Adolescents' needs for information and psychosocial support during their mother's breast cancer trajectory: A systematic review

OBJECTIVE

Breast cancer is the most common cancer diagnosis among women. The acute crisis and uncertainty that often follow diagnosis put the family at risk of exhaustion and dysfunction. Adolescents have been identified as a particularly vulnerable group of relatives. To investigate how to prevent distress in this group, we systematically reviewed research on adolescents' (11-21 years) needs for information and psycho-social support during their mothers' breast cancer trajectory.

METHOD

Systematic searches were conducted in five bibliometric databases. Peer-reviewed, original research of adolescents aged 11-21 with a mother diagnosed with breast cancer was included. Two researchers conducted screening, quality assessment, and data extraction independently. Thematic synthesis was applied to the included studies.

RESULTS

A total of 8066 studies were screened, and five quantitative and six qualitative studies were included. The results indicated that adolescents' information and psycho-social support needs were poorly met. Many were reluctant to share feelings with family and peers and experienced abandonment during the crisis. Adolescents who were not well informed experienced distress. Poor family functioning increased the level of adolescents' distress.

CONCLUSIONS

Despite limitations regarding heterogeneity among the studies, eligibility criteria, and quality assessment, this review provides clear clinical implications. Encounter groups may support adolescents during their mother's breast cancer trajectory. Furthermore, healthcare professionals could provide more indirect support to adolescents by providing support and clearer guidelines to parents. Finally, adolescents from poor-functioning families need extra attention.

Maternal Cancer and Perception of Child Psychological Adjustment: The Role of Mother's Anxiety, Depression, and Parenting Stress

A mother's cancer diagnosis may have consequences for all family members, particularly for children, since it makes a parent less physically and emotionally available, with effects on the relationship with the child and his/her development. The main aim of this study was to analyze children's psychological adjustment in the context of maternal cancer by considering factors related to the child (i.e., age and sex), the mother (psychological adjustment), and cancer (i.e., time elapsed from the diagnosis and current oncological treatment). Self-report questionnaires investigating mothers' parenting stress, depression, anxiety, and children's emotional and behavioral problems were administered to 124 mothers (mean age = 44.52 years; SD = 7.22) diagnosed with cancer. A hierarchical regression analysis highlighted that time since diagnosis and mothers' anxiety and parenting stress accounted for almost 44% of the variance of the children's difficulties. Maternal depression, current oncological treatment, and the child's age and sex were not statistically significant. Higher mothers' parenting stress and anxiety and a longer time elapsed since the first diagnosis predicted higher levels of children's emotional and behavioral problems. These findings highlight the need to identify precursors of childhood distress in the context of maternal cancer and to develop structured programs to support both mothers and children.

Experiences of Adolescent Daughters in Beginning to Live With Their Mothers' Cancer: A Qualitative Study

This study reveals the experiences of adolescent daughters who are beginning to live with their mothers' cancer diagnosis. Participants were 14 adolescent daughters who were either junior or senior high school students when their mothers were diagnosed with breast cancer. We analyzed semi-structured interviews using content analysis. Using interview data, four categories were created from 23 subcategories and 183 codes: (1) using trial and error to attempt to steady their minds against upset and anxiety; (2) minimizing the effect on their own school life and future; (3) moving forward with the help and support of those around them; and (4) advancing together with their family to protect and take care of their mother. As supporters, we must understand adolescent daughters' experiences in living with their mothers' cancer. Open communication with an important outside individual is essential in promoting adolescent daughters' ability to obtain support and live with their mothers' cancer.

How to support parenting in patients with cancer and co-parents? From research to practice

PURPOSE OF REVIEW

When a parent is diagnosed with cancer, the entire family is impacted. Patients with cancer and co-parents may no longer feel able to fulfill their parenting roles. The aims of this article are to describe interventions designed to support parenting in the oncological context and to make suggestions for the development and assessment of such interventions.

RECENT FINDINGS

Ten parenting support interventions published in the last 10 years in oncology were identified, among which four randomized controlled trials (RCTs). The therapeutic aims, techniques, and modalities of these interventions were heterogeneous. Five main therapeutic aims were addressed to: increase parents' knowledge, promote parents' emotion regulation, enhance parents' self-efficacy related to parenting, promote parents' support of their children's reactions and coping strategies, and promote open and appropriate parent-child communication. Few studies have combined informational resources with experiential techniques.

SUMMARY

Very few studies examining the efficacy of parenting support interventions have been published. There is still a need to develop, test, and compare interventions that meet the many needs of parents and their children. Suggestions are made about the contents and formats of parenting support interventions in oncology.

Child Posttraumatic Stress after Parental Cancer: Associations with Individual and Family Factors

Objective

This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms.

Methods

The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6–20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression.

Results

Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors.

Conclusions

The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD.

Psychosocial consequences in offspring of women with breast cancer

OBJECTIVE

Breast cancer (BC) accounts for 24% of female cancers, with approximately one quarter of women likely to have offspring aged less than 25 years. Recent publications demonstrate negative psychosocial well-being in these offspring. We prospectively assessed for psychological distress and unmet needs in offspring of BC patients.

METHODS

Eligible offspring aged 14 to 24 years were consented and completed the Kessler-10 Questionnaire and Offspring Cancer Needs Instrument. Demographic and BC details were obtained.

RESULTS

Over a 7-month period, 120 offspring from 74 BC patients were included. Fifty-nine mothers had nonmetastatic BC (nMBC), and 27 had metastatic BC (MBC) with median time from diagnosis of 27.6 and 36.1 months, respectively. The prevalence of high/very high distress was 31%, with significantly higher scores reported by female offspring (P = .017). Unmet needs were reported by more than 50% of offspring with the majority of needs relating to information about their mother's cancer. Greater unmet needs were seen in female offspring and offspring with none or one sibling for several domains (practical assistance, time-out, dealing with feelings, and support from friends; P < .05). Greater unmet needs were seen in regard to feelings for MBC patients' offspring compared with nMBC but were similar for other unmet needs.

CONCLUSIONS

Our study confirms high levels of psychological distress in offspring of BC patients, with female offspring reporting significantly higher emotional distress and unmet needs. More than 50% of respondents reported unmet needs in areas that can potentially be supported, including greater information provision, improving practical issues, and enabling sufficient recreational time.

[When a Parent Falls Severely Ill - Challenges for the Medical Practice from the Children's Perspective]

When a Parent Falls Severely Ill - Challenges for the Medical Practice from the Children's Perspective Abstract. A serious somatic parental illness affects the whole family. However, children of ill parents rarely attract attention in the medical system. They often feel their parents' distress, show over-adapted behavior and remain trapped in their fears and concerns. Knowledge of the children's stage of development and the nature of communication within the family are essential requirements for effective support. Interventions aim at supporting parents in their responsibility, strengthening communication, exchanging of feelings and therefore facilitating the children's cognitive orientation.

Study protocol: a randomized control trial of African American families fighting parental cancer together

Background

African American adults experience a disproportionate burden and increased mortality for most solid tumor cancers and their adolescent children are negatively impacted by the illness experience. The purpose of this randomized clinical trial is to evaluate the efficacy of a culturally sensitive family-based intervention program developed for African American families coping with solid tumor parental cancer using an intention-to-treat approach. Primary outcome is adolescent depressive symptoms at end of treatment.

Methods

A sample of 172 African American families will be enrolled from two diverse oncology centers (Helen Graham Cancer Center in Newark, DE, and Kimmel Cancer Center in Philadelphia, PA). Eligible families will be randomized either to a 5-session intervention Families Fighting Cancer Together (FFCT) or a 5-session parent-only psycho-educational (PED) program. Assessments will occur at weeks 0 (baseline), 8 (end-of-treatment), 24, and 52.

Discussion

Treatments to help African American adolescents cope with the impact of parental cancer are scarce and urgently needed. If successful, this proposed research will change the nature of intervention support options available to African Americans, who are overrepresented and underserved by existing services or programs.

Trial registration

This project is registered with ClinicalTrials.gov (Protocol #: NCT03567330).

How are the kids holding up? A systematic review and meta-analysis on the psychosocial impact of maternal breast cancer on children

BACKGROUND

Having a mother diagnosed with breast cancer can be a distressing time for a child. This review examines the impact maternal breast cancer has on the psychosocial functioning of children and what factors possibly moderate this relationship.

METHODS

Using PRISMA guidelines, five electronic databases were systematically searched for published studies examining maternal breast cancer and the psychosocial functioning of children.

RESULTS

A total of 15 studies contributed to the analysis. Results from a random effects meta-analysis show that children experience marginally elevated internalizing problems (standardized mean difference=.14, 95% CI .00, .28), significantly fewer total problem behaviors (standardized mean difference=-.13, 95% CI -.23, -.03), and no changes in externalizing problems (standardized mean difference=-.07, 95% CI -.19, .05) relative to comparison groups. Consistent with this, the narrative review suggests the children may experience elevated depression, anxiety and mental distress yet show more social competence and little aggressive or disruptive behavior. Significant moderating variables included informant type (i.e., self-ratings vs mother's ratings vs other's ratings) and comparison group used (i.e., controls vs normative data). There is also evidence that illness severity and maternal mental health may impact the results.

CONCLUSIONS

The results suggest that children may be at risk for internalizing-type problems, especially when their mother experiences depression and has serious medical complications. Research using larger and more diverse samples is needed to fully understand how maternal breast cancer impacts children.

Parenting changes in adults with cancer

BACKGROUND

Children whose parents have cancer are at risk for psychosocial difficulties; however, the mechanisms are not well understood. This cross-sectional study sought support for a model connecting parental cancer to child distress through its impact on parenting self-efficacy beliefs and parenting behaviors by examining relations among parental illness, quality of life/parent functioning, parenting efficacy beliefs, and concerns about children's emotional distress.

METHODS

One hundred ninety-four adult oncology outpatients with children who were 18 years old or younger completed questionnaires assessing their health-related quality of life (Functional Assessment of Cancer Therapy-General), depression and anxiety symptoms (Hospital Anxiety and Depression Scale), overall distress (Distress Thermometer), and parenting efficacy beliefs and parenting concerns (Parenting Concerns Questionnaire).

RESULTS

Parenting efficacy scores for parents and coparents declined significantly after diagnosis. This decline correlated with more visits to a medical clinic, treatment with intravenous chemotherapy in the past month, poorer health-related quality of life, and more depression and distress. Parents experiencing the most concern about the impact of mood, physical limitations, and changes in routines on their children experienced the biggest declines in their own sense of efficacy as parents and in their belief in their coparent's efficacy. Finally, declines in parenting efficacy beliefs correlated with parental concerns about children's emotional distress about aspects of the parent's illness.

CONCLUSIONS

This study highlights the importance of identifying and addressing parenting concerns to alleviate patient distress, and it may help to guide future intervention efforts.

Maintaining everyday life in a family with a dying parent: Teenagers' experiences of adapting to responsibility

Objective:

Teenagers are living through a turbulent period in their development, when they are breaking away from the family to form their own identities, and so they are particularly vulnerable to the stressful situation of having a parent affected by a progessive and incurable illness. The current study sought to gain more knowledge about the ways that teenagers themselves describe living in a family with a seriously ill and dying parent. More specifically, the aims were to describe how teenagers are emotionally affected by everyday life in a family with a dying parent and to determine how they attempt to adapt to this situation.

Method:

The study employed a descriptive and interpretive design using qualitative content analysis. A total of 10 teenagers (aged 14–19 years, 7 boys and 3 girls) participated through repeated, individual, informal interviews that were carried out as free-ranging conversations.

Results:

While contending with their own vulnerable developmental period of life, the teenagers were greatly affected by their parent's illness and took on great responsibility for supporting their parents and siblings, and for maintaining family life. Lacking sufficient information and support left them rather unprepared, having to guess and to interpret the vague signs of failing health on their own, with feelings of uncertainty and loneliness as a consequence.

Significance of Results:

Support from healthcare professionals should be designed to help and encourage parents to have open communications about their illness with their teenaged children. Our results add further support to the literature, reinforcing the need for an approach that uses a systemic perspective and considers the family to be the appropriate unit of care and offers a suitable support system.

The experience of adolescents who have a parent with advanced cancer: A phenomenological inquiry

Objective:

Adolescents are considered the group most susceptible to negative psychosocial outcomes when faced with a parent's illness. However, there has been extremely limited research on the adolescent's adjustment to advanced parental cancer. The aim of our study was to gain understanding of the experiences of adolescents, in their own words, to gather pilot data about the needs of this population that will be valuable in developing interventions for adolescents facing parental cancer.

Method:

A hermeneutic phenomenological approach was applied using in-depth semistructured interviews to inquire about adolescents' experiences. Some 10 adolescents (7 males, 3 females) aged 14–17 were interviewed.

Results:

Four essential themes about adolescents living with a parent's advanced cancer emerged from the analysis: “life interrupted,” “being there,” “managing emotions,” and “positives prevail.” These findings underscore the significant impact an advanced cancer diagnosis can have on a family unit and suggest that the experience may also have the potential of creating opportunities for growth and well-being. Our findings reinforce previous results that advocate for the importance of family and peer support, positive attitude, and open communication when a family is coping with advanced parental cancer.

Significance of results:

Understanding how adolescents gain strength from their relationships with family and peers offers healthcare professionals an opportunity to have services and strategies in place to foster these relationships.

Exploration of the Short-Term and Long-Term Effects of Parental Illness on Children’s Educational and Behavioral Functioning Using a Large Taiwanese Sample

This study used data from Waves I and II of the Taiwan Educational Panel Survey (TEPS) to explore the potential short-term and long-term effects of parental illness and health condition on children’s behavioral and educational functioning. A sample of 11,018 junior high school students and their parents and teachers in Taiwan were included in this present study. The results supported previous work that parental illness may place children at slight risk for poor psychosocial adjustment and behavioral problems. Parental illness was associated with lower adaptive skills and more behavioral problems in children. Children of ill parents showed resilience in their educational functioning in the event of parental illness as children’s academic achievement and learning skills were not related to parental illness/health condition.

Caring for a loved one with cancer: it is my job

This study investigated the experiences of caregivers of loved ones with cancer in Lomé, Togo. The authors developed a framework that captures the experiences of 17 caregivers. The framework explains the exploratory factors that influenced the lives of caregivers from the caregivers' own perspectives. Findings showed that even though the caregivers experienced significant challenges that affected their lives and the lives of their families, because of cultural norms and expectations, they tried their best to overcome the challenges. Although some reported positive impacts on their family functioning, others reported negative impacts such as fragmentation of the family unit. Implications for practice and policy are discussed.

Children's emotional adaptation to parental BMT

Few studies have examined the effect of parental BMT on the family and less is known regarding the impact on children. The purpose of this prospective study was to increase understanding of children's adaptation to the stress of parental BMT across a 12-month trajectory. Data were obtained from 61 children ages 10-18 before parental transplant, during parental hospitalization, 1, 4 , 8 and 12 months post BMT. Mixed linear modeling was used to analyze longitudinal data from children nested within families. Analyses examined change in child emotional adaptation, points of greatest vulnerability throughout the BMT trajectory and the impact of theoretically relevant variables on their adaptation. Children's emotional adaptation became significantly more positive over time, although their level of distress remained above the norm. Pre-transplant was the period of greatest emotional distress. Negative self-esteem, disruption within the family structure, use of disengagement coping and the mother as transplant recipient were associated with more negative adaptation. Further research is needed to fully understand the effects of parental BMT on children. However, these findings point to the importance of considering the adaptation of children and its implications for the development of preventive family interventions for this vulnerable population.

Predictors of parenting stress in patients with haematological cancer

This study was designed to identify potential determinants of parenting stress in parents with leukemia or lymphoma and with children younger than age 18 years. Participants recruited at a comprehensive cancer center completed self-report measures of parenting stress, attachment style, parenting alliance, depression, and anxiety. Depression was positively correlated with parenting stress. Anxious and avoidant attachment styles, but not the degree of physical distress or the quality of the parenting alliance, significantly predicted parenting stress. These findings underscore the relationship of parenting stress to psychological well-being and the contribution of individual characteristics in parents to this stress.

Parental cancer: factors associated with children's psychosocial adjustment--a systematic review

OBJECTIVE

Children of cancer patients have an increased risk of developing psychosocial problems. But not all children are alike vulnerable to this stressful event. Thus, knowledge of risk and protective factors is required to design specific diagnostic tools and interventions for this vulnerable population. This study aims to provide a review and methodological evaluation of current studies examining factors associated with children's psychosocial adjustment when a parent has cancer.

METHODS

Four databases were systematically searched for quantitative research articles examining associative factors of children's adjustment. Study characteristics were analyzed and methodological quality was assessed by two independent reviewers.

RESULTS

28 studies examining associative factors in 2896 families were identified. The included studies used a broad range of instruments assessing children's adjustment. Most patients were female breast cancer patients with middle to high socio-economic status. The majority of included studies used correlational approaches and cross-sectional designs. None of the studies examined toddlers or assessed children's quality of life. Across studies with low to high quality, we found no evidence of illness-related factors, except worse disease status that was related to lower adjustment. Evidence from moderate to high quality studies suggest that better family functioning indicates better adjustment, whereas parent's depressive mood indicates worse adjustment of the children. Child-related factors were inconsistent.

CONCLUSION

Health professionals should pay attention to cancer patients' dependent children. In order to identify this at-risk population, parent's depressive mood and poor family functioning should be considered. Future studies should also assess children's quality of life and child-related factors.

Kinder krebskranker Eltern: Entwicklungspsychologische Aspekte, kindliche Belastungen und psycho-soziale Unterstützungsmöglichkeiten

Zusammenfassung. Psychosoziale Interventionen für Krebspatienten und Einbezug der Partner gehören mittlerweile zum Behandlungsstandard integrativer Versorgung. Allerdings werden die Patienten immer noch selten in ihrer Elternrolle wahrgenommen und familienzentrierte Angebote bei der Behandlung von körperlich kranken Patienten ungenügend berücksichtigt. Aktuelle Studien zeigen, dass Kinder krebskranker Eltern ein erhöhtes Risiko für psychopathologische Symptome aufweisen. Das Ziel des Artikels ist es, anhand qualitativer und quantitativer empirischer Studien einen Überblick über kindliche Belastungen und familiäre Verarbeitungsformen der elterlichen Krebserkrankung zu geben sowie eine entwicklungspsychologische Sichtweise zu vermitteln. Das Hamburger COSIP-Beratungskonzept für Familien mit einem ernsthaft körperlich erkrankten Elternteil wird vorgestellt.

Associations of child adjustment with parent and family functioning: comparison of families of women with and without breast cancer

OBJECTIVE

To examine the impact of maternal breast cancer on the emotional and behavioral functioning of school-age children; evaluate whether child adjustment is associated with variations in distress, marital satisfaction, and parenting behavior evidenced by mothers and fathers; and determine whether these associations differ from families that are not contending with cancer.

METHOD

Participants included 40 children (age 8-16 years) of mothers with breast cancer along with their parents as well as 40 families of comparison classmates not affected by parental illness. Questionnaires assessing the domains of interest were administered in families' homes.

RESULTS

Mothers with breast cancer and their spouses reported higher levels of distress than comparison parents; child internalizing problems were inversely associated with parental adjustment in both groups. No group differences were found in any indicators of family functioning, including parent-child relationships. Warm and supportive parenting by both mothers and fathers were associated with lower levels of child internalizing behavior, but only in families affected by breast cancer.

CONCLUSION

These results suggest that children of mothers with breast cancer, such as most children, may be at risk for internalizing behavior when parents are distressed. These children may particularly benefit from interactions with mothers and fathers who are warm and supportive, and maintenance of positive parenting may partially account for the apparent resilience of these youth.

[Psychosocial stress in children of somatically ill parents. Perspectives of mental health prevention]

Irrespective of their well-known increased risk for mental health problems, children of somatically ill parents are a clinically underserved as well as under-researched group. In this article, the authors introduce the epidemiologic and clinical relevance of this topic and present a theoretical framework for understanding the sequelae of a serious parental illness on minor-age children, based on family dynamics and developmental concepts. This is followed by a comprehensive review of current empirical studies in this field, with a special emphasis on results from a transnational European collaborative study (COSIP = Children of Somatically Ill Parents), which was coordinated by the last author. The most important recommendations from intervention concepts published to date are summarized. Some outlooks for clinical practice as well as future research are presented.

[Children of somatically ill parents: psychological stressors, ways of coping and perspectives of mental health prevention]

Irrespective of their well-known increased risk for mental health problems, children of somatically ill parents are a clinically under-served as well as under-researched group. In this article, the author introduces the epidemiologic and clinical relevance of this topic and presents a theoretical framework for understanding the sequelae of a serious parental illness on minor-age children, based on family dynamics and developmental concepts. This is followed by a comprehensive review of current empirical studies in this field, with a special emphasis on results from a transnational European collaborative study (COSIP = Children of Somatically III Parents), which was coordinated by the author. The most important recommendations from intervention concepts published to date are summarized. The Hamburg COSIP Concept of Counselling for families with a somatically ill parent is introduced. The author concludes in some outlooks for clinical practice as well as future research.

Impact of maternal breast cancer on the peer interactions of children at school

Relatively little research has investigated the impact of parental cancer on developmental outcomes for school-aged children beyond the home. The current study was designed to examine the impact of maternal breast cancer on the social behavior, peer acceptance, and friendships of children and adolescents at school. It was hypothesized that children of women with breast cancer would have fewer friends and be viewed by peers, teachers, and themselves as more socially isolated than comparison classmates. A sample of 60 school-aged children (age 8-16) of women with breast cancer, 58 teachers, and 1138 classmates provided data in classroom settings. Comparisons were made between children in the maternal cancer sample and 60 classmates matched for gender, race, and age. No overall group differences were found on indicators of peer acceptance or friendships at school. Although marked behavioral similarities were found between groups, analyses indicated that sons, but not daughters, of mothers with breast cancer were seen by teachers and peers as more socially sensitive and isolated than comparison peers. Further research is warranted to confirm findings that sons of mothers with breast cancer may experience social isolation and to examine the stability and consequences of this behavioral pattern.

The psychosocial impact of parental cancer on children and adolescents: a systematic review

This review aimed to identify (i) whether early stage parental cancer is associated with an increased risk of psychosocial difficulties amongst children and adolescents; (ii) which factors are associated with variations in psychosocial functioning amongst these children and adolescents. Searches of four electronic databases and the reference lists of relevant articles revealed 10 studies which satisfied the inclusion criteria for the first review question and thirteen studies for the second. Limitations in methodological quality and modest numbers of studies examining the same variables, restricted the conclusions which could be drawn. Overall, the evidence suggests that children and adolescents do not generally experience elevated levels of serious psychosocial difficulties compared to reference groups, but they are at a slightly increased risk for internalising type problems. Adolescent daughters appear to be the most negatively affected group. The prevalent use of measures of child psychopathology may be masking more context-specific problems and lower levels of distress. Family variables, especially family communication/expressiveness, are consistently associated with child/adolescent psychosocial functioning and there is suggestive evidence for the role of maternal depression/adjustment and parenting variables. There is little evidence that medical/treatment variables are important predictors of child outcomes. These findings have implications for identifying families with children most in need of support and indicating variables to target in interventions.

The impact of parental cancer on the adolescent: an analysis of the literature

Research has revealed the impact of the diagnosis of cancer on an individual, their spouse, and their family. One dimension that has received little attention is the impact of the cancer diagnosis on the patient's adolescent. This article offers an analysis of descriptive studies, intervention studies, and databased book chapters, published between 1966 and 2006, that examined the impact of parental cancer on the adolescent. The results of 45 studies and three databased book chapters are organized around four themes: adolescents' (1) emotions and behaviors (2) perceptions and knowledge of parental cancer (3) changes in roles and (4) ways of coping. These themes will assist the reader in understanding the application of the knowledge gained from the analysis of the literature to directions for future research.

Interdependent anxiety and psychological distress in women with breast cancer and their partners

The purpose of this study was to determine the extent of interdependence on anxiety within dyads where one person was undergoing treatment for breast cancer. Perceptions of relationship quality were expected to mitigate the anxiety experienced by both members of the dyad. 96 dyads participated in a 3-wave longitudinal study that took place over 10 weeks. Dyads were composed of a woman with stage I-III breast cancer who was currently undergoing treatment, and a partner who she nominated to participate in the study along with her. Results indicated that anxiety felt by women with breast cancer was consistently associated with that of her partner. Structural equation analyses suggest that the within-dyad influence runs mostly from partners' anxiety to the anxiety of women with breast cancer. Partners' anxiety was also associated with other indicators of the women's well being including depression, fatigue, and symptom management. Perceptions of relationship quality from women with breast cancer and their partners were negatively associated with partners' anxiety. However, women's anxiety was only correlated with their partners', but not their own, perceptions of relationship quality. These findings underscore the benefit of having partners who are able to cope with or get help for their own personal distress as women cope with the stress of breast cancer and its treatment.

Factors associated with emotional and behavioural problems among school age children of breast cancer patients

To identify factors linked with emotional and behavioural problems in school age (6- to 17-year-old) children of women with breast cancer. Reports of children's emotional and behavioural problems were obtained from patient mothers, their healthy partners, the children's teacher and adolescents using the Child Behaviour Checklist and Mental Health subscale of the Child Health Questionnaire. Parents reported on their own level of depression and, for patients only, their quality of life. Family functioning was assessed using the Family Assessment Device and Cohesion subscale of the Family Environment Scale. Using a cross-sectional within groups design, assessments were obtained (N=107 families) where the patients were 3-36 months postdiagnosis. Risk of problems in children were linked with low levels of family cohesion, low affective responsiveness and parental over-involvement as reported by both child and mother. Adolescents reported family communication issues, which were associated with externalising behaviour problems. Maternal depression was related to child internalising problems, particularly in girls. Whether the mother was currently on or off chemotherapy was not associated with child problems nor was time since cancer diagnosis. These findings held across child age. Where mothers have early stage breast cancer, a substantial minority of their school-aged children have emotional and behavioural problems. Such cases are characterised by the existence of maternal depression and poor family communication, rather than by the mother's treatment status or time since diagnosis. Targeted treatments, which focus on maternal depression and family communication may benefit the children and, through improved relationships, enhance the patients' quality of life.

Parental cancer

BACKGROUND

The vulnerability of children when a parent is diagnosed with cancer may depend on a variety of variables. The current study examined the impact of characteristics of 180 parents diagnosed with cancer, along with 145 spouses, on the prevalence of emotional and behavioral problems in children.

METHODS

Ill parents provided information on sociodemographics and illness-related variables and on the prevalence of problems in children by using the Child Behavior Checklist (CBCL). Both parents completed the two subscales that measure physical functioning and mental health of the RAND-36.

RESULTS

The family situation (single parents, no or few siblings, oldest child) was one of the most important predictors of reported problems in primary school children, whereas adolescents were reported as having more problems when parents experienced treatment complications. A decrease in ill parents' physical functioning affected primary school daughters and adolescents, and both age groups were affected by the mental health of ill parents. Problems of ill fathers did not have a different impact on children from those of ill mothers. Spouses' physical limitations were indicative for problems in primary school children, whereas a worsening parental mental health was indicative for problems in adolescents.

CONCLUSIONS

Findings illustrated that parents' characteristics must be taken into account when assessing vulnerability of children in this situation. Which variables particularly heighten the risk for problems depend on children's ages.

The quality of communication between parents and adolescent children in the case of parental cancer

BACKGROUND

This study was designed to investigate: (i) parent-adolescent communication in families of cancer patients; (ii) relationships between parent-adolescent communication and posttraumatic stress symptoms (PTSS) in adolescent children; and (iii) associations between parents' illness characteristics and parent-adolescent communication.

PATIENTS AND METHODS

A total of 212 adolescents completed the Impact of Event Scale and Parent-Adolescent Communication Scale.

RESULTS

Adolescents communicated less openly with mothers with cancer than controls with mothers; this was the only significant difference with the reference group. Daughters communicated more openly with ill parents than with healthy parents. More open communication with healthy parents was related to fewer PTSS in daughters. More problem communication with both parents was related to more PTSS in both sons and daughters. Sons reported more problems in communication with ill parents in case of more intensive treatment or recurrent disease. Daughters experienced less open communication with both parents when ill parents received more intensive treatment. Time since diagnosis was not related to parent-adolescent communication. Multivariate analyses showed that communication patterns specifically affected PTSS of daughters. Problem communication with the healthy parent was the strongest predictor of intrusion while problem communication with the ill parents was the strongest predictor of avoidance.

CONCLUSIONS

Parent-adolescent communication in families of cancer patients differs little from that in families not confronted with parental cancer. Problem communication outweighed lack of openness with respect to development of PTSS. Recurrent disease and intensive treatment regimens affected parent-adolescent communication negatively.