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Karlson CW, Barajas KG, Erp LS, Winston K. Psychosocial Assessment Tool 2.0 and Long-Term Mental Health Outcomes in Childhood Cancer. J Pediatr Hematol Oncol 2024:00043426-990000000-00473. [PMID: 39120592 DOI: 10.1097/mph.0000000000002935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/02/2024] [Indexed: 08/10/2024]
Abstract
To identify childhood cancer patients and their families at the greatest risk for psychosocial difficulties, this study examined the predictive validity of the Psychosocial Assessment Tool 2.0 (PAT2.0) on caregiver and patient-reported mental health outcomes at 1-year follow-up. The PAT2.0 was administered to caregivers a median of 0.08 years after cancer diagnosis. A brief psychosocial screening battery (Family Symptom Inventory and PROMIS v1.0 Pediatric Profile-25) was administered to patient-caregiver dyads (n=53) ∼1-year later. Linear regressions support the longitudinal predictive validity of the PAT2.0 for caregiver-reported child and caregiver mental health symptoms and child-reported peer relationships difficulties.
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Affiliation(s)
- Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Kimberly G Barajas
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Lauren S Erp
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Kaysie Winston
- Division of Hematology/Oncology, Department of Pediatrics
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2
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Patterson V, Olsavsky A, Garcia D, Sutherland-Foggio M, Vannatta K, Prussien KV, Bemis H, Compas BE, Gerhardt CA. Impact of sociodemographic factors, stress, and communication on health-related quality of life in survivors of pediatric cancer. Pediatr Blood Cancer 2024; 71:e31001. [PMID: 38644596 DOI: 10.1002/pbc.31001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND While most research has largely focused on medical risks associated with reduced health-related quality of life (HRQOL) in survivors, sociodemographic and family factors may also play a role. Thus, we longitudinally examined sociodemographic factors and family factors associated with survivor HRQOL, including adolescent's cancer-specific stress, mother's general stress, and mother-adolescent communication. METHODS Mothers (N = 80) and survivors (ages 10-23, N = 50) were assessed 5 years following initial diagnosis. Mothers completed measures regarding sociodemographic background adolescent's cancer-specific stress, mother's general stress, mother-adolescent communication, and adolescent HRQOL. Survivors also reported on their own HRQOL. Two hierarchical multiple regressions examined predictors of (a) mother's report of adolescent HRQOL, and (b) survivor's self-report of HRQOL. RESULTS The final model predicting mother-reported adolescent HRQOL was significant, F(5,74) = 21.18, p < .001, and explained 59% of the variance in HRQoL. Significant predictors included adolescent stress (β = -.37, p < .001), mothers' stress (β = -.42, p < .001), and communication (β = .19, p = .03). The final model predicting survivor-reported HRQOL was also significant, F(5,44) = 5.16, p < .01 and explained 24% of the variance in HRQOL. Significant predictors included adolescent stress (β = -.37, p = .01) and communication (β = -.31, p = .04). Sociodemographic factors were not a significant predictor of HRQOL in any model. CONCLUSION Family stress and communication offer potential points of intervention to improve HRQOL of pediatric cancer survivors from mother and survivor perspectives. While additional research is needed, healthcare professionals should encourage stress management and strong mother-child communication to enhance survivors' long-term HRQOL. Such interventions may be complimentary to efforts targeting the known sociodemographic factors that often affect health.
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Affiliation(s)
- Valdeoso Patterson
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Anna Olsavsky
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dana Garcia
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Kemar V Prussien
- Vanderbilt University, Nashville, Tennessee, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Bemis
- Vanderbilt University, Nashville, Tennessee, USA
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
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3
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Yaldo M, Pai AL, McGrady ME, Wallens E, Allen JM, Spraker-Perlman H, Ast A, Reeves T, Tillery Webster R. Factors influencing caregiver decisions to use complementary and integrative therapies in pediatric oncology settings: Findings from a qualitative analysis. Eur J Oncol Nurs 2024; 70:102588. [PMID: 38669955 DOI: 10.1016/j.ejon.2024.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Complementary and integrative medicine (CIM) therapies (i.e., non-conventional Western medicine interventions) may reduce side-effects associated with pediatric oncology treatment. CIM therapies may also improve caregiver psychological and physical health that is exacerbated during pediatric cancer treatment. Despite known benefits, these therapies are not widely used within pediatric oncology populations in the United States. To guide and promote CIM use among this population, the aim of this project was to qualitatively explore factors that contribute to caregivers' decision to include CIM use in their own and child's care. METHODS Twenty caregivers of children (ages 0.5-14 years) being treated for cancer participated in this study. Each completed a demographic form and the CIM use questionnaire. Qualitative interviews followed by a card sort task were used to assess barriers and facilitators of uptake for caregivers and their child with cancer. RESULTS A number of predisposing (e.g., child age, beliefs) and needs factors (e.g., potential to treatment-related side-effects) provide insight into caregivers' decisions to use CIM for their child. Analyses also revealed the importance of enabling factors (e.g., resources) for caregiver use. Caregivers also reported benefiting from additional information about risk/benefit analysis of these therapies, and current research for CIM use in caregivers and children being treated for cancer. CONCLUSION Children may benefit from individually tailored complementary and integrative medicine consultations that explore patient history and specific needs factors to improve preference concordant care and uptake. Caregivers may benefit from support that improves enabling factors associated with care (e.g., improved accessibility).
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Affiliation(s)
- Marissa Yaldo
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ahna Lh Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emma Wallens
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jennifer M Allen
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Holly Spraker-Perlman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Allison Ast
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tegan Reeves
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Rachel Tillery Webster
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA; Comprehensive Cancer Center, St. Jude Children's Research Hospital, Memphis, TN, USA.
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4
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Himelhoch AC, Olsavsky AL, Darow EL, Lipak KG, Kenney AE, Fisher RS, Prussien KV, Vannatta KA, Compas BE, Gerhardt CA. Cancer-related stress in childhood cancer survivorship: Prevalence and associations with perceptions of health risks and quality of life. Psychooncology 2024; 33:e6253. [PMID: 38009605 PMCID: PMC10841662 DOI: 10.1002/pon.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Limited research has characterized cancer-related stress (CRS) among families of childhood cancer survivors. We examined the prevalence of CRS among survivors and caregivers, as well as its association with health risk perceptions (i.e., prognosis, risk for diminished quality of life) and views of survivor quality of life (QoL). METHODS At five years post-diagnosis or relapse, survivors (n = 100; Mage = 15.84 years; 89% White), mothers (n = 127), and fathers (n = 59) reported their CRS. Perceived prognosis and risk for diminished QoL were rated on a 0%-100% visual analogue scale, while the PedsQL assessed QoL. RESULTS CRS was low (M = 1.6-1.8, scale: 1-4); mothers reported greater stress than survivors, p = 0.038, d = 0.25. There was an indirect effect of survivors' perceived prognosis on their QoL through CRS, CI = 0.04 to 0.25, R2 = 0.32. Among mothers, there was an indirect effect of perceived prognosis/risk for diminished QoL on their reports of survivor QoL through CRS, CI = 0.03 to 0.23 and -0.15 to -0.03, R2 = 0.28 and 0.32, respectively. There were no indirect effects among fathers. CONCLUSIONS CRS may be an important, modifiable factor that could improve survivors' QoL. Research is needed to examine how CRS changes over time to assess the utility of interventions among female survivors, mothers, and those with lower prognosis estimates.
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Affiliation(s)
- Alexandra C. Himelhoch
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Anna L. Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Eva L. Darow
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Keagan G. Lipak
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Ansley E. Kenney
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Rachel S. Fisher
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Kemar V. Prussien
- Department of Psychology and Human Development, Vanderbilt
University, Nashville, Tennessee, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
- Department of Pediatrics and Psychology, The Ohio State
University, Columbus, Ohio, USA
| | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt
University, Nashville, Tennessee, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
- Department of Pediatrics and Psychology, The Ohio State
University, Columbus, Ohio, USA
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5
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Iwahata Y, Takae S, Iwahata H, Matsumoto K, Hirayama M, Takita J, Manabe A, Cho Y, Ikeda T, Maezawa T, Miyachi M, Keino D, Koizumi T, Mori T, Shimizu N, Woodruff TK, Suzuki N. Investigation of Fertility Preservation Education Videos for Pediatric Patients Based on International and Historical Survey. J Adolesc Young Adult Oncol 2023; 12:835-842. [PMID: 37155199 DOI: 10.1089/jayao.2022.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Purpose: Recently, direct communication with children about cancer seems to have shifted, but little is known about communication regarding discussions of future infertility risk due to cancer therapy. This study conducted cross-cultural comparisons between Japan and the United States to clarify communication patterns about cancer notification and develop appropriate information about fertility issues. Methods: An online survey was distributed to members of the Japanese Society of Pediatric Hematology/Oncology in July 2019 and the American Society of Pediatric Hematology/Oncology in July 2020. Based on the results from the survey, we developed three types of educational videos: a prepubertal version A, B, and a pubertal version. Next, we conducted a survey to assess whether these were appropriate for clinical practice. Results: We analyzed 325 physicians in Japan and 46 in the United States. In Japan, 80.5%, 91.7%, and 92.1% of the physicians notified patients aged 7-9, 10-14, and 15-17 years of their cancer diagnosis directly, respectively, compared within the United States, where the rate was 100%, regardless of age. Further, 9% and 45% of physicians in Japan and the United States, respectively, discuss fertility issues directly with patients aged 7-9 years. In the survey to assess the educational videos, 85% of the physicians preferred to use the educational videos in clinical practice. Conclusion: This is the first step in bringing concordance to communication patters for emerging cancer care around the globe and that this study and its intervention arm provide guidance in ways that ensure global equity in care.
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Affiliation(s)
- Yuriko Iwahata
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Seido Takae
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hideyuki Iwahata
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kimikazu Matsumoto
- National Center for Child Health and Development, Children's Cancer Center, Tokyo, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - Tadashi Maezawa
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Dai Keino
- Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tomoe Koizumi
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
- International Center for Reproductive Medicine, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Mori
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Naoki Shimizu
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Michigan State University, East Lansing, Michigan, USA
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
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Tan BWZ, Teo LL, Tong JWK, Chan MY. An exploration of the psychosocial needs of children diagnosed with cancer and their parents in Singapore: a cross-sectional study. Singapore Med J 2023; 64:580-584. [PMID: 35509214 PMCID: PMC10564097 DOI: 10.11622/smedj.2022050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Beron Wei Zhong Tan
- Psychology Service, KK Women’s and Children’s Hospital, Singapore
- Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore
| | - Lois Ling’en Teo
- Psychology Service, KK Women’s and Children’s Hospital, Singapore
| | | | - Mei-Yoke Chan
- Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore
- Haematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore
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7
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Bates CR, Pallotto IK, Moore RM, Covitz LM, Dreyer Gillette ML. Barriers and facilitators of family rules and routines during pediatric cancer treatment. J Pediatr Nurs 2023; 72:e33-e39. [PMID: 37308340 DOI: 10.1016/j.pedn.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Pediatric nurses work closely with families of children with new cancer diagnoses and can provide essential supports to promote coping and adjustment. This cross-sectional qualitative study aimed to gather caregiver perspectives on barriers and facilitators to adaptive family functioning during the early phases of cancer treatment, with a focus on family rules and routines. METHODS Caregivers (N = 44) of a child diagnosed with cancer and receiving active treatment completed a semi-structured interview about their engagement in family rules and routines. Time since diagnosis was abstracted from the medical record. A multi-pass inductive coding strategy was utilized to extract themes identifying caregiver-reported facilitators and barriers to maintaining consistent family rules and routines during the first year of pediatric treatment. RESULTS Caregivers identified three primary contexts that presented barriers and facilitators to engagement in family rules and routines: the hospital setting (n = 40), the family system (n = 36), and the broader social and community setting (n = 26). Caregivers reported barriers primarily related to the demands of their child's treatment, additional caregiving needs, and needing to prioritize basic daily tasks (e.g., food, rest, household needs). Caregivers reported that different networks of support across contexts facilitated family rules and routines by expanding caregiver capacity in distinctive ways. CONCLUSIONS Findings provided insight into the importance of having multiple networks of support to extend caregiving capacity in the context of cancer treatment demands. PRACTICE IMPLICATIONS Providing nurses with training to facilitate problem-solving skills in the context of competing demands may provide a new avenue of clinical intervention at the bedside.
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Affiliation(s)
- Carolyn R Bates
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA; University of Kansas Cancer Center, Kansas City, KS, USA.
| | | | - Rachel M Moore
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Lynne M Covitz
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
| | - Meredith L Dreyer Gillette
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA; Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri - Kansas City School of Medicine, Kansas City, MO, USA
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Tanaka K, Hayakawa M, Mori M, Maeda N, Nagata M, Horibe K. Medical staff's sense of awareness of informed consent for adolescent cancer patients and the need for decision-making support practiced from the perspective of trauma-informed approach. BMC Med Ethics 2023; 24:28. [PMID: 37149683 PMCID: PMC10164311 DOI: 10.1186/s12910-023-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/14/2023] [Indexed: 05/08/2023] Open
Abstract
It has not been established how to assess children's and adolescents' decision-making capacity (DMC) and there has been little discussion on the way their decision-making (DM). The purpose of this study was to examine actual situation and factors related to difficulties in explaining their disease to adolescent cancer patients or obtaining informed consent (IC). The cross-sectional questionnaire survey was conducted. Physicians who have been treating adolescent cancer patients for at least five years answered a self-administered questionnaire uniquely developed about clinical difficulties in explaining, IC and factors related patient's refusal of medical treatment (RMT). Descriptive statistics for each item and a polychoric correlation analysis of the problems and factors related to the explanation were conducted. As a result, fifty-six physicians were participated (rate of return: 39%). Explaining the disease and treatment to patients (83.9%), IC to patients (80.4%), and explaining the disease and treatment to parents (78.6%) was particularly problematic. Difficulties to provide support related with patient's refusal of medical treatment and to explain disease and treatment for patient and parents were related to difficulties obtaining IC for the patient. Conclusion: There are clinically difficult to explain for the patient or parents and to obtain IC for the patient. It is necessary to establish a disease acceptance assessment tool for the adolescence generation so that it can be applied in the field.
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Affiliation(s)
- Kyoko Tanaka
- National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
- Division of Consultation liaison Department of Psychosocial Medicine, 2-10-1 Okura, Setagaya- ku, Tokyo, 157-8535, Japan.
| | - Maoko Hayakawa
- National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
- Ochanomizu University Human Developmental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Saitama, Japan
| | - Naoko Maeda
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Masako Nagata
- Psychological Support&Research Center for Human Development, NAGOYA UNIVERSITY, Nagoya-shi, Aichi, Japan
| | - Keizo Horibe
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
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Ionio C, Bigoni F, Sacchi M, Zecca M, Bergami E, Landoni M, Ciuffo G, Rovati A, Rizzi D. Exploring the Effects of Cancer as a Traumatic Event on Italian Adolescents and Young Adults: Investigating Psychological Well-Being, Identity Construction and Coping Strategies. Pediatr Rep 2023; 15:254-262. [PMID: 36976728 PMCID: PMC10056441 DOI: 10.3390/pediatric15010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Cancer in adolescence is considered a family disease that can have numerous negative psychological consequences for adolescents and the entire household. The aim of this study was to investigate the impact of oncological disease in adolescence, with particular reference to the psychological and post-traumatic consequences for the adolescents themselves and the family system. An explorative case-control study was conducted with 31 adolescents (mean age 18.03 ± 2.799) hospitalised for cancer at IRCCS San Matteo Hospital in Pavia and 47 healthy adolescents (mean age 16.17 ± 2.099). The two samples completed a survey that included sociodemographic information and questionnaires assessing psychological well-being, traumatic effects of the disease, and adequacy of the relationship with parents. 56.7% of oncology adolescents scored below average in psychological well-being, and a small proportion of them fell within the range of clinical concern for anger (9.7%), PTS (12.9%), and dissociation (12.9%). Compared with peers, there were no significant differences. However, in contrast to peers, oncology adolescents showed a strong influence of the traumatic event on the construction of their identity and life perspectives. A significantly positive correlation also emerged between adolescents' psychological well-being and the relationship with their parents (mothers: r = 0.796; p < 0.01; fathers: r = 0.692; p < 0.01). Our findings highlight how cancer in adolescence could represent a central traumatic event that can shape the identity and life of teenagers who are in an intrinsically delicate and vulnerable stage of life.
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Affiliation(s)
- Chiara Ionio
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy
- Società Italiana di Psicologia Pediatrica (S.I.P.Ped), 90144 Palermo, Italy
| | - Francesca Bigoni
- Fondazione Soleterre, 20125 Milano, Italy
- Fondazione Policlinico San Matteo IRCCS, 27100 Pavia, Italy
| | - Maddalena Sacchi
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy
| | - Marco Zecca
- Fondazione Policlinico San Matteo IRCCS, 27100 Pavia, Italy
| | - Elena Bergami
- Fondazione Policlinico San Matteo IRCCS, 27100 Pavia, Italy
| | - Marta Landoni
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy
| | - Giulia Ciuffo
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Università Cattolica, 20123 Milano, Italy
- Società Italiana di Psicologia Pediatrica (S.I.P.Ped), 90144 Palermo, Italy
| | - Anna Rovati
- Fondazione Soleterre, 20125 Milano, Italy
- Fondazione Policlinico San Matteo IRCCS, 27100 Pavia, Italy
| | - Damiano Rizzi
- Fondazione Soleterre, 20125 Milano, Italy
- Fondazione Policlinico San Matteo IRCCS, 27100 Pavia, Italy
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10
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Haase E. Using Case-Based Teaching of Climate Change to Broaden Appreciation of Socio-Environmental Determinants of Mental Health. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:574-578. [PMID: 36109425 DOI: 10.1007/s40596-022-01697-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Elizabeth Haase
- Carson Tahoe Regional Medical Center, Carson City, NV, USA.
- University of Nevada School of Medicine, Reno, NV, USA.
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11
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Traino KA, Mullins LL. JPP Student Journal Club Commentary: Assessing Parent Distress Trajectories in the Context of Congenital Heart Disease. J Pediatr Psychol 2022; 48:317-319. [PMID: 36173360 DOI: 10.1093/jpepsy/jsac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/12/2022] Open
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12
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Koutná V, Blatný M, Jelínek M. Posttraumatic stress and growth in adolescent childhood cancer survivors: Links to quality of life. Front Psychol 2022; 13:992310. [PMID: 36160575 PMCID: PMC9505020 DOI: 10.3389/fpsyg.2022.992310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric cancer can be considered an event potentially leading to posttraumatic stress symptoms (PTSS) as well as posttraumatic growth (PTG). While clinically significant levels of PTSS are rare in childhood cancer survivors, PTG is common in this population. However, the relationship of PTG to overall adaptation and quality of life (QOL) in pediatric cancer patients is not clear. Therefore, our study aims to analyse the relationships of PTSS and PTG with QOL in childhood cancer survivors. In this study, 172 childhood cancer survivors completed measures of quality of life (Minneapolis-Manchester Quality of Life Scale; child and adolescent version), posttraumatic stress (UCLA PTSD Reaction Index for DMS-IV) and posttraumatic growth (Benefit Finding Scale for Children). Correlation analyses were carried out separately for the child (up to 13 years, N = 47) and adolescent (more than 13 years, N = 125) groups and each QOL dimension. In the adolescent group, the relationship of PTSS and PTG with QOL was further verified by regression analyses while controlling for age, gender, and time off treatment. In children, negative relationships between PTSS and QOL were found, but the relationships between QOL and PTG were not significant. In adolescents, significant relationships were found for all dimensions of QOL and PTSS and also for several dimensions of QOL and PTG. The relationships between PTSS and QOL dimensions were negative in both groups, and the relationships between PTG and QOL in the adolescent group were weakly positive. In adolescents, regression analyses controlling for age, gender and time off treatment were performed and confirmed a negative relationship of PTSS with all QOL dimensions except for social functioning. For PTG, regression analyses revealed a significant positive relationship with QOL dimensions of social functioning, outlook on life and intimate relations. While the relationship between PTSS and QOL is negative for almost all QOL dimensions in children and adolescents, the nature of the relationship between PTG and QOL appears to be more complex and changing over time. PTG in children may reflect different processes with different outcomes than PTG in adolescents.
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Affiliation(s)
- Veronika Koutná
- Institute of Psychology, Czech Academy of Sciences, Brno, Czechia
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
- *Correspondence: Veronika Koutná,
| | - Marek Blatný
- Institute of Psychology, Czech Academy of Sciences, Brno, Czechia
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
| | - Martin Jelínek
- Institute of Psychology, Czech Academy of Sciences, Brno, Czechia
- Department of Psychology, Faculty of Arts, Masaryk University, Brno, Czechia
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13
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Rheel E, Heathcote LC, van der Werff Ten Bosch J, Schulte F, Pate JW. Pain science education for children living with and beyond cancer: Challenges and research agenda. Pediatr Blood Cancer 2022; 69:e29783. [PMID: 35593047 DOI: 10.1002/pbc.29783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/05/2022]
Abstract
Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients' understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric research. PSE could help childhood cancer survivors experiencing persistent pain and pain-related worry after active treatment. PSE may also help children receiving cancer treatment, providing them with a foundation of adaptive pain beliefs and cognitions, and preparing them for procedural and treatment-related pain. We direct this paper toward pediatric oncology clinicians, policy makers, and researchers working with children living with and beyond cancer. We aim to (a) identify challenges in adapting PSE for children living with and beyond cancer, (b) offer possible solutions, and (c) propose research questions to guide the implementation of PSE for children living with and beyond cancer.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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14
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Faith MA, Boone DM, Healy A, Davila E. Parent coping, emotion socialization beliefs, and sibling relationship quality in pediatric cancer. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2076682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Melissa A. Faith
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dianna M. Boone
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
| | - Ashly Healy
- Center for Behavioral Health, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, USA
| | - Esther Davila
- Department of Psychology, University of South Florida, Tampa, FL, USA
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15
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16
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Desjardins L, Solomon A, Shama W, Mills D, Chung J, Hancock K, Barrera M. The impact of caregiver anxiety/depression symptoms and family functioning on child quality of life during pediatric cancer treatment: From diagnosis to 6 months. J Psychosoc Oncol 2022; 40:790-807. [PMID: 35016592 DOI: 10.1080/07347332.2021.2015646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A pediatric cancer diagnosis can have a significant impact on the quality of life (QOL) of the child. Diagnosis and treatment impact caregiver anxiety/depression symptoms and family functioning, and these in turn may influence child QOL. However, there has been limited longitudinal examination of the impact of both caregiver anxiety/depression symptoms and family functioning on youth QOL at specific points during the early diagnosis and treatment period. Ninety-six caregivers of youth (diagnosed with leukemia/lymphoma or a solid tumor) reported on their own anxiety/depression symptoms, family functioning, demographic and medical factors, and on their child's generic and cancer-specific QOL shortly after diagnosis (T1) and 6 months later (T2). Caregiver anxiety/depression symptoms were associated with poorer cancer-specific and generic child QOL within and across time points. Family conflict was associated with youth cancer-related QOL at T1. Attendance to caregiver anxiety/depression symptoms and family functioning, beginning early in the cancer trajectory, is an important aspect of family-centered care. Routine psychosocial screening and triage may help identify and intervene to support both caregiver and child psychosocial well-being.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada.,Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Aden Solomon
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Wendy Shama
- Department of Social Work, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Denise Mills
- Department of Nursing, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Joanna Chung
- Department of Psychology, Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Kelly Hancock
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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17
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Deodhar J, Goswami SS, Sonkusare LN. A Retrospective Observational Study of Problems Faced by Children and Adolescents with Cancer: A 5-year Experience from a Pediatric Psycho-Oncology Service in India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1740069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Psychological concerns are common in children and adolescents with cancer, for which they require referral to specialist services. There is a dearth of pediatric psycho-oncology services in India. There are limited studies on emotional and related distress in children.
Objectives To evaluate the types of problems and associated factors in children and adolescents with cancer referred to the pediatric psycho-oncology service in a tertiary care oncology center in India.
Materials and Methods A retrospective analysis of all referrals to the institution's pediatric psycho-oncology service over 5 years was performed. Patients newly referred to the service, up to 18 years of age, with a cancer diagnosis, on active disease-modifying treatment or supportive care or following up within 2 years of completion of treatment were included. Patients not on any disease-modifying treatment and receiving the best supportive care only were excluded as needs and problems would differ in this group. Patients whose medical records were incomplete were excluded too. Descriptive measures and tests of association were performed for analysis.
Results Of the 278 children referred to the service in 5 years, 66.5% were males. The average age was 11 years (standard deviation [SD]: 4.5). Most children had hematolymphoid cancers (58.2%). All reported problems were mainly emotional/behavioral (59%), physical health-related (21%), and academic (14%). Male children, referred from outpatient clinics and undergoing treatment with palliative intent, had more emotional problems, but these factors were not statistically significant.
Conclusion Children and adolescents with cancer had different problems, most commonly emotional/behavioral and physical health-related. Age, gender, and treatment intent were factors associated with emotional problems. Psychosocial care services for children and adolescents with cancer are necessary for low-resource settings.
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Affiliation(s)
- Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - Savita S. Goswami
- Psycho-oncology Unit, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Lekhika N. Sonkusare
- Psycho-oncology Unit, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
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18
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Hassan E, Nagui Rizk D, Aly NM, El Chazli Y. Impact of the COVID-19 pandemic on health-related quality of life and anxiety in pediatric hematology/oncology patients. Pediatr Hematol Oncol 2021; 38:683-694. [PMID: 33974490 DOI: 10.1080/08880018.2021.1922559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Since the World Health Organization declared the COVID-19 pandemic in March 2020, the strain on healthcare services affected patients suffering from various comorbidities and added to the psychological burden. The study aimed to assess the health-related quality of life (HRQoL) and anxiety levels of pediatric Hematology/Oncology patients during the COVID19 pandemic and evaluate the association between anxiety levels and physical, emotional, and social aspects of HRQoL. A cross-sectional study was conducted on 292 children between 2.5 - 13 years with chronic hematological/oncological disorders. Pediatric Quality of Life Generic Core Scale and Spence Children's Anxiety Scale were used for assessment of HRQoL and anxiety, respectively. Linear regression was performed to assess the association between background and COVID-19 related factors with anxiety level. Multivariate Analysis of Variance (MANOVA) was performed to assess the association between the three HRQoL dimensions with child anxiety and different independent variables. Transfusion-dependent patients had lower anxiety levels than patients receiving chemotherapy (B=-14.45, 95% CI=-21.94,-6.95).Children who were aware of the pandemic had lower anxiety scores than those who were not, while those suffering from canceled clinic days had higher anxiety levels (B=-8.66,95% CI=-14.86,-2.45, and B = 7.33,95% CI =1.22,13.45, respectively). Anxiety significantly reduced the three HRQoL domains (B=-0.36, 95% CI=-0.47, -0.24 for physical functioning, B=-0.45, 95% CI =-0.56, -0.33 for social functioning and B=-0.50, 95% CI=-0.63,-0.38 for emotional functioning). This study highlights the effect of the pandemic on the anxiety level and hence the HRQoL of chronic hematological/oncological pediatric patients for guiding policies and interventions to maintain their psychological well-being.
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Affiliation(s)
- Eman Hassan
- Department of Pediatrics, Hematology and Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.,Paediatric Haematology Department, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Dalia Nagui Rizk
- Department of Neuropsychiatry, Psychiatry Unit, Faculty of Medicine, Alexandria, Egypt
| | - Nourhan M Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Yasmine El Chazli
- Department of Pediatrics, Hematology and Oncology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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19
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Guido A, Marconi E, Peruzzi L, Dinapoli N, Tamburrini G, Attinà G, Balducci M, Valentini V, Ruggiero A, Chieffo DPR. Psychological Impact of COVID-19 on Parents of Pediatric Cancer Patients. Front Psychol 2021; 12:730341. [PMID: 34630243 PMCID: PMC8493250 DOI: 10.3389/fpsyg.2021.730341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
The changes and general alarm of the current COVID-19 pandemic have amplified the sense of precariousness and vulnerability for family members who, in addition to the emotional trauma of the cancer diagnosis, add the distress and fear of the risks associated with infection. The primary objectives of the present study were to investigate the psychological impact of the COVID-19 pandemic on the parents of pediatric cancer patients, and the level of stress, anxiety, and the child's quality of life perceived by the parents during the COVID-19 epidemic. The parents of 45 consecutive children with solid and hematological tumors were enrolled. Four questionnaires (Impact of Event Scale-Revised - IES-R; Perceived Stress Scale - PSS; Spielberger State - Trait Anxiety Inventory - STAI-Y; Pediatric Quality of Life Inventory - PedsQL) were administered to the parents at the beginning of the pandemic lockdown. A 75% of parents exhibited remarkable levels of anxiety, with 60 subjects in state scale and 45 subjects in trait scale having scores that reached and exceeded the STAI-Y cut off. The bivariate matrix of correlation found a significant positive correlation between the IES-R and PSS scores (r = 0.55, P < 0.001). There was a positive correlation between the PSS and PedsQL (emotional needs) scale (P < 0.001) and a negative correlation between IES-R and STAI-Y (P < 0.001). The results confirm that parents of pediatric cancer patients have a high psychological risk for post-traumatic symptoms, high stress levels, and the presence of clinically significant levels of anxiety.
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Affiliation(s)
- Antonella Guido
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Elisa Marconi
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Peruzzi
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Nicola Dinapoli
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Mario Balducci
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
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20
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Atout MM, Carter B. Communication styles between family carers and children with leukaemia in occupied Palestinian territory. J Child Health Care 2021; 25:427-441. [PMID: 32783747 DOI: 10.1177/1367493520949318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores the experience of communication regarding the care of children with cancer, from the perspective of family carers, children and health professionals in occupied Palestinian territory. This study employed an ethnographic collective qualitative case study approach, which was applied in one oncology unit in a Palestinian hospital. Participant observation and semi-structured interviews were used. This study only reports the findings of the interviews with the participating family carers. Fifteen interviews were conducted with family carers (n = 14 children), namely mothers (n = 7), grandmothers (n = 7) and a father (n = 1). The findings reveal that styles of information were given to children by their family carers: minimal/practical information, gradual information, false information, reassuring information and several sources of information. The term cancer was avoided in the discussion of the disease to ameliorate the negative effect of this term, which is considered taboo in the studied culture. Despite the recent trend emphasising the importance of parents communicating openly with their children with cancer, the findings of this study suggest that such open communication is not accepted by all parents. Hence, a case-by-case strategy could be adopted to treat each child in a way that is individual to that child and their culture.
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Affiliation(s)
- Maha M Atout
- Nursing School, 74428Philadelphia University, Jordan
| | - Bernie Carter
- Children's Nursing, Faculty of Health, Social Care and Medicine, 6249Edge Hill University, UK
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21
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The Impact of Parental Pain-attending and Non-pain-attending Responses on Child Pain Behavior in the Context of Cancer-related Painful Procedures: The Moderating Role of Parental Self-oriented Distress. Clin J Pain 2021; 37:177-185. [PMID: 33273274 DOI: 10.1097/ajp.0000000000000902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Literature has demonstrated inconsistent findings regarding the impact of parental responses on child pain-related outcomes. Yet, research into factors that may underlie inconsistent findings regarding the variable impact of parental responses is lacking. The current study investigated the moderating role of parental distress in understanding the impact of parental pain-attending (eg, reassuring the child) and non-pain-attending (eg, distracting the child with humor) responses on child pain behavior (eg, crying). METHODS Children (18 y and younger) with leukemia, undergoing a lumbar puncture (LP) and/or bone marrow aspiration procedure, and one of their parents, were recruited from the Pediatric Ghent University Hospital. Parent-child interactions were videotaped after the procedure allowing coding of parental responses and child pain behavior. Parents self-reported on experienced personal distress. RESULTS Participants consisted of 42 children (24 boys, 18 girls) with leukemia and one of their parents. Children were 0.6 to 15 (7.08±4.39) years old. Findings indicated a positive association between parental pain-attending and child pain behavior, but only when parents reported high levels of distress (β=0.56, P=0.001). No association was observed for parents reporting low levels of distress (β=-0.09, ns). Parental non-pain-attending responses contributed to lower child pain behavior (β=-0.24, P=0.045), independently of parental distress (β=-0.07, ns). DISCUSSION The current findings point to the moderating role of parental distress in understanding the impact of parental responses on child pain behavior and highlight the importance of interventions targeting parental emotion regulation to promote optimal child pain outcomes.
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22
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Pediatric sarcoma survivorship: A call for a developmental cascades approach. Dev Psychopathol 2021; 34:1221-1230. [PMID: 33851573 DOI: 10.1017/s095457942100002x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Survivors of pediatric sarcomas often experience greater psychological and psychosocial difficulties than their non-afflicted peers. We consider findings related to poorer outcomes from a developmental cascade perspective. Specifically, we discuss how physical, neurocognitive, psychological, and psychosocial costs associated with pediatric sarcomas and their treatment function transactionally to degrade well-being in long-term pediatric sarcoma survivors. We situate the sarcoma experience as a broad developmental threat - one stemming from both the presence and treatment of a life-imperiling disease, and the absence of typical childhood experiences. Ways in which degradation in one developmental domain spills over and effects other domains are highlighted. We argue that the aggregate effect of these cascades is two-fold: first, it adds to the typical stress involved in meeting developmental milestones and navigating developmental transitions; and second, it deprives survivors of crucial coping strategies that mitigate these stressors. This position suggests specific moments of intervention and raises specific hypotheses for investigators to explore.
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23
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Jones JK, Evans JF, Barfield RC. The Utility of Verbal Therapy for Pediatric Cancer Patients and Survivors: Expressive Writing, Video Narratives, and Bibliotherapy Exercises. Front Pediatr 2021; 9:579003. [PMID: 33614548 PMCID: PMC7889798 DOI: 10.3389/fped.2021.579003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Childhood cancer is a stressful experience. No pediatric patient, however, should be made to feel as if their concerns and feelings about their cancer experience must be bottled up inside. Importantly, talking and writing about one's illness has myriad implications for young cancer patients and survivors. The most salient of these may include increased understanding of one's condition as well as improved physical and cognitive symptoms (e.g., lowered depression, decreased anxiety, and an enhanced quality of life overall). This literature review explores three promising avenues for verbal therapy in the pediatric oncology setting: expressive writing, video narratives, and bibliotherapy exercises. Several recent studies, covering verbal therapy methods from illness blogging to book interventions, are referenced and discussed. Ultimately, we conclude that expressive writing, video narratives, and bibliotherapy exercises are valuable, feasible, inexpensive, and acceptable tools for patients and survivors of childhood cancer to facilitate self-expression-and to find meaning in the uncertainty and anxiety that cancer inherently fosters. We recommend that future studies investigate this theme so that we may improve quality of life and mental health for pediatric cancer patients and survivors worldwide.
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Affiliation(s)
- Jill K Jones
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States.,Duke Integrative Medicine, Durham, NC, United States
| | - John F Evans
- Duke Integrative Medicine, Durham, NC, United States
| | - Raymond C Barfield
- Memorial Health University Medical Center (Palliative Care), Savannah, GA, United States
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24
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Patel SK, Kim SH, Johansen C, Mullins W, Nolty A, Fernandez N, Delgado N, Folbrecht J, Dekel N, Meier A. Threshold score for the self-report Pediatric Distress Thermometer Rating Scale in childhood cancer patients. Psychooncology 2020; 30:340-348. [PMID: 33103298 DOI: 10.1002/pon.5583] [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] [Received: 07/12/2019] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although there is enthusiasm for identifying and treating psychosocial problems in childhood cancer patients, there are few validated instruments to help providers identify at-risk children for further assessment. The study objective was to evaluate the sensitivity and specificity of the self-report pediatric Distress Thermometer Rating Scale (Peds DTRS) in childhood cancer survivors and identify a threshold score to help providers classify pediatric patients. METHODS We evaluated 54 children 7-17 years old using 178 Peds DTRS longitudinal data points from the cohort that was used for the original pediatric adaptation of the DTRS. We compared Peds DTRS scores against two established standardized measures using a generalized linear mixed model to deal with the dependency in the longitudinal data to estimate ROC curves and related statistics. RESULTS Results indicate that a score of 3 is a reasonable cutoff to identify distress with children 7-17 years old. This cutoff yielded high sensitivity (87.0%) and specificity (79.7%) using the PedsQL Emotional Domain score as the standard. Similar results were obtained using the CDI as the standard, but we are cautious as very few CDI scores reached the cutoff criterion. Exploratory analysis highlighted clinical factors that correlate with increased distress measured using the Peds DTRS. CONCLUSIONS The Peds DTRS is a very brief, convenient, and rapid screening tool for global distress in children. Further investigation of the Peds DTRS and other tools can improve the ability of providers to prevent and treat the negative emotional consequences of cancer and improve the quality of survivorship.
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Affiliation(s)
- Sunita K Patel
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA.,Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, California, USA
| | - Seong-Hyeon Kim
- Department of Clinical Psychology, Fuller Theological Seminary, Pasadena, California, USA
| | - Christopher Johansen
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Wendy Mullins
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Anne Nolty
- Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, California, USA
| | - Nathaniel Fernandez
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Nicole Delgado
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Jeanelle Folbrecht
- Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, California, USA
| | - Noya Dekel
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
| | - Adrienne Meier
- Department of Population Sciences, City of Hope Medical Center, Duarte, California, USA
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25
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Gilleland Marchak J, Halpin SN, Escoffery C, Owolabi S, Mertens AC, Wasilewski-Masker K. Using formative evaluation to plan for electronic psychosocial screening in pediatric oncology. Psychooncology 2020; 30:202-211. [PMID: 32931620 DOI: 10.1002/pon.5550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To demonstrate how formative research methods can be used to plan for implementation of evidence-based psychosocial screening in pediatric oncology. METHODS Multidisciplinary pediatric oncology professionals participated in focus groups to adapt the distress thermometer for electronic administration and develop health systems processes to promote psychosocial screening in the pediatric oncology outpatient clinic setting. Seven 1-hour focus groups were conducted using a structured guide based on the reach, efficacy, adoption, implementation, and maintenance framework and transcribed verbatim. Two independent raters coded transcripts using a quasi-deductive approach with high inter-coder reliability (Cohen kappa >0.80). RESULTS Participants' (N = 44) responses were used to identify overarching topics related to the adoption, implementation, and maintenance of electronic screening (e-screening) including: barriers to meeting families' psychosocial needs, identification of champions, suggestions to adapt the proposed e-screening program, perceived barriers to e-screening, and potential impact of carrying out e-screening. Following review of qualitative data, we employed specific implementation strategies to promote adoption, implementation, and maintenance of an e-screening program. CONCLUSIONS Perceived barriers to the implementation of psychosocial screening remain substantial, yet enthusiasm for using electronic health records (EHRs) technology to help meet patient needs through regular assessment was evident among pediatric oncology professionals. Electronic administration of screening and integration of results into the EHR in real time were identified as critical needs to overcome barriers to e-screening. Formative research including qualitative data from stakeholders can be used to tailor implementation strategies to successfully support the adoption, implementation, and maintenance of e-screening programs in pediatric oncology.
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Affiliation(s)
- Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sean N Halpin
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Shadé Owolabi
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Alba-Suarez J, Davidson SL, Priebe C, Patel P, Greenspahn E, Boucher L, Rodríguez EM. Patient and sibling adjustment to pediatric cancer: the roles of parental relationship adjustment and depressive symptoms. J Psychosoc Oncol 2020; 39:613-628. [PMID: 32942948 DOI: 10.1080/07347332.2020.1819932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Pediatric cancer may impact parents' partner relationship and increase patient, parent, and sibling distress. This study examined parents' reports of their relationship adjustment and depressive symptoms and their association with their ratings of patients' and siblings' emotional/behavioral problems in families of recently diagnosed pediatric cancer patients. DESIGN Cross-sectional questionnaire study. SAMPLE A total of 31 parents (87% female; 71% Latino) of pediatric cancer patients. METHODS Parents reported on their relationship adjustment, depressive symptoms, and the patients' and siblings' emotional/behavioral problems. FINDINGS Poorer relationship adjustment was correlated with more parent depressive symptoms and patient emotional/behavioral problems. Parent depressive symptoms were positively correlated with emotional/behavioral problems in patients and siblings. After accounting for child age and parent depressive symptoms, relationship adjustment remained significantly associated with patient, but not sibling, problems. CONCLUSIONS When parents have poorer relationship adjustment following diagnosis, children with cancer may be at increased risk for emotional/behavioral problems. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY Interventions targeting the partner relationship may be relevant to supporting family adjustment following diagnosis.
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Affiliation(s)
- Juliana Alba-Suarez
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Savannah L Davidson
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Courtney Priebe
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Puja Patel
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA.,Dell Children's Medical Center, Austin, Texas, USA.,Dell Medical School, Austin, Texas, USA
| | - Emily Greenspahn
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA.,Dell Children's Medical Center, Austin, Texas, USA.,Dell Medical School, Austin, Texas, USA
| | - Lori Boucher
- Dell Children's Medical Center, Austin, Texas, USA
| | - Erin M Rodríguez
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
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27
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Yoshitsugu M, Sobue I. Nurse's difficulty and their educational needs regarding pediatric cancer care in Japan. Jpn J Nurs Sci 2020; 18:e12370. [PMID: 32945119 PMCID: PMC7891603 DOI: 10.1111/jjns.12370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 01/22/2023]
Abstract
Aim Aiming at environmental arrangements for pediatric cancer patients and their families to receive appropriate medical care and support with a sense of security, the Japanese Ministry of Health, Labour, and Welfare designated 15 hub hospitals for childhood cancer. These hub hospitals have established networks with approximately 200 centers/hospitals treating pediatric cancer. In order to promote equal access to nursing, we investigated nurses' difficulties and needs at these treatment hospitals with limited experience in pediatric cancer nursing. Methods In order to examine education on pediatric cancer nursing, we investigated difficulties felt by treatment hospital nurses, their educational experience and their educational needs. A total of 584 nurses (66.51%) from 52 hospitals from which written consent was received completed the questionnaires. Results Nurses had difficulties regarding nursing care for patients with critical conditions, such as terminal care, and actions to be taken when a patient's physical condition rapidly changes. Nurses most strongly desired education on nursing care for patients with serious problems, such as terminal care, and follow‐up provided in the form of in‐ and hub‐hospital lectures. Conclusion Our study suggested that in order to provide nurses in treatment hospitals with education focusing on nursing care for patients with serious problems, education systems based on cooperation between hub and treatment hospitals are needed.
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Affiliation(s)
- Mayu Yoshitsugu
- Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Ikuko Sobue
- Division of Nursing Science, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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28
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Yardeni M, Abebe Campino G, Bursztyn S, Shamir A, Mekori-Domachevsky E, Toren A, Gothelf D. A three-tier process for screening depression and anxiety among children and adolescents with cancer. Psychooncology 2020; 29:2019-2027. [PMID: 32691478 DOI: 10.1002/pon.5494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To establish and to evaluate the effectiveness of a three-tier screening process of depressive and anxiety disorders among children and adolescents with cancer based on questionnaires (first tier), semistructured psychiatric interviews (second tier), and referral for psychiatric assessment and recommendations for treatment (third tier). We also aimed to determine the rates of depressive and anxiety disorders among participants. METHODS Participants and their parents completed the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety modules. Then, they were interviewed separately using the semistructured Affective and Anxiety Modules of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). PROMIS cutoff values for diagnosing depressive and anxiety disorders, based on the K-SADS, were calculated by receiver-operating characteristics (ROCs). RESULTS Of 91 participants 34 (37.4%) aged 7 to 21 years with cancer met the K-SADS criteria for depressive and/or anxiety disorders. The results of the ROC analyses were stronger for depressive disorders than for anxiety disorders and for more severe cases. The cutoff of 13 on the child-reported PROMIS for a major depressive episode had a sensitivity of 0.80 and a specificity of 0.82, and a cutoff of 14 on the parent-reported PROMIS for generalized anxiety disorder had a sensitivity of 0.78 and a specificity of 0.79. CONCLUSIONS Using the K-SADS, we found that anxiety and depressive disorders are very common in youngsters with cancer. The three-tier screening process we developed for depression and anxiety in this population provides practical cutoff values for identifying depressive and anxiety disorders in children with cancer.
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Affiliation(s)
- Maya Yardeni
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel
| | - Gadi Abebe Campino
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Bursztyn
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Mekori-Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Amos Toren
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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29
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Heitzer AM, Ris D, Raghubar K, Kahalley LS, Hilliard ME, Gragert M. Facilitating Transitions to Adulthood in Pediatric Brain Tumor Patients: the Role of Neuropsychology. Curr Oncol Rep 2020; 22:102. [PMID: 32719944 DOI: 10.1007/s11912-020-00963-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Transition-age patients with history of a pediatric brain tumor are at significant risk for difficulties transitioning to adulthood. We review current transition models and the potential role of neuropsychology in the transition process for adolescent and young adult brain tumor survivors. RECENT FINDINGS Several recently developed healthcare transition models include consideration of patients' cognitive and functional capacities, yet currently available transition readiness tools are limited in scope and do not possess adequate normative data across pediatric medical populations. We explore the potential utility and added benefit of systematically incorporating neuropsychology in the transition process for pediatric brain tumor survivors. The literature supports increased evaluation and intervention targeted at psychosocial barriers to transition. Based on these findings, we propose a family-centered and multidisciplinary care model that promotes both medical and broader psychosocial transition processes. Neuropsychology is ideally suited to assess the wide-ranging areas encompassed in transition readiness and to facilitate the transition process.
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Affiliation(s)
- Andrew M Heitzer
- Department of Pediatrics, Psychology Section, Baylor College of Medicine / Texas Children's Hospital, 6701 Fannin St., CC 1630, Houston, TX, 77030-2399, USA
| | - Douglas Ris
- Department of Pediatrics, Psychology Section, Baylor College of Medicine / Texas Children's Hospital, 6701 Fannin St., CC 1630, Houston, TX, 77030-2399, USA
| | - Kimberly Raghubar
- Department of Pediatrics, Psychology Section, Baylor College of Medicine / Texas Children's Hospital, 6701 Fannin St., CC 1630, Houston, TX, 77030-2399, USA
| | - Lisa S Kahalley
- Department of Pediatrics, Psychology Section, Baylor College of Medicine / Texas Children's Hospital, 6701 Fannin St., CC 1630, Houston, TX, 77030-2399, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Psychology Section, Baylor College of Medicine / Texas Children's Hospital, 6701 Fannin St., CC 1630, Houston, TX, 77030-2399, USA
| | - Marsha Gragert
- Department of Pediatrics, Psychology Section, Baylor College of Medicine / Texas Children's Hospital, 6701 Fannin St., CC 1630, Houston, TX, 77030-2399, USA.
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30
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Lai JS, Beaumont JL, Kupst MJ, Peipert JD, Cella D, Fisher AP, Goldman S. Symptom burden trajectories experienced by patients with brain tumors. Cancer 2020; 126:3341-3351. [PMID: 32374469 PMCID: PMC11317761 DOI: 10.1002/cncr.32879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 02/07/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Survivors of childhood brain tumors experience persistent health concerns across their lifespan. In the current study, the authors evaluated changes in symptom burden over the course of 12 months using pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) measures. METHODS Data from 202 survivors aged 8 to 21 years and 262 parents of survivors who were aged 5 to 21 years were analyzed. All completed a PROMIS Cognition short form and computerized adaptive tests of pediatric Anxiety, Depressive Symptoms, Fatigue, Mobility, Upper Extremity Function, and Peer Relationships. Approximately one-half of participants (223 participants: 97 survivors of childhood brain tumors and 126 parents) completed the 12-month follow-up. Linear mixed-effects models evaluated group-level symptoms over time. Cox proportional hazard models explored whether symptoms predicted survival, and latent class growth analysis investigated patterns of individual-level symptom changes over time. RESULTS Linear mixed-effects models demonstrated that patient-reported Cognition and parent-reported Anxiety worsened over time. Latent class growth analysis results indicated that patient and parent reports diverged, both with regard to the number of classes identified and in the trends of these classes. Parents and patients reported similar patterns of depression over time. For the other areas, parents either were more likely to observe different patterns (Peer Relationships and Mobility) or less likely to observe different patterns (Upper Extremity Function, Cognition, Anxiety, and Fatigue). Baseline patient-reported Mobility and Upper Extremity Function were found to be associated with survival. CONCLUSIONS Survivors of childhood brain tumors demonstrated different trajectory patterns of symptom burden. Along with baseline functioning status and days since treatment, patient-reported Mobility and Upper Extremity Function were associated with survival, suggesting a possible role for patient-reported outcomes in clinical care, especially individualized, tailored assessments such as PROMIS.
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Affiliation(s)
- Jin-Shei Lai
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer L Beaumont
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Biostatistics, Clinical Outcomes Solutions, Tucson, Arizona
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Allison Piazza Fisher
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stewart Goldman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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31
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de Jong NB, Elzinga-Plomp A, Hulzebos EH, Poppe R, Nijhof SL, van Geelen S. Coping with paediatric illness: Child's play? Exploring the effectiveness of a play- and sports-based cognitive behavioural programme for children with chronic health conditions. Clin Child Psychol Psychiatry 2020; 25:565-578. [PMID: 32508158 PMCID: PMC7370645 DOI: 10.1177/1359104520918327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Little is known about how play affects the development of children with a chronic condition. Studying play poses major methodological challenges in measuring differences in play behaviour, which results in a relative scarcity of research on this subject. This pilot study seeks to provide novel directions for research in this area. The effectiveness of a play- and sports-based cognitive behavioural programme for children (8-12 years) with a chronic condition was studied. The children and parents completed a battery of measurement tools before and after the programme. Moreover, the application of automated computer analyses of behaviour was piloted. Behaviour (Child Behavior Checklist) seemed to be positively affected by the programme. An increase in psychological well-being was observed (KIDSCREEN). Perceived competence (Self-Perception Profile for Children) and actual motor competence (Canadian Agility and Movement Skill Assessment) did not show any positive trends. These results of 13 participants suggest that children might learn to better cope with their illness by stimulating play behaviour. For the analysis of the effectiveness of programmes like this, we therefore propose to focus on measuring behaviour and quality of life. In addition, pilot measurements showed that automated analysis of play can provide important insights into the participation of children.
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Affiliation(s)
- Nynke Boukje de Jong
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Alda Elzinga-Plomp
- Department of Paediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Erik Hj Hulzebos
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Ronald Poppe
- Department of Information and Computing Sciences, Utrecht University, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Stefan van Geelen
- Center for Education, University Medical Center Utrecht, The Netherlands
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32
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Zucchetti G, Ambrogio G, Bertolotti M, Besenzon L, Borghino F, Candela F, Galletto C, Fagioli F. Effects of a high-intensity psychosocial intervention among child-parent units in pediatric oncology. TUMORI JOURNAL 2020; 106:362-368. [PMID: 32539655 DOI: 10.1177/0300891620926226] [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: 11/15/2022]
Abstract
AIM To compare the efficacy of a high-intensity psychosocial intervention with standardized usual care in countering psychosocial complexity among child-parent units in a pediatric oncology setting. METHODS Two hundred pediatric oncology patients and their parents were recruited from Italian hospitals. A total of 81 child-parent units were assigned to the high-intensity psychosocial intervention and 119 child-parent units to standardized usual care. Psychosocial factors were assessed before and 1 year after intervention to measure efficacy. RESULTS More improvements over time were observed in the high-intensity intervention group of child-parent units compared to the standard intervention group. CONCLUSION An intensive, structured, and tailored high-intensity intervention positively affects the psychosocial factors of child-parent units. Patients and families should have access to intensive psychosocial support throughout the cancer trajectory.
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Affiliation(s)
- Giulia Zucchetti
- Pediatric Oncology Division, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Turin, Italy.,University of Turin, Turin, Italy
| | | | - Marina Bertolotti
- Pediatric Oncology Division, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Turin, Italy
| | | | | | | | | | - Franca Fagioli
- Pediatric Oncology Division, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Turin, Italy.,University of Turin, Turin, Italy
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Leclerc AA, Lippé S, Bertout L, Chapados P, Boulet-Craig A, Drouin S, Krajinovic M, Laverdière C, Michon B, Robaey P, Rondeau É, Sinnett D, Sultan S. Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors: Description and understanding. Psychooncology 2020; 29:1201-1208. [PMID: 32391960 DOI: 10.1002/pon.5410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/24/2020] [Accepted: 05/05/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The frequency of cognitive difficulties in childhood cancer survivors varies according to the measurement strategy. The goal of this research is to (a) describe agreements and differences between measures of working memory and attention (b) identify contributors of these differences, such as emotional distress, affects, and fatigue. METHODS We used data available for 138 adults successfully treated for childhood acute lymphoblastic leukemia (ALL) (PETALE cohort). Working memory and attention were assessed using subtests from the WAIS-IV and self-reported questionnaires (BRIEF-SR and CAARS-S:L). Potential contributors included emotional distress, anxiety, depression (BSI-18), affects (PANAS), and fatigue (PedsQL-MFS). We explored measurement agreements and differences using diagnostic indices and multivariate regression models. RESULTS The frequencies of working memory and attention deficits were higher when using cognitive tests (15%-21%) than with self-reports (10%-11%). Self-reported questionnaires showed high specificity (median 0.87) and low sensitivity (median 0.10), suggesting they did not reliably identify positive cases on cognitive tests. We identified negative affectivity as a possible contributor to inconsistencies between self-report and test results. CONCLUSIONS When measuring working memory and attention in childhood ALL survivors, cognitive test results and self-reports should not be considered equivalent. At best, self-report may be used for screening (high specificity), but not to assess prevalence in large samples. Self-reported difficulties are also probably influenced by the negative mood in this population.
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Affiliation(s)
- Andrée-Anne Leclerc
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Laurence Bertout
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Pascale Chapados
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Aubrée Boulet-Craig
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Simon Drouin
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
| | - Bruno Michon
- Department of Hematology-Oncology, Quebec University Health Center (QUHC), Montréal, Québec, Canada
| | - Philippe Robaey
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Émélie Rondeau
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
| | - Serge Sultan
- Research Centre, Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Montréal, Québec, Canada
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Igler EC, Sejkora EK, Austin JE, Davies WH. Friendship changes following a friend's school absence after serious illness or injury. J Child Health Care 2020; 24:233-245. [PMID: 31146538 DOI: 10.1177/1367493519853437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social support is vital in helping adolescents cope following a serious illness or injury, though it is not known how their healthy peers react to potential changes in the nature of their friendships during this time. In this questionnaire-based study, emerging adults in the community indicated whether they had an experience with a friend's serious illness during adolescence and responded to structured and open-ended questions about their experience. Participants reported diminished contact with friends following diagnosis, such as decreased frequency of visits and communication. Participants most commonly cited logistical issues, such as transportation, and their friend's emotional and/or physical functioning as barriers to staying connected. Friends reported a mixture of positive and negative experiences associated with a friend's illness. The communication barriers highlighted provide a potential focus for intervention. Results suggest positive communication promotion with healthy friends may be an important path to enhance social support after a serious illness diagnosis or injury.
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Affiliation(s)
- Eva C Igler
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Ellen Kd Sejkora
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jillian E Austin
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Raghubar KP, Rothhaar MC, Yeates KO, Mahone EM, Grosshans DR, Scheurer ME, Ris MD. Premorbid functioning as a predictor of outcome in pediatric brain tumor: An initial examination of the normalcy assumption. Pediatr Blood Cancer 2020; 67:e28135. [PMID: 31886612 DOI: 10.1002/pbc.28135] [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: 10/24/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Research on neurodevelopmental outcome in survivors of pediatric brain tumor (BT) is often based on the assumption of normal development up to the onset of overt symptoms. We sought to verify the "normalcy assumption" and to investigate corollary issues including challenges inherent to the measurement of premorbid neurobehavioral functioning. PROCEDURE The Brain Radiation Investigative Study Consortium (BRISC) is a prospective longitudinal multisite study of 58 children diagnosed with BT. Premorbid functioning was assessed via retrospective parent report on standardized rating scales and detailed questionnaires. Findings were examined for the sample as a whole and in patients grouped by tumor histology (embryonal and non-embryonal). RESULTS Mean age at diagnosis was 9.84 years (range, 3-16). The overall sample showed low proportions of pre/postnatal risk factors and delays in development. The proportion of children with clinically significant premorbid attention (18%) problems based on the BASC-2 exceeded expectation of that in healthy children (6.68%). Similar findings were obtained for somatization (18%) and anxiety (14%). Delays in talking were significantly more common in children with embryonal than non-embryonal tumors (P = 0.02). The non-embryonal tumor group had significantly higher overall rates of premorbid psychosocial problems than the embryonal tumor group (P < 0.001). CONCLUSIONS We describe a rigorous approach to estimating premorbid developmental status in pediatric BT. The findings suggest mixed support for the "normalcy assumption" and highlight the complexity of this concept and need for further investigation. Our results also suggest the need for further study of potential premorbid correlates with tumor histology.
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Affiliation(s)
| | - Maria C Rothhaar
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | | | - E Mark Mahone
- Kennedy Krieger Institute/Johns Hopkins University, Baltimore, Maryland
| | | | | | - M Douglas Ris
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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Tremolada M, Taverna L, Chiavetta IT, Bonichini S, Putti MC, Biffi A. Psychological Wellbeing in Adolescents with Leukaemia: A Comparative Study with Typical Development Peers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020567. [PMID: 31963108 PMCID: PMC7014127 DOI: 10.3390/ijerph17020567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
There is still little research on psychological wellbeing, life satisfaction and reported problems in preadolescents and adolescents under therapy for leukaemia, and also little research comparing them with their healthy peers. The present study aimed to analyse the life satisfaction, hope, psychological wellbeing and reported problems’ intensity in 60 patients aged 8–18 during the first year of therapy, to identify those more at risk and to compare their reports with matched healthy peers. A battery of self-reported questionnaires was administered during hospitalisation or day hospital admissions post 6 months and post 12 months from the diagnosis. Younger patients (aged 8–13 years) were more at risk than older ones in their problems’ intensity and psychological symptoms; females and Acute Myeloid Leukaemia patients reported lower current life satisfaction perceptions; hope was associated with lower depression symptoms and mood problems. Healthy peers have a better perception of current life, but reported a lower hope score, more anxiety symptoms and more cognitive problems than patients. The first 6 months were more critical for patients’ psychological health. Basing on these empirical data, the inclusion of mental health care professionals or supportive psychotherapy into the treatment is recognized as extremely useful.
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Affiliation(s)
- Marta Tremolada
- Department of Development and Social Psychology, University of Padua, 35131 Padua, Italy; (I.T.C.); (S.B.)
- Department of Child and Woman Health, University of Padua, 35127 Padua, Italy; (M.C.P.); (A.B.)
- Correspondence: ; Tel.: +39-34-7486-8835
| | - Livia Taverna
- Faculty of Education, Free University of Bolzano-Bozen, 39042 Brixen, Italy;
| | - Ilaria Tamara Chiavetta
- Department of Development and Social Psychology, University of Padua, 35131 Padua, Italy; (I.T.C.); (S.B.)
| | - Sabrina Bonichini
- Department of Development and Social Psychology, University of Padua, 35131 Padua, Italy; (I.T.C.); (S.B.)
| | - Maria Caterina Putti
- Department of Child and Woman Health, University of Padua, 35127 Padua, Italy; (M.C.P.); (A.B.)
| | - Alessandra Biffi
- Department of Child and Woman Health, University of Padua, 35127 Padua, Italy; (M.C.P.); (A.B.)
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Harper FWK, Albrecht TL, Trentacosta CJ, Taub JW, Phipps S, Penner LA. Understanding differences in the long-term psychosocial adjustment of pediatric cancer patients and their parents: an individual differences resources model. Transl Behav Med 2020; 9:514-522. [PMID: 31094435 DOI: 10.1093/tbm/ibz025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The experience of childhood cancer is a major life stressor for children and their parents. There is substantial variability among pediatric cancer patients and their parents in their ability to cope with the cancer. Although other models typically focus on the psychological resources families use to broadly cope with a diagnosis of pediatric cancer, we present a model that focuses specifically how parents and children cope with the stress of invasive and often painful treatment episodes. Our resources model is further distinct with its focus on individual differences in personal (e.g., personality traits) and social (e.g., social support) resources and the role these differences may play in psychosocial adjustment of families confronting pediatric cancer. We use findings from the broader pediatric cancer research literature and our own 15-year program of research on individual differences in psychological resources and parents and children's responses to treatment episodes to provide empirical support for our model. Support was found for the six premises of the model: (a) parent resources influence their longer-term psychosocial adjustment, (b) parent resources influence children's responses to treatment episodes, (c) parent resources indirectly influence their longer-term psychosocial adjustment through their responses to treatment episodes, (d) children's personal resources influence how parent responses to treatment episodes, (e) children's resources influence their longer-term psychosocial adjustment, and (f) children's resources indirectly influence their longer-term psychosocial adjustment through their responses to treatment episodes. Understanding how the availability of resources influences parents and children confronting cancer provides a foundation for future research on individual differences in resources and offers other avenues through which clinicians can assess and treat families at risk for poor psychosocial adjustment during treatment and in their life beyond cancer treatments.
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Affiliation(s)
- Felicity W K Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Terrance L Albrecht
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Jeffrey W Taub
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Louis A Penner
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
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Psychosocial difficulties identified by health care providers as they predict pain-related quality of life in children with cancer. Support Care Cancer 2019; 28:3459-3466. [PMID: 31802251 DOI: 10.1007/s00520-019-05195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
This study examined the predictive validity of the Psychosocial Care Checklist (PCCL), a psychosocial screener completed by a pediatric cancer health care provider (HCP), on child pain-related and nausea-related quality of life (QOL), and whether these associations are moderated by family psychosocial risk (Psychosocial Assessment Tool, PAT). Caregivers (N = 122) of children newly diagnosed with cancer and 62 HCPs (11 social workers, 17 nurses, 34 oncologists) at two Canadian sites participated. Near diagnosis (T1) and six months later (T2), caregivers reported on child QOL and family psychosocial risk, which was categorized as universal (typical distress), targeted (targetable distress), or clinical (severe distress). HCPs completed the PCCL at T1 and T2. HCP identification of more psychosocial problems in PCCL at T1 predicted reduced child pain-related (but not nausea-related) QOL at T2 among children with universal risk. The PCCL scores did not predict pain-related QOL in families with higher psychosocial needs (i.e., targeted and clinical). HCPs may have difficulty identifying psychosocial problems among families with high risk in a manner that predicts child's pain-related QOL. A hybrid model of psychosocial screening that includes both HCP and caregiver reports is recommended to best match family problems and interventions to improve QOL.
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Maurice‐Stam H, Nijhof SL, Monninkhof AS, Heymans HSA, Grootenhuis MA. Review about the impact of growing up with a chronic disease showed delays achieving psychosocial milestones. Acta Paediatr 2019; 108:2157-2169. [PMID: 31250466 DOI: 10.1111/apa.14918] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023]
Abstract
AIM This review aimed to provide a comprehensive overview of the psychosocial developmental trajectory of various diseases during childhood and adolescence. METHODS Studies of Dutch young adults aged 18-35 years, who had grown up with a chronic disease, were included if the Course of Life Questionnaire had been used to assess psychosocial developmental milestones in three domains: social, autonomy and psychosexual. Differences between the disease groups and the general population were presented as Cohen's d and odds ratios. RESULTS We included 17 studies comprising 1899 young adults, who had grown up with 18 different paediatric diseases. Psychosocial development was delayed in all three questionnaire domains. Remarkable findings with regard to specific milestones were as follows: less participation in sports clubs in the social domain, less likely to have had paid jobs in the autonomy domain and later sexual intimacy in the psychosexual domain. End-stage renal disease, galactosaemia (males), childhood cancer and orthotopic liver transplants were the most affected disease groups. CONCLUSION Children and adolescents with chronic diseases risked delays in psychosocial development. This should be addressed by healthcare providers, along with the physical aspects of diseases, and they should focus on the optimal psychosocial development of the patient.
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Affiliation(s)
- Heleen Maurice‐Stam
- Psychosocial Department Emma Children's Hospital Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
| | - Sanne L. Nijhof
- Division of Paediatrics Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Anneke S. Monninkhof
- Division of Paediatrics Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Hugo S. A. Heymans
- Department of Paediatrics Emma Children's Hospital Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
| | - Martha A. Grootenhuis
- Psychosocial Department Emma Children's Hospital Amsterdam University Medical Centers University of Amsterdam Amsterdam The Netherlands
- Princess Máxima Center for Paediatric Oncology Utrecht The Netherlands
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Buchbinder D, Patel SK, Casillas JN, Nugent DJ, Neudorf S, Sender LS, Torno L, Huszti H, Zeltzer LK, Parsons SK. Parent proxy assessment of sibling quality of life following pediatric hematopoietic cell transplantation. Health Qual Life Outcomes 2019; 17:162. [PMID: 31665035 PMCID: PMC6819636 DOI: 10.1186/s12955-019-1231-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022] Open
Abstract
Background When a child undergoes hematopoietic cell transplantation (HCT), the impact extends to the entire family, including siblings. Assessment of the quality of life (QoL) of siblings is challenged by their general lack of availability for regular assessment by clinical providers. Thus, the use of parent proxy reporting may be useful. Our aim was to describe the QoL of siblings of HCT survivors, as reported by their parents, as well as to identify parent and family factors associated with lower sibling QoL. Methods A cross-sectional study was utilized to assess parent-reported QoL of the HCT recipient’s sibling (Short Form (SF)-10 Health Survey for Children and the Pediatric Symptom Checklist (PSC)-17). Parent QoL was assessed using the SF-12. Multivariable linear regression was used to explore hypothesized predictors of sibling QoL, including parent QoL, family impact/function (Impact on Family Scale, Family Adaptability and Cohesion Evaluation Scales, IV, and a question asking about financial problems) while adjusting for demographic and HCT characteristics. Results Ninety-seven siblings (55% males) with a mean age of 12 years (standard deviation [SD] 4 years) were assessed, representing HCT survivors, who were an average of 5 years (SD 4 years) post-HCT. Neither sibling psychosocial (mean 49.84, SD 10.70, p = 0.87) nor physical health scores (mean 51.54, SD 8.42, p = 0.08) differed from norms. Parent proxies reported behavioral/emotional problems (PSC-17 total score > 15) in 24% of siblings. While parental ratings of their own physical health (SF-12 were higher than norms (mean 53.04, SD 8.17, p = 0.0005), mental health scores were lower (mean 45.48, SD 10.45, p < 0.0001). In multivariable analysis, lower parent emotional functioning and adverse family function were associated with lower sibling QoL, as reported by parents. Conclusions While proxy-reported QoL of siblings did not differ significantly from normative data, both parent QoL and family function were associated with sibling QoL. Future research is needed to understand how siblings themselves perceive their QoL following HCT.
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Affiliation(s)
- David Buchbinder
- Department of Pediatrics and Division of Pediatric Hematology, CHOC Children's Hospital and University of California at Irvine's Chao Family Comprehensive Cancer Center, Irvine, California, USA. .,CHOC Children's Hospital, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
| | - Sunita K Patel
- Department of Cancer Control and Population Sciences, City of Hope, Duarte, California, USA
| | - Jacqueline N Casillas
- Department of Pediatrics and Division of Pediatric Hematology and Oncology, David Geffen School of Medicine at University of California at Los Angeles and University of California at Los Angeles's Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Diane J Nugent
- Department of Pediatrics and Division of Hematology at CHOC Children's Hospital, Orange, California, USA
| | - Steven Neudorf
- Department of Pediatrics and Division of Oncology at CHOC Children's Hospital, Orange, California, USA
| | - Leonard S Sender
- Department of Pediatrics and Division of Oncology at CHOC Children's Hospital, Orange, California, USA
| | - Lilibeth Torno
- Department of Pediatrics and Division of Oncology at CHOC Children's Hospital, Orange, California, USA
| | - Heather Huszti
- Department of Pediatrics and Division of Psychology at CHOC Children's Hospital, Orange, California, USA
| | - Lonnie K Zeltzer
- Psychiatry / Biobehavioral Science, and Division of Cancer Prevention and Control Research, David Geffen School of Medicine at University of California at Los Angeles and University of California at Los Angeles's Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Susan K Parsons
- Institute of Clinical Research and Health Policy Studies at Tufts Medical Center and Departments of Medicine and Pediatrics, at Tufts University School of Medicine, Boston, Massachusetts, USA
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Germann JN, Leonard D, Heath CL, Stewart SM, Leavey PJ. Hope as a Predictor of Anxiety and Depressive Symptoms Following Pediatric Cancer Diagnosis. J Pediatr Psychol 2019; 43:152-161. [PMID: 29049751 DOI: 10.1093/jpepsy/jsx097] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/05/2017] [Indexed: 12/25/2022] Open
Abstract
Objective To examine hope and its components of agency and pathways as predictors of anxiety and depressive symptoms in children receiving cancer treatment. Methods Sixty patients (mean standard deviation age = 13.3 (2.7); 57% male) completed Snyder's Hope Scales, the Children's Depression Inventory, and the State-Trait Anxiety Inventory at diagnosis and 3 month intervals for 1 year following pediatric cancer diagnosis. Parents also completed Snyder's Hope Scales. Linear mixed-effect regression was used to assess hope's role in longitudinal models of symptoms of depression and anxiety. Results Agency was a significant predictor of between-patient differences and within-patient changes in symptoms of depression and anxiety. Neither patient pathways nor either component of parent hope was predictive of symptoms of depression or anxiety. Patients who were more likely to have depressive symptoms at baseline were older, diagnosed with leukemia, and non-Hispanic White as opposed to Hispanic. Patient demographics were not predictive of anxiety. Conclusions Patient agency is a potential target for intervention to prevent or reduce anxiety and depressive symptoms following pediatric cancer diagnosis.
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Affiliation(s)
- Julie N Germann
- Children's Health Children's Medical Center Dallas.,University of Texas Southwestern Medical Center
| | | | | | - Sunita M Stewart
- Children's Health Children's Medical Center Dallas.,University of Texas Southwestern Medical Center
| | - Patrick J Leavey
- Children's Health Children's Medical Center Dallas.,University of Texas Southwestern Medical Center
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Smith LE, Maybach AM, Feldman A, Darling A, Akard TF, Gilmer MJ. Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment. J Pediatr Oncol Nurs 2019; 36:390-401. [DOI: 10.1177/1043454219859235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children’s diagnoses and treatment, the family’s quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children’s feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child’s disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.
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Affiliation(s)
| | | | - Amanda Feldman
- Vanderbilt University, Nashville, TN, USA
- James Madison University, Nashville, TN, USA
| | - Austin Darling
- Vanderbilt University, Nashville, TN, USA
- Southern Illinois University Edwardsville, Nashville, TN, USA
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Bakula DM, Sharkey CM, Perez MN, Espeleta HC, Gamwell KL, Baudino M, Delozier AM, Chaney JM, Matt Alderson R, Mullins LL. Featured Article: The Relationship Between Parent and Child Distress in Pediatric Cancer: A Meta-Analysis. J Pediatr Psychol 2019; 44:1121-1136. [DOI: 10.1093/jpepsy/jsz051] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 05/18/2019] [Accepted: 06/02/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Objective
Parents and children affected by pediatric cancer are at risk for psychological distress, including depression, anxiety, and post-traumatic stress. A link is believed to exist between parent and child distress; however, no systematic analysis of this relationship has occurred. A meta-analysis was conducted to assess the relationship between parent and child distress among families affected by pediatric cancer.
Methods
A systematic review and meta-analysis was conducted using EBSCO (searching PsycINFO, MEDLINE, Academic search Premiere, and Health Source: Nursing/Academic Edition) and PubMed. The initial search yielded a total of 29,118 articles. Inclusion criteria were that studies assessed the relation between parent and child distress in the context of pediatric cancer, were written in English, and were published in peer-reviewed journals. 28 articles met inclusion criteria.
Results
A statistically significant association was found between overall parent and child distress (r = .32, p < .001), such that increased parent-reported distress was associated with increased distress in their children. Significant relationships were also present among each type of parental distress (i.e., depression, anxiety, post-traumatic stress, and global distress; rs = .31–.51, ps < .001) and overall child distress. Moderation analyses via meta-regression indicated that parent proxy-report of child symptoms was associated with a stronger relationship between parent and child distress than child self-report of their own distress.
Conclusions
Aligned with the social–ecological framework, familial factors appear to be highly relevant in understanding distress following pediatric cancer diagnosis. Indeed, greater parent distress was associated with greater child distress.
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Dalton L, Rapa E, Ziebland S, Rochat T, Kelly B, Hanington L, Bland R, Yousafzai A, Stein A. Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent. Lancet 2019; 393:1164-1176. [PMID: 30894272 DOI: 10.1016/s0140-6736(18)33202-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022]
Abstract
Many adults diagnosed with a life-threatening condition have children living at home; they and their partners face the dual challenge of coping with the diagnosis while trying to maintain a parenting role. Parents are often uncertain about how, when, and what to tell their children about the condition, and are fearful of the effect on their family. There is evidence that children are often aware that something is seriously wrong and want honest information. Health-care professionals have a key role in supporting and guiding parents and caregivers to communicate with their children about the diagnosis. However, the practical and emotional challenges of communicating with families are compounded by a scarcity of evidence-based guidelines. This Review considers children's awareness and understanding of their parents' condition, the effect of communication around parental life-threatening condition on their wellbeing, factors that influence communication, and the challenges to achieving effective communication. Children's and parents' preferences about communication are outlined. An expert workshop was convened to generate principles for health-care professionals, intended as practical guidance in the current absence of empirically derived guidelines.
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Affiliation(s)
- Louise Dalton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tamsen Rochat
- Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Human Sciences Research Council, Johannesburg, South Africa
| | - Brenda Kelly
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucy Hanington
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ruth Bland
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; Institute of Health and Wellbeing, Glasgow, UK; University of Glasgow and Royal Hospital for Children, Glasgow, UK
| | | | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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Lai JS, Kupst MJ, Beaumont JL, Manley PE, Chang JHC, Hartsell WF, Kwok Y, Piazza Fisher A, Goldman S. Using the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure symptom burden reported by patients with brain tumors. Pediatr Blood Cancer 2019; 66:e27526. [PMID: 30426667 PMCID: PMC6344265 DOI: 10.1002/pbc.27526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with brain tumors can experience symptom burden throughout their disease continuum. The aim of the study was to evaluate symptom burden reported by children with brain tumors and factors that potentially were associated with their symptoms. METHODS Data from 199 children with brain tumors aged 7-22 (mean age = 14 years; 52% males; 76% white) were analyzed. Symptom burden was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) via computerized adaptive testing (CAT)-anxiety, depression, fatigue, mobility, upper extremity function, peer relationship, and cognition. Patients and parents completed Symptom Distress Scales (SDS). Test statistics and ANOVA were used to evaluate relationships between PROMIS measures and potentially influential variables. RESULTS Significant results (P < 0.01) showing impact of symptom burden included: PROMIS measures correlated with SDSs reported by patients and parents on all comparisons. Fatigue, mobility, and upper extremity function were associated with Karnofsky functional performance status, number of treatment modalities (0-3), and time since last treatment (≤1 year, >1 year). Fatigue and cognition were associated with educational program (regular classroom without an individualized education plan vs those that had an individualized education plan); mobility and upper extremity function were associated with time since last radiation. Mobility, upper extremity function, and anxiety were associated with time since last chemotherapy. CONCLUSIONS Significant associations were found between PROMIS and SDS as well as clinical and demographic characteristics. Brief-yet-precise PROMIS CATs can be used to systematically assess symptom burden experienced by children with brain tumors.
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Affiliation(s)
- Jin-Shei Lai
- Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine
| | | | - Jennifer L. Beaumont
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Terasaki Research Institute, Los Angeles, California, USA
| | - Peter E. Manley
- Children’s Hospital Boston and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - John Han-Chih Chang
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William F. Hartsell
- Northwestern Medicine Chicago Proton Center, Warrenville, Illinois, USA, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Young Kwok
- Radiation Oncology, University of Maryland School of Medicine
| | | | - Stewart Goldman
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
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Chan SF, Hoag JA, Karst JS, Bingen KM. Social adjustment of adolescent cancer patients transitioning off active treatment: A short-term prospective mixed methods study. Pediatr Blood Cancer 2019; 66:e27530. [PMID: 30426663 DOI: 10.1002/pbc.27530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/20/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychosocial follow-up in survivorship is a standard of care in pediatric oncology; however, little is known about patients' psychosocial functioning during the transition off active treatment, a unique time in the cancer journey. This study examined the social adjustment of adolescent cancer patients during this transition period, which has been understudied to date. PROCEDURE Participants were 21 patients (ages 12-18 years; age M = 14.71 years; 62% female, 81% White) with various cancer diagnoses. Patients and their parents completed the Social Competence subscale of the Youth Self-Report (YSR) and Child Behavior Checklist (CBCL), respectively, PedsQL Social Functioning subscale, and a semistructured interview 1-2 months prior to ending treatment (time 1) and 3-7 months after ending treatment (time 2). RESULTS YSR and CBCL social competence scores were within the normal range at both time points. PedsQL social functioning scores were more consistent with norms for pediatric cancer samples at time 1 and norms for healthy children at time 2, with self-reported scores significantly improving from time 1 to time 2. A subset of patients had elevated social concerns at time 1, a number that decreased by time 2. Interviews revealed both positive and negative themes related to peer relationships and support, quantity of friends, and socialization. CONCLUSIONS Most adolescent cancer patients are socially well adjusted as they transition off treatment, although a subset have elevated concerns. Interviews provide insight into complex social experiences not captured on questionnaires. Patients may benefit from screening and support during this unique time.
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Affiliation(s)
- Sherilynn F Chan
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Vaarwerk B, Limperg PF, Naafs-Wilstra MC, Merks JHM, Grootenhuis MA. Getting control during follow-up visits: the views and experiences of parents on tumor surveillance after their children have completed therapy for rhabdomyosarcoma or Ewing sarcoma. Support Care Cancer 2019; 27:3841-3848. [PMID: 30747278 PMCID: PMC6726689 DOI: 10.1007/s00520-019-04678-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
Purpose Patients treated for rhabdomyosarcoma (RMS) or Ewing sarcoma (ES) are subject to extensive follow-up after completion of therapy. The aim of this follow-up is to monitor treatment side effects and to detect relapse in an early phase to improve prognosis after relapse. Little is known about parental emotional experiences during this period. We assessed the views and experiences of parents of children treated for RMS or ES on the follow-up examinations after completion of therapy. Methods We conducted two focus group meetings and four semi-structured telephone interviews with parents of children treated for RMS or ES in Dutch pediatric oncology centers. Parents of children 0–5 years after end-of-therapy were invited via letters (response rate 31%) and via social media channels of “Dutch Childhood Association for Children and Parents” (VOKK). An inductive thematic approach was used to analyze the data. Results In total, 12 parents (fathers, n = 3; mothers, n = 9) of 12 patients treated for RMS (n = 6) or ES (n = 6) participated. Median age at diagnosis for their children was 7.9 years and median time after end-of-treatment was 37 months. Four major themes were identified: content of follow-up, distress and anxiety, search for reassurance and hope, and interaction with others. Parents of children treated for RMS or ES report experiencing significant distress after completion of treatment. They report that their distress was decreased by adequate communication about content, timing, and reasoning behind follow-up. Conclusion Physicians should pay attention to the needs of individual parents to reduce distress in the period after completion of therapy.
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Affiliation(s)
- B Vaarwerk
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 CS, Utrecht, The Netherlands.
| | - P F Limperg
- Paediatric Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - J H M Merks
- Department of Paediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 CS, Utrecht, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584 CS, Utrecht, The Netherlands.,Paediatric Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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48
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Braam KI, van Dijk-Lokkart EM, Kaspers GJL, Takken T, Huisman J, Buffart LM, Bierings MB, Merks JHM, van den Heuvel-Eibrink MM, Veening MA, van Dulmen-den Broeder E. Effects of a combined physical and psychosocial training for children with cancer: a randomized controlled trial. BMC Cancer 2018; 18:1289. [PMID: 30587148 PMCID: PMC6307314 DOI: 10.1186/s12885-018-5181-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background Physical fitness and psychosocial function is often reduced in children during or shortly after cancer treatment. This study evaluates the effect of a combined physical exercise and psychosocial intervention on cardiorespiratory fitness, muscle strength, body composition, psychosocial function and health-related quality of life (HrQoL). In addition, intervention mediators, applicability and adherence were examined. Methods This multicenter randomized controlled trial included 68 children with cancer [mean age 13.2 (SD: 3.1) years; 54% male] during treatment or within 12-months post-treatment. The 12-week intervention consisted of 24 individual physical exercise sessions supervised by a physiotherapist, and 6 psychosocial training sessions for children and 2 for parents. Physical fitness and psychosocial function were assessed at baseline, directly post-intervention and at 12 months’ post-baseline. Generalized estimating equations were used to simultaneously assess intervention effects at short and long-term. Additionally, we evaluated within-group differences over time. Potential physical and psychosocial mediators in the intervention effect on HrQoL were examined using the product-of-coefficient test. Applicability and adherence were assessed by trainer-report. Results This study was able to compare 26 children who received the study intervention, with 33 children who received usual care. No significant differences in the effects of the intervention were found on physical fitness and psychosocial function at short-term. At 12-months follow-up, significantly larger improvements in lower body muscle strength (β = 56.5 Newton; 95% CI: 8.5; 104.5) were found in the intervention group when compared to the control group. Within-group changes showed significant improvements over time in HrQoL and bone density in both groups. Intervention effects on HrQoL were not significantly mediated by physical fitness and psychological function. Intervention applicability was satisfactory with an average session attendance of 67% and 22% dropout (mainly due to disease recurrence). Conclusions This 12-week physical exercise and psychosocial training intervention for children with cancer was applicable and showed satisfactory adherence. We found no significant between-group differences in effect, except for a significant improvement in lower body muscle strength at long-term in the intervention group compared to the control group. Yet, both the intervention and the control group showed improvements in bone mineral density and HrQoL over time. Trial registration The trial was registered at the Dutch Trial Registry (NTR1531). Registered 12 November 2008.
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Affiliation(s)
- Katja I Braam
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Center for Innovative Health Practice, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Elisabeth M van Dijk-Lokkart
- Department of Medical Psychology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap Huisman
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Medical Oncology, VU University Medical Center and the Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marc B Bierings
- Department of Pediatric Oncology/Hematology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Margreet A Veening
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, the Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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49
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Zucchetti G, Bellini S, Bertolotti M, Biasin E, Brignardello E, Fagioli F. The biopsychosocial condition of childhood cancer survivors in the transition towards adult care: a national survey from the joint pediatric and adult transition care group. Int J Adolesc Med Health 2018; 33:/j/ijamh.ahead-of-print/ijamh-2018-0189/ijamh-2018-0189.xml. [PMID: 30864415 DOI: 10.1515/ijamh-2018-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/04/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND To provide successful transfer from childhood to adult-oriented healthcare is one of the priorities of survivorship care plans. PURPOSE This study describes adolescent and young adult childhood cancer survivors' conditions at the moment of the transition to adult care deepening their biological, psychological, social and assistant state and their associations with socio-demographic and clinical characteristics. METHODS A biopsychosocial check-list in four health domains (biological, psychological, social and assistant) was filled in by healthcare professionals (oncologists, psychologists, social workers and nurses) through qualitative interviews and clinical observations of 79 survivors (58% boys; Mage = 20 years old) at the moment of the transition from the Pediatric Oncology Unit to the Transition Unit of the Childhood Cancer Survivors. RESULTS At the moment of transition, 38% of survivors showed a positive condition in all the four health domains without any kind of impairment. Biological (37%) and psychological areas (44%) were found to be those with major incidence of impairments. Association phenomena were found between psychological and social condition (p < 0.05) and between social and assistant condition (p < 0.05). Biological condition was also significantly associated with the type of cancer (χ = 6,2414, p < 0.05). CONCLUSION Although many survivors entered in adult care system without any impairment, the biopsychosocial approach highlighted that there is a presence of impairments in at least one of the main health domains.
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Affiliation(s)
- Giulia Zucchetti
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, City of Science and Health of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Simona Bellini
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, City of Science and Health of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Marina Bertolotti
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, City of Science and Health of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Eleonora Biasin
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, City of Science and Health of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, City of Science and Health of Turin, Turin, Italy
| | - Franca Fagioli
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, City of Science and Health of Turin, Regina Margherita Children's Hospital, Turin, Italy
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50
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Cox LE, Kenney AE, Harman JL, Jurbergs N, Molnar AE, Willard VW. Psychosocial Functioning of Young Children Treated for Cancer: Findings From a Clinical Sample. J Pediatr Oncol Nurs 2018; 36:17-23. [DOI: 10.1177/1043454218813905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Many pediatric cancers are diagnosed in early childhood, a time of significant growth and development that lays the foundations for overall adjustment and functioning. The objective of this article was to characterize the psychosocial functioning of young children with cancer. Method: Data from a sample of young children with cancer ( N = 92) who completed a psychological evaluation that included the Behavior Assessment Scale for Children–second edition (BASC-2) parent report were abstracted from the medical record. Patients were primarily White (70.7%), male (54.3%), and 4.81 ± 0.89 years old at evaluation. Most were treated for brain tumors (64.1%). Results: Overall group means on each of the BASC-2 subscales were within normal limits, though significantly more patients than expected had elevated scores on the Internalizing and Behavioral Symptoms indexes. Patients who were on-treatment had higher mean overall Internalizing Problems scores, as well as greater Anxiety and Somatization scores, than those who were off-treatment (Wilks’s λ = 0.75, p < .001). Patients treated for brain tumors had lower mean Activities of Daily Living scores than those with other diagnoses ( F = 15.81, p < .001). Conclusions: Findings from this clinically referred sample indicate that while most young children with cancer are doing well psychosocially, approximately 20% to 30% demonstrated difficulties in at least one area. Findings support the need for monitoring of young children with cancer as well as appropriate intervention services.
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Affiliation(s)
- Lauren E. Cox
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ansley E. Kenney
- St. Jude Children’s Research Hospital, Memphis, TN, USA
- University of Memphis, Memphis, TN, USA
| | | | - Niki Jurbergs
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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