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Oberoi S, Garland A, Yan AP, Lambert P, Xue L, Decker K, Israels SJ, Banerji S, Bolton JM, Deleemans JM, Garand-Sheridan B, Louis D, Lix LM, Mahar AL. Mental Disorders Among Adolescents and Young Adults With Cancer: A Canadian Population-Based and Sibling Cohort Study. J Clin Oncol 2024; 42:1509-1519. [PMID: 38335465 DOI: 10.1200/jco.23.01615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/01/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To compare the cumulative incidence of mental disorders among adolescents and young adults (AYAs) diagnosed with cancer with the general population and their unaffected siblings. METHODS A retrospective, population-based, matched cohort design was used to investigate the impact of cancer diagnosis on mental disorders among individuals age 15-39 diagnosed between 1989 and 2019. Two cancer-free cohorts were identified: matched population-based and sibling cohorts. Outcomes included incidence of mood and anxiety disorders, substance use disorders, suicide outcomes, psychotic disorders, and any of the preceding four categories within 5 years of cancer diagnosis. Competing risk regression was used to estimate adjusted subhazard ratios (aSHR) and 95% CIs. RESULTS Among 3,818 AYAs with cancer matched to the population-based cancer-free cohort, individuals with cancer were more likely to be diagnosed with incident mental disorders than those without cancer; the risk was highest immediately after a cancer diagnosis and decreased over time with aSHR [95% CI] for mood and anxiety disorders at 0-6 months (11.27 [95% CI, 6.69 to 18.97]), 6-12 months (2.35 [95% CI, 1.54 to 3.58]), and 12-24 months (2.06 [95% CI, 1.55 to 2.75]); for substance use disorders at 0-6 months (2.73 [95% CI, 1.90 to 3.92]); for psychotic disorders at 0-6 months (4.69 [95% CI, 2.07 to 10.65]); and for any mental disorder at 0-6 months (4.46 [95% CI, 3.41 to 5.85]), 6-12 months (1.56 [95% CI, 1.14 to 2.14]), and 12-24 months (1.7 [95% CI, 1.36 to 2.13]) postcancer diagnosis. In sibling comparison, cancer diagnosis was associated with a higher incidence of mood and anxiety and any mental disorder during first 6 months of cancer diagnosis. CONCLUSION AYAs with cancer experience a greater incidence of mental disorders after cancer diagnosis relative to population-based and sibling cohorts without cancer, primarily within first 2 years, underscoring the need to address mental health concerns during this period.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Allan Garland
- Department of Internal Medicine, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Adam P Yan
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Pascal Lambert
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Lin Xue
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Kathleen Decker
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatric Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Shantanu Banerji
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Julie M Deleemans
- Department of Oncology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | | | - Deepak Louis
- Section of Neonatology, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
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Osmani V, Hörner L, Klug SJ, Tanaka LF. Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: A systematic review and meta-analysis. Cancer Med 2023; 12:18354-18367. [PMID: 37559504 PMCID: PMC10523984 DOI: 10.1002/cam4.6435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer survivors (CS) face unique psychosocial challenges, which may affect their mental health. However, there are inconsistencies in AYA definitions and varying prevalence data on psychological distress, anxiety, and depression. We aimed to synthesize published literature on prevalence, risk, longitudinal changes, and predictors for these outcomes and estimate pooled prevalences. METHODS We searched for observational studies published in English before June 1 2022, in PubMed, PsycINFO, Scopus, and Web of Science. Two researchers extracted independently information on study characteristics, prevalence, and risk. The pooled prevalence (PP) of psychological distress, anxiety, and depression was estimated using random-effects models. Geographical region, treatment status, and assessment instruments were considered in stratified meta-analyses. RESULTS Sixty-eight studies were included in the systematic review and 57 in the meta-analyses. We estimated an overall prevalence of 32% (n = 30; 4226/15,213 AYAs; 95% CI, 23%-42%; I2 = 99%) for psychological distress, 29% for anxiety (n = 24; 2828/8751 AYAs; 95% CI, 23%-36%; I2 = 98%), and 24% (n = 35; 3428/16,638 AYAs; 95% CI, 18%-31%; I2 = 98%) for depression. The range of PP of psychological distress varied across geographical regions, treatment status, and assessment instruments. The PP of anxiety varied significantly across continents, while no variations were seen for depression. Studies found higher risks for psychological distress, anxiety, and depression in AYAs compared to older cancer survivors or cancer-free peers. CONCLUSIONS Our research found that one in three AYA-CS experience psychological distress or anxiety and one in four are affected by depression, highlighting the need for specialized psychological services for AYA-CS in oncology settings and AYA-focused interventions.
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Affiliation(s)
- Vanesa Osmani
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Lucy Hörner
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Stefanie J. Klug
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Luana Fiengo Tanaka
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
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Koehler M, Hoppe S, Kropf S, Lux A, Bartsch R, Holzner B, Krauter J, Florschütz A, Jentsch-Ullrich K, Frommer J, Flechtner HH, Fischer T. Randomized Trial of a Supportive Psychotherapy for Parents of Adolescents and Young Adults With Hematologic Malignancies. J Natl Compr Canc Netw 2022; 20:jnccn20614. [PMID: 35405661 DOI: 10.6004/jnccn.2021.7075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer regularly disrupts health and developmental trajectories in adolescents and young adults (AYAs). Parents have been shown to have a substantial impact on the health and cancer survivorship activities of AYA patients in the form of symptom management. However, no randomized controlled trial has evaluated a coping support intervention (CSI) program for parents of AYAs with cancer aged 18 to 40 years. PATIENTS AND METHODS From November 30, 2012, to August 29, 2016, parents of AYAs with hematologic malignancies were randomized in a phase III controlled trial (1:1 ratio, stratified sampling) to either the research-based CSI AYA-Parents group (CSI group; n=82) or the standard care (SC) group (n=70). CSI consisted of 5 sessions to achieve the enhancement of parental adaptive coping as the primary outcome (per the adaptive coping scale of the 28-item Brief COPE, a validated multidimensional self-assessment-questionnaire recommended for clinical cancer research). Measures of adaptive coping, depression, and mental health were collected at pre-CSI (measurement date T1), at the end of the intervention sessions (measurement date T2), and at follow-up (3 months). We calculated mean change scores in outcomes and estimated intervention effect sizes (Cohen's d) for changes from T1 to T2/T3, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. All statistical tests were 2-sided. RESULTS In the intention-to-treat analysis, the CSI group significantly improved their adaptive coping compared with the SC group (95% CI, 0.30-2.54; P=.013; d=0.405), whereas adaptive coping in the SC group deteriorated. The CSI group also experienced a significant decrease in depressive symptoms and improved mental health with clinical significance (95% CI, -1.98 to -0.30; P=.008; d=0.433, and 95% CI, -0.19 to 3.97; P=.074; d=0.292, respectively). Sensitivity analyses confirmed the robustness of the main intention-to-treat analysis. CONCLUSIONS CSI improved effectively adaptive coping and depression in parents of AYAs with hematologic malignancies. It may represent a novel family-based approach in AYA oncology care.
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Affiliation(s)
- Michael Koehler
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Susanne Hoppe
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Siegfried Kropf
- 3Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Anke Lux
- 3Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Rainer Bartsch
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Bernhard Holzner
- 4Department of Psychiatry, Psychotherapy and Psychosomatic, Innsbruck Medical University, Innsbruck, Austria
| | - Juergen Krauter
- 5Department of Hematology and Oncology, Braunschweig Municipal Hospital, Braunschweig, Germany
| | - Axel Florschütz
- 6Department of Internal Medicine, Dessau Municipal Hospital, Dessau-Roßlau, Germany
| | | | - Joerg Frommer
- 8Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, and
| | - Hans-Henning Flechtner
- 9Department of Child and Adolescent Psychiatry, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Fischer
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
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Early Evidence of the Interplay between Separation Anxiety Symptoms and COVID-19-Related Worries in a Group of Children Diagnosed with Cancer and Their Mothers. CHILDREN 2022; 9:children9040481. [PMID: 35455525 PMCID: PMC9028105 DOI: 10.3390/children9040481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
Having cancer in childhood is a risk factor for separation anxiety symptoms, with negative effects on the disease and psychological wellbeing. The Covid-19-pandemic-related concerns could have a negative effect. The present study explores the interplay between separation anxiety symptoms and COVID-19-related worries in pediatric cancer patients and their mothers, compared to a group of healthy children and their mothers, during the pandemic. Thirty-three subjects with cancer, aged 7–15 years, and their mothers were compared to a control sample of 36 healthy children and caregivers. They were administered a pandemic-related psychological experience survey and standardized questionnaires assessing psychological wellbeing, anxiety, and separation anxiety symptoms. Children with cancer reported significantly higher prosocial behaviors, fear of being alone, and fear of abandonment. Their mothers had worse psychological wellbeing, higher COVID-19 concerns, anxiety, and separation anxiety symptoms. The multiple linear regression model showed that an increase in children’s separation anxiety symptoms was associated with younger age, more recent diagnosis, more mother-child time, lower mothers’ worry for children’s contagion, and higher mothers’ and children’s anxiety. COVID-19-related worries of clinical children’s mothers seem to be protective for children’s psychological wellbeing. Early psychosocial support interventions for mothers are essential in health services for cancer.
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Licková K, Čoček A, Ambruš M, Soumarová R, Vránová J, Klézl P, Mitchell AJ, Raudenská J, Javůrková A. Rapid screening of depression and anxiety in cancer patients: Interview validation of emotion thermometers. Asian J Psychiatr 2021; 65:102827. [PMID: 34560569 DOI: 10.1016/j.ajp.2021.102827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to determine the degree of depression and anxiety in cancer patients using the Emotion Thermometers (ET) and confirming their clinical usefulness compared to the gold standard interview, as well as determining optimal cut-off values for the appropriate identification of cancer patients' distress. METHODS We included 238 cancer patients and we used ET (Emotion Thermometers) to screen depression and anxiety and the Beck depression inventory for adults (BDI-II), the Generalized Anxiety Disorder 7-item scale (GAD-7) and the Mini-International Neuropsychiatric Interview (M.I.N.I) was used as the criterial validity standard. RESULTS The prevalence of anxiety on the M.I.N.I. was 24% and depression was 11%. The optimal value for diagnosis of depression from ET (Dep ET) appears to be > 4.5 (AUC 0.928) against M.I.N.I. Optimal score for anxiety from ET (AnxT ET) compared to GAD according to M.I.N.I. we determined the value of 3.5 (AUC 0.899). To determine the cut off score for distress using from ET (DT), we compared against GAD-7 and BDI-II RS (raw total score) and the most optimal was 4.5 (AUC 0.953). For analysis of the cut off score for quality of life (QoL) against the total sums of all parts of the ET, the value of 14.5 (AUC 0.892) forms the cut off between the negative and the positive clinical finding. CONCLUSIONS The results of the study support the use of ET as a rapid screening tool for the detection of depression, anxiety and distress in cancer patients.
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Affiliation(s)
- K Licková
- Radiotherapy and Oncology Department, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - A Čoček
- Department of Ear, Nose and Throat, Thomayer Hospital, Prague, Czechia
| | - M Ambruš
- Radiotherapy and Oncology Department, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - R Soumarová
- Radiotherapy and Oncology Department, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - J Vránová
- Institute of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - P Klézl
- Department of Urology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia
| | - A J Mitchell
- Department of Psycho-oncology, University of Leicester, Leicester LE1 5WW, UK
| | - J Raudenská
- Department of Nursing, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - A Javůrková
- Department of Nursing, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia; Department of Clinical Psychology, University Hospital Kralovske Vinohrady, Prague, Czechia.
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6
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Kolemen AB, Akyuz E, Toprak A, Deveci E, Yesil G. Evaluation of the parents' anxiety levels before and after the diagnosis of their child with a rare genetic disease: the necessity of psychological support. Orphanet J Rare Dis 2021; 16:402. [PMID: 34583726 PMCID: PMC8480067 DOI: 10.1186/s13023-021-02046-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background The diagnosis of the rare genetic diseases has great importance in treating multisystemic conditions, preventing potential complications, and estimating disease risk for family members. The duration of obtaining genetic test results is varies. The demand to learn the diagnosis of a possible untreatable illness involves a struggle between uncertainty and a lifetime chronic disease. The current uncertainty of their child's condition and the long wait for a diagnosis may increase the parents' anxiety level and cause difficulties in the continuation of diagnostic procedures in some families. This study aimed to investigate the prediagnosis and postdiagnosis anxiety levels of parents who have a child with a rare genetic disease. Method The parents in this study, mothers or fathers, admitted their children to the Bezmialem Vakıf University Medical Genetics Clinic due to a suspected rare genetic disease (n = 40). Researchers created “The Sociodemographic Questionnaire” and used it to analyze the parents' sociodemographic status. In addition, they used the State-Trait Anxiety Inventory (STAI) to determine the anxiety levels of the parents. Results The state anxiety levels of parents decreased significantly after learning the diagnosis. However, there was no statistically significant decrease observed in trait anxiety levels. Conclusion Data from this study revealed that informing parents about their child's disease and properly explaining to them the expected difficulties might help to reduce their anxiety levels. Psychological support for parents is necessary to reduce their long-term stress, thus increasing the patient's compliance with treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02046-2.
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Affiliation(s)
- Ayse B Kolemen
- Department of Medicine, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Enes Akyuz
- Department of Biophysics, Saglık Bilimleri University Faculty of International Medicine, Istanbul, Turkey
| | - Ali Toprak
- Department of Biostatistics and Medicine Informatics, Division of Basic Medical Sciences, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Erdem Deveci
- Department of Psychiatry, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yesil
- Department of of Medical Genetics, Istanbul University Faculty of Medicine, Istanbul, Turkey.
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Gürcan M, Atay Turan S. The effectiveness of mandala drawing in reducing psychological symptoms, anxiety and depression in hospitalised adolescents with cancer: A randomised controlled trial. Eur J Cancer Care (Engl) 2021; 30:e13491. [PMID: 34322921 DOI: 10.1111/ecc.13491] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of individual mandala drawing methods on psychological symptoms, anxiety and depression in hospitalised adolescents with cancer. METHODS A randomised controlled trial design with repeated measures was conducted. The study was carried out in a paediatric haematology and oncology clinic in Turkey. The study protocol is registered at ClinicalTrials.gov NCT04297982. The study sample consisted of 60 hospitalised adolescents aged between 12 and 17. Participants were randomly assigned to receive two 1- to 2-h mandala drawing sessions (intervention group, n = 30) or routine care only (control group, n = 30). Each adolescent was assessed using the Hospital Anxiety and Depression Scale and the Memorial Symptom Assessment Scale (Psychological subscale) questionnaires and was evaluated at baseline and after 5 days. RESULTS The anxiety and depression scores significantly decreased in the intervention group, compared with the control group, after 5 days of intervention, F(1, 57) = 28.9, p < 0.01, η2 = 0.337. Similarly, the psychological symptoms scores significantly decreased in the intervention group, compared with the control group, F(1, 57) = 69.7, p < 0.001, η2 = 0.550). CONCLUSION The individual mandala activity intervention was effective in reducing on psychological symptoms, anxiety and depressive symptoms in adolescents with cancer.
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Affiliation(s)
- Meltem Gürcan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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8
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Miroshnychenko A, Rae C, Tsangaris E, Breakey VR, D'Agostino N, Klassen AF. Clinical and Demographic Factors Associated with Distress in Adolescent and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:682-689. [PMID: 33844943 DOI: 10.1089/jayao.2020.0196] [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] [Indexed: 02/03/2023] Open
Abstract
Purpose: Distress in cancer is defined as multifactorial unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with ones' ability to cope with cancer and its symptoms and treatment. The aim of this study was to determine clinical and demographic factors associated with the presence of distress in adolescent and young adults (AYAs) with cancer. Methods: Data were collected as part of a field-test study conducted between August 2016 and November 2017 in Canada (Toronto, Edmonton, and Vancouver) to determine the reliability and validity of CDS-AYA (Cancer Distress Scales for Adolescent and Young Adults). The CDS-AYA consist of five independently functioning scales including impact of cancer, physical, emotional, cognitive, and cancer worry. Multivariate logistic regression analyses, using established CDS-AYA cut points, were performed to identify clinical and demographic factors associated with the presence of distress in AYAs of ages 15-39 years with cancer. Results: Across all scales, increased distress was associated with female gender (p < 0.05), on-treatment status (p < 0.05), and reported poor overall health (p < 0.001). For the emotional scale, distress was also associated with being of age 15-19 years (p = 0.01). The greatest effect size for all scales was associated with treatment status [exp(β) = 1.78-4.6], except for the cognitive scale where gender had a slightly greater effect size. Conclusion: Factors associated with distress in AYA patients with cancer were similar across five CDS-AYA scales. Although it is important to screen all patients for distress, our findings reveal that patients who are female, on treatment, or who report having poorer health may be at a greater risk.
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Affiliation(s)
- Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vicky R Breakey
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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9
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Mahakwe G, Johnson E, Karlsson K, Nilsson S. A Systematic Review of Self-Report Instruments for the Measurement of Anxiety in Hospitalized Children with Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041911. [PMID: 33669455 PMCID: PMC7920462 DOI: 10.3390/ijerph18041911] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/07/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
Anxiety has been identified as one of the most severe and long-lasting symptoms experienced by hospitalized children with cancer. Self-reports are especially important for documenting emotional and abstract concepts, such as anxiety. Children may not always be able to communicate their symptoms due to language difficulties, a lack of developmental language skills, or the severity of their illness. Instruments with sufficient psychometric quality and pictorial support may address this communication challenge. The purpose of this review was to systematically search the published literature and identify validated and reliable self-report instruments available for children aged 5–18 years to use in the assessment of their anxiety to ensure they receive appropriate anxiety-relief intervention in hospital. What validated self-report instruments can children with cancer use to self-report anxiety in the hospital setting? Which of these instruments offer pictorial support? Eight instruments were identified, but most of the instruments lacked pictorial support. The Visual Analogue Scale (VAS) and Pediatric Quality of Life (PedsQL™) 3.0 Brain Tumor Module and Cancer Module proved to be useful in hospitalized children with cancer, as they provide pictorial support. It is recommended that faces or symbols be used along with the VAS, as pictures are easily understood by younger children. Future studies could include the adaptation of existing instruments in digital e-health tools.
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Affiliation(s)
- Gomolemo Mahakwe
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa; (G.M.); (E.J.)
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, Private Bag X20, Hatfield 0028, South Africa; (G.M.); (E.J.)
| | - Katarina Karlsson
- Department of Health Sciences, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden;
| | - Stefan Nilsson
- Institute of Health and Care Sciences, Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
- Correspondence: ; Tel.: +46-738538951
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10
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Weidler EM, Grimsby G, Garvey EM, Zwayne N, Chawla R, Hernandez J, Schaub T, Rink R, van Leeuwen K. Evolving indications for surgical intervention in patients with differences/disorders of sex development: Implications of deferred reconstruction. Semin Pediatr Surg 2020; 29:150929. [PMID: 32571514 PMCID: PMC7322933 DOI: 10.1016/j.sempedsurg.2020.150929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rare medical conditions are difficult to study due to the lack of patient volume and limited research resources, and as a result of these challenges, progress in the care of patients with these conditions is slow. Individuals born with differences of sex development (DSD) fall into this category of rare conditions and have additional social barriers due to the intimate nature of the conditions. There is also a lack of general knowledge in the medical community about this group of diverse diagnoses. Despite these limitations, progress has been made in the study of effective ways to care for patients who are born with chromosomal or anatomical differences of their internal reproductive organs or external genitalia. Advocacy groups have placed a spotlight on these topics and asked for a thoughtful approach to educate parents of newborns, medical providers, and the adolescents and young adults themselves as they mature.1 There is growing interest in the approaches to surgical reconstruction of the genitalia and the management of internal gonads, specifically the timing of procedures and the indications for those procedures.2 Advocates suggest deferring surgical procedures until the affected individual can participate in the decision-making process. This approach requires a roadmap for addressing the long-term implications of delayed surgical management. Presented here is a review of the specific issues regarding the complex management of the various categories of DSD.
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Affiliation(s)
- Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Gwen Grimsby
- Division of Pediatric Urology, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Erin M Garvey
- Division of Pediatric Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Noor Zwayne
- Division of Pediatric and Adolescent Gynecology, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Reeti Chawla
- Division of Pediatric Endocrinology, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Janett Hernandez
- Division of Pediatric Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Timothy Schaub
- Division of Plastic Surgery, Phoenix Children‟s Hospital, Phoenix, AZ
| | - Richard Rink
- Division of Pediatric Urology, Riley Hospital for Children, Indianapolis, IN
| | - Kathleen van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, 85006, United States.
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11
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Bikmazer A, Orengul AC, Buyukdeniz A, Okur FV, Gokdemir Y, Perdahli Fis N. Coping and psychopathology in children with malignancy and bronchiectasis. Pediatr Pulmonol 2020; 55:214-220. [PMID: 31816196 DOI: 10.1002/ppul.24534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/07/2019] [Indexed: 11/12/2022]
Abstract
AIM We aimed to evaluate the coping styles and social support perceived by the children with two different chronic diseases (cancer and bronchiectasis), their mothers' coping styles and compare them with a control group without any chronic physical or psychiatric disorder. METHODS Our sample consisted of 114 children and adolescents, with an age range from 9 to 15 years. The data were collected by using schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, kid-coping orientation to problems experienced (Kid-COPE), social support appraisals scale (SSAS), and COPE. RESULTS All three groups were similar with respect to age and sex distribution. Around 50% to 60% of the children in both patient groups had a psychiatric diagnosis. Remarkably, 30% of the children had an internalizing disorder. The most commonly used coping style by the mothers was religious coping in all groups. Kid-COPE scores did not significantly differ between groups. The scores on Family and Friend subscales of SSAS in the bronchiectasis group were significantly lower when compared with those of participants in hematology-oncology and control groups. CONCLUSION Chronic medical illnesses may have a similar psychological impact on children regardless of disease-specific clinical presentations and outcomes. Future studies need to focus on identifying protective and risk factors that potentially mediate psychosocial well-being.
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Affiliation(s)
- Alperen Bikmazer
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Istanbul Medeniyet University, Uskudar, Istanbul, Turkey
| | - Abdurrahman Cahid Orengul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Bezmialem University, Fatih, Istanbul, Turkey
| | - Ayşe Buyukdeniz
- Department of Child and Adolescent Psychiatry, Sancaktepe Research and Training Hospital, Sancaktepe, Istanbul, Turkey
| | - Fatma Visal Okur
- Department of Pediatric Haematology-Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Gokdemir
- Department of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Pendik, Istanbul, Turkey
| | - Nese Perdahli Fis
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Marmara University, Pendik, Istanbul, Turkey
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The Many Roles of the Rock: A Qualitative Inquiry into the Roles and Responsibilities of Fathers of Children with Brain Tumors. CHILDREN-BASEL 2019; 6:children6100113. [PMID: 31614522 PMCID: PMC6826713 DOI: 10.3390/children6100113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 12/29/2022]
Abstract
A pediatric brain tumor diagnosis impacts an entire family unit, from diagnosis through curative treatment, and into survivorship or bereavement. Paternal caregiver experience has been significantly underexplored in pediatric neuro-oncology research as compared to maternal experience. This case series study explores the paternal roles, responsibilities, strengths, challenges, personal growth, and support needs of fathers of children with brain tumors receiving new palliative care consultations. In the study setting, a neuro-oncology diagnosis results in an automatic referral to the palliative care team, and thus, a convenience sampling model was employed based on consecutive palliative care consults for new childhood brain tumor diagnoses. In this study, four fathers of pediatric brain tumor patients receiving palliative care consultations responded to eight open-ended questions. Individual, voice-recorded interviews were transcribed for semantic content qualitative analysis. Analysis followed Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Participants completed quantitative surveys of their information preferences and support needs. Participants defined their father role as: being a team parent, an adaptable father, supporter, provider, a present father, and protector. Role conflict due to paternal responsibilities were recognized, such as the absence from the hospital to provide financial security for the family, and yet a desire to be physically present for the child. Fathers prioritized their knowledge needs about their child’s diagnosis, prognosis, and treatment above emotional needs. Fathers shared experiences of their personal growth through their child’s brain tumor diagnosis and advised on preferred support formats to include both verbal and written information. Understanding how paternal caregivers of children with cancer define their roles and goals has potential to improve the care and communication delivered to families of pediatric neuro-oncology patients.
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13
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Greenblatt A, Saini M. Experiences of adolescents with cancer from diagnosis to post-treatment: a scoping review. SOCIAL WORK IN HEALTH CARE 2019; 58:776-795. [PMID: 31311459 DOI: 10.1080/00981389.2019.1640338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 05/19/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
Adolescence is a turbulent time of transition. Facing a serious health issue such as cancer during this time can be challenging and confusing. This study presents a scoping review of 33 research articles including quantitative, qualitative, mixed method, and reviews focused on the experiences of adolescents throughout the cancer journey. Extracted themes across studies identified individual, interpersonal, and environmental aspects of adolescents' experiences in each stage of this trajectory. Implications for these findings are discussed including a need for early diagnosis and treatment of adolescent cancers and developmentally appropriate clinical supports.
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Affiliation(s)
- Andrea Greenblatt
- Factor-Inwentash School of Social Work, University of Toronto , Toronto , Ontario , Canada
| | - Michael Saini
- Factor-Inwentash School of Social Work, University of Toronto , Toronto , Ontario , Canada
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14
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Tsangaris E, D'Agostino N, Rae C, Breakey V, Klassen AF. Development and Psychometric Evaluation of the Cancer Distress Scales for Adolescent and Young Adults. J Adolesc Young Adult Oncol 2019; 8:566-580. [PMID: 31274372 DOI: 10.1089/jayao.2019.0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose: The use of valid and reliable screening tools to measure distress may help to identify adolescent and young adults (AYA) with cancer who need additional support. Our study describes a two-phase approach to adapt the Australian AYA oncology and survivorship distress screening tools for use in Canada. Methods: Phase 1 involved refining the Australian AYA oncology and survivorship screening tools using cognitive interviews with AYA with cancer and feedback from experts. In phase 2, a field-test study was performed, and Rasch Measurement Theory (RMT) analysis was used for item reduction and to examine reliability and validity. Results: Cognitive interviews with 45 AYA with cancer and feedback from 25 experts resulted in a field-test version of the Cancer Distress Scales for AYA (CDS-AYA) consisting of 91 items that measure 9 constructs. The field-test sample included 515 participants. RMT analysis identified five scales (impact of cancer, physical, emotional, cancer worry, and cognitive) with ordered thresholds, good item fit (-3.70 to 2.82), and acceptable reliability (0.85-0.94). Reliability for the remaining four scales (employment, education, practical, and social) was low, and the scales were retained as checklists, with the exception of the social scale that was dropped. Conclusion: The final item-reduced CDS-AYA consist of 48 items in 5 scales, with 2 stand-alone items in the physical and emotional scales and 23 items in 3 checklists. The CDS-AYA can be used in research and in clinical practice to measure distress in AYA with cancer.
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Affiliation(s)
- Elena Tsangaris
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Vicky Breakey
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
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A Comparison of Limb Salvage Versus Amputation for Nonmetastatic Sarcomas Using Patient-reported Outcomes Measurement Information System Outcomes. J Am Acad Orthop Surg 2019; 27:e381-e389. [PMID: 30958808 DOI: 10.5435/jaaos-d-17-00758] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The Patient-reported Outcomes Measurement Information System (PROMIS) is a scoring tool that allows comparisons between patients with rare conditions and more common ailments, or the general US population. PROMIS outcomes were compared between the limb salvage and amputee patients for nonmetastatic sarcomas to the US population. METHODS One hundred thirty-eight patients were included in the analysis. Patients were divided into the limb salvage and amputee cohorts, as well as based on the follow-up (1 to 11 or 12+ months). RESULTS Seven PROMIS domains were evaluated, and higher scores were found in both the limb salvage group and patients >12 months from surgery. The limb salvage group also had improved emotional health compared with the US population. DISCUSSION Improvements in PROMIS values are observed in limb salvage patients and in patients >12 months from surgery. Limb salvage patients demonstrate improved emotional health compared with the US population.
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16
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Evaluation of Planned versus Unplanned Soft-Tissue Sarcoma Resection Using PROMIS Measures. Sarcoma 2019; 2019:1342615. [PMID: 30956533 PMCID: PMC6425353 DOI: 10.1155/2019/1342615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/02/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Patient Reported Outcomes Measurement Information System (PROMIS) is a tool developed by the National Institutes of Health that allows comparisons across conditions or even the United States (U.S.) general population. Objectives Our purpose was to compare PROMIS outcomes between patients who underwent a planned resection to those who underwent an initial unplanned excision of their sarcoma followed by a definitive oncologic resection. We then compared these groups to the U.S. general population. Methods Eighty-five patients were included and were divided into those who underwent an initial planned resection (67) and unplanned excision (18). These patients were then further categorized based on the length of follow-up since their last surgery, either early (<12 months) or late (>12 months). Results We evaluated seven PROMIS domains and found no differences between patients who underwent planned resection versus those who underwent an initial unplanned excision followed by a wide resection of the previous wound bed. When compared to the U.S. population, both cohorts demonstrated significantly improved scores in several emotional health domains. Conclusions Patients who undergo an unplanned excision followed by a definitive oncologic procedure have similar PROMIS scores compared to patients who undergo an initial planned resection.
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Morgan TL, Clark OE, Whiteside S, Audino A, Yeager ND, Klosky JL, O'Brien SH, Quinn GP, Gerhardt CA, Nahata L. Recruiting families and children newly diagnosed with cancer for behavioral research: Important considerations and successful strategies. Psychooncology 2019; 28:928-930. [DOI: 10.1002/pon.5012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Taylor L. Morgan
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
| | - Olivia E. Clark
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
| | - Stacy Whiteside
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
| | - Anthony Audino
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
| | - Nicholas D. Yeager
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
- Department of PediatricsThe Ohio State University Columbus Ohio
| | - James L. Klosky
- Department of Pediatrics, Emory University School of MedicineChildren's Healthcare of Atlanta Atlanta Georgia
| | - Sarah H. O'Brien
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
| | - Gwendolyn P. Quinn
- Department of Obstetrics and GynecologyNew York University School of Medicine New York New York
| | - Cynthia A. Gerhardt
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
- Department of PediatricsThe Ohio State University Columbus Ohio
| | - Leena Nahata
- Center for Biobehavioral HealthThe Research Institute at Nationwide Children's Hospital Columbus Ohio
- Divisions of Hematology/Oncology and EndocrinologyNationwide Children's Hospital Columbus Ohio
- Department of PediatricsThe Ohio State University Columbus Ohio
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18
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An Evaluation of PROMIS Health Domains in Sarcoma Patients Compared to the United States Population. Sarcoma 2019; 2019:9725976. [PMID: 30799982 PMCID: PMC6360068 DOI: 10.1155/2019/9725976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background The Patient Reported Outcomes Measurement Information System (PROMIS) is a patient-directed system that allows comparisons across medical conditions. With this tool, comparisons can now be made between rare conditions, such as sarcomas, and more common ailments, of the United States general population. This allows comparisons between rare conditions, such as sarcomas, to more common ailments, or even the United States (US) general population. Objectives Our purpose was to use PROMIS to compare outcomes in patients that had undergone resection of a nonmetastatic sarcoma to the US population. Methods One hundred thirty-eight patients were included in the analysis. These patients were divided into early (<2 years) and late follow-up (>2 years). Results We evaluated results from seven health domains and found significantly lower scores in the physical function and depression domains. These differences were present in both the early and late cohorts when compared to the US population. Conclusion While physical function was found to be worse in the sarcoma cohorts, we observed significantly improved levels of depression in these patients when compared to the US population. This finding was maintained over time and is an important reminder that a patient's goals and desires change following a cancer diagnosis and must be taken into consideration when planning treatment and determining a successful outcome.
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Levine DR, Liederbach E, Johnson LM, Kaye EC, Spraker-Perlman H, Mandrell B, Pritchard M, Sykes A, Lu Z, Wendler D, Baker JN. Are we meeting the informational needs of cancer patients and families? Perception of physician communication in pediatric oncology. Cancer 2019; 125:1518-1526. [PMID: 30602057 DOI: 10.1002/cncr.31937] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND High-quality oncology care is marked by skillful communication, yet little is known about patient and family communication perceptions or content preferences. Our study sought to elicit pediatric oncology patient and parent perceptions of early cancer communication to establish whether informational needs were met and identify opportunities for enhanced communication throughout cancer care. METHOD An original survey instrument was developed, pretested, and administered to 129 patients, age 10-18 years, and their parents at 3 cancer centers between 2011 and 2015. Statistical analysis of survey items about perceived communication, related associations, and patient/parent concordance was performed. RESULTS A greater percentage of participants reported "a lot" of discussion about the physical impact of cancer (patients, 58.1% [n = 75]; parents, 69.8% [n = 90]) compared with impact on quality of life (QOL) (patients, 44.2% [n = 57]; parents, 55.8% [n = 72]) or emotional impact (patients, 31.8% [n = 41]; parents, 43.4% [n = 56]). One fifth of patients (20.9% [n = 27]) reported they had no up-front discussion about the emotional impact of cancer treatment. Parents indicated a desire for increased discussion regarding impact on family life (27.9% [n = 36]), long-term QOL (27.9% [n = 36]), and daily activities (20.2% [n = 26]). Patients more frequently than parents indicated a desire for increased physician/patient discussion around the impact on daily activities (patients, 40.3% [n = 52]; parents, 21.7% [n = 28]; P < .001), long-term QOL (patients, 34.9% [n = 45]; parents, 16.3% [n = 21]; P < .001), pain management (patients, 23.3% [n = 30]; parents, 7% [n = 9]; P < .001), physical symptom management (patients, 24% [n = 31]; parents, 7.8% [n = 10]; P < .001), short-term QOL (patients, 23.3% [n = 30]; parents, 9.3% [n = 12]; P = .001), and curative potential (patients, 21.7% [n = 28]; parents, 8.5% [n = 11]; P = .002, P values calculated using McNemar's test). CONCLUSION Oncologists may not be meeting the informational needs of many patients and some parents/caregivers. Communication could be enhanced through increased direct physician-patient communication, as well as proactive discussion of emotional symptoms and impact of cancer on QOL.
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Affiliation(s)
- Deena R Levine
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erik Liederbach
- Department of Oncology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Liza-Marie Johnson
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica C Kaye
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Holly Spraker-Perlman
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Belinda Mandrell
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michele Pritchard
- Division of Nursing Research, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Dave Wendler
- Department of Bioethics, National Institute of Health, Bethesda, Maryland
| | - Justin N Baker
- Division of Quality-of-life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Coughtrey AE, Shafran R, Su MT, Allcott-Watson H, Christie D, Hough R. Health Professionals' Perspectives on the Nature of Distress and Low Mood in Young People with Cancer. J Adolesc Young Adult Oncol 2018; 8:190-196. [PMID: 30418093 DOI: 10.1089/jayao.2018.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Young people with cancer are at increased risk of depression, yet evidence-based psychological interventions that are tailored to the specific needs of young people with cancer are scarce, and depression in this group may be particularly challenging to recognize and treat. The aims of this study were to (1) explore the views of health professionals in recognizing and treating low mood in young people with cancer and (2) identify the key components of an effective online treatment package for depression in this population. METHODS Eighteen NHS health professionals with a range of professional backgrounds working directly with young people with cancer were interviewed using a semi-structured interview schedule. Responses were analyzed using thematic analysis. RESULTS Five themes emerged: (1) one size doesn't fit all-the nature of depression is complex and varied, and symptoms fluctuate greatly in relation to physical health; (2) distress is completely understandable-it is important not to pathologize a normal reaction; (3) a stepping stone intervention-online interventions may promote engagement with face-to-face therapy; (4) connecting with others-the intervention should promote sharing experiences with others to reduce isolation; and (5) ownership and empowerment-lack of independence may be a cause of distress, and young people should have control of the intervention. CONCLUSION The nature of depression in young people with cancer is complex and multifaceted. Online guided self-help may be useful when added as a component or first step of a treatment package including face-to-face talking therapies.
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Affiliation(s)
- Anna E Coughtrey
- 1 UCL Great Ormond Street Institute of Child Health , London, United Kingdom
| | - Roz Shafran
- 1 UCL Great Ormond Street Institute of Child Health , London, United Kingdom
| | - Merina T Su
- 1 UCL Great Ormond Street Institute of Child Health , London, United Kingdom
| | | | - Deborah Christie
- 2 University College London Hospital NHS Trust , London, United Kingdom
| | - Rachael Hough
- 2 University College London Hospital NHS Trust , London, United Kingdom
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21
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Katz LF, Fladeboe K, King K, Gurtovenko K, Kawamura J, Friedman D, Compas B, Gruhn M, Breiger D, Lengua L, Lavi I, Stettler N. Trajectories of child and caregiver psychological adjustment in families of children with cancer. Health Psychol 2018; 37:725-735. [PMID: 30024229 PMCID: PMC6091867 DOI: 10.1037/hea0000619] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the trajectory of patient and caregiver mental health from diagnosis through the first year of treatment for pediatric cancer and assess whether rates of clinically relevant symptoms were elevated compared with norms. We examined mean levels of internalizing and externalizing symptoms and posttraumatic stress symptoms (PTSS) in children with cancer, and depression, anxiety, and PTSS in caregivers during the first year of treatment; the proportion of patients and caregivers that scored in the clinical range at each time point; and the typical trajectory of symptoms in patients and caregivers and whether trajectories differed between individuals. METHOD Families (N = 159) of children newly diagnosed with cancer (Mage = 5.6 years; range = 2-18 years) participated in a short-term prospective study. Primary caregivers provided monthly reports of their own and their children's psychological adjustment. RESULTS On average, children were well-adjusted. However, compared with norms, there was a higher than expected proportion of children with clinically relevant internalizing symptoms around the time of diagnosis. On average children's symptoms declined over time, though variability was observed. Caregivers were less well-adjusted on average, with a high proportion reporting clinically relevant symptoms over time for depression and anxiety. Caregiver symptoms also declined over time, though considerable variability was observed. CONCLUSION Although most children remain well-adjusted during the first year of treatment, many caregivers experience clinically relevant symptoms of psychological distress. Implications for development of interventions targeting at-risk patients and caregivers are discussed. Identifying processes that predict between-family variability in trajectories of psychopathology is an important next step. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Iris Lavi
- Department of Social Work, University of Haifa
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22
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Kim B, Patterson P, White K. Developmental considerations of young people with cancer transitioning to adulthood. Eur J Cancer Care (Engl) 2018. [PMID: 29542833 DOI: 10.1111/ecc.12836] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The literature concerning the impact of having cancer during adolescence and emerging adulthood has been widely discussed in relation to the unique nature of psychosocial challenges. The current study presents these findings within the context of developmental literature to further our understanding on how their developmental transitioning can be affected by having cancer. Specifically, two developmental milestones considered to be the pre-requisites for acquiring an adult status were focused on: forming identity and establishing independence. Several traditions of developmental literature were incorporated, including the psychosocial, sociological and psychoanalytical perspectives. The study discusses challenges to these developmental processes and suggests measures to foster young people's normative development.
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Affiliation(s)
- B Kim
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - P Patterson
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Research & Youth Cancer Services, Research, Evaluation, and Social Policy Unit, CanTeen Australia, Sydney, NSW, Australia
| | - K White
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
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The Impact of a Mother's Emotional Strains and Disclosure of Cancer on Her Child's Defensiveness and Adjustment to Cancer. Cancer Nurs 2017; 41:290-297. [PMID: 28591010 DOI: 10.1097/ncc.0000000000000516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Defensiveness is one of the strategies that children with cancer use against psychosocial difficulties, yet it remains unclear what factors may impact children's use of defensiveness. OBJECTIVE The aim of this study was to explore the psychological adjustment, including use of defensive behaviors, in children who may or may not be told about the diagnosis of cancer. METHODS A total of 58 children and 51 mothers participated in the study. Children answered questionnaires about defensiveness, anxiety, and depression, whereas mothers completed a questionnaire of anxiety, depression, and stress and a question about disclosure of cancer to child. RESULTS Significant differences were found in the defensiveness and depression scores between children with full disclosure and those with no disclosure about their cancer. Although children's adjustment has been directly related to that of their mother's adjustment, we did not find this variable to be a predictor of child's adjustment. The child's defensiveness scores were a strong predictor of child's anxiety and eventually for a high risk for depression. CONCLUSIONS Mothers' emotional strains and lack of open disclosure about cancer significantly affect the psychosocial well-being of children. IMPLICATIONS FOR PRACTICE It is essential for nurses to assess the emotional adjustment and defensiveness strategies that children with cancer use. We believe that nurses caring for children with cancer have a professional responsibility to identify and understand defensive behaviors and other characteristics of psychosocial distress and advocate for psychological interventions that will help mothers and their children cope with cancer.
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The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment. Eur J Oncol Nurs 2017; 28:1-6. [DOI: 10.1016/j.ejon.2017.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 02/03/2017] [Accepted: 02/20/2017] [Indexed: 01/06/2023]
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Zucchetti G, Bellini S, Bertolotti M, Bona F, Biasin E, Bertorello N, Tirtei E, Fagioli F. Body Image Discomfort of Adolescent and Young Adult Hematologic Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:377-380. [DOI: 10.1089/jayao.2016.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulia Zucchetti
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Simona Bellini
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Marina Bertolotti
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Francesca Bona
- Psycho-Oncology Service, Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Eleonora Biasin
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Nicoletta Bertorello
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Elisa Tirtei
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
| | - Franca Fagioli
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O. Città della Salute e della Scienza—Ospedale Infantile “Regina Margherita,” Turin, Italy
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Resilience and Psychosocial Function Among Mainland Chinese Parents of Children With Cancer: A Cross-sectional Survey. Cancer Nurs 2017; 38:466-74. [PMID: 25629894 DOI: 10.1097/ncc.0000000000000220] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resilience is commonly used to refer to the capacity to resist negative psychological reactions when encountering aversive circumstances. However, clinicians generally define resilience as a lack of psychological distress or an adoption of positive attitude in response to a potentially traumatic event. Although resilience was initially considered to be a psychological variable, it has gradually become seen as a psychosocial indicator now used in clinical settings in the Western world but is still a relatively new topic in most Eastern countries. In this study, we aimed to extend our understandings of the psychological responses of a group of mainland Chinese parents upon being informed that their children were diagnosed with cancer, using resilience as a major indicator. OBJECTIVE The aim of this study was to evaluate the level of resilience among mainland Chinese parents in response to knowing that their children were diagnosed with cancer and to examine the relationships between resilience and other psychosocial outcomes. METHODS A descriptive and a cross-sectional survey design was used and involved a sample of 125 parents who visited a specialist cancer hospital in southeast China between September 2013 and February 2014. RESULTS The participants reported lower level of resilience as compared with a control population in the Chinese community (P < .01). Resilience was negatively correlated with uncertainty in illness (P < .01) and depression (P < .01) and was positively correlated with social support (P < .01) and all other positive coping strategies subscales (P < .01). Parents from the high- resilience group reported better psychosocial functions than did those from the low-resilience group (P < .01). In addition, 6 influencing factors were identified and entered into the multiple linear regression equation of psychological resilience, which predicts 38.3% (adjusted R) of total variation in psychological resilience. CONCLUSION A high level of resilience in parents of children diagnosed with cancer is associated with better psychosocial function in response to the traumatic event. IMPLICATIONS FOR CLINICAL PRACTICE Additional attention should be given to those Mainland Chinese parents who demonstrated a low level of resilience in response to their child's diagnosis. This is particularly important because of the long and stressful process for cancer treatment. Clinicians should also provide targeted interventions to those parents to promote their psychological resilience.
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Prevalence and predictors of posttraumatic stress symptoms in parents of children with ongoing treatment for cancer in South China: a multi-centered cross-sectional study. Support Care Cancer 2016; 25:1159-1167. [PMID: 27966022 DOI: 10.1007/s00520-016-3506-6] [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] [Received: 07/22/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Parents of children with ongoing cancer treatment are exposed to risks of developing posttraumatic stress symptoms (PTSS), but little is known about the prevalence and predictors of PTSS among Chinese parents of children with cancer. This study aimed to examine the predictors of PTSS, and explored the correlation of depression, resilience, and family functions with severe PTSS. METHODS This cross-sectional survey was conducted from May 2014 to September 2015 among the parents of cancer children treated in four general hospitals in South China. PTSS in the parents were measured using post-traumatic stress checklist-civilian version (PCL-C). Multiple regression analyses were performed to evaluate the predictive values of depression, resilience, family functioning, and the demographic variables for severe PTSS. RESULTS A total of 279 parents (192 mothers and 87 fathers) participated in the survey. Severe PTSS, as defined by a PCL-C score ≥50, were reported in 32.97% (n = 92) of the total participants, 26.44% (23/87) in the fathers and 35.94% (69/192) in the mothers. The level of PTSS was positively correlated with depression (r = 0.782, P < 0.01) and a poor general family function (r = 0.325, P < 0.01) and negatively correlated with resilience (r = -0.236, P < 0.01). Multivariate analyses indicated that depression, general family function, gender, and education level were significant predictive factors of severe PTSS in the overall parents, accounting for 64.2% of the variance in the prediction of PTSS (R 2 = 0.642, F = 122.602, P = 0.000). For the mothers, depression and family function accounted for 66.5% of the variance in the prediction of PTSS (R 2 = 0.665, F = 187.451, P = 0.000); for the fathers, depression and educational level accounted for 58.8% of the variance in the prediction of PTSS (R 2 = 0.588, F = 59.829, P = 0.000). CONCLUSION Parents, especially the mothers, of children with ongoing treatment for cancer are at risk of developing PTSS. Supportive psychological interventions to attenuate the negative emotions of the parents and improve their family functions are important means to promote their natural protective mechanisms to cope with the stressful events.
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Fayad D, Genadry KC, Hanna K, Itani A, Kibbi N, Rustam LB, Saab R, Nabulsi M. Predictors of benzodiazepine use among parents of children with cancer: a cross-sectional study from Lebanon. Psychooncology 2016; 26:1225-1228. [PMID: 27548760 DOI: 10.1002/pon.4252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/31/2016] [Accepted: 08/14/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Danielle Fayad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Kamil Hanna
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Aya Itani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine Kibbi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Raya Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Children's Cancer Institute, American University of Beirut, Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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29
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Al-Maliki SK, Al-Asadi J, Al-Waely A, Agha S. Prevalence and Levels of Depression Among Parents of Children with Cancer in Basrah, Iraq. Sultan Qaboos Univ Med J 2016; 16:e329-34. [PMID: 27606113 DOI: 10.18295/squmj.2016.16.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/10/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cancer in a family member can be a major source of psychological disorders, especially for the parents of children diagnosed with cancer. This study aimed to determine the prevalence and levels of depression among parents of children with cancer in Basrah, Iraq. METHODS This cross-sectional study was conducted between November 2014 and April 2015 at the Specialist Paediatric Hospital in Basrah City, Iraq. One parent each of 384 children with cancer admitted to the hospital for treatment or follow-up during the study period were invited to participate in the study. Age, gender, years of education, occupation, monthly income, place of residence and the overall number of children in a family were recorded. The Center for Epidemiologic Studies Depression Scale was used to identify depression and assess levels of depression. RESULTS A total of 336 parents participated in the study (response rate: 87.5%). Of these, 70.5% were depressed, 54.1% of which had major depression. Depression was significantly more common (77.2% versus 57.1%) and more severe (60.7% versus 41.1%) among mothers compared to fathers (P = 0.001). Parents with fewer years of education were more likely to be depressed; this association was significant for mothers but not fathers (P = 0.001 and 0.814, respectively). Depression was significantly inversely associated with monthly income (P = 0.001). CONCLUSION The prevalence of depression among the parents of children with cancer was high. Depression was significantly more severe among mothers compared to fathers and among mothers who were less educated. Income also had a significant association with levels of depression among parents.
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Affiliation(s)
- Shukrya K Al-Maliki
- Department of Community Medicine, College of Medicine, University of Basrah, Basrah, Iraq
| | - Jasim Al-Asadi
- Department of Community Medicine, College of Medicine, University of Basrah, Basrah, Iraq
| | - Akeel Al-Waely
- Department of Community Medicine, College of Medicine, University of Misan, Maysan, Iraq
| | - Sabah Agha
- General Directorate of Health, Basrah, Iraq
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Vernon L, Eyles D, Hulbert C, Bretherton L, McCarthy MC. Infancy and pediatric cancer: an exploratory study of parent psychological distress. Psychooncology 2016; 26:361-368. [PMID: 27146642 DOI: 10.1002/pon.4141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/17/2016] [Accepted: 03/25/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research on the psychological experiences of parents of infants within pediatric oncology is sparse. This study examined rates and indicative risk factors for psychological distress in parents where there is either an infant patient or infant sibling of a patient. METHODS Participants were mothers (n = 41) and fathers (n = 25) of infants under 2 years who either had a cancer diagnosis (n = 37; infant patients) or was an infant sibling of an older child with cancer (n = 29; infant siblings) recruited from a single oncology center. There were 21 couple dyads. Parents completed the Depression Anxiety Stress Scales short form and the Posttraumatic Stress Disorder Checklist. RESULTS Mothers (47.5%) and fathers (37.5%) reported elevated, cancer-related posttraumatic stress symptoms. Rates of depression (12.2% of mothers and 12.0% of fathers) and anxiety symptoms (17.1% of mothers and 8.0% of fathers) were lower. Compared with parents of infant patients, parents of infant siblings reported significantly higher rates of depressive symptoms and trends toward higher rates of posttraumatic stress symptoms and anxiety symptoms. Parent anxiety was higher with increased time post diagnosis. No demographic or illness-related variables were associated with psychological distress, with the exception of the number of children in the family. CONCLUSIONS Parent-child relationships are of fundamental importance during infancy. This study provides novel data highlighting the psychological impact for parents when a cancer diagnosis is made during this critical developmental period, including the contribution of family structure to parental distress. Results provide further support for applying a traumatic stress framework when exploring parent experiences of pediatric cancer. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- L Vernon
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Psychology, University of Melbourne, Melbourne, Victoria, Australia
| | - D Eyles
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - C Hulbert
- Department of Psychology, University of Melbourne, Melbourne, Victoria, Australia
| | - L Bretherton
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Psychology, University of Melbourne, Melbourne, Victoria, Australia
| | - M C McCarthy
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
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31
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Kearney JA, Salley CG, Muriel AC. Standards of Psychosocial Care for Parents of Children With Cancer. Pediatr Blood Cancer 2015; 62 Suppl 5:S632-83. [PMID: 26700921 PMCID: PMC5066591 DOI: 10.1002/pbc.25761] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/24/2015] [Indexed: 11/12/2022]
Abstract
Parents and caregivers of children with cancer are both resilient and deeply affected by the child's cancer. A systematic review of published research since 1995 identified 138 studies of moderate quality indicating that parent distress increases around diagnosis, then returns to normal levels. Post-traumatic symptoms are common. Distress may be impairing for vulnerable parents and may impact a child's coping and adjustment. Moderate quality evidence and expert consensus informed a strong recommendation for parents and caregivers to receive early and ongoing assessment of their mental health needs with access to appropriate interventions facilitated to optimize parent, child, and family well being.
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Affiliation(s)
- Julia A Kearney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Christina G Salley
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Anna C Muriel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
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32
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Psychometric properties of the RCMAS-2 in pediatric cancer patients. Eur J Oncol Nurs 2015; 20:36-41. [PMID: 26233436 DOI: 10.1016/j.ejon.2015.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/18/2015] [Accepted: 07/16/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE OF THE RESEARCH The Revised Children's Manifest Anxiety Scale, second edition (RCMAS-2) is widely used internationally to assess anxiety. However, there is little data regarding its validity for pediatric cancer patients. This study evaluated the psychometric properties of the RCMAS-2 in pediatric cancer patients. METHODS AND SAMPLE This cross-sectional study included 370 pediatric cancer patients (aged 6-19 years) that were recruited from three medical centers between August 2008 and March 2011 in Taiwan. Reliability was evaluated by internal consistency. Confirmatory factor analysis was performed to examine the factor structure. Construct validity was examined by known-groups analyses. KEY RESULTS The internal consistency of the full scale was good (α = 0.90) but the scores of Physiological Anxiety subscale was low (α = 0.65). Using known-groups validity, significant differences in anxiety were observed between genders and between patients that were on and off treatment. The hypothesized three-factor model did not adequately fit (χ(2)/d.f = 2.4; p < 0.01, GFI = 0.80, CFI = 0.71, RMSEA = 0.06, SRMR = 0.01). CONCLUSIONS The RCMAS-2 demonstrated reliability and validity for use with pediatric cancer patients aged 6 and 19 years. Further structure evaluation of the RCMAS-2 in pediatric oncology population is needed, and the scores of the Physiological Anxiety subscale should be interpreted with caution.
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Hamner T, Latzman RD, Latzman NE, Elkin TD, Majumdar S. Quality of life among pediatric patients with cancer: Contributions of time since diagnosis and parental chronic stress. Pediatr Blood Cancer 2015; 62:1232-6. [PMID: 25755193 PMCID: PMC5839300 DOI: 10.1002/pbc.25468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric cancer is associated with a host of negative psychosocial consequences; however, outcomes vary extensively suggesting a need to better understand this variation. Empirical research suggests a positive association between time since diagnosis (TSD) and Quality of Life (QoL). In addition to TSD, family stressors have been found to be particularly important in predicting QoL among children. The current study examined parental chronic stress beyond TSD in explanation of QoL functioning among a sample of pediatric patients with cancer. PROCEDURE Participants included 43 pediatric patients aged 5-18 years (M(age) = 10.2 ± 3.6) who were undergoing oncological treatment. Parents reported on TSD, child's QoL, and their own chronic stress. RESULTS TSD was associated with greater physical functioning (r = 0.30, P < 0.05). Parental chronic stress was associated with poorer emotional (r = -0.54, P < 0.01), physical (r = -0.41, P < 0.01), and social functioning (r = -0.44, P < 0.01). Further, hierarchal linear regression analyzes indicated parental chronic stress contributed incrementally beyond TSD in the explanation of physical (β = -0.37, t = -2.58, P < 0.01), emotional (β = -0.47, t = -3.51, P < 0.00), and social functioning (β = -0.38, t = -2.67, P < 0.01). CONCLUSIONS Parental chronic stress is associated with reduced levels of emotional, physical, and social functioning among pediatric patients. Future research is needed to further investigate the process by which chronic stress within the family interferes with adaptive coping among pediatric patients. In addition, clinical services may benefit from increased consideration of family factors, such as parental chronic stress, during oncological treatment.
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Affiliation(s)
| | - Robert D. Latzman
- Georgia State University, Atlanta, Georgia,Correspondence to: Robert D. Latzman, Department of Psychology, Georgia State University, PO Box 5010, Atlanta, GA 30302-5010.
| | | | - T. David Elkin
- University of Mississippi Medical Center, Jackson, Mississippi
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Germann JN, Leonard D, Stuenzi TJ, Pop RB, Stewart SM, Leavey PJ. Hoping Is Coping: A Guiding Theoretical Framework for Promoting Coping and Adjustment Following Pediatric Cancer Diagnosis. J Pediatr Psychol 2015; 40:846-55. [PMID: 25842378 DOI: 10.1093/jpepsy/jsv027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/02/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the pattern of resilience and adjustment following pediatric cancer diagnosis and to evaluate hope as a mediator of adjustment. METHODS 61 participants with pediatric cancer completed measures of hope, depression, anxiety, and quality of life (QoL) within 4 weeks of cancer diagnosis and every 3 months for 1 year. RESULTS Participants showed high and increasing levels of hope and QoL, as well as low and decreasing levels of depression and anxiety. Linear mixed-effects regression analyses revealed changes in depression, anxiety, and hope to be significant predictors of changes in QoL. Changes in hope were found to partially mediate the effects of depression and anxiety on QoL. CONCLUSIONS While a variety of interventions are efficacious for treating anxiety and depression, hope theory provides a framework for choosing interventions that may more globally promote children's ability to maintain good functioning, adjustment, well-being, and QoL following cancer diagnosis.
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Affiliation(s)
- Julie N Germann
- Department of Psychiatry, Children's Health Children's Medical Center Dallas, University of Texas Southwestern Medical Center,
| | - David Leonard
- Department of Clinical Research, Children's Health Children's Medical Center Dallas
| | - Thomas J Stuenzi
- Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health Children's Medical Center Dallas, and
| | - Radu B Pop
- Department of Psychiatry, Children's Health Children's Medical Center Dallas
| | - Sunita M Stewart
- Department of Psychiatry, Children's Health Children's Medical Center Dallas, University of Texas Southwestern Medical Center
| | - Patrick J Leavey
- Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Health Children's Medical Center Dallas, and Department of Pediatrics, University of Texas Southwestern Medical Center Dallas
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Smith HR. Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncol Lett 2015; 9:1509-1514. [PMID: 25788991 PMCID: PMC4356432 DOI: 10.3892/ol.2015.2944] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 02/02/2015] [Indexed: 12/14/2022] Open
Abstract
Depression is a common comorbidity in cancer cases, affecting >10% of patients. A cancer diagnosis is life-changing, and is a source of considerable psychological and emotional stress. Non-pathological sadness may be a normal response to a cancer diagnosis, however, stress beyond the coping mechanisms of patients may result in major depressive disorder. The current review, in addition to the obvious psychosocial elements of depression, explores its biological mechanisms, including tissue damage, inflammatory mediators and the chronic stress response, and how these immune and endocrine pathways may underlie depression in cancer. Possible iatrogenic causes of depression in cancer are also explored. There is a strong need to identify and treat depression in cancer patients in order to increase quality of life and reduce mortality. The most popular clinical and potential future biochemical screening tools for depression in cancer are briefly discussed. The interventions used will vary for every patient, but may include psychosocial therapies or pharmacotherapy; however, a paucity of research on the most effective management of depression in cancer means the optimal combination of therapies is unknown. Selection of antidepressants should be carefully considered, given the common side effects of chemotherapy (such as nausea), and the necessity to avoid serious interactions, including reducing the effectiveness of chemotherapeutic drugs. The possible link between the chronic stress response, which may predispose patients to depression, and the risk of mortality from cancer is also explored. The complex interactions between the endocrine, nervous and immune systems, which continue to be elucidated, may offer the opportunity for the development of more rapid and efficacious treatments for depression in cancer in the future.
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Affiliation(s)
- Hamish R Smith
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia
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Sulkers E, Tissing WJE, Brinksma A, Roodbol PF, Kamps WA, Stewart RE, Sanderman R, Fleer J. Providing care to a child with cancer: a longitudinal study on the course, predictors, and impact of caregiving stress during the first year after diagnosis. Psychooncology 2014; 24:318-24. [PMID: 25113320 DOI: 10.1002/pon.3652] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/06/2014] [Accepted: 07/24/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study investigated the course, predictors, and impact of caregiving stress on the functioning of primary caregivers of children with cancer during the first year after a child's cancer diagnosis. METHODS Primary caregivers (N = 95, 100% mother, 86% response rate) of consecutive newly diagnosed paediatric cancer patients (0-18 years) completed measures of caregiving stress, depressive symptoms, anxiety, and self-reported health at diagnosis, and 3, 6, and 12 months thereafter. RESULTS Results indicated a significant decrease in caregiving stress (especially during the first 3 months after diagnosis). Caregiving stress was predicted by single marital status and the ill child being the mother's only child. Multilevel analyses, controlled for socio-demographic and medical covariates, showed that, over time, the decline in caregiving stress was accompanied by a reduction in depressive symptoms and anxiety. The amount of variance explained by caregiving stress was 53% for depressive symptoms, 47% for anxiety, and 3% for self-reported health. CONCLUSIONS The present study suggests that caregiving stress is an important factor in understanding parental adjustment to childhood cancer. This offers possibilities for developing interventions aimed at preventing caregiving stress, and strengthening mothers' confidence in their ability to provide good care.
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Affiliation(s)
- Esther Sulkers
- University of Groningen, University Medical Center Groningen, UMCG School of Nursing and Health, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Paediatric Oncology/Haematology Beatrix Children's Hospital, Groningen, The Netherlands
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Tsitsi T, Raftopoulos V, Papastavrou E, Charalambous A. Complementary and alternative medical interventions for the management of anxiety in parents of children who are hospitalized and suffer from a malignancy: A systematic review of RCTs. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van der Geest IM, van den Heuvel-Eibrink MM, Passchier J, van den Hoed-Heerschop C, Pieters R, Darlington ASE. Parenting stress as a mediator of parents' negative mood state and behavior problems in children with newly diagnosed cancer. Psychooncology 2014; 23:758-65. [DOI: 10.1002/pon.3475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Ivana M. van der Geest
- Department of Pediatric Oncology/Hematology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | | | - Jan Passchier
- Department of Clinical Psychology; VU University Amsterdam; Amsterdam The Netherlands
| | | | - Rob Pieters
- Department of Pediatric Oncology/Hematology; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
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A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy. Cancer Nurs 2013; 36:60-71. [PMID: 22561919 DOI: 10.1097/ncc.0b013e318250da1a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms. OBJECTIVES The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables. METHODS Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed. RESULTS The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = -0.82, P < .001), and stress and pain (r = 0.78, P = .039). CONCLUSIONS Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated. IMPLICATIONS FOR PRACTICE Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.
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Creswell PD, Wisk LE, Litzelman K, Allchin A, Witt WP. Parental depressive symptoms and childhood cancer: the importance of financial difficulties. Support Care Cancer 2013; 22:503-11. [PMID: 24101152 DOI: 10.1007/s00520-013-2003-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Research suggests a relationship between caring for a child with cancer and psychological distress in caregivers. Less evident is the role which financial difficulties might play in this relationship. We sought to determine if caring for a child with cancer was related to clinically relevant depressive symptoms among parents, whether or not financial difficulties mediated this relationship, and if financial difficulties were independently associated with symptoms of depression among parents of children with cancer. METHODS Data are from 215 parents of children diagnosed with cancer or brain tumors (n = 75) and a comparison group of parents of healthy children (n = 140). Multiple logistic regression analyses were used to assess the factors associated with reporting clinically relevant depressive symptoms. RESULTS Caring for a child with cancer was associated with increased odds of clinically relevant depressive symptoms in parents (OR = 4.93; 95 % CI 1.97-12.30), controlling for covariates. The mediating effect of financial burden on this relationship was not statistically significant. However, among parents of children with cancer, negative financial life events increased the likelihood of reporting symptoms of depression (OR = 4.89; 95 % CI 1.26-18.96). CONCLUSIONS Caring for a child with cancer was associated with depressive symptoms for parents. Financial difficulties were the strongest correlate of these symptoms among parents of children with cancer. Our results suggest that it may not only be the burden of caring for the child with cancer but also the associated financial difficulties that contribute to a higher likelihood of depressive symptoms in parents.
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Affiliation(s)
- Paul D Creswell
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 North Walnut Street, WARF Office 503, Madison, WI, 53726, USA
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Sansom-Daly UM, Wakefield CE. Distress and adjustment among adolescents and young adults with cancer: an empirical and conceptual review. Transl Pediatr 2013; 2:167-97. [PMID: 26835313 PMCID: PMC4729076 DOI: 10.3978/j.issn.2224-4336.2013.10.06] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Adolescents and young adults (AYAs) with cancer must simultaneously navigate the challenges associated with their cancer experience, whilst striving to achieve a number of important developmental milestones at the cusp of adulthood. The disruption caused by their cancer experience at this critical life-stage is assumed to be responsible for significant distress among AYAs living with cancer. The quality and severity of psychological outcomes among AYAs remain poorly documented, however. This review examined the existing literature on psychological outcomes among AYAs living with cancer. All psychological outcomes (both distress and positive adjustment) were included, and AYAs were included across the cancer trajectory, ranging from newly-diagnosed patients, to long-term cancer survivors. Four key research questions were addressed. Section 1 answered the question, "What is the nature and prevalence of distress (and other psychological outcomes) among AYAs living with cancer?" and documented rates of clinical distress, as well as evidence for the trajectory of this distress over time. Section 2 examined the individual, cancer/treatment-related and socio-demographic factors that have been identified as predictors of these outcomes in this existing literature. Section 3 examined current theoretical models relevant to explaining psychological outcomes among AYAs, including developmental models, socio-cognitive and family-systems models, stress-coping frameworks, and cognitive appraisal models (including trauma and meaning making models). The mechanisms implicated in each model were discussed, as was the existing evidence for each model. Converging evidence implicating the potential role of autobiographical memory and future thinking systems in how AYAs process and integrate their cancer experience into their current sense of self and future goals are highlighted. Finally, Section 4 addressed the future of psycho-oncology in understanding and conceptualizing psychological outcomes among AYAs living with cancer, by discussing recent empirical advancements in adjacent, non-oncology fields that might improve our understanding of psychological outcomes in AYAs living with cancer. Included in these were models of memory and future thinking drawn from the broader psychology literature that identify important mechanisms involved in adjustment, as well as experimental paradigms for the study of these mechanisms within analogue, non-cancer AYA samples.
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Affiliation(s)
- Ursula M Sansom-Daly
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia;; School of Psychology, The University of New South Wales, Sydney, Australia; School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia;; School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
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Shortman RI, Beringer A, Penn A, Malson H, Lowis SP, Sharples PM. The experience of mothers caring for a child with a brain tumour. Child Care Health Dev 2013; 39:743-9. [PMID: 22971015 DOI: 10.1111/cch.12005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brain tumours are the second most common form of childhood cancer, accounting for over 20% of all cases in European children. Understanding the impact of diagnosis and treatment of a brain tumour on the family is an essential pre-requisite to identifying ways to provide effective support. AIM (1) To explore the impact of having a child with a brain tumour on the main caregiver in the family; (2) to describe mothers' experiences of coping with their child's illness, including personal barriers and strengths; and (3) to identify causes of stress and sources of support to inform improvements in care delivery. METHOD Participants were drawn from a group of caregivers enrolled in a longitudinal study of outcome following diagnosis of a childhood brain tumour. Six caregivers took part, two from each of the high-, medium- and low-impact groups based on their Impact on Families Scale scores. Semi-structured interviews were used, with questions covering: (1) impact of the diagnosis on main caregiver and family; (2) personal barriers and strengths; and (3) causes of stress and sources of support. Interviews were transcribed verbatim and coded manually into five themes, which comprised 19 subthemes. FINDINGS Coping methods and provision of help and support were major preoccupations for main caregivers from all impact groups. Caregivers in the high-impact group reported less conflict. High- and medium-impact group caregivers had experienced less 'hindrance and heartache', than those with low impact scores, suggesting that the stress associated with diagnosis and treatment of the tumour may have increased cohesion and acceptance within these families. CONCLUSION Families of children diagnosed with a brain tumour experience considerable negative impact and may perceive themselves as struggling to cope. Provision of help and support, within and outside the extended family, including from health, education and other services, is perceived as helpful.
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Affiliation(s)
- R I Shortman
- Department of Neuropsychology, Frenchay Hospital, Bristol, UK.
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Vécu subjectif de la maladie et de la guérison chez 13 adolescents et jeunes adultes traités pour une hémopathie maligne dans l’enfance. PSYCHO-ONCOLOGIE 2012. [DOI: 10.1007/s11839-012-0387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Paredes T, Pereira M, Simões MR, Canavarro MC. A longitudinal study on emotional adjustment of sarcoma patients: the determinant role of demographic, clinical and coping variables. Eur J Cancer Care (Engl) 2011; 21:41-51. [PMID: 21812845 DOI: 10.1111/j.1365-2354.2011.01269.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study examined change on emotional distress of sarcoma patients from the diagnostic to treatment phases, the distinct trajectories of adjustment and the influence of demographic, clinical and coping variables on anxiety and depression. Thirty-six sarcoma patients completed questionnaires on emotional distress (Hospital Anxiety and Depression Scale) and coping strategies (Brief Cope) at time of diagnosis, and again during treatment. No significant change in emotional distress levels was found from diagnostic to treatment phase, with mean anxiety and depression scores remaining below the clinical range. Over time, 52.8% and 66.7% of patients maintained non-clinical anxious and depressive symptoms respectively, and 25% and 11.1% remained with clinical anxiety and depression. Living with partner, less use of humour and more denial were associated with high emotional distress at time of diagnosis and during treatments, and high levels of distress at baseline were predictive of poorer emotional adjustment during treatments. Although sarcoma patients, in general, seem to exhibit good psychological adjustment, there is a significant minority that requires mental health services in order to help decrease their emotional distress following the diagnosis, and prevent psychological difficulties during treatments. Our findings are an important contribution to understanding the psychological adjustment of patients with a specific and rare type of cancer.
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Affiliation(s)
- T Paredes
- Institute of Cognitive Psychology, Vocational and Social Development, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.
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Gudmundsdottir E, Schirren M, Boman KK. Psychological resilience and long-term distress in Swedish and Icelandic parents' adjustment to childhood cancer. Acta Oncol 2011; 50:373-80. [PMID: 20586659 DOI: 10.3109/0284186x.2010.489572] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Studies of parental reactions to a child's cancer have traditionally been carried out within the framework of psychiatry and psychopathology. We studied the significance of individual resource factors strengthening parents' resilience to long-term cancer-related distress, a focus that has rarely been used. PARTICIPANTS AND METHODS The two-nation Nordic sample included 398 parents; 190 of whom had experienced a child's cancer, and 208 reference parents. We studied the sense of coherence (SOC) using the SOC-13 questionnaire. For assessing distress reactions we used a primarily illness-specific 11-dimensional Parental Psychosocial Distress in Cancer (PPD-C) self-report questionnaire developed for use with parents of childhood cancer patients, and the General Health Questionnaire (GHQ). Resilience was defined as absence of/less severe distress. RESULTS Low SOC was significantly associated with more severe distress in all dimensions of the PPD-C and GHQ. The protective effect of SOC was indicated by it being most negatively related to general psychiatric symptoms, physical and psychological stress symptoms, anxiety and depression. The influence of SOC varied with parents' gender, showing a stronger modifying influence among mothers. Mothers and fathers also differed in their utilisation of professional psychosocial support when confronted with the child's cancer. CONCLUSION Parental resilience to cancer-related distress varies with identifiable strength factors. A strengths-oriented approach helps in understanding parental adjustment to childhood cancer. In order to counteract psychological vulnerability, addressing resilience instead of pathology helps to identify parents at risk and in need of professional support when faced with a child's cancer.
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Affiliation(s)
- Eyglo Gudmundsdottir
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Dyson GJ, Thompson K, Palmer S, Thomas DM, Schofield P. The relationship between unmet needs and distress amongst young people with cancer. Support Care Cancer 2011; 20:75-85. [DOI: 10.1007/s00520-010-1059-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 12/06/2010] [Indexed: 01/06/2023]
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Impacto do cancro do osso e tecidos moles no ajustamento emocional e qualidade de vida. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s0870-9025(11)70006-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ladehoff N, Koch U, Mehnert A. Körperliche und psychosoziale Belastung bei Jugendlichen und jungen Erwachsenen mit einer Krebserkrankung. ACTA ACUST UNITED AC 2011. [DOI: 10.1026/0943-8149/a000036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Zielsetzung dieser Literaturanalyse ist die Erfassung des gegenwärtigen empirischen Erkenntnisstands zu den körperlichen und psychosozialen Belastungen bei Jugendlichen mit einer Krebserkrankung. Spezifische Fragestellungen beinhalten die Untersuchung der Art und der Auftretenshäufigkeit spezifischer Belastungen im körperlichen, psychischen und sozialen Bereich unter Berücksichtigung der krankheits- und behandlungsbezogenen Faktoren. Ziel ist es, den psychologischen und pädagogischen Unterstützungsbedarf sowie relevante Forschungsfragestellungen abzuleiten. Für den Suchzeitraum von 01/1986 bis 06/2009 konnten 33 Originalarbeiten in die Übersichtsarbeit einbezogen werden. Es wurden insgesamt 1751 Jugendliche mit einem Durchschnittsalter von 15.4 Jahren untersucht. Die Ergebnisse der Literaturanalyse zeigen, dass Jugendliche mit einer Krebserkrankung mit vielfältigen Belastungen konfrontiert sind, die alle elementaren Entwicklungsbereiche (physisch, psychisch, kognitiv und sozial) betreffen. Als besondere Belastungen zeigten sich in den Studien folgende Bereiche: die körperlichen Veränderungen, krebs- und behandlungsspezifische Erschöpfung (Fatigue) und die beeinträchtigte Lebensqualität, Ängste und Depression sowie ein verringertes Selbstwertgefühl, Sorgen, von den Freunden verlassen zu werden, Sorgen um verändertes Aussehen sowie darüber, die Schule zu versäumen. Als weiteres Ergebnis des Reviews kann festgehalten werden, dass für krebskranke Jugendliche der Aspekt Schule und Lernen einen großen Stellenwert einnimmt. Es besteht insgesamt ein großer Forschungsbedarf zu den psychosozialen und pädagogischen Unterstützungsbedürfnissen von jugendlichen Krebspatienten.
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Affiliation(s)
- Natalie Ladehoff
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Uwe Koch
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Anja Mehnert
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
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Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Psychooncology 2010; 21:247-54. [DOI: 10.1002/pon.1898] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 10/18/2010] [Accepted: 10/18/2010] [Indexed: 11/07/2022]
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Clarke NE, McCarthy MC, Downie P, Ashley DM, Anderson VA. Gender differences in the psychosocial experience of parents of children with cancer: a review of the literature. Psychooncology 2009; 18:907-15. [PMID: 19319828 DOI: 10.1002/pon.1515] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To build a descriptive literature base of investigated and identified gender differences in the psychosocial experience of parents of children with cancer, in order to guide future research in this area. METHODS An extensive literature search was conducted using Medline, PsycINFO, CINAHL and EMBASE databases. Thirty papers were included in the review. Themes from these papers were identified, and on this basis, the review findings were grouped according to five main outcome categories: role perceptions, illness beliefs, psychological distress, coping strategies and perceptions of marital, family and child functioning. RESULTS Few gender differences were found in perceptions of marital, family and child functioning. There was a tendency toward traditional gender roles in the division of parental tasks. Findings in relation to parent psychological distress and preferred coping strategies were mixed, with trends toward increased distress, more emotion-focused coping and greater social support-seeking in mothers. CONCLUSIONS Further studies using longitudinal designs with solid theoretical groundings will provide valuable information on the unique psychosocial experiences of mothers and fathers throughout the child's illness, which may in turn guide the development of evidence-based interventions.
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Affiliation(s)
- Naomi E Clarke
- Children's Cancer Centre, Royal Children's Hospital, Vic., Australia.
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