Psychological distress, role, and identity changes in mothers following a diagnosis of cancer: A systematic review

Parenting under pressure: a cross-sectional questionnaire study of psychological distress, parenting concerns, self-efficacy, and emotion regulation in parents with cancer

BACKGROUND AND PURPOSE

As many as one in four adults with cancer have children under 18 years. Balancing parenting and cancer is challenging and can be a source of psychological distress. This study aimed to examine psychological distress in parents with cancer and its associations with parenting concerns, self-efficacy, and emotion regulation.

MATERIALS AND METHODS

This was a cross-sectional questionnaire study of 406 parents (aged 25-60 years) diagnosed with cancer within the last 5 years, with at least one dependent child (≤ 18 years). Parents completed questionnaires on psychological distress (DASS-21), parenting concerns (PCQ), self-efficacy (GSE), emotion regulation (ERQ), mental and physical health, and sociodemographics. Data were analysed using multiple logistic regressions on depression (yes/no), anxiety (yes/no), and stress (yes/no).

RESULTS

Higher parenting concerns were associated with greater odds of depression (OR = 2.33, 95% CI: 1.64-3.31), anxiety (OR = 2.30, 95% CI: 1.64-3.20), and stress (OR = 3.21, 95% CI: 2.20-4.69) when adjusting for health and sociodemographic factors. Poorer self-efficacy was associated with increased odds of anxiety (OR = 0.94, 95% CI: 0.89-0.99, p < 0.05), whereas lower use of cognitive reappraisal and higher use of expressive suppression increased the odds of depression (OR = 0.76, 95% CI: 0.59-0.98 | OR = 1.46, 95% CI: 1.18-1.80).

INTERPRETATION

The findings highlight the complexity of parental well-being in relation to parenthood and cancer, stressing the need for interventions that address relevant psychological factors to improve overall mental health in this population.

Cancer parents' experiences of parenting concerns about minor children: A meta-synthesis of qualitative studies

Background

Some cancer patients not only endure physical and mental distress due to the disease and treatment but also shoulder the responsibility of raising their children. This situation significantly impacts the patients' quality of life. While there is a growing body of qualitative research focusing on parenting concerns among cancer patients, there remains a lack of comprehensive qualitative evidence.

Objective

This study aims to conduct a systematic review and synthesis of qualitative research evidence, investigating the experiences of cancer patients in raising minor children.

Design

Systematic review and synthesis of qualitative studies.

Settings

Through a screening process employing inclusion/exclusion criteria, qualitative studies specifically addressing cancer patients raising minor children were identified.

Participants

Participants: A total of 669 participants from 40 studies were included in the review.

Methods

Four English (Pubmed, Web of Science, Embase and Cochrane Library) and three Chinese (CNKI, Wanfang and Sinomed) databases were searched for qualitative studies of the real-life experiences of raising children in cancer patients from the establishment of the library to January 2024. The methodological quality of the included literature was assessed using the Critical Appraisal Skill Program (CSAP). Qualitative data were extracted, summarized, and meta-synthesized.

Results

A total of 26 studies were included in this meta-synthesis, encompassing 11 different countries. 160 themes were extracted from these included literatures, which were combined into ten categories, ultimately forming four themes: the impact of parents' disease on their children, the challenges of parenting, coping strategies, and multifaceted parenting needs. Based on the Confidence in the Output of Qualitative research synthesis (ConQual) approach, the confidence level of the synthesized findings ranged from moderate to low.

Conclusions

Cancer patients experience significant psychological stress while raising children, which can lead to a reduction in their quality of life and influence treatment decisions. These findings elucidate the parenting concerns experienced by cancer patients, allowing medical staff to understand their emotions and treatment preferences. Additionally, healthcare professionals should pay attention to the special needs of this group and develop targeted interventions to support and reduce patients' psychological stress and burden.

Effectiveness of a comprehensive support program for families with parental cancer (Family-SCOUT): results of a multicenter non-randomized controlled trial

BACKGROUND

Cancer patients with minor children but also their families suffer from significant psychological distress and comorbidity. Protective factors predicting successful coping are well known. Corresponding systematic interventions are rare and limited by access barriers. We developed a comprehensive family-centered intervention for cancer patients with at least one dependent minor.

PATIENTS AND METHODS

Family-SCOUT represents a multicentric, prospective, interventional, and controlled study for families with parental cancer and their minor children. In the intervention group (IG), all family members were addressed using a care and case management approach for nine months. Families in the control group (CG) received standard of care. Participating parents were asked to complete the Hospital-Anxiety-Depression-Scale (HADS) questionnaire at enrolment (T0) and after 9 months (T2). The primary outcome was a clinically relevant reduction of distress in at least one parent per family, measured as minimal important difference (MID) of ≥1.6 in the HADS total score. The percentage of families achieving MID is compared between the IG and CG by exact Fisher's test, followed by multivariate confounder analyses.

RESULTS

T0-questionnaire of at least one parent was available for 424 of 472 participating families, T2-questionnaire after 9 months was available for 331 families (IG n = 175, CG n = 156). At baseline, both parents showed high levels of distress (HADS total: sick parents IG: 18.7 ± 8.1; CG: 16.0 ± 7.2; healthy partners: IG: 19.1 ± 7.9; CG: 15.2 ± 7.7). The intervention was associated with a significant reduction in parental distress in the IG (MID 70.4% in at least one parent) compared with the CG (MID 55.8%; P = 0.008). Adjustment for group differences from specific confounders retained significance (P = 0.047). Bias from other confounders cannot be excluded.

CONCLUSIONS

Parental cancer leads to a high psychosocial burden in affected families. Significant distress reduction can be achieved through an optimized and structured care approach directed at the family level such as family-SCOUT.

Self-compassion and parenting efficacy among mothers who are breast cancer survivors: Implications for psychological distress

Mothers who are breast cancer survivors may experience psychological distress in relation to diminished parenting efficacy. Self-compassion may protect mothers from psychological distress, yet little is known about self-compassion in this population. The extent to which self-warmth (self-kindness, mindfulness and sense of common humanity) and self-coldness (self-judgement, isolation and over-identification) dimensions of self-compassion moderate parenting efficacy in predicting depression, anxiety and stress was examined in a sample of 95 mothers who were breast cancer survivors. Independently, poorer parenting efficacy was associated with more depression and stress symptoms. Within regression models, self-coldness was a direct predictor of depression, anxiety and stress, while self-warmth moderated the relationship between parenting efficacy and stress. Self-warmth presents as a potential protective factor for stress associated with poor parenting efficacy, while self-coldness is a potential direct risk factor for psychological distress. Mothers who are breast cancer survivors may benefit from self-compassion focused psychosocial interventions.

Psychosocial interventions for improving mental health and family functioning in families with parental cancer: A systematic review

PURPOSE

Parental cancer significantly impacts both parents and children, necessitating psychosocial interventions to enhance family well-being. This systematic review aimed to assess the effectiveness of psychosocial interventions targeting parents with cancer on their mental health, quality of life, their children's well-being, and family functioning.

METHODS

A comprehensive search was conducted in Ovid MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials databases for relevant articles published from 2006 to 2023. The methodological aspects of eleven studies from diverse countries were critically evaluated.

RESULTS

The review included 496 parents, primarily female breast cancer patients, and their children. Narrative synthesis highlighted interventions that aimed to strengthen parent-child connection (Enhancing Connection (EC)), enhance family communication, improve psychological well-being of parents (Struggle for Life Intervention), and address children's mental health (Wonders and Worries (W&W)). Additionally, interventions like Cancer PEPSONE Program (CPP) aimed to expand social networks and support systems. These interventions demonstrated success in reducing depressive and anxiety symptoms, parenting stress, and mitigating children's externalizing and internalizing problems. However, they were not exempt from methodological limitations such as participant selection bias, lack of blinding, and low follow-up rates.

CONCLUSIONS

Based on the review, psychological support for parents with cancer is an emerging field, predominantly explored in Western countries with a significant emphasis on maternal experiences. The early stage of this field and inherent methodological limitations warrant cautious interpretation of these findings and further research for comprehensive understanding and application.

The Role of Parents in Their Child's Cancer Diagnosis, Treatment, Rehabilitation, and Socialization

OBJECTIVE

To investigate the role of parents (family) as participants in their child's cancer diagnosis, treatment, and rehabilitation.

METHODS

This survey research was carried out by the Institute of Social Sciences, I.M. Sechenov First Moscow State Medical University (Sechenov University) in 2019-2020. The survey involved 237 parents of children with cancer admitted to oncological clinics of the North Caucasus Federal District. More than half of parents (54.9%) took their child to a pediatrician because of the unusual and strange symptoms. The overwhelming majority of respondents (99.1%) admitted stress and shock on hearing the cancer diagnosis. Besides emotional issues, they reported financial problems (55.3%), and a change in lifestyle (38.4%).

RESULTS

During the treatment period, parents sought financial and organizational support from medical institutions (49.4%), as well as charitable and public organizations (40.5%). At the end of treatment, almost half of the respondents (48.9%) applied for rehabilitation services.

CONCLUSION

Parents play one of the key roles in their child's cancer journey. They provide the child with basic psychological support and care, and they search for resources to enable treatment and rehabilitation. Parents help their child re-enter and return to a normal life (schooling, communication with friends, etc.) after going through cancer.

Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study

PURPOSE

To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories.

METHODS

Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories.

RESULTS

Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms.

CONCLUSIONS

Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

Psychosocial interventions targeting parenting distress among parents with cancer - A systematic review and narrative synthesis of available interventions

BACKGROUND

Balancing having cancer and parenting a major stressor, and may result in parenting distress, negatively affecting the whole family. To provide adequate support, knowledge of existing psychosocial interventions are crucial to guide future interventions. This study aimed to describe available psychosocial interventions for parents with cancer and dependent children (<18 years).

METHOD

We conducted a systematic review, and four databases were searched from January 2000 to March 2023.

RESULTS

Thirty studies were included, reporting on 22 psychosocial interventions for parents with cancer. They aimed to improve different aspects of parenting distress, and included psychoeducation and communication strategies. Interventions were beneficial to and acceptable among parents, but only a few had been evaluated. The study quality was, overall, assessed as moderate.

CONCLUSIONS

The results of this review highlight the diversity of available psychosocial interventions for parents with cancer and the outcomes on parenting distress, as well as methodological challenges.

Breast cancer treatment and recovery: pets' roles as emotional buffers and stressors

BACKGROUND

Research suggests pets foster affection, connection, and physical activity, yet has failed to address the challenges people diagnosed with cancer face in caring for their pets. The objective of this study was to better understand how pets serve as emotional buffers and/or stressors for people diagnosed with breast cancer, and how their ability to meet their pet's needs affects their well-being.

METHODS

A cross-section study of people diagnosed with breast cancer in the United States was conducted. Adults diagnosed with stages 0 (in situ) -IV breast cancer and currently the primary guardian of at least one dog or cat and owned the animal(s) for at least 6 months, were recruited for the study. A total of 211 responses, obtained between July - November 2022 were analyzed. The survey included questions about participants' demographics; attachment to their pets; physical, emotional, and functional well-being; social support received from their pet; and 'pet parenting' concerns. Descriptive statistics were calculated to describe participants' demographics. Multiple regression analyses were conducted to determine predictors of pet attachment, well-being, support from pet, and 'pet parenting' concerns.

RESULTS

People diagnosed with breast cancer derive substantial support from their pets (80% feel their pet makes them feel loved, needed, and offers a positive presence in the home), yet only 50% of participants feel this relationship is supported by their medical team. Controlling for owner demographics, heightened levels of pet-related guilt and concerns, along with lower perceived support from their pet, are all significant predictors of a lower quality of life.

CONCLUSIONS

Findings highlight the benefits pets offer people diagnosed with breast cancer, yet also the distress they feel in trying to meet their pet's needs. Assessment conversations about pet ownership, including pet-related support systems, are needed to validate people's concerns and support the identification and development of pet support teams. Medical team facilitated discussions about pet care needs is suggested to demonstrate support for the pet-parent bond and help normalize feelings of guilt related to challenges in meeting their pet's needs. These discussions could be aided through the development of research-driven intervention strategies and online, freely accessible targeted tools.

Effectiveness of a training program for healthcare professionals on parental cancer: Results of a randomized controlled pilot-study

OBJECTIVE

Cancer patients parenting minor children face specific burden and supportive needs, which are often not adequately addressed by their healthcare professionals (HCPs), due to a lack of knowledge, self-efficacy and competencies. Therefore, we developed a 3-h intervention enhancing HCPs' competencies in caring for these patients. We pilot-evaluated the intervention's feasibility and efficacy, assuming intervention group participants reveal higher improvements over time compared to non-trained participants.

METHODS

We conducted a 3-armed randomized controlled pilot-trial (RCT), comparing face-to-face training (F2F), e-Learning (EL), waitlist-control group with three measurements (baseline, post-training, 3-month follow-up). Primary outcome was the competency to approach child- and family-related themes; secondary outcomes were knowledge, self-efficacy in (specific) communication skills. Intervention effects were analyzed using linear mixed models.

RESULTS

Participants (n = 152) were mostly female (89%) and psychologists (38%; physicians 26%; nurses 18%). F2F and EL participants reported high training satisfaction. Analyses did not reveal any significant differences on the primary outcome between groups, but indicate positive intervention effects over time regarding secondary outcomes including knowledge and self-efficacy in communication skills.

CONCLUSIONS

This is the first pilot-study evaluating a training for HCPs in oncology on parental cancer using a 3-armed RCT. The 3-h training program is a feasible approach and findings indicate to increase HCPs' knowledge and self-efficacy in caring for cancer patients with minor children. Further research is needed to verify preliminary findings of this pilot study. The study was pre-registered within the German Clinical Trial Register (DRKS-00015794).

The Complexity of Being a Parent in the Hospital and a Patient at Home: A Qualitative Study on Parenting Concerns and Challenges Among Parents With Cancer

BACKGROUND

Parents given a diagnosis of cancer must balance the demands of their illness and caregiving responsibilities. This can result in parental stress and have a negative impact on the well-being of the whole family. A greater understanding of the experiences of parents with cancer is necessary to provide adequate support.

OBJECTIVE

The aim of this study was to explore parenting concerns and challenges among parents with cancer who were caring for dependent children younger than 18 years.

METHODS

Semistructured interviews were carried out with 22 parents with cancer. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Parental concerns and challenges affected parents in their parental role and their everyday family life. Three overarching themes described the struggles in balancing life as a parent and as a patient: navigating dual roles as a parent with cancer, impact of cancer on parenting, and impact on family life. Parents' primary focus was on their children's well-being, and they struggled to manage their own expectations of parenting and the demands on their role in the family.

CONCLUSION

The results highlight the complexity of being a parent with cancer while caring for dependent children. To support parents during the cancer journey, it is important to understand the consequences of their illness on their parental role and the family.

IMPLICATIONS FOR PRACTICE

Supporting parents to feel secure in their parental role and providing support to them during their cancer journey should be integrated into routine cancer care, where parenting concerns and challenges are addressed.

What Promotes Positive Parenting During Breast Cancer? A Cross-Sectional Analysis of Social Support, Emotion Regulation, and Meaning in Life

BACKGROUND

Motherhood and maintaining the child-parent relationship are top priorities for mothers with breast cancer (BC). The current study aimed to assess the positive intra- and inter-personal resources related to positive parenting among mothers with BC, as these may be promotive factors for positive parenting. Specifically, we examined whether social support (family, friend, spiritual), emotion regulation, and a sense of meaning in life are related to positive parenting among mothers undergoing BC treatments.

METHODS

The sample consisted of 100 Israeli mothers (mean age = 46.02 years, SD = 6.06 years) who were undergoing treatment for BC. Participating mothers had at least one child aged 6-17 years. Participants were recruited via closed social media groups to complete a questionnaire containing: the Alabama Parenting Questionnaire, Cancer Perceived Agents of Social Support tool, Emotion Regulation Questionnaire, Meaning in Life Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and sociodemographic and clinical questions. We used structural equation modeling to regress the study variables on positive parenting.

RESULTS

Friend support (β = .35, p = .009) and meaning in life (β = .30, p = .012) were significantly related to positive parenting. Family support, spiritual support, cognitive reappraisal, and the sociodemographic and clinical variables were not related to positive parenting.

CONCLUSIONS

Our study suggests that promoting meaning in life and friend support may be key to helping mothers to sustain positive parenting behaviors throughout their cancer treatment. Future research may examine whether psychosocial interventions which foster meaning in life and friend support impact positive parenting among mothers with BC.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

Lived experiences of young adult Chinese American breast cancer survivors: A qualitative analysis of their strengths and challenges using expressive writing

PURPOSE

Immigrant young adults of cancer survivors face unique challenges but their unmet needs are not well understood. The purpose of this study was to identify the challenges and strengths of immigrant young adult Chinese American breast cancer survivors.

METHOD

Descriptive phenomenology using a qualitative research approach was employed in this study. Expressive writing was used to explore the experiences of 15 young adult Chinese American immigrant breast cancer survivors. Thematic analysis was conducted to gain an understanding of the lived experiences of young adult Chinese American breast cancer survivors.

RESULTS

On average, participants had been diagnosed at 37 years (ranging from 32 to 39) and living in the USA for 12 years. Participants' writings revealed their challenges during and after treatment (major theme), including difficulty accepting having cancer at a young age, financial difficulties, self-blame, inadequate family support, uncertainty about their futures, and worries about their children and infertility (sub-themes). Participants' strengths and coping strategies (major theme) included physical recovery and positive self-perception, family as motivation for survival, and support from family and friends (sub-themes). Post-traumatic growth (major theme) included shifting life priorities and enjoying life and self-transcendence (i.e., forgiving and helping others) (sub-themes).

CONCLUSIONS

The overarching topic found across the major themes in the young adult Chinese American breast cancer survivors' essays was the importance of interpersonal relationships, especially with family and children. Healthcare providers should respond with culturally appropriate support, referrals, and resources based on these findings.

Fear of cancer recurrence as a pathway from fatigue to psychological distress in mothers who are breast cancer survivors

Fatigue is prevalent and pervasive among breast cancer survivors. Mothers are particularly susceptible to fatigue due to the ongoing demands of their caring role. While fatigue has been associated with psychological distress in prior research, the pathway by which fatigue translates into psychological distress is unclear. Given the theoretical and empirical links between fatigue, fear of cancer recurrence (FCR) and psychological distress, the role of FCR in mediating the relationship between fatigue and psychological distress in mothers who are breast cancer survivors was investigated. Ninety-two mothers who were breast cancer survivors completed the Depression, Anxiety and Stress Scale, PROMIS-Cancer Fatigue Short Form and Concerns About Cancer Recurrence scale in an online survey. Mediation analysis via PROCESS was used to examine whether fatigue predicted depression, anxiety or stress through FCR. Fear of cancer recurrence mediated the relationships between fatigue and anxiety and fatigue and stress, while fatigue directly predicted depression. This study highlights FCR as a potential pathway to anxiety and stress in response to ongoing fatigue, and as a mechanism of action to reduce psychological distress among mothers who are breast cancer survivors. Future research examining this pathway from fatigue to psychological distress should also explore the nature of mothers' fears about their cancer recurring.

Play and Mothers' Relationships With Children in the Context of Breast Cancer

This interpretative phenomenological study explored play experiences between mothers who had completed, or were receiving treatment for, breast cancer and their young children and disease-related factors influencing those experiences. Six Puerto Rican mothers who had young children at the time of their primary treatment were interviewed. Interviews were recorded, transcribed, and analyzed through constant comparative method. Two themes emerged: (a) "changes and challenges," which contextualized disease-related factors affecting the maternal role; and (b) "play and relationships with children" described play moments and how treatment affected these. Participants emphasized the benefits of playing and relating with their children while in treatment. Play as a co-occupation and an effective means to connect mothers with their children must be considered in the practice of occupational therapy. Future studies with more diverse samples of mothers at different stages of the disease are warranted to expand this exploratory work.

"I know I didn't ask for it, but I've got it and I've let my kids down": A secondary data analysis of qualitative maternal perspectives of their and adolescent children's unmet needs through a cancer diagnosis

PURPOSE

This article is a secondary data analysis which explores maternal unmet needs and their perception of the 'unmet needs' of adolescent children when they experienced maternal cancer. The analysis is underpinned by the theoretical framework of the Offspring Cancer Needs Instrument OCNI, (Patterson et al., 2013).

METHOD

A secondary data analysis was carried out with ten maternal interviews analyzed using a deductive Thematic Analysis. This was to identify maternal unmet needs as well as their perceptions of their adolescent children's unmet needs and determine whether the OCNI framework was suitable to identify unmet needs of mothers and adolescent children in an Irish context.

RESULTS

The study found cancer is a challenging emotional burden for both mothers and their adolescent children. Emotions related to cancer recurrence were particularly difficult to deal with. Mothers struggle to identify the unmet needs of adolescent children and recognize that they lack the skills to approach the children, which adds to the burden of their illness burden and feelings of guilt.

CONCLUSIONS

The study highlights the need to provide safe spaces for patients and adolescent children to deal with their emotions, strengthen relationships and improve communication associated with maternal cancer as these have a significant impact in their lives and may lead to tension and conflict within families.

Natural Language Processing for Automated Classification of Qualitative Data From Interviews of Patients With Cancer

OBJECTIVES

This study sought to explore the use of novel natural language processing (NLP) methods for classifying unstructured, qualitative textual data from interviews of patients with cancer to identify patient-reported symptoms and impacts on quality of life.

METHODS

We tested the ability of 4 NLP models to accurately classify text from interview transcripts as "symptom," "quality of life impact," and "other." Interview data sets from patients with hepatocellular carcinoma (HCC) (n = 25), biliary tract cancer (BTC) (n = 23), and gastric cancer (n = 24) were used. Models were cross-validated with transcript subsets designated for training, validation, and testing. Multiclass classification performance of the 4 models was evaluated at paragraph and sentence level using the HCC testing data set and analyzed by the one-versus-rest technique quantified by the receiver operating characteristic area under the curve (ROC AUC) score.

RESULTS

NLP models accurately classified multiclass text from patient interviews. The Bidirectional Encoder Representations from Transformers model generally outperformed all other models at paragraph and sentence level. The highest predictive performance of the Bidirectional Encoder Representations from Transformers model was observed using the HCC data set to train and BTC data set to test (mean ROC AUC, 0.940 [SD 0.028]), with similarly high predictive performance using balanced and imbalanced training data sets from BTC and gastric cancer populations.

CONCLUSIONS

NLP models were accurate in predicting multiclass classification of text from interviews of patients with cancer, with most surpassing 0.9 ROC AUC at paragraph level. NLP may be a useful tool for scaling up processing of patient interviews in clinical studies and, thus, could serve to facilitate patient input into drug development and improving patient care.

Content Analysis of Multifaceted Needs for Improving the Quality of Pediatric Palliative Care Among Parents of Children With Life-threatening Conditions

This study aimed to identify parental needs for pediatric palliative care and obtain their opinions on developing pediatric palliative care in South Korea. This qualitative research design used inductive and deductive methods. The data were collected through semistructured interviews. A total of 6 parents actively caring for a child with life-threatening conditions and 7 bereaved parents participated in this study. A total of 707 significant statements, 43 subthemes, and 16 themes according to 6 structured matrices (advance care planning and symptom control, psychological and spiritual care, supporting everyday lives, end-of-life care and bereavement support, delivery model of pediatric palliative care, and unmet needs within current services) on the care and bereavement experiences of parents of children with life-threatening conditions were derived. Palliative care for children is a multidisciplinary approach to evaluate, prevent, and manage multifaceted symptoms and to support children with life-threatening conditions and their families. Our findings suggest that parents of children with life-threatening conditions in South Korea present multidimensional needs across the diagnostic groups and the illness trajectories and inform policy makers and health care professionals to design a pediatric palliative care delivery model. Further studies examining the unmet needs are required to enhance the quality of pediatric palliative care.

Perceptions and experiences of the subjective well-being of people with glioblastoma: a longitudinal phenomenological study

Background

Glioblastoma (GBM) is a devastating form of brain cancer, with a short life expectancy. In addition to this poor prognosis, people with GBM often experience symptoms that may have a profound impact on their subjective well-being (SWB). The aim of this study was to investigate the lived experiences and perceptions of people with GBM regarding their SWB.

Methods

The study adopted a longitudinal, hermeneutical phenomenological approach. Twenty-seven interviews were conducted with 15 patients over a period of two years. Most participants were interviewed twice on a face-to-face basis (during combined chemotherapy and radiotherapy, and again during adjuvant chemotherapy). The hermeneutic circle was used to guide data analysis.

Results

Data analysis identified four key themes that depicted the lived experiences and perceptions of SWB of people with GBM. "Experience of the disease" focuses on the impact of diagnosis, symptoms and side effects. "Daily life" relates to daily activities, family roles, work and social lives. "Coping" includes the importance of normality and goal-setting. "Experiences of care" focuses on the impact of the treatment schedule, experiences of care and impressions of the monitoring of QoL.

Conclusion

SWB is affected by a variety of factors throughout the GBM disease and treatment journey. The findings of this study suggest that healthcare professionals can enhance the SWB of people with GBM by providing personalized care that supports people to set themselves goals for the future and retain a degree of normality wherever possible.

Psychological distress, multimorbidity and health services among older adults in rural South Australia

OBJECTIVE

Psychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization.

DESIGN

A cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013-2017 population health survey. The Modified Monash Model MM2-7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population.

RESULTS

The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ² = 14.4, p < 0.001), <80 years (χ² = 11.7, p = 0.019), lower education (χ² = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ² = 51.1, p < 001), increasing age (χ² = 173.6, p < 0.001) and lower education (χ² = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6-5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2-5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3-4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6-8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4-4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9-5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress.

CONCLUSION/IMPLICATION

Psychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.

Prevalence and predictors of psychological distress among patients with thyroid cancer during transitional period in China: a cross-sectional study

OBJECTIVE

This study aimed to explore the psychological distress and its predictors among Chinese patients with thyroid cancer during their transitional period from hospital to home.

METHODS

A cross-sectional study was conducted in a cancer hospital in Tianjin, China. A total of three hundred patients with thyroid cancer completed the Chinese version of the National Comprehensive Cancer Network Distress Thermometer (DT), Cancer Fatigue Scale, and the Brief Illness Perception Questionnaire. Logistic regression was used to obtain the model of predictors of psychological distress among patients with thyroid cancer during the transitional period.

RESULTS

The DT score of 300 patients with thyroid cancer ranged from 0 to 10, and the median DT score was 2 [1-4]. The prevalence of clinically relevant psychological distress (DT score ≥ 4) in Chinese patients with thyroid cancer during their transitional period was 29.33% (88/300). The results of logistic regression analysis showed that gender (OR = 2.505, P = 0.036), fatigue (OR = 1.086, P = 0.005), and illness perception (OR = 1.137, P < 0.001) were significantly related to psychological distress in patients with thyroid cancer.

CONCLUSIONS

The psychological distress of patients with thyroid cancer during the transitional period is medium level. Patients with thyroid cancer who are female, easily fatigued, and have worse illness perceptions are more likely to experience psychological distress. Therefore, clinical attention should be paid to female patients and potential interventions aimed at improving fatigue and illness perception. It may reduce the prevalence of psychological distress during the transitional period.

The Impact of Cancer on the Mental Health of Patients Parenting Minor Children: A Systematic Review of Quantitative Evidence

OBJECTIVE

To provide an overview of quantitative data on the impact of cancer on the mental health of patients parenting minor children. We focused on mental health outcomes, their levels and prevalence and applied measurement tools.

METHODS

MEDLINE, CINAHL, PsycInfo and Web of Science were searched up to March 2021. We included quantitative studies, published in a peer-reviewed journal and reporting outcomes on the mental health (e.g., depression, anxiety) of cancer patients parenting minor children (≤ 21 years). Study quality was assessed based on the NIH assessment tool for observational studies. This study is registered on PROSPERO (CRD42019141954).

RESULTS

A total of 54 articles based on 36 different studies were included in this systematic review. Studies differ markedly regarding study and sample characteristics (e.g., outcome measures, sample size, parental health status). Depression and anxiety levels range from normal to abnormal, according to applied measurement tools. 7%-83% of parents with cancer have depression scores indicating probable depression and 19%-88% have anxiety scores indicating anxiety disorder.

CONCLUSIONS

This review reveals the dimension of mental burden affecting cancer patients parenting minor children. To identify, address and timely treat potentially arising mental health problems and support needs, affected parents should be closely monitored by healthcare professionals and referred to specialized support offers, if necessary. In the context of a comprehensive patient- and family-oriented care, it is highly relevant to integrate mental health (including parental) issues routinely into oncological care by proactively asking for the patient's psychosocial situation and the family status. This article is protected by copyright. All rights reserved.

A Promotive Process of Resource Gain Against Harsh and Inconsistent Discipline in Mothers Coping With Breast Cancer: A Serial Mediation Model

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.

Parenting stress in mothers with asthma during the postpartum period

OBJECTIVE

Maternal asthma often complicates pregnancy and is linked with poorer quality of life. Additionally, individuals with asthma are at an increased risk of depression and anxiety. We examined whether asthma during pregnancy is related to parenting stress in the first year postpartum and if this relationship varies with level of asthma control.

METHODS

This cohort survey-based study included mothers with (n = 157) and without (n = 79) asthma. Mothers with asthma participated in this study following participation in a randomized controlled trial of a novel asthma management strategy during pregnancy. Mothers completed the Parenting Stress Index - Short Form during the first 12 months postpartum. Mothers with asthma also completed the Asthma Control Questionnaire.

RESULTS

Parenting stress did not differ between mothers with and without asthma. Additionally, for mothers with asthma, there were no differences in levels of parenting stress based on asthma control.

CONCLUSIONS

This study suggests that mothers with asthma are not at an increased risk for excessive parenting stress. However, due to response and sampling bias, levels of parenting stress in asthmatic mothers may be underreported in our sample.

Cancer and Pregnancy: A Comprehensive Review

Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.

Disrupted mothering in Iranian mothers with breast cancer: a hybrid concept analysis

Background

Defining the disrupted mothering would contribute to developing strategies to support mothers with breast cancer. The aim of this study was to analyze the concept of mothering disruption using a hybrid model.

Methods

The Hybrid method for concept analysis was implemented consisting of three phases: theoretical, fieldwork, and final analysis. In the theoretical phase, the literature was searched using electronic databases including PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, CINAHL, Wiley, Ovid, Magiran, and SID from 2000 to 2020. Any quantitative or qualitative studies published in English or Persian, which were focused on mothering disruption in mothers with breast cancer were included in the study. In the phase of fieldwork, 20 mothers were interviewed to explore the aspects of mothering disruption. The interviews were transcribed and analyzed with conventional content analysis. In the final phase, an overall analysis of the two previous phases was performed.

Results

In the theoretical phase, the following attributes were determined: “disturbance in maternal identity and roles”, “maternal insensitivity and unresponsiveness: disconnection physically and psychologically”, “the career disruption process” and “biographical disruption”. The fieldwork phase explored three themes including “the unbalance between multiple roles”, “role failure”, and “reduced maternal sensitivity”. The final synthesis yielded that the main integrated elements of mothering disruption are “disease as threating maternal role and identity”, “inability to interpret and respond to child behaviors and needs”, and “support for transitioning from being patient toward maternal competency”.

Conclusion

With a deeper understanding of the term ‘disrupted mothering’ or ‘mothering disruption’, healthcare providers will have a foundation to improve cancer care, deliver effective communication and help such mothers cross this disruption and achieve restoration of their mothering role. Future research is needed to validate this concept and explore connections with health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01346-w.

Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience

Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.

Psychological aspects of gestational cancer: A systematic review

OBJECTIVE

Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer.

METHODS

Five journal databases were searched to identify peer-reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The Mixed-Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis.

RESULTS

Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy-related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies; concerns about the baby's health, lost opportunities, "not fitting in," and healthcare decision-making.

CONCLUSIONS

These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.

Assessing competencies of healthcare professionals caring for parents with cancer: The development of an innovative assessment tool

OBJECTIVE

This paper describes the development of an assessment tool capturing competencies of healthcare professionals (HCPs) in caring for cancer patients with minor children.

METHODS

We combined the methods of clinical case vignettes and situational judgement tests (SJTs). Scenarios were created based on literature and interviews with patients, HCPs, and experts. We pretested the instrument by conducting cognitive interviews with n = 6 HCPs, who gave feedback on realism, clarity, and difficulty of the scenarios.

RESULTS

The developed assessment tool measures the following competencies: HCPs' (1) application of knowledge, (2) behavioural responses to clinical scenarios, (3) attitudes regarding the relevance of integrating the parental role in cancer care, and (4) empathic behaviour towards affected parents. Results of the cognitive interviews indicate that the scenarios are perceived as realistic and clear.

CONCLUSIONS

We provide an innovative approach by methodologically combining clinical case vignettes and SJTs. Next, the assessment tool will be applied in the context of a pilot evaluation of a newly developed training for HCPs that aims at enhancing their competencies in caring for cancer patients with minor children.

The Mediational Role of Burden and Perceived Stress in Subjective Memory Complaints in Informal Cancer Caregivers

The role of informal caregiver of cancer patients is considered a situation of chronic stress that could have impact on cognitive functioning. Our aim was to evaluate differences in perceived stress, subjective memory complaints, self-esteem, and resilience between caregivers and non-caregivers, as well as the possible mediational role of burden in caregivers. The sample was composed of 60 participants divided into two groups: (1) Primary informal caregivers of a relative with cancer (CCG) (n = 34); and (2) non-caregiver control subjects (Non-CG) (n = 26). All participants were evaluated through a battery of tests: Socio-demographic questionnaire, subjective memory complaints questionnaire (MFE-30), Rosenberg Self-Esteem Scale, resilience (CD-RISC-10), and perceived stress scale (PSS). The CCG group also completed the Zarit burden interview. Results indicated that CCG displayed higher scores than Non-CG in MFE-30 (p = 0.000) and PSS (p = 0.005). In the CCG group, Pearson correlations indicated that PSS showed a negative relationship with resilience (p = 0.000) and self-esteem (p = 0.002) and positive correlation with caregiver’s burden (p = 0.015). In conclusion, CCG displayed higher number of subjective memory complaints and higher perceived stress than Non-CG, whereas no significant differences were obtained on self-esteem and resilience. These results could aid in designing new intervention strategies aimed to diminish stress, burden, or cognitive effects in informal caregivers of cancer patients.