pon.3942] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 05/29/2015] [Accepted: 07/17/2015] [Indexed: 11/09/2022]
Affiliation(s)
- F. E. J. McDonald
- CanTeen Australia; Sydney New South Wales Australia
- Cancer Nursing Research Unit, Sydney Nursing School; The University of Sydney; Sydney New South Wales Australia
| | - P. Patterson
- CanTeen Australia; Sydney New South Wales Australia
- Cancer Nursing Research Unit, Sydney Nursing School; The University of Sydney; Sydney New South Wales Australia
| | - K. J. White
- Cancer Nursing Research Unit, Sydney Nursing School; The University of Sydney; Sydney New South Wales Australia
| | - P. N. Butow
- Psycho-Oncology Co-operative Research Group (POCoG); The University of Sydney; Sydney New South Wales Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); The University of Sydney; Sydney New South Wales Australia
| | - D. S. J. Costa
- Psycho-Oncology Co-operative Research Group (POCoG); The University of Sydney; Sydney New South Wales Australia
| | - I. Kerridge
- Centre for Values, Ethics and Law in Medicine; The University of Sydney; Sydney New South Wales Australia
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34
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Cho OH, Yoo YS, Hwang KH. Comparison of parent–child communication patterns and parental role satisfaction among mothers with and without breast cancer. Appl Nurs Res 2015; 28:163-8. [DOI: 10.1016/j.apnr.2014.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 09/15/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
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Götze H, Ernst J, Brähler E, Romer G, von Klitzing K. Predictors of quality of life of cancer patients, their children, and partners. Psychooncology 2014; 24:787-95. [PMID: 25488818 DOI: 10.1002/pon.3725] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study is to assess the quality of life (QOL) of cancer patients and their family members over 1-year period post therapy. METHODS We evaluated QOL in cancer patients (N = 161) (Short Form-8 Health Survey (SF-8), European Organization for Research and Treatment of Cancer 30- Item Core Quality of Life Questionnaire (EORTC QLQ-C30)), their partners (N = 110) (SF-8), and their children (N = 115) (KIDSCREEN-27) using a longitudinal design (t1: post therapy, t2: 6 months after t1, t3: 12 months after t1). Multiple regression models were employed to examine factors related to QOL. RESULTS After cancer therapy, impairments in the patients' QOL were found primarily in emotional and social areas and also in role functions. We found the highest symptom burden in fatigue (M = 45.21), sleep disturbances (M = 41.04), and financial difficulties (M = 39.2). Partners had lower mental QOL compared with the general population at each assessment point (p < 0.05). No significant difference was found in physical QOL between partners and the general population (p > 0.05). Social support, full-time employment, tumor stage 0-2, time since diagnosis <1 year, and lower levels of anxiety and depression were associated with better QOL in patients. Full-time employment, social support, and lower levels of anxiety and depression had a significant impact on the partners' QOL. Higher levels of anxiety and depression in patients (p = 0.006) adversely influenced children's QOL. CONCLUSIONS Family members' QOL is overall stable over time indicating the need for professional psychosocial support for those family members with low QOL. For the children, new measures are needed to better examine the experience with parental cancer.
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Affiliation(s)
- Heide Götze
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Leipzig, Leipzig, Germany
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Cancer: a family at risk. MENOPAUSE REVIEW 2014; 13:253-61. [PMID: 26327863 PMCID: PMC4520372 DOI: 10.5114/pm.2014.45002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/07/2014] [Accepted: 07/17/2014] [Indexed: 01/18/2023]
Abstract
The diagnosis of cancer is a family experience that changes the lives of all its members, bringing an immense amount of stress and many challenging situations. The daily routine, common activities and distribution of duties all have to change. Family members follow the phases of the disease, very often suffering comparable or greater distress than the patient. They use various coping methods which aim at helping both the sick relative and themselves. These methods, together with emotional responses, change over time according to the phase of the disease. Cancer puts the family at risk since it imposes an alternation in the relations among family members. It affects the couple's relationship, their sex life, and it can also be a cause of major trauma among their children and adolescents. The diagnosis of cancer brings also individual risks for the family members in terms of psychological and physical health impairment. Family caregivers often feel overloaded with the additional obligations and roles they have to pick up. They find it increasingly burdening to care full-time for the household and provide emotional support for the patient. The family's problems and the way family members regard the disease may be also a result of the family system they are in. This article describes the nature of caregiving to a patient with cancer and the biggest concerns for the family.
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Möller B, Barkmann C, Krattenmacher T, Kühne F, Bergelt C, Beierlein V, Ernst J, Brähler E, Flechtner HH, Herzog W, von Klitzing K, Führer D, Resch F, Romer G. Children of cancer patients: Prevalence and predictors of emotional and behavioral problems. Cancer 2014; 120:2361-70. [DOI: 10.1002/cncr.28644] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 01/17/2014] [Accepted: 02/05/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Birgit Möller
- University Medical Center Hamburg-Eppendorf; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Hamburg Germany
- University Medical Center Münster; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Münster Germany
| | - Claus Barkmann
- University Medical Center Hamburg-Eppendorf; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Hamburg Germany
| | - Thomas Krattenmacher
- University Medical Center Hamburg-Eppendorf; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Hamburg Germany
| | - Franziska Kühne
- University Medical Center Hamburg-Eppendorf; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Hamburg Germany
| | - Corinna Bergelt
- University Medical Center Hamburg-Eppendorf; Department of Medical Psychology; Hamburg Germany
| | - Volker Beierlein
- University Medical Center Hamburg-Eppendorf; Department of Medical Psychology; Hamburg Germany
| | - Johanna Ernst
- University Medical Center Hamburg-Eppendorf; Department of Medical Psychology; Hamburg Germany
| | - Elmar Brähler
- University Hospital Leipzig; Department of Medical Psychology and Medical Sociology; Leipzig Germany
| | - Hans-Henning Flechtner
- Otto-von-Guericke University Magdeburg; Child and Adolescent Psychiatry; Magdeburg Germany
| | - Wolfgang Herzog
- Heidelberg University Hospital; Department of General Internal and Psychosomatic Medicine; Heidelberg Germany
| | - Kai von Klitzing
- University of Leipzig; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics; Leipzig Germany
| | - Daniel Führer
- Charité Universitätsmedizin Berlin; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy; Berlin Germany
| | - Franz Resch
- Heidelberg University Hospital; Child and Adolescent Psychiatry; Heidelberg Germany
| | - Georg Romer
- University Medical Center Münster; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Münster Germany
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Bultmann JC, Beierlein V, Romer G, Möller B, Koch U, Bergelt C. Parental cancer: Health-related quality of life and current psychosocial support needs of cancer survivors and their children. Int J Cancer 2014; 135:2668-77. [DOI: 10.1002/ijc.28905] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/12/2014] [Accepted: 03/20/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - Volker Beierlein
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry; Psychosomatics, and Psychotherapie, University Medical Center Münster; Münster Germany
| | - Birgit Möller
- Department of Child and Adolescent Psychiatry; Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Uwe Koch
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Corinna Bergelt
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Al-Zaben F, Al-Amoudi SM, El-deek BS, Koenig HG. Impact of maternal breast cancer on school-aged children in Saudi Arabia. BMC Res Notes 2014; 7:261. [PMID: 24758552 PMCID: PMC4014657 DOI: 10.1186/1756-0500-7-261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background We examine whether mothers with breast cancer told their children about the diagnosis, explore mothers’ perceptions of the impact of doing so on the mother-child relationship, and assess perceptions of how this affected the children. Methods A convenience sample of 28 women with breast cancer ages 35 to 60 was interviewed using a 39-item close-ended questionnaire at the Al-Amoudi Breast Cancer Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia. Inclusion criteria were having a diagnosis of breast cancer and having school-aged children (ages 5 to 16 years). Questions were asked concerning each child (n = 99). Results The majority of women (75%) told their children about the diagnosis, and explained the treatment (61%). In most cases, telling the children had a positive effect on how the children treated their mothers (84%), on the maternal-child relationship (80%), and on the personality and behavior of the child (90%). The most common negative reaction by children was increased clinging behavior to the mother (15%). Despite the perceived positive impact on the mother-child relationship and on the child’s overall behavior towards the mother, school performance suffered as a result (77%). Conclusions These preliminary results suggest that when a mother with breast cancer tells a child about the diagnosis and discusses it with them, this often results in an improvement in the maternal-child relationship. However, the knowing the mother’s diagnosis may adversely affect the child’s school performance, which will need to be anticipated and addressed with formal counseling if it persists.
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Affiliation(s)
| | - Samia M Al-Amoudi
- Sheikh Mohammed Hussein Al-Amoudi Breast Cancer Center of Excellence and Faculty of Medicine, King Abdulaziz University, Jeddah, Saudia Arabia.
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Jeppesen E, Bjelland I, Fosså SD, Loge JH, Sørebø O, Dahl AA. Does a parental history of cancer moderate the associations between impaired health status in parents and psychosocial problems in teenagers: a HUNT study. Cancer Med 2014; 3:919-26. [PMID: 24723456 PMCID: PMC4303159 DOI: 10.1002/cam4.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 11/15/2022] Open
Abstract
Severe disease in a parent is associated with increased psychosocial problems in their children. However, moderating factors of such associations are less studied. In this cross-sectional population-based controlled study we examined the moderating effects of a history of parental cancer on the association between impaired health status in parents and psychosocial problems among their teenagers. Among families with both parents responding to the adult Health Survey of Nord-Trøndelag County of Norway (the HUNT-2 study) 71 couples were identified with primary invasive cancer in one parent. Their 81 teenage children took part in the Young-HUNT study. These families were compared to 322 cancer-free families with 328 teenagers. Based on self-report data the relations between three variables of parental impaired health and six psychosocial problems in teenagers were analyzed family wise by structural equation modeling. Significant associations between parental and teenagers' variables were observed in eight of 18 models. A history of parental cancer was a significant moderator which decreased four of eight significant associations. Such a history significantly weakened the associations between parental poor self-rated health and teenagers' anxiety/depression and school problems. A similar association of a history of parental cancer was found between psychological distress in parents and teenagers' feelings of loneliness and poor self-rated health. This study confirmed strong associations between impaired parental health and psychosocial problems in their teenagers. A history of parental cancer weakened several of the significant associations between parental impaired health variables and psychosocial problems in their teenagers.
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Affiliation(s)
- Elisabeth Jeppesen
- National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
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Krattenmacher T, Kühne F, Halverscheid S, Wiegand-Grefe S, Bergelt C, Romer G, Möller B. A comparison of the emotional and behavioral problems of children of patients with cancer or a mental disorder and their association with parental quality of life. J Psychosom Res 2014; 76:213-20. [PMID: 24529040 DOI: 10.1016/j.jpsychores.2013.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life. METHODS A total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered. RESULTS Half of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents. CONCLUSION Family members confronted with parental cancer or mental disorders are more burdened compared with those from the "normal" population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment.
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Affiliation(s)
- Thomas Krattenmacher
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany.
| | - Franziska Kühne
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Susanne Halverscheid
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Silke Wiegand-Grefe
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Corinna Bergelt
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Germany
| | - Georg Romer
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - Birgit Möller
- University Medical Center Hamburg-Eppendorf, Department of Child Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany
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Krauel K, Simon A, Krause-Hebecker N, Czimbalmos A, Bottomley A, Flechtner H. When a parent has cancer: challenges to patients, their families and health providers. Expert Rev Pharmacoecon Outcomes Res 2013; 12:795-808. [PMID: 23252360 DOI: 10.1586/erp.12.62] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
At least 14% of cancer patients live with minor children. Being a parent with cancer has far-reaching consequences for individual treatment decision-making and quality of life in patients and their families. Even though the majority of children and adolescents do not show clinically relevant symptoms of psychopathology, worries about the survival of the parent and the future development of the family are present, and experienced as distressing, in most children. Open communication by parents and clinicians has been found to be of major importance for children and adolescents in adjusting to parental cancer. Support for parents with cancer on relevant parenting issues, starting in the diagnostic phase, should be acknowledged as an important facet of cancer care to reduce the psychosocial burden for cancer patients and their families.
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Affiliation(s)
- Kerstin Krauel
- Department of Child and Adolescent Psychiatry, University of Magdeburg, Magdeburg, Germany
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Krattenmacher T, Kühne F, Führer D, Beierlein V, Brähler E, Resch F, Klitzing KV, Flechtner HH, Bergelt C, Romer G, Möller B. Coping skills and mental health status in adolescents when a parent has cancer: a multicenter and multi-perspective study. J Psychosom Res 2013; 74:252-9. [PMID: 23438718 DOI: 10.1016/j.jpsychores.2012.10.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 10/05/2012] [Accepted: 10/08/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Parental cancer increases the risk of psychosocial problems in adolescents. We investigated the frequency and efficacy of adolescents' coping strategies and relationships between those strategies and mental health status. Age and gender differences regarding coping and mental health were also investigated. METHODS In total, 214 adolescents from 167 families participated in a cross-sectional, multicenter study. All participants were recruited from standard oncological care. Among the participants, 52% utilized a child-centered intervention program. Adolescents' coping skills were measured using KIDCOPE. Mental health status was rated by adolescents and parents by the SDQ for symptomatology and the KIDSCREEN for well-being. RESULTS We found that 29% of the adolescents showed emotional and behavioral problems. We found gender differences in mental health status but not in coping. Adolescents used a broad spectrum of coping strategies. Active problem-solving, distraction, acceptance, wishful thinking and seeking social support were the most frequently used coping strategies. The utilization of certain coping skills was mediated by their perceived efficacy. Problem-focused or approach-oriented coping strategies generally are associated with better mental health, while avoidance-oriented coping are associated with worse mental health. Emotion-focused coping was associated with both lower and higher mental health. CONCLUSION The strategies used by adolescents to cope with parental cancer are associated with their mental health. Problem-solving and approach-oriented coping strategies should be facilitated by psychological interventions regardless of age and gender. Age and gender differences in adolescents' mental health should be further investigated because these differences are not explained by differences in coping strategies.
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Affiliation(s)
- Thomas Krattenmacher
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Germany.
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Inbar C, Ety B, Ayala H, Tamer P. The mental health of breast cancer survivors and their adolescent daughters. Psychooncology 2012; 22:1236-41. [DOI: 10.1002/pon.3127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 06/04/2012] [Accepted: 06/05/2012] [Indexed: 11/06/2022]
Affiliation(s)
| | - Berant Ety
- Department of Psychology; Bar-Ilan University; Ramat-Gan; Israel
| | - Hubert Ayala
- Sharett Institute of Oncology; Hadassah University Hospital; Jerusalem; Israel
| | - Perez Tamer
- Sharett Institute of Oncology; Hadassah University Hospital; Jerusalem; Israel
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Depressivität bei 11- bis 17-jährigen Kindern krebskranker Eltern im Verlauf und Abhängigkeit zur elterlichen Belastung. Prax Kinderpsychol Kinderpsychiatr 2012; 61:432-46. [DOI: 10.13109/prkk.2012.61.6.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Krattenmacher T, Kühne F, Ernst J, Bergelt C, Romer G, Möller B. Parental cancer: factors associated with children's psychosocial adjustment--a systematic review. J Psychosom Res 2012; 72:344-56. [PMID: 22469276 DOI: 10.1016/j.jpsychores.2012.01.011] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Children of cancer patients have an increased risk of developing psychosocial problems. But not all children are alike vulnerable to this stressful event. Thus, knowledge of risk and protective factors is required to design specific diagnostic tools and interventions for this vulnerable population. This study aims to provide a review and methodological evaluation of current studies examining factors associated with children's psychosocial adjustment when a parent has cancer. METHODS Four databases were systematically searched for quantitative research articles examining associative factors of children's adjustment. Study characteristics were analyzed and methodological quality was assessed by two independent reviewers. RESULTS 28 studies examining associative factors in 2896 families were identified. The included studies used a broad range of instruments assessing children's adjustment. Most patients were female breast cancer patients with middle to high socio-economic status. The majority of included studies used correlational approaches and cross-sectional designs. None of the studies examined toddlers or assessed children's quality of life. Across studies with low to high quality, we found no evidence of illness-related factors, except worse disease status that was related to lower adjustment. Evidence from moderate to high quality studies suggest that better family functioning indicates better adjustment, whereas parent's depressive mood indicates worse adjustment of the children. Child-related factors were inconsistent. CONCLUSION Health professionals should pay attention to cancer patients' dependent children. In order to identify this at-risk population, parent's depressive mood and poor family functioning should be considered. Future studies should also assess children's quality of life and child-related factors.
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Affiliation(s)
- Thomas Krattenmacher
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry and Psychotherapy, Hamburg, Germany.
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Niemelä M, Paananen R, Hakko H, Merikukka M, Gissler M, Räsänen S. The prevalence of children affected by parental cancer and their use of specialized psychiatric services: The 1987 Finnish Birth Cohort study. Int J Cancer 2012; 131:2117-25. [DOI: 10.1002/ijc.27466] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/12/2012] [Indexed: 11/10/2022]
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Mazzotti E, Serranò F, Sebastiani C, Marchetti P. Mother-Child Relationship as Perceived by Breast Cancer Women. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/psych.2012.312154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kieffer-Kristensen R, Teasdale TW, Bilenberg N. Post-traumatic stress symptoms and psychological functioning in children of parents with acquired brain injury. Brain Inj 2011; 25:752-60. [DOI: 10.3109/02699052.2011.579933] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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