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Nolan L, Jacobson LA, Peterson RK. Practical adaptive skills in pediatric brain tumor survivors: the contribution of medical factors and social determinants of health. Child Neuropsychol 2024; 30:847-860. [PMID: 37930038 DOI: 10.1080/09297049.2023.2275826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
Pediatric brain tumor survivors demonstrate weaknesses in adaptive functioning, most notably practical adaptive skills; however, the specific areas of weakness within practical skills are unknown. This study examined the aspects of practical adaptive functions that are most impacted in brain tumor survivors, and identified medical and socio-demographic variables that predicted outcomes. The sample included 117 pediatric brain tumor patients seen for a clinical neuropsychological evaluation and whose parents completed the Adaptive Behavior Assessment System, Second or Third Edition. T-tests compared practical adaptive skills to normative means. Correlations examined associations between medical and socio-demographic variables and each of the practical adaptive subscales (Community Use, Home Living, Health & Safety, Self-Care). Significant correlations were entered into linear regression models for each practical adaptive skill. All practical subscales were significantly below the normative mean. Community Use was positively correlated with age at diagnosis and negatively correlated with treatment burden, time since diagnosis, and neighborhood deprivation. Health and Safety was positively correlated with age at diagnosis. Home Living was positively correlated with neighborhood deprivation. Self-Care was positively correlated with age at diagnosis and parental education. Specific medical and socio-demographic factors predicted practical adaptive functioning, highlighting the importance of considering the role of medical and socio-demographic determinants of health on adaptive functioning outcomes in pediatric brain tumors.
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Affiliation(s)
- Lily Nolan
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Peterson RK, King TZ. A systematic review of pediatric neuropsychological outcomes with proton versus photon radiation therapy: A call for equity in access to treatment. J Int Neuropsychol Soc 2023; 29:798-811. [PMID: 36323679 DOI: 10.1017/s1355617722000819] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is increasing interest in the utilization of proton beam radiation therapy (PRT) to treat pediatric brain tumors based upon presumed advantages over traditional photon radiation therapy (XRT). PRT provides more conformal radiation to the tumor with reduced dose to healthy brain parenchyma. Less radiation exposure to brain tissue beyond the tumor is thought to reduce neuropsychological sequelae. This systematic review aimed to provide an overview of published studies comparing neuropsychological outcomes between PRT and XRT. METHOD PubMed, PsychINFO, Embase, Web of Science, Scopus, and Cochrane were systematically searched for peer-reviewed published studies that compared neuropsychological outcomes between PRT and XRT in pediatric brain tumor patients. RESULTS Eight studies were included. Six of the studies utilized retrospective neuropsychological data; the majority were longitudinal studies (n = 5). XRT was found to result in lower neuropsychological functioning across time. PRT was associated with generally stable neuropsychological functioning across time, with the exception of working memory and processing speed, which showed variable outcomes across studies. However, studies inconsistently included or considered medical and sociodemographic differences between treatment groups, which may have impacted neuropsychological outcomes. CONCLUSIONS Despite methodological limitations, including limited baseline neuropsychological evaluations, temporal variability between radiation treatment and first evaluation or initial and follow-up evaluations, and heterogenous samples, there is emerging evidence of sociodemographic inequities in access to PRT. With more institutions dedicating funding towards PRT, there may be the opportunity to objectively evaluate the neuropsychological benefits of patients matched on medical and sociodemographic variables.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, USA
- Neuroscience Institute, Georgia State University, Atlanta, USA
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3
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Papini C, Willard VW, Gajjar A, Merchant TE, Srivastava D, Armstrong GT, Hudson MM, Krull KR, Brinkman TM. Social cognition and adjustment in adult survivors of pediatric central nervous system tumors. Cancer 2023; 129:3064-3075. [PMID: 37329245 PMCID: PMC10528486 DOI: 10.1002/cncr.34889] [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: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Survivors of pediatric central nervous system (CNS) tumors are at risk for neurocognitive and social difficulties throughout childhood. This study characterized social cognition (perception and reasoning from social cues) and adjustment in adulthood. METHODS A total of 81 adult survivors of pediatric CNS tumors (51% female; mean [SD] age, 28.0 [5.8] years), were recruited across four groups: (1) no radiation therapy (RT) [n = 21], (2) infratentorial (IT) tumors + focal RT [n = 20], (3) IT tumors + craniospinal irradiation [n = 20], and (4) supratentorial tumors + focal RT [n = 20]. Prevalence of social cognitive and adjustment impairments was compared to test norms. Multivariable models examined clinical and neurocognitive predictors of social cognition and its impact on functional outcomes. RESULTS Survivors demonstrated elevated risk of severe social cognitive impairments (social perception Morbidity Ratio [95% CI] 5.70 [3.46-9.20]), but self-reported few social adjustment problems. Survivors of IT tumors treated with craniospinal irradiation performed nearly 1 SD worse than survivors treated without RT on multiple measures of social cognition (e.g., social perception: β = -0.89, p = .004). Impaired executive functioning and nonverbal reasoning were associated with worse social cognitive performance (e.g., social perception: β = -0.75, p < .001; β = -0.84, p < .001, respectively). Better social perception was associated with higher odds of attaining full-time employment (odds ratio, 1.52 [1.17-1.97]) and at least some college education (odds ratio, 1.39 [1.11-1.74]). CONCLUSIONS Adult survivors of CNS tumors are at elevated risk of severely impaired social cognition, but do not perceive social adjustment difficulties. Better understanding of potential mechanisms underlying social cognitive deficits may inform intervention targets to promote better functional outcomes for at-risk survivors.
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Affiliation(s)
- Chiara Papini
- Department of Psychology and Biobehavioral Sciences, St.
Jude Children’s Research Hospital, Memphis, TN, USA
| | - Victoria W. Willard
- Department of Psychology and Biobehavioral Sciences, St.
Jude Children’s Research Hospital, Memphis, TN, USA
| | - Amar Gajjar
- Department of Pediatric Medicine, St. Jude
Children’s Research Hospital, Memphis, TN, USA
| | - Thomas E. Merchant
- Department of Radiation Oncology, St. Jude
Children’s Research Hospital, Memphis, TN, USA
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children’s
Research Hospital, Memphis, TN, USA
| | - Gregory T. Armstrong
- Department of Oncology, St. Jude Children’s Research
Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research
Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN, USA
| | - Kevin R. Krull
- Department of Psychology and Biobehavioral Sciences, St.
Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M. Brinkman
- Department of Psychology and Biobehavioral Sciences, St.
Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN, USA
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Desjardins L, Young M, Hancock K, Lai MC, Bartels U, Vorstman J, Barrera M. Pediatric Brain Tumor Survivors' Understanding of Friendships: A Qualitative Analysis of ADOS-2 Interview Responses. J Pediatr Psychol 2022; 47:662-673. [PMID: 34981125 DOI: 10.1093/jpepsy/jsab131] [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] [Received: 05/14/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTS) are at risk of experiencing social competence challenges, but only a limited number of studies have used a qualitative approach to understand their social relationships. We examined PBTS responses to social interview questions within the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2), which includes questions related to their understanding of their own relationships, as well as the construct of friendship more generally. METHODS Twenty-four PBTS (ages 9-17 years; M = 14.2 years from diagnosis; 50% male; 42% received radiation treatment) completed the ADOS-2. ADOS-2 social interview responses were recorded and transcribed verbatim. Themes were derived using an inductive thematic analysis approach. RESULTS PBTS reported that they considered trust, acceptance, respect, emotional support, and spending time together to be important aspects of friendships in general. When describing their own social relationships, some PBTS noted a lack of intimacy or closeness, spending time with their friends almost exclusively at school, with structured activities outside of school being an additional basis for friendship. Challenges to their social relationships included loneliness and reliance on family for social support, experiences of teasing and bullying, social skills deficits, and lack of insight into social situations. CONCLUSION Although PBTS were able to acknowledge many important qualities of friendships in general (e.g., trust, emotional support), these were not necessarily reported in their own friendships. PBTS also appeared to have difficulty identifying whether someone was their friend. These findings offer potential opportunities for supporting PBTS in achieving friendships consistent with their conception of this important relationship.
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Affiliation(s)
- Leandra Desjardins
- Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Canada.,Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Canada
| | - Melissa Young
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati Medical Center, USA
| | - Kelly Hancock
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Canada
| | - Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Canada
| | - Jacob Vorstman
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada.,Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Canada
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Laliberté Durish C, Moxon-Emre I, Bouffet E, Bartels U, Mabbott DJ. [Formula: see text]Family environment as a predictor and moderator of cognitive and psychosocial outcomes in children treated for posterior fossa tumors. Child Neuropsychol 2021; 27:641-660. [PMID: 33596780 DOI: 10.1080/09297049.2021.1885639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective. The current study examined the effects of clinical factors (i.e., treatment type, history of cerebellar mutism) as well as environmental factors (i.e., family environment) as predictors of cognitive and psychosocial outcomes in children treated for posterior fossa tumors.Method. Twenty-seven children/adolescents treated for posterior fossa tumors (treatment type: radiation [n = 12], surgery [n = 15]; history of mutism: yes [n = 7], no [n = 20]) and n = 13 healthy controls, aged 8-17 years, and their caregivers completed measures assessing cognitive and psychosocial functioning, as well as the family environment (i.e., parental education, family functioning, family psychiatric history). Hierarchical linear regression analyses were conducted to examine the role of clinical factors and the family environment as predictors of cognitive and psychosocial outcomes. Family environment was also examined as a moderator of clinical factor group differences in outcomes.Results. Regression analyses revealed lower intelligence scores among the radiation group compared to the control group, lower verbal memory scores among both treatment groups compared to the control group, and a significant positive effect of parental education on verbal memory scores. Further, history of cerebellar mutism predicted poorer performance on a speeded naming task, and this relationship was moderated by family functioning, with a greater effect of mutism present among those with poorer family functioning.Conclusions. Interventions aimed at improving the family environment may help to mitigate negative cognitive effects of pediatric brain tumors, particularly among those most at-risk for poor outcomes.
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Affiliation(s)
| | - Iska Moxon-Emre
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Eric Bouffet
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Haematology/OncologyDivision of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ute Bartels
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Haematology/OncologyDivision of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald J Mabbott
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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Desjardins L, Rodriguez E, Dunn M, Bemis H, Murphy L, Manring S, Winning A, Vannatta K, Gerhardt CA, Compas BE. Coping and Social Adjustment in Pediatric Oncology: From Diagnosis to 12 Months. J Pediatr Psychol 2020; 45:1199-1207. [PMID: 32930722 DOI: 10.1093/jpepsy/jsaa077] [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: 11/10/2019] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Children diagnosed with cancer experience stress associated with their diagnosis and treatment and are at heightened risk for problems in social adjustment. This study investigated the association between coping with cancer-related stress and problems in social adjustment across the first year after a pediatric cancer diagnosis. METHODS Mothers of children (ages 5-17 years) with cancer (N = 312) were recruited from two children's hospitals. Mother's reported on their child's social adjustment and coping near diagnosis (T1) and 12 months (T2). RESULTS Primary, secondary control, and disengagement coping were significantly associated with concurrent social adjustment at 12 months. The bivariate associations between baseline primary and secondary control coping and social problems 12 months later were no longer significant in a multivariate regression model. CONCLUSIONS These findings inform our understanding of the association between coping with cancer-related stress and social adjustment of children diagnosed with cancer. Interventions teaching primary and secondary control coping strategies for cancer-related stressors may offer some benefit to concurrent youth social adjustment. Further research is needed on how best to support social adjustment in this population over time.
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Affiliation(s)
| | | | | | | | | | | | - Adrien Winning
- The Research Institute at Nationwide Children's Hospital
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
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7
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Alias H, Morthy SK, Zakaria SZS, Muda Z, Tamil AM. Behavioral outcome among survivors of childhood brain tumor: a case control study. BMC Pediatr 2020; 20:53. [PMID: 32020861 PMCID: PMC7001196 DOI: 10.1186/s12887-020-1951-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advances in the treatment of childhood brain tumors have significantly improved survival rates. With improved survival rates, long-term treatment-related toxicities have become important, and the resulting complications can affect patients' emotion and behavior. This study aimed to 1) evaluate behavioral outcomes among survivors of childhood brain tumors, 2) compare behavioral outcomes among survivors of childhood brain tumors with survivors of childhood leukemia and healthy children, and 3) determine any demographic, disease, and/or treatment-related factors that could affect the behavioral outcomes of survivors of childhood brain tumors. METHODS A comparative cross-sectional study was conducted over a period of 1 year (June 1st, 2018-May 31st, 2019) in two tertiary referral centers in Kuala Lumpur, Malaysia. Thirty-eight survivors of childhood brain tumors aged 6 to 18 years old who had been off-treatment for at least 1 year and were in remission, 38 age- and gender-matched survivors of childhood leukemia who had been off-treatment for at least 1 year and were in remission, and 38 age- and gender-matched unrelated healthy children were recruited. The Child Behaviour Checklist (CBCL) parent report and Youth Self-Report (YSR) questionnaires were used to assess behavioral outcomes. RESULTS Survivors of childhood brain tumors showed statistically significantly worse behavioral outcomes than healthy children for social problems and attention problems (p < 0.05, respectively). A significantly worse outcome was found for "social problems" (p < 0.05) in survivors of childhood brain tumors compared to survivors of childhood leukemia. Significant associations were also found between physical disability, visual impairment, education level of survivors, and father's occupation and behavioral outcomes among survivors of childhood brain tumors. CONCLUSIONS Survivors of childhood brain tumors in our center showed poor behavioral outcomes for social problems and attention problems. Thus, effective psychosocial support interventions tailored to individual patients as soon as treatment is completed are important to prevent potentially debilitating emotional problems.
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Affiliation(s)
- Hamidah Alias
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia.
| | | | - Syed Zulkifli Syed Zakaria
- Department of Pediatrics, UKM Medical Centre, Faculty of Medicine, The National University of Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Zulaiha Muda
- Institut Pediatrik, General Hospital Kuala Lumpur, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Azmi Mohd Tamil
- Department of Public Health, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
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8
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Kok TB, Koerts J, Lemiere J, Post WJ, de Bont ESJM, Gidding C, Happé F, Jacobs S, Oostrom K, Schieving J, Tucha O, Kingma A. Social competence in newly diagnosed pediatric brain tumor patients. Pediatr Hematol Oncol 2020; 37:41-57. [PMID: 31682775 DOI: 10.1080/08880018.2019.1682089] [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] [Indexed: 10/25/2022]
Abstract
Brain tumors (BTs) are a common pediatric malignancy. Improved treatment has resulted in higher survival rates. There is, however, increasing concern about adverse effects of the disease and its treatment, including effects on social competence (i.e. effective social functioning in everyday life). The aim of this study is to examine multiple levels of social competence (i.e. social skills and social adjustment) in newly diagnosed pediatric BT patients. Thirty newly diagnosed BT patients aged 5-12 years were assessed shortly after diagnosis with a neuropsychological test battery focusing on social competence, including tests for IQ, social skills (i.e. social-affective and executive functioning) and social adjustment (rated by parents and teachers). Their performance was compared to 95 healthy controls who completed the same assessment. Patients and healthy controls were largely comparable with regard to demographic and environmental factors and did not differ on measures of IQ, social skills and social adjustment. Furthermore, age was found to have a positive significant effect on social skills independent of group. Shortly after diagnosis, pediatric BT patients did not perform different from healthy controls on IQ and measures of social skills and social adjustment. This is an encouraging finding. However, because of potentially neurotoxic adjuvant therapy and the ongoing development of social skills, longitudinal follow-up studies are needed to investigate long-term outcome regarding social competence in BT survivors.
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Affiliation(s)
- Tessa B Kok
- Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Jurgen Lemiere
- Department of Pediatric Oncology/Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Wendy J Post
- Department of Orthopedagogy, University of Groningen, Groningen, The Netherlands
| | - Eveline S J M de Bont
- Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands
| | - Corrie Gidding
- Department of Pediatric Oncology/Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Franscesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sandra Jacobs
- Department of Pediatric Oncology/Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Kim Oostrom
- Department of Psychology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Jolanda Schieving
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Annette Kingma
- Department of Pediatric Oncology/Hematology, University of Groningen, Groningen, The Netherlands
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Are we friends? Best friend nominations in pediatric brain tumor survivors and associated factors. Support Care Cancer 2019; 27:4237-4244. [PMID: 30847703 DOI: 10.1007/s00520-019-04706-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pediatric brain tumor survivors (PBTSs) are at risk of impairments in social competence. Limited information is available regarding nominations and reciprocated nominations of PBTSs as best friends and factors which may predict these. PROCEDURE Caregivers of children (n = 32) aged 8-16 (38% low-grade glioma, 34% medulloblastoma, 28% other) completed ratings of child adjustment at baseline (T1) and PBTSs and classmates completed the Three Best Friends measure approximately 12 months later (T2). Sociometric data yielded ratings of best friend nominations and reciprocated best friend nominations. RESULTS Nominations of PBTSs as best friends were not significantly different than controls, but PBTSs had fewer reciprocated best friend nominations than controls. Approximately half of PBTSs in this study did not have any reciprocated best friend nominations and 25% were not nominated by any peer as a best friend. Greater symptoms of depression and lower social skills in PBTSs were associated with fewer nominations as a best friend by peers and a greater likelihood of no reciprocal best friend nominations. Greater difficulties in emotional control were associated with fewer nominations as a best friend by peers. CONCLUSIONS The discrepancy between reciprocated best friend nominations and best friend nominations highlights a need to attend to reciprocal friendships in PBTSs and further understand social information processes in this population. Longitudinal analyses illustrate the impact of emotional adjustment on PBTS friendships.
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Desjardins L, Barrera M, Schulte F, Chung J, Cataudella D, Janzen L, Bartels U, Downie A. Predicting social withdrawal, anxiety and depression symptoms in pediatric brain tumor survivors. J Psychosoc Oncol 2019; 37:22-36. [DOI: 10.1080/07347332.2018.1535531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Leandra Desjardins
- 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
| | - Fiona Schulte
- Department of Psychology, Division of Hematology/Oncology, Alberta Children’s Hospital, Calgary, Canada
| | - Joanna Chung
- Department of Psychology, Division of Hematology/Oncology, BC Children’s Hospital, Vancouver, Canada
| | - Danielle Cataudella
- Department of Psychology, Division of Hematology/Oncology, London Health Sciences Centre, London, Canada
| | - Laura Janzen
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Andrea Downie
- Department of Psychology, Division of Hematology/Oncology, London Health Sciences Centre, London, Canada
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11
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Willard VW. Social skills interventions for survivors of pediatric brain tumors: A review and reformulation. Pediatr Blood Cancer 2018; 65:e27434. [PMID: 30160028 DOI: 10.1002/pbc.27434] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022]
Abstract
Youth with brain tumors are at risk for late effects. Families report that survivors' difficulties with peer relationships are among the most distressing and impactful on quality of life. As such, interventions have been designed to improve social functioning. The objective was to review the nine published social skills intervention studies for survivors of brain tumors with regard to study design, participation rates, skills targeted, assessment measures, and outcomes. Results of this review were used to discuss future directions, with a focus on alternative approaches to inclusion criteria (including developmental considerations and screening for weaknesses), intervention timing and modality.
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12
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Paltin I, Schofield HL, Baran J. Rehabilitation and Pediatric Oncology: Supporting Patients and Families During and After Treatment. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0181-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Barrera M, Atenafu EG, Schulte F, Bartels U, Sung L, Janzen L, Chung J, Cataudella D, Hancock K, Saleh A, Strother D, McConnell D, Downie A, Hukin J, Zelcer S. Determinants of social competence in pediatric brain tumor survivors who participated in an intervention study. Support Care Cancer 2017; 25:2891-2898. [DOI: 10.1007/s00520-017-3708-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
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14
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Barrera M, Atenafu EG, Sung L, Bartels U, Schulte F, Chung J, Cataudella D, Hancock K, Janzen L, Saleh A, Strother D, Downie A, Zelcer S, Hukin J, McConnell D. A randomized control intervention trial to improve social skills and quality of life in pediatric brain tumor survivors. Psychooncology 2017; 27:91-98. [PMID: 28124799 DOI: 10.1002/pon.4385] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND To determine if a group social skills intervention program improves social competence and quality of life (QOL) in pediatric brain tumor survivors (PBTS). METHODS We conducted a randomized control trial in which PBTS (8-16 years old, off therapy for over 3 months) were allocated to receive social skills training (eg, cooperation, assertion, using social cognitive problem solving strategies, role playing, games, and arts and crafts) in 8 weekly 2-hour sessions, or an attention placebo control (games and arts and crafts only). Outcomes were self-reported, proxy-reported (caregiver), and teacher-reported using the Social Skills Rating System (SSRS), to measure social competence, and the Pediatric Quality of Life (PedsQL4.0, generic) to measure QOL at baseline, after intervention, and at 6 months follow-up. At baseline, SSRS were stratified into low and high scores and included as a covariate in the analysis. RESULTS Compared to controls (n = 48), PBTS in the intervention group (n = 43) reported significantly better total and empathy SSRS scores, with improvements persisting at follow-up. The PBTS in the intervention group who had low scores at baseline reported the greatest improvements. Proxy and teacher reports showed no intervention effect. CONCLUSIONS Participating in group social skills intervention can improve self-reported social competence that persisted to follow up. The PBTS should be given the opportunity to participate in social skills groups to improve social competence.
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Affiliation(s)
- Maru Barrera
- Psychology Department, Hematology/Oncology Division, Sick Kids Hospital, Toronto, Canada
| | - Eshetu G Atenafu
- Biostatistics Department, University Health Network, Toronto, Canada
| | - Lillian Sung
- Hematology/Oncology Division, Sick Kids Hospital, Toronto, Canada
| | - Ute Bartels
- Hematology/Oncology Division, Sick Kids Hospital, Toronto, Canada
| | - Fiona Schulte
- Psychology Department, Hematology/Oncology Division, Alberta Children's Hospital, Calgary, Canada
| | - Joanna Chung
- Psychology Department, Hematology/Oncology Division, BC Children's Hospital, Vancouver, Canada
| | - Danielle Cataudella
- Psychology Department, Hematology/Oncology Division, London Health Sciences Centre, London, Canada
| | - Kelly Hancock
- Psychology Department, Hematology/Oncology Division, Sick Kids Hospital, Toronto, Canada
| | - Laura Janzen
- Psychology Department, Hematology/Oncology Division, Sick Kids Hospital, Toronto, Canada
| | - Amani Saleh
- Psychology Department, Hematology/Oncology Division, Sick Kids Hospital, Toronto, Canada
| | - Douglas Strother
- Hematology/Oncology Division, Alberta Children's Hospital, Calgary, Canada
| | - Andrea Downie
- Psychology Department, Hematology/Oncology Division, London Health Sciences Centre, London, Canada
| | - Shayna Zelcer
- Hematology/Oncology Division, London Health Sciences Centre, London, Canada
| | - Juliette Hukin
- Hematology/Oncology Division, BC Children's Hospital, Vancouver, Canada
| | - Dina McConnell
- Psychology Department, Hematology/Oncology Division, BC Children's Hospital, Vancouver, Canada
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15
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Deatrick JA, Thibodeaux AG, Mooney K, Schmus C, Pollack R, Davey BH. Family Management Style Framework: A New Tool With Potential to Assess Families Who Have Children With Brain Tumors. J Pediatr Oncol Nurs 2016; 23:19-27. [PMID: 16689400 DOI: 10.1177/1043454205283574] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Qualitative studies of families with children who have cancer or other serious illnesses have found that families often come to view their child and their lives as normal. They manage illness-related demands using family management styles that sustain usual patterns of family and child functioning. Few studies have addressed the family management styles of families who express less satisfaction with family and child functioning or who are identified by health care professionals as having difficulty with family functioning. Such families are likely to be overrepresented among those whose children are being treated for brain tumors that entail extremely burdensome treatments as well as a range of unfavorable prognoses and long-term sequelae. In fact, little is known about how these families manage on a day-to-day basis and how the interdisciplinary team can best provide supportive care to optimize their functioning. The purpose of this article is to present the Family Management Styles Framework as a tool that is useful in both clinical practice and research for assessing families who have children with cancer, including those with brain tumors.
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Affiliation(s)
- Janet A Deatrick
- Center for Health Disparities Research, University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104-6096, USA.
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16
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Sint Nicolaas SM, Hoogerbrugge PM, van den Bergh EMM, Custers JAE, Gameiro S, Gemke RJBJ, Verhaak CM. Predicting trajectories of behavioral adjustment in children diagnosed with acute lymphoblastic leukemia. Support Care Cancer 2016; 24:4503-13. [PMID: 27296238 PMCID: PMC5031747 DOI: 10.1007/s00520-016-3289-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 11/22/2022]
Abstract
Purpose Previous research showed that children with cancer are at risk for developing behavioral adjustment problems after successful treatment; however, the course of adjustment remains unclear. This study focuses on adjustment trajectories of children during treatment for acute lymphoblastic leukemia (ALL) and aims to distinguish subgroups of patients showing different trajectories during active treatment, and to identify sociodemographic, medical, and psychosocial predictors of the distinct adjustment trajectories. Methods In a multicenter longitudinal study, 108 parents of a child (response rate 80 %) diagnosed with ALL were assessed during induction treatment (T0), after induction/consolidation treatment (T1), and after end of treatment (T2). Trajectories of child behavioral adjustment (Child Behavior Checklist; CBCL) were tested with latent class growth modeling (LCGM) analyses. Results For internalizing behavior, a three-trajectory model was found: a group that experienced no problems (60 %), a group that experienced only initial problems (30 %), and a group that experienced chronic problems (10 %). For externalizing behavior, a three-trajectory model was also found: a group that experienced no problems (83 %), a group that experienced chronic problems (12 %), and a group that experienced increasing problems (5 %). Only parenting stress and baseline QoL (cancer related) were found to contribute uniquely to adjustment trajectories. Conclusions The majority of the children (77 %) showed no or transient behavioral problems during the entire treatment as reported by parents. A substantial group (23 %) shows maladaptive trajectories of internalizing behavioral problems and/or externalizing behavioral problems. Screening for risk factors for developing problems might be helpful in early identification of these children. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3289-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simone M Sint Nicolaas
- Department of Medical Psychology 840, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Peter M Hoogerbrugge
- Pediatric Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,Dutch Childhood Oncology Group (SKION), The Hague, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - José A E Custers
- Department of Medical Psychology 840, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sofia Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff, Wales, UK
| | | | - Chris M Verhaak
- Department of Medical Psychology 840, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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17
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Hocking MC, McCurdy M, Turner E, Kazak AE, Noll RB, Phillips P, Barakat LP. Social competence in pediatric brain tumor survivors: application of a model from social neuroscience and developmental psychology. Pediatr Blood Cancer 2015; 62:375-84. [PMID: 25382825 PMCID: PMC4304946 DOI: 10.1002/pbc.25300] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022]
Abstract
Pediatric brain tumor (BT) survivors are at risk for psychosocial late effects across many domains of functioning, including neurocognitive and social. The literature on the social competence of pediatric BT survivors is still developing and future research is needed that integrates developmental and cognitive neuroscience research methodologies to identify predictors of survivor social adjustment and interventions to ameliorate problems. This review discusses the current literature on survivor social functioning through a model of social competence in childhood brain disorder and suggests future directions based on this model. Interventions pursuing change in survivor social adjustment should consider targeting social ecological factors.
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Affiliation(s)
| | - Mark McCurdy
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Psychology, Drexel University
| | - Elise Turner
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Psychology, Drexel University
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health System
- Department of Pediatrics, Sidney Kimmel School of Medicine at Thomas Jefferson University
| | | | - Peter Phillips
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania
| | - Lamia P. Barakat
- Division of Oncology, The Children’s Hospital of Philadelphia
- Department of Pediatrics, University of Pennsylvania
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18
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Roberts RM, Robins T, Gannoni AF, Tapp H. Survivors of Childhood Cancer in South Australia Attending a Late-Effects Clinic: A Descriptive Report of Psychological, Cognitive, and Academic Late-Effects. J Psychosoc Oncol 2014; 32:152-66. [DOI: 10.1080/07347332.2013.873998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Social competence in pediatric brain tumor survivors: evaluating the psychometric properties of assessment tools. Support Care Cancer 2013; 22:561-9. [DOI: 10.1007/s00520-013-2035-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
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20
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Brinkman TM, Palmer SL, Chen S, Zhang H, Evankovich K, Swain MA, Bonner MJ, Janzen L, Knight S, Armstrong CL, Boyle R, Gajjar A. Parent-reported social outcomes after treatment for pediatric embryonal tumors: a prospective longitudinal study. J Clin Oncol 2012; 30:4134-40. [PMID: 23071220 DOI: 10.1200/jco.2011.40.6702] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine longitudinal parent-reported social outcomes for children treated for pediatric embryonal brain tumors. PATIENTS AND METHODS Patients (N=220) were enrolled onto a multisite clinical treatment protocol. Parents completed the Child Behavior Checklist/6-18 at the time of their child's diagnosis and yearly thereafter. A generalized linear mixed effects model regression approach was used to examine longitudinal changes in parent ratings of social competence, social problems, and withdrawn/depressed behaviors with demographic and treatment factors as covariates. RESULTS During the 5-year period following diagnosis and treatment, few patients were reported to have clinically elevated scores on measures of social functioning. Mean scores differed significantly from population norms, yet remained within the average range. Several factors associated with unfavorable patterns of change in social functioning were identified. Patients with high-risk treatment status had a greater increase in parent-reported social problems (P=.001) and withdrawn/depressed behaviors (P=.01) over time compared with average-risk patients. Patients with posterior fossa syndrome had greater parent-reported social problems over time (P=.03). Female patients showed higher withdrawn/depressed scores over time compared with male patients (P<.001). Patient intelligence, age at diagnosis, and parent education level also contributed to parent report of social functioning. CONCLUSION Results of this study largely suggest positive social adjustment several years after diagnosis and treatment of a pediatric embryonal tumor. However, several factors, including treatment risk status and posterior fossa syndrome, may be important precursors of long-term social outcomes. Future research is needed to elucidate the trajectory of social functioning as these patients transition into adulthood.
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Affiliation(s)
- Tara M Brinkman
- St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, 262 Danny Thomas Place, MS 735, Memphis, TN 38105, USA.
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21
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Selove R, Kroll T, Coppes M, Cheng Y. Psychosocial services in the first 30 days after diagnosis: results of a web-based survey of Children's Oncology Group (COG) member institutions. Pediatr Blood Cancer 2012; 58:435-40. [PMID: 21755591 DOI: 10.1002/pbc.23235] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 05/18/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study examines what proportion of families of recently diagnosed pediatric cancer patients are offered recommended psychosocial services, and if that proportion is linked to size of institution or number of psychosocial staff. PROCEDURES A web-based survey was offered to all institutions belonging to the Children's Oncology Group (COG). RESULTS Respondents from 127/212 (=59.9%) COG institutions provided information about percentage of families offered specific services within the first 30 days after diagnosis, and barriers to providing such services, as well as information about other factors that might affect their ability to provide psychosocial care. All sites reported that ≥50% of families are offered 21 of the 27 services investigated in this study. Over half of respondents (n=290) indicated that inadequate funding for staff (72%) and families' time constraints (63%) were barriers to providing psychosocial care. There was a positive relationship between the total number of psychosocial staff and the number of new patients seen annually (Pearson correlation=0.3409, P-value < 0.0004), but not between the total number of psychosocial staff and specific services offered. Most sites do not use validated assessment tools or evidence-based psychosocial interventions. CONCLUSIONS While some version of most recommended psychosocial services are offered across COG institutions, evidence-based psychosocial services are offered at only 11% of sites. Advances in psychosocial outcomes in pediatric oncology could be accelerated by multi-site collaboration, use of standardized assessment tools, and evidence-based interventions.
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Affiliation(s)
- Rebecca Selove
- Centerstone Research Institute, 44 Vantage Way, Nashville, TN 37228, USA.
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22
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Social competence in childhood brain tumor survivors: a comprehensive review. Support Care Cancer 2010; 18:1499-513. [DOI: 10.1007/s00520-010-0963-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 07/20/2010] [Indexed: 10/19/2022]
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23
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Lim AN, Lange BJ, King AA. Rehabilitation for survivors of pediatric brain tumors: our work has just begun. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.09.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
CNS tumors are the second most common childhood cancer, and survival rates for children with these tumors have increased over the last few decades. Children are often treated with a combination of neurosurgery, chemotherapy and cranial radiation. Both the tumors and these therapies can lead to cognitive challenges, decreased social participation or coping, and physical dysfunction, which can impede a child’s ability to complete daily activities and participate in his or her environment. This review describes these late effects in the framework of the International Classification of Functioning, Disability and Health, and discusses the few studies that have attempted to improve children’s functioning in their environment beyond just survival.
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Affiliation(s)
- Audrey N Lim
- Program of Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Beverly J Lange
- University of Pennsylvania Department of Pediatrics & The Children’s Hospital of Philadelphia, PA, USA
| | - Allison A King
- Washington University School of Medicine, 660 South Euclid, Campus Box 8505, St Louis, MO 3110, USA
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Abstract
OBJECTIVE This preliminary study investigated prevalence rates of multiple health-related behaviors (ie, tobacco, alcohol, and other drug use; sexual risk-taking; nutrition/physical activity; overweight and dietary behaviors; sun safety) among 42 adolescents on active treatment for cancer, as compared with healthy adolescent norms. METHODS Health-related behaviors were assessed using the 2005 National Youth Risk Behavior Survey, for which healthy adolescent norms were publicly available. RESULTS Adolescents with cancer reported significantly lower current and lifetime rates of tobacco, alcohol, and other drug use; fruit/vegetable consumption; physical activity; and dietary behavior, in addition to lower rates of lifetime sexual intercourse, early-onset sexual intercourse, and alcohol/drug use before last sexual intercourse, compared with healthy peers. Among those who have previously engaged in sexual intercourse, there appeared to be a trend toward increased partners, current sexual activity, and lack of protection at last episode of sexual intercourse. Adolescents with cancer also reported significantly higher rates of television watching compared with healthy peers. CONCLUSIONS Adolescents on active treatment for cancer are engaging in multiple health-risk behaviors, including sedentary behavior, poor nutrition, lack of sun safety, and sexual risk-taking (eg, multiple partners, lack of protection at last sexual intercourse). Health promotion interventions are needed during active treatment to facilitate the acquisition of good health practices as adolescents transition into survivorship.
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25
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Carpentier MY, Mullins LL, Elkin TD, Wolfe-Christensen C. Predictors of health-harming and health-protective behaviors in adolescents with cancer. Pediatr Blood Cancer 2008; 51:525-30. [PMID: 18478576 DOI: 10.1002/pbc.21605] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Given adolescent cancer survivors' increased susceptibility to late effects, it is imperative that we understand factors that influence their engagement in healthy and unhealthy behaviors. The purpose of this exploratory study was to identify significant predictors of health-harming and health-protective behaviors in adolescent cancer patients. PROCEDURE Forty-two adolescents (ages 12-19 years) currently on-treatment for cancer and their parents were recruited from outpatient pediatric cancer clinics. Adolescents completed a battery of questionnaires that assessed their health-behaviors, quality of life, and psychological distress, while parents completed a demographic questionnaire. RESULTS Regression analyses indicated that specific demographic, illness, and psychosocial variables significantly predicted health-harming and health-protective behaviors. Older adolescent age and unmarried parent status emerged as the best predictors of adolescent health-harming behaviors, whereas married parent status, increased adolescent time since diagnosis, increased adolescent-rated quality of life, and increased distress emerged as the best predictors of health-protective behaviors. CONCLUSIONS Demographic, illness, and psychosocial variables may help inform the development of interventions designed to promote the initiation and/or maintenance of good health practices among adolescents on-treatment for cancer. Interventions are needed that target health behaviors while adolescents are approaching treatment completion, in order to help facilitate the practice of good health practices in survivorship.
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Affiliation(s)
- Melissa Y Carpentier
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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