Worrying about one’s children after breast cancer diagnosis: desired timing of psychosocial intervention

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.

How is my child doing - parental understanding of their children when a parent has cancer

To explore the difficulties parents face when understanding their children's reactions to parental cancer and parents' reactions to their children's perceived needs.

Qualitative interviews with cancer patients and their partners.

Eleven patients and seven partners took part. Their children were aged 1-15 years. Eight patients were mothers and cancer was diagnosed median 28 (7-104) months ago.

Inductive analysis with systematic text condensation.

Parents were groping in the dark when understanding their children's reactions. They observed signs of distress in their children, but often avoided communication about emotional reactions. We suggest parental difficulties in containing own and children's emotions as an important cause for this situation.

Parents lacked relevant support offers for the family as a unit. Identification of children's difficulties cannot be based on parental evaluation alone. We suggest family support as part of standard care for patients with minor children.

The linked lives of young women with metastatic breast cancer

PURPOSE/OBJECTIVES

With a growing number of young women with metastatic breast cancer (MBC) in the United States, it is important to consider how their diagnoses affect their relationships with others. The dual identities of being young and having MBC create unique challenges for women's relationships. However, there is little extant research on the relationship experiences and needs of young women with MBC. The purpose of this study is to understand how young women describe their lived experiences with social and intimate relationships following their diagnoses of MBC.

DESIGN

A cross-sectional qualitative study with a life course theoretical framework was employed.

SAMPLE/PARTICIPANTS

Purposive sampling yielded nine participants who took part in semi-structured interviews. Phenomenology informed understanding of the lived experience of young women with MBC.

FINDINGS

The findings describe how young women with MBC made meaning out of their relationships to other people following their diagnoses, via themes of feeling alienated from other women with breast cancer, friendship trajectories, managing intimate relationships, how much to share with children, losing the dream of (more) children, and finding a voice in the MBC community.

CONCLUSION

MBC links participants' lives to individuals from their preexisting relationships, new friendships, and the breast cancer community in irrevocable ways.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

These findings present new information about the social and relationship needs of young women with MBC. Psychosocial providers and medical team members should not presume MBC patients' disinterest in fertility preservation.

The Parenting Concerns Questionnaire: A validation study with Portuguese parents with cancer

OBJECTIVES

To examine the psychometric properties of the Parenting Concerns Questionnaire (PCQ) in a sample of Portuguese parents with cancer.

METHODS

The PCQ was completed by 209 adults with cancer, who are parents of at least one minor child. Participants reported on parenting concerns, depressive and anxiety symptoms, parental stress as well as quality of life. Confirmatory factor analysis and Item Response Theory (IRT) were used to assess the psychometric properties of the PCQ. Cronbach's alpha was used to examine its reliability. Pearson correlation coefficients provided information regarding convergent validity. Criterion validity was analysed.

RESULTS

Confirmatory factor analysis confirmed the original three-factor structure. IRT indicated that most of the items were highly discriminant and better identified as moderate versus low or high levels of parenting concerns in the three dimensions of PCQ. The pattern of associations with depressive and anxiety symptoms, parental stress, and quality of life provided evidence for the convergent validity. The PCQ differentiated between parents with and without depressive symptoms.

CONCLUSION

Exploring parenting concerns provides additional relevant information about the experiences and the potential psychological distress experienced by these parents with cancer. The PCQ can be an important tool to identify parents with cancer who might benefit from psychological support regarding parenting.

Assessing preferences for receiving supportive care resources among patients seen at a Breast Care Center

BACKGROUND

Patients with breast cancer or at high risk for breast cancer have supportive care needs. Although cancer centers offer social, psychological, and other support to these patients, these services are not always utilized, and patients continue to report unmet supportive care needs. Reasons for non-utilization of these services have not been well documented. In this analysis, we examine patient reasons for service non-utilization and evaluate patients' interest in receiving information about and paying for other supportive care services.

METHODS

Study participants were contacted by email 7-14 months following appointments at the University of California, San Francisco (UCSF) Breast Care Center (BCC) and were invited to complete a 26-question survey about supportive care utilization at UCSF.

RESULTS

In total, 195 patients (45%) completed surveys. Of these, 68% had breast cancer. Among patients with breast cancer, fewer than half completed appointments with psychological services. Lack of self-perceived need was the primary reason patients did not pursue psychological services. Overall, 61% of participants were interested in learning more about psychological services, 27% in nutrition counseling, and 20% in exercise counseling. Participants were more interested in individual counseling than in group counseling but were less interested in paying for services.

CONCLUSION

Patients often feel that they do not need supportive services. Breast cancer patients are interested in learning more about psychological services, exercise counseling, and nutrition counseling. Although many cancer centers offer group coaching and counseling sessions on these topics, patients may be more willing to engage in individual counseling.

Chronic Stress in Vocational and Intimate Partner Domains as Predictors of Depressive Symptoms After Breast Cancer Diagnosis

BACKGROUND

After cancer diagnosis, depressive symptoms are elevated on average and decline over time, but substantial variability is apparent. Few studies have examined to what extent chronic stress in distinct life domains affects depressive symptoms.

PURPOSE

Chronic stress in vocational and intimate partner life domains, and their interaction, were tested as predictors of depressive symptoms after breast cancer diagnosis.

METHODS

Women (N = 460) completed validated interviews regarding chronic stress in specific life domains shortly after diagnosis and a measure of depressive symptoms every 6 weeks for 6 months.

RESULTS

In latent growth curve modeling analyses, greater chronic stress in work (b = 2.90; p < .001) and intimate partner domains (b = 1.38, p = .02) was associated with higher depressive symptoms at study entry (intercept), and greater work stress predicted faster recovery from depressive symptoms over time (b = -0.10; p = .01). The two domains of chronic stress also interacted significantly on depressive symptoms at study entry (b = -1.54; p < .02) and over time (b = 0.14; p < .001). Greater work stress was associated with higher depressive symptoms at study entry regardless of intimate partner stress, but greater intimate partner stress was associated with higher depressive symptoms when work stress was low. The decline over 6 months in initially elevated depressive symptoms predicted by high work stress was significantly steeper when intimate partner stress was low.

CONCLUSIONS

Targeting interventions to recently diagnosed breast cancer patients living with chronically stressful vocational and intimate partner life circumstances could be worthwhile.

Somatic symptoms in children who have a parent with cancer: A systematic review

BACKGROUND

This systematic review explored the occurrence and types of somatic symptoms in children (0-20 years) who have experienced parental cancer.

METHODS

We complemented a systematic literature search from PubMed and PsycInfo with a reference search. We identified 1,694 articles, which were independently screened by two authors; they further evaluated potentially relevant papers for quality and extracted the data. We found nine relevant studies (10 publications) on altogether 672 children with a parent who had cancer; four studies included a control group.

RESULTS

The studies typically focused on children's psychosocial reactions on parental cancer rather than somatic complaints, so symptom prevalence cannot be reliably summarized. Several studies were small, and the types of somatic symptoms were only specified in five studies. Somatic symptoms were reported as a measure of emotional reactions in the remaining four studies. Three studies provided longitudinal data. The main types of specific symptoms reported were eating problems, pain, sleeping troubles, and bed-wetting. Children of cancer patients tended to show an increase of unspecified somatic symptoms and pain, but evidence was inconsistent. There was a tendency that somatic complaints were associated with increased emotional distress in the children. The material did not allow for separate analysis by age group or bereavement status.

CONCLUSIONS

Children in families with parental cancer may present with somatic complaints, but the prevalence and significance is not possible to estimate due to very sparse research in this area. Health professionals or counselling providers should not overlook this possible sign of distress. Qualitative studies report significant health anxiety in these children; this may represent a specific topic for counselling in this population. Targeted studies are needed to evaluate the prevalence and significance of somatic symptoms, and especially vulnerable groups need to be identified.

Mothers with breast cancer: A mixed-method systematic review on the impact on the parent-child relationship

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.

Understanding parenting concerns in cancer survivors with minor and young-adult children

OBJECTIVE

Parents with cancer are concerned about the impact of their disease on their children. However, parenting concerns and associated factors in cancer survivors have not previously been analyzed. The purpose of this study is to examine parenting concerns and to test a path model for understanding parenting concerns in cancer survivors.

METHODS

In a cross-sectional study, a total of 1416 parents with cancer (mean age 47.5years, 74% women) having minor or young-adult children were recruited through two cancer registries. Parenting concerns were assessed using the Parenting Concerns Questionnaire. Structural equation modeling (SEM) was used to analyze the associations between social support, parenting confidence, emotional distress, family functioning and parenting concerns.

RESULTS

Mothers reported higher total parenting concerns than fathers (p<0.001). We observed strong effects of emotional distress and parenting confidence on parenting concerns. Family dysfunctioning was associated with lower concerns. An indirect association between social support and parenting concerns was identified.

CONCLUSION

Parenting concerns in cancer survivors display the need for interventions and after care programs that focus on affected families with minor and young adult children. The results of the structural path model illustrate the associations between psychological and interactional factors. Supporting parents with cancer in their parenting confidence and strengthen social support and family functioning may not only reduce the long-term burden on the parents themselves but also the burden on the entire family.

Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment

PURPOSE OF REVIEW

This review examines recent literature on the psychosocial needs of and interventions for young women. We focus on the active treatment period given the toxicity of treatment, the incidence of anxiety, and depressive symptoms in these women during treatment. This review summarizes research relevant to addressing their social and emotional concerns.

RECENT FINDINGS

Young women undergoing treatment for breast cancer remain understudied despite unique needs. Psychoeducational interventions help to relieve symptoms and emotional distress during treatment, but effects do not appear to persist over the longer term. In the clinical context, the performance of prognostic-risk prediction models in this population is poor. Surgical decision-making is often driven by fear of recurrence and body image rather than prognosis, and decision aids may help young women to synthesize information to preserve their role in the treatment process.

SUMMARY

First, shared decision-making, second, balancing body image, fear of recurrence, and recommended treatment, and third, palliative care for metastasis are essential research priorities for the clinical setting. In the larger social context, unique family/partner dynamics as well as financial and insurance concerns warrant particular attention in this population.