The impact of caregiver anxiety/depression symptoms and family functioning on child quality of life during pediatric cancer treatment: From diagnosis to 6 months

The essential and evolving nature of oncology social work: Accomplishments and impact, 2010-present

This paper demonstrates the essential nature of oncology social work and the critical role that oncology social workers (OSWs) play in the achievement of high-quality cancer care that improves patient outcomes, contains cost, advances population health, reduces provider burn-out among healthcare providers, and does it in a manner that addresses disparities and achieves equity. To this end, this paper's purpose is two-fold: (1) to review and demonstrate OSW contributions to the advancement of comprehensive cancer care over the last 15 years, and (2) to consider next steps for the Association of Oncology Social Work (AOSW) and the Oncology Social Work profession to achieve its mission and calling. To enhance the viability and security of OSWs and the professional organizations that support them, this report summarizes a breadth and depth of work and includes recommendations for the profession.

Raising a child with cancer: Impact on parents' health-related quality of life

Background

Having a child with a serious illness like cancer has a detrimental and negative impact on the parents' health-related quality of life (HRQOL). Many factors have been identified as being associated with poorer HRQOL. Acquiring knowledge about these factors is essential to enhancing the quality of life (QOL) of children as well as their parents.

Aim

This study aims to analyze HRQOL in parents of children with cancer and to explore relationships between parent and child variables and parental quality of life.

Materials and Methods

A total of 80 parents of children with cancer were enrolled in this cross-sectional study. To evaluate the parental HRQOL, the Short Form 36 Health Survey Questionnaire (SF-36) was used.

Results

Child age and time since diagnosis showed a positive correlation with all domains of HRQOL on Spearman's correlation. A statistically significant difference in SF-36 scores across four cancer groups was seen on the Kruskal-Wallis test. Mothers showed poorer quality of life in the physical role functioning domain as compared to fathers (U = 248, P < 0.01).

Conclusion

The present study shows poor HRQOL for parents of children with cancer, despite learning to cope and adjust over time. Parents of children with retinoblastoma demonstrate a poorer QOL as compared to other cancer groups. The study suggests close monitoring of parents' QOL and the provision of appropriate treatment and psychosocial support for parents along with the treatment of children.

Quality of life in children and adolescents after treatment for acute lymphoblastic leukemia according to the NOPHO ALL2008 protocol

BACKGROUND

The improved outcome of childhood acute lymphoblastic leukemia (ALL) over the last decades has increased the importance of assessing late effects and health-related quality of life (HRQoL), particularly when evaluating and comparing outcomes in clinical trials. This study aimed to assess HRQoL in children treated for ALL according to the NOPHO ALL2008 protocol.

PROCEDURE

Children, aged 1 to less than 18 years at diagnosis, alive in first remission, and their parents, were asked to complete PedsQL 4.0 Generic Core Scales (self- and proxy-report) at ≥6 months after end of therapy. Data on socioeconomic factors and parent-reported toxicity were collected through a study-specific questionnaire, and the NOPHO ALL2008 database was used to identify eligible families and add additional disease- and treatment-related data. HRQoL data were collected during 2013-2019 in Sweden, Finland, and Denmark.

RESULTS

A total of 299 children were included. The older children (8 years and older) reported similar HRQoL scores compared to Finnish reference data, except lower scores for School Functioning in high-risk patients. Scores from the parent-proxy and self-reports from 5-7-year olds were notably lower than reference. Parent-reported toxicity was associated with lower total and physical HRQoL scores in adjusted models for younger as well as older children in the self-report and parent-proxy versions, and also with lower psychosocial score in the parent-proxy.

CONCLUSIONS

Self-reported HRQoL was similar to reference population. The most important determinant for HRQoL after end of ALL treatment was parent-reported toxicity during treatment. Thus, minimizing complications is an obvious focus for future treatment protocols.

Promoting psychological support services for parents of children with sarcoma through health-social partnership: A quality improvement project

PURPOSE

A significant portion of parents of children diagnosed with sarcoma experience excessive stress and anxiety disorder. This quality improvement project aimed to implement a psychological support service program tailored for parents of children with sarcoma and evaluate its effects.

DESIGN AND METHODS

An interprofessional team was formed through a health-social partnership to deliver comprehensive psychological support service program involving multiple cognitive-behavioral components to parents of children with sarcoma. Parents who were identified as having excessive stress and/or anxiety disorder and voluntarily agreed to participate were enrolled. Pre- and post-intervention assessments were conducted, and previously recorded data from parents of children hospitalized in the year prior to this quality improvement project were included as historical controls.

RESULTS

A total of 48 parents, including 35 mothers and 13 fathers, participated in the quality improvement project. Results showed that participants achieved greater reduction in emotional, somatic, and behavioral stress when compared with historical controls (all p < .001). Significantly lower prevalence of moderate to severe anxiety disorder was also found (4.2% vs. 85.4%, p < .001).

CONCLUSIONS

The implementation of a psychological support service program, informed by cognitive-behavioral theory and delivered through a health-social partnership, effectively alleviated multiple facets of stress and anxiety disorder in parents of children newly diagnosed with sarcoma.

PRACTICE IMPLICATIONS

Nurses can facilitate and coordinate the collaboration among interprofessional team to deliver specialized psychological support services and ensure that parents of children with sarcoma have access to these services, ultimately enhancing their psychological well-being.

Resiliency process in the family after childhood leukaemia diagnosis: A longitudinal qualitative study

AIMS

To construct a conceptual framework on the process of family resilience during the first year following childhood leukaemia diagnosis.

DESIGN

A longitudinal qualitative interview study.

METHODS

A longitudinal qualitative study following a grounded theory methodology was employed. Semi-structured interviews were conducted with parents of children with leukaemia in a general hospital. The participants were recruited through purposive and theoretical sampling and longitudinal engagement was achieved by conducting interviews at 1, 3, 6, and 12 months after the leukaemia diagnosis. The core category and categories were saturated following the enrolment of parents of children with leukaemia. Data collection and analyses were performed simultaneously.

RESULTS

Sixteen parents of children with leukaemia participated. The core category of 'families living with childhood leukaemia' refers to the process of family resilience during the first year following childhood leukaemia diagnosis, which includes three phases: (1) destruction and resiliency period; (2) adjustment and consolidation period; and (3) growth and planning period.

CONCLUSION

This study explored the dynamic, complex and continuous processes of resilience among families coping with childhood leukaemia during the first year following diagnosis. Further research should design tailored family interventions that characterise the different phases of family resilience, aiming to support family well-being, integrity and functioning.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Both families and healthcare professionals must create an enabling environment that supports families coping with difficulties. Understanding the different phases of family resilience allows healthcare professionals to provide holistic care that meets the demands of families with childhood leukaemia.

IMPACT

Unique knowledge emerged about the family's resiliency process when facing childhood leukaemia, suggesting a family-led revolution in understanding and managing childhood leukaemia. Therefore, the development of phased, resilience-based family interventions is imperative.

REPORTING METHOD

This study was reported using the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed via study participation.

It's about living a normal life: parents' quality of life when their child has a life-threatening or life-limiting condition - a qualitative study

BACKGROUND

Pediatric palliative care (PPC) seeks to enhance the quality of life (QoL) for both children and their families. While most studies within PPC have focused on the ill child's QoL, less is known about parents' experiences of their own QoL. The aim of this study was to explore parents' QoL when their child has a life-threatening or life-limiting condition.

METHODS

The study has a qualitative, hermeneutic phenomenological design inspired by van Manen's phenomenology of practice. In-depth interviews were conducted with 12 fathers and 12 mothers of children living with cancer or a genetic condition. A deeper understanding of parents' lived experiences was obtained through an adapted photo elicitation method. Two rounds of thematic analysis were conducted, covering both the photo elicitation data, and interview data.

RESULTS

The findings describe four themes related to parents' QoL: living a normal life, giving my child a good life, having time to fulfill siblings' needs, and feeling heard and respected in the health and social care system.

CONCLUSIONS

The complexity of elements shaping parents' QoL is evident. The interconnectedness between parents, the ill child, siblings, and interactions with the health and social care system, highlights the need to understand and address diverse aspects in enhancing parents QoL.

Relationships Between Parental Anxiety and Child Quality of Life in Advanced Childhood Cancer

Background: Family factors, such as household income and parental psychosocial distress, have been associated with quality of life in children with cancer. However, relationships between parent anxiety and child health-related quality of life (HRQoL) have not been evaluated in children with advanced cancer. Objective: To examine relationships between parent anxiety and both parent-reported and child self-reported HRQoL for children with advanced cancer. Method: Children (aged 5-17 years) with relapsed or refractory cancer and their parents participated in this single-institution cross-sectional study. Parents completed measures of their own baseline anxiety (State-Trait Anxiety Inventory-Trait [STAI-T] form) and their ill child's HRQoL (PedsQL Generic and PedsQL Cancer, parent report). Children completed age-specific PedsQL Generic and PedsQL Cancer, child report. Spearman's rho coefficients assessed correlations between total parent STAI-T score and both parent-reported and child-reported HRQoL scales. Results: Twenty children (Mage = 9.5 years, 50% female) and their 20 parents (90% mothers) participated. The strongest and statistically significant (p < .05) correlations were inverse associations between parental trait anxiety and parent-reported child psychosocial HRQoL (rs = -.54), emotional functioning (rs = -.49), school functioning (rs = -.45), and child pain and hurt (rs = -.45). Correlations of parental anxiety with all dimensions of child-reported HRQoL were generally smaller (rs < .40), positive, and not statistically significant (p > .05). Discussion: Given the inverse correlations between parental anxiety and child psychosocial HRQoL, assessment of parent mental health needs and access to interventions should be provided routinely for parents of children with advanced cancer.

Finding family resilience in adversity: A grounded theory of families with children diagnosed with leukaemia

AIMS AND OBJECTIVES

To develop a conceptual framework that explores the process of building family resilience among Chinese families with children diagnosed with leukaemia.

BACKGROUND

The diagnosis of childhood leukaemia has a devastating effect on the family. Nonetheless, some families were able to positively respond to the crisis. The process through which Chinese families bounce back has received little attention.

DESIGN

Grounded theory.

METHODS

This study used purposive and theoretical sampling to select 16 parents who agreed to participate in semistructured interviews after children were diagnosed with leukaemia. Data collection and analysis occurred simultaneously. Data were analysed through a process of open, axial and selective coding. The COREQ checklist was followed for reporting.

RESULTS

A core category of 'finding family resilience in adversity' was generated. The core category was underpinned by a transition process between two fluid stages: (a) Disrupting the family system, informed by subcategories of negative emotional disturbances and challenges of the diagnosis and treatment journey; (b) Cultivating resilience in families, informed by subcategories of increasing positive attitudes; establishing new family routines; activating good support systems; and practising open family communication.

CONCLUSIONS

The transition process from the disruption of the family system to the cultivation of family resilience is perceived as a complex family dynamic in response to childhood leukaemia. Our findings can form the basis for further research about resilience-based family interventions that promote family well-being during the early stages of a childhood leukaemia diagnosis.

RELEVANCE TO CLINICAL PRACTICE

It is necessary for healthcare professionals to provide essential support for families to face the challenges of diagnosis and treatment to facilitate the successful transition to family resilience. By understanding the dynamic process of developing family resilience, healthcare professionals are able to focus on these families to provide holistic care that satisfies the specific demands of family members.

Quality of life in mothers and fathers of children treated for acute lymphoblastic leukaemia in Sweden, Finland and Denmark

Acute lymphoblastic leukaemia (ALL) has a high survival rate, but treatment is lengthy with risk of severe side‐effects, which may also impact parents' health‐related quality of life (HRQOL). We present data on 526 parents of 310 children treated for ALL according to the NOPHO ALL2008‐protocol, in Sweden, Finland and Denmark. Parents were asked to complete the 36‐Item Short Form Survey (SF‐36) at least 6 months after end of treatment and data were compared with Norwegian reference data. Parental background factors were collected via a study‐specific questionnaire. Participating parents scored significantly lower than the reference population on both physical and mental summary indexes, but only surpassed a minimal clinically important difference for the mental summary index (Mental Component Summary [MCS]). Mothers scored lower than fathers in the MCS and stopped working and took care of the affected child more often than the fathers. Higher mental HRQOL was associated with male gender and living in Finland or Denmark (compared to Sweden). Correlations within spouses in physical and mental scores were weak to moderate. In conclusion, ALL negatively affects parental HRQOL, especially the mental domains, even after treatment. Findings suggest that mothers are more affected than fathers and may require extra support.

RESILIENCE OF FAMILY CAREGIVERS OF CHILDREN AND ADOLESCENTS WITH CANCER AND ASSOCIATED FACTORS: MIXED METHOD STUDY

ABSTRACT Objective to analyze the relationship between resilience and associated factors (stress, minor psychiatric disorders and quality of life) of family caregivers with children and adolescents undergoing cancer treatment. Method mixed methods research, with sequential explanatory strategy, carried out with family caregivers of children and adolescents undergoing cancer treatment in a public hospital in the Rio Grande do Sul State, Brazil. Data collection took place from February to September 2018. The quantitative study was cross-sectional in nature, and the qualitative research was descriptive-exploratory. Participants included 62 family caregivers in the quantitative stage and 16 responded to semi-structured interviews. An instrument containing sociodemographic, economic, labor, health and resilience scales (CD-RISC-10-Br), minor psychiatric disorders (MPDs) (SRQ-20), quality of life (QOL) (WHOQO-Bref) and stress and semi-structured interview were applied. Descriptive and inferential statistics were used for quantitative data and content analysis for qualitative data. Results family caregivers had a moderate level of resilience (48.4%); high level of perceived stress (41%); suspicion for MPDs (45%). They presented satisfaction in the physical Qol domains (67.7%); psychological (62.9%); personal relationships (61.3%), and dissatisfaction in the environment domain (75.8%). The interviews reported for health changes that could trigger MPD, stress and changes in quality of life. Conclusion high level of stress; suspicion for MPD and low QoL, with the environment, were evidenced as associated factors for a lower level of resilience of family caregivers. The need to develop actions that strengthen resilience was percieved, as caregivers were essential for the effectiveness of the care plan for children and adolescents undergoing cancer treatment.

RESILIÊNCIA DE CUIDADORES FAMILIARES DE CRIANÇAS E ADOLESCENTES COM CÂNCER E FATORES ASSOCIADOS: ESTUDO DE MÉTODOS MISTOS

RESUMO Objetivo analisar a relação entre resiliência e fatores associados (estresse, distúrbios psíquicos menores e qualidade de vida) de cuidadores familiares de crianças e adolescentes em tratamento oncológico. Método pesquisa de métodos mistos, com estratégia explanatória sequencial, realizado com cuidadores familiares de crianças e adolescentes em tratamento oncológico em um hospital público do interior do Rio Grande do Sul, Brasil. A coleta de dados ocorreu de fevereiro a setembro de 2018. O estudo quantitativo foi de natureza transversal e a pesquisa qualitativa teve caráter descritivo-exploratório. Participaram 62 cuidadores familiares na etapa quantitativa e 16 responderam as entrevistas semiestruturadas. Aplicaram-se instrumento contendo questões sociodemográficas, econômicas, laborais, de saúde e escalas de resiliência (CD-RISC-10-Br), distúrbios psíquicos menores (DPMs) (SRQ-20), qualidade de vida (QV) (WHOQO-Bref) e estresse e entrevista semiestruturada. Utilizou-se estatística descritiva e inferencial para os dados quantitativos e análise de conteúdo para os qualitativos. Resultados os cuidadores familiares possuíam nível moderado de resiliência (48,4%); alto nível de estresse percebido (41%); suspeição para distúrbios psíquicos menores (45%). Apresentaram satisfação nos domínios de qualidade de vida físico (67,7%); psicológico (62,9%); relações pessoais (61,3%), e insatisfação no domínio meio ambiente (75,8%). As entrevistas reportaram para alterações de saúde que poderiam desencadear distúrbios psíquicos menores, estresse e alterações na qualidade de vida. Conclusão alto nível de estresse; suspeição para distúrbios psíquicos menores e baixa qualidade de vida, com o meio ambiente, evidenciaram-se como fatores associados para um menor nível de resiliência dos cuidadores familiares. Percebeu-se a necessidade de desenvolver ações que fortalecessem a resiliência, pois os cuidadores foram essenciais para a efetividade do plano de cuidado de crianças e adolescentes em tratamento oncológico.