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Wang L, Duan H, Zuo H, Wang Z, Jiao S, Liu Y, Li H, Chen J. Cognitive-behavioral stress management relieves anxiety, depression, and post-traumatic stress disorder in parents of pediatric acute myeloid leukemia patients: a randomized, controlled study. Hematology 2024; 29:2293498. [PMID: 38095309 DOI: 10.1080/16078454.2023.2293498] [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: 08/21/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Cognitive-behavioral stress management (CBSM) is an effective psychological intervention to relieve psychological and symptomatic distress. This study aimed to investigate the effect of CBSM in anxiety, depression, and post-traumatic stress disorder (PTSD) in parents of pediatric acute myeloid leukemia (AML) patients. METHODS Totally, 56 pediatric AML patients and 100 parents were randomized into the CBSM group (28 patients and 49 parents) and the normal control (NC) group (28 patients and 51 parents) to receive corresponding interventions for 10 weeks. The questionnaire scores were assessed at month M0, M1, M3, and M6. RESULTS In parents of pediatric AML patients, self-rating anxiety scale score at M1 (p = 0.034), M3 (p = 0.010), and M6 (p = 0.003), as well as anxiety at M3 (p = 0.036) and M6 (p = 0.012) were decreased in the CBSM group versus the NC group. Self-rating depression scale score at M3 (p = 0.022) and M6 (p = 0.002), as well as depression at M6 (p = 0.019) were declined in the CBSM group versus the NC group. Symptom checklist-90 (a psychotic status questionnaire) score at M3 (p = 0.031) and M6 (p = 0.019) were declined in the CBSM group versus the NC group. Regarding PTSD, the impact of the events scale-revised score at M3 (p = 0.044) and M6 (p = 0.010) were decreased in the CBSM group versus the NC group. By subgroup analyses CBSM (versus NC) improved all outcomes in parents with anxiety at M0 and depression at M0 (all p < 0.050), but could not affect the outcomes in parents without anxiety or depression at M0 (all p > 0.050). CONCLUSION CBSM reduces anxiety, depression, and PTSD in parents of pediatric AML patients.
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Affiliation(s)
- Li Wang
- Department of Pediatrics, Affiliated Hospital of Hebei Engineering University, Handan, People's Republic of China
| | - Hui Duan
- Department of Pediatrics, Affiliated Hospital of Hebei Engineering University, Handan, People's Republic of China
| | - Hongmei Zuo
- Department of Pediatrics, Affiliated Hospital of Hebei Engineering University, Handan, People's Republic of China
| | - Zhongyu Wang
- Department of Oncology, Handan Central Hospital, Handan, People's Republic of China
| | - Shuili Jiao
- Department of Pediatrics Ward 2, Handan Central Hospital, Handan, People's Republic of China
| | - Yanli Liu
- Department of Neonatology Ward 1, Handan Central Hospital, Handan, People's Republic of China
| | - Huihui Li
- Department of Neonatology Ward 1, Handan Central Hospital, Handan, People's Republic of China
| | - Jie Chen
- Department of Nephrology 2, Handan Central Hospital, Handan, People's Republic of China
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Christensen V, Varnum M, Parker K, Chan LHK, Saxton L, Cottrell E. The Impact of Structural and Meso-Level Factors on Caregiver Coping Abilities When Supporting a Child with Cancer: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:907. [PMID: 39063484 PMCID: PMC11277199 DOI: 10.3390/ijerph21070907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Family caregivers of children diagnosed with cancer often experience periods of significant stress. We provide an in-depth examination of the impacts of structural (health care and leave policies) and meso-level (organizations and communities/social networks) factors on caregiver coping during childhood cancer treatment. We conducted a secondary analysis of a comprehensive qualitative dataset examining the impacts of structural and meso-level factors on caregiver coping from in-depth, semi-structured interviews with 49 caregivers representing 38 unique cases of childhood cancer. Using a modified grounded theory approach, transcripts were analyzed using inductive thematic analysis. Caregivers experienced multiple and often intersecting structural and meso-level factors, both facilitating and impeding their ability to cope during their child's cancer treatment. Our analysis revealed the following themes: having few out-of-pocket medical expenses, access to paid time off from employment, and support from one's health system, organizations, or community/social networks fostered caregiver coping. Significant financial burdens due to cancer treatment, having to take unpaid leave from employment, remaining employed regardless of one's circumstances, and lack of support from one's health system, organizations, or community/social networks hindered caregiver coping. Our findings point to several policies that may ease caregiver burden and facilitate caregiver coping during childhood cancer treatment.
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Affiliation(s)
- Vivian Christensen
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Melissa Varnum
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Kellee Parker
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Utah, 81 N Mario Capecchi Dr., Salt Lake City, UT 84113, USA
| | - Lai Hin Kimi Chan
- Department of Family Medicine, University of California Davis, 4860 Y Street Suite 1600, Sacramento, CA 95817, USA
| | - Lauren Saxton
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Erika Cottrell
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
- OCHIN, Inc., 1881 SW Naito Pkwy, Portland, OR 97201, USA
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Rinaldo C, Stenmarker M, Øra I, Pergert P. Living with the threat of losing a child: Parents' experiences of the transplantation process with a severely ill child who received stem cells from a sibling. J Pediatr Nurs 2024; 77:e495-e502. [PMID: 38762421 DOI: 10.1016/j.pedn.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE When a child needs a hematopoietic stem cell transplant, the seriousness of the child's illness is highlighted. The purpose of this study was to explore parents' experiences of the transplantation process when two children in the family are involved, one severely ill child as the recipient and the other as the donor. METHODS In this qualitative study, interviews were conducted with 18 parents of 13 healthy minor donors after successful stem cell transplants. Qualitative content analysis was used to explore parents' experiences. FINDINGS The parents described they were living with the threat of losing a child. They lived with an uncertain future as they were confronted with life-changing information. Whether the ill child would survive or not could not be predicted; thus, parents had to endure unpredictability, and to cope with this they chose to focus on positives. Finally, the parents managed family life in the midst of chaos, felt an inadequacy and a perception that the family became a fragmented although close team during hospital stays. They expressed a need for both tangible and emotional support. CONCLUSIONS When a child needs a stem cell transplant, the parents feel inadequate to their healthy children including the donating child. It is obvious that they experience an uncertain future and struggle to keep the family together amid the chaos. PRACTICE IMPLICATIONS Considering these results, psychosocial support should be mandatory for parents in connection with pediatric HSCT, to enable a process where parents can prepare for the outcome, whether successful or not.
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Affiliation(s)
- Carina Rinaldo
- Astrid Lindgren children's hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Margaretha Stenmarker
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Paediatrics, Futurum Academy of Health and Care, Jönköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Sweden.
| | - Ingrid Øra
- Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Pernilla Pergert
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Paul V, Inhestern L, Sigmund D, Winzig J, Rutkowski S, Escherich G, Bergelt C. Addressing gaps and enhancing experiences in support services for families of pediatric cancer survivors. Pediatr Res 2024:10.1038/s41390-024-03320-2. [PMID: 38886508 DOI: 10.1038/s41390-024-03320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Childhood cancer's enduring challenges extend beyond primary therapy. Diverse medical and psychosocial services are available to assist families in follow-up care. This interview study sought to gain a thorough understanding of family motives, satisfaction levels, and barriers to utilization. METHODS The design of this cross-sectional study involves a qualitative content analysis of semi-structured interviews. We interviewed parents of minor cancer survivors within the first 5 years after primary treatment. RESULTS Survivors readily accessed medical support services when necessary. While parents expressed overall satisfaction with the available services, there was a notable gap in their knowledge regarding appropriate psychosocial and family-orientated services. Barriers to access included geographical distances, time constraints, and the absence of childcare options. CONCLUSION There are familial challenges and burdens that fall outside the scope of conventional care services. Tailoring services to family-centered needs, providing more information and easier access to interventions might help to reduce barriers. IMPACT Existing need notwithstanding, families did not frequently utilize psychosocial services as they did medical ones. Identified barriers included lack of awareness, limited availability, long distances, and scheduling conflicts. While many studies primarily focus on adult patients or young adults, the present study examines the gaps and strengths in follow-up care for pediatric cancer survivors and their families. By acknowledging and addressing the unique challenges and strengths of families with pediatric cancer survivors, we can lead to a more tailored and effective follow-up approach that can enhance their overall well-being by minimizing barriers and providing targeted support.
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Affiliation(s)
- Verena Paul
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Désirée Sigmund
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jana Winzig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Perak K, McDonald FEJ, Conti J, Yao YS, Skrabal Ross X. Family adjustment and resilience after a parental cancer diagnosis. Support Care Cancer 2024; 32:409. [PMID: 38834818 PMCID: PMC11150317 DOI: 10.1007/s00520-024-08608-x] [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: 01/18/2024] [Accepted: 05/26/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To explore the resources, parents with cancer and their partners draw upon to sustain their family resilience through the cancer experience. METHODS Fifteen participants who were parents of children aged 8 to 25 years completed phone, audio-recorded, and semi-structured interviews. Of these participants, 11 were parents diagnosed with cancer, and four were partners of a parent diagnosed with cancer. Interview questions aimed to increase understanding about how families communicate, connect, and face challenges from the cancer experience. Interview data was analysed using inductive thematic analysis to provide scope to generate themes from parent's experiences rather than to test pre-existing frameworks. RESULTS The thematic analysis of interview transcripts generated three key themes related to family resilience: (1) adaptability to changes in roles and routines, (2) open communication within the family, and (3) accepting support from others. CONCLUSION This study found that parents' ability to use personal resources when faced with significant challenges helped to improve the resilience of parents' family system. Further research is needed to understand the factors that influence family resilience when a parent is diagnosed with cancer. Implications for the development of targeted interventions that provide support to not only the patient, but their whole family system will be discussed.
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Affiliation(s)
- Katarina Perak
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Fiona E J McDonald
- Research, Policy & Patient Department, Canteen Australia, Sydney, Australia.
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Yi Sing Yao
- Research, Policy & Patient Department, Canteen Australia, Sydney, Australia
| | - Xiomara Skrabal Ross
- Research, Policy & Patient Department, Canteen Australia, Sydney, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia
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Ben-Arye E, Samuels N, Seifert G, Gressel O, Peleg R, Jong M. Integrative Medicine Across the Pediatric Cancer Care Trajectory: A Narrative Review. Curr Oncol Rep 2024; 26:714-734. [PMID: 38733465 PMCID: PMC11169001 DOI: 10.1007/s11912-024-01538-1] [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] [Accepted: 04/13/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE OF THE REVIEW Children and adolescents with cancer, along with their parents and other informal caregivers, often report using complementary and alternative medicine (CAM) during active oncology and hemato-oncology treatment. Some adopt an "alternative" approach to conventional medical care, which often entails the use of these practices without the knowledge of the treating pediatrician. In contrast, many others search for consultation provided by a pediatric integrative oncology (IO) practitioner working with the conventional medical team. IO seeks to provide evidence-based complementary medicine therapies, many of which have been shown to augment conventional supportive and palliative care, while ensuring the patient's safety. The present narrative review examines the current state of and future direction for the IO setting of care. RECENT FINDINGS A large body of published clinical research supports the effectiveness of leading Pediatric IO modalities, while addressing potential safety-related concerns. Despite the growing amount of clinical research supporting the beneficial effects and implementation of Pediatric IO models of care, there is still a need for further studies in order to establish clinical guidelines in the treatment of children and adolescents with cancer. Such IO-directed guidelines will need to address both the effectiveness and the safety of the CAM modalities being used in pediatric oncology and hemato-oncology settings, promoting a better understanding among pediatric healthcare professionals and helping them understand the indications for referral to the IO treatment service.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service, Zebulun Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Carmel &, Lin, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Noah Samuels
- Center for Integrative Complementary Medicine, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Orit Gressel
- Integrative Oncology Program, The Oncology Service, Zebulun Medical Centers, Clalit Health Services, Haifa and Western Galilee District, Carmel &, Lin, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Raviv Peleg
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Integrative Pediatric Medicine Program, Petach Tikva, Israel
| | - Miek Jong
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT, Tromsø, Norway
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Inhestern L, Nasse ML, Krauth KA, Kandels D, Rutkowski S, Escherich G, Bergelt C. Reintegration into school, kindergarten and work in families of childhood cancer survivors after a family-oriented rehabilitation program. Front Pediatr 2024; 12:1288567. [PMID: 38516352 PMCID: PMC10954838 DOI: 10.3389/fped.2024.1288567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Objective To describe the situation of childhood cancer survivors and their parents before and one year after a family-oriented rehabilitation program (FOR) and to identify factors influencing reintegration. Methods We included parents of children diagnosed with leukemia or central nervous system tumor. We assessed parental functioning using the functioning subscale of the Ulm Quality of Life Inventory for Parents (ULQIE) and children's school/kindergarten related quality of life (parental assessment, subscale KINDL-R). Descriptive analyses, group comparisons and multiple regression analyses on data of 285 parents of 174 children diagnosed with leukemia or central nervous system tumor. Results Parents reported changes in their work situation (e.g., reduction of working hours) due to their child's diagnosis. Parental functioning increased significantly over time. Children's leukemia diagnosis and shorter time since the end of treatment were associated with higher functioning in parents one year after FOR. Parents reported difficulties in the child's work pace, concentration, stress resilience and empathy. The school/kindergarten-related quality of life (QoL) of the children was lower than in the general population. One year after FOR, most children reintegrated fully in school/kindergarten, partly with support (e.g., integration assistant). No significant predictors for children's reintegration were identified. Discussion Parents and children experience major changes in their work/school/kindergarten life. One year after FOR most parents reported a reintegration of their children, however the children's school/kindergarten-related QoL remained below average compared to norm values. Even after rehabilitation families of childhood cancer survivors might benefit from psychosocial and practical support offers to support families with the reintegration into work/school/kindergarten.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mona L. Nasse
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konstantin A. Krauth
- Department of Pediatrics, Pediatric Hematology & Oncology, Klinik Bad Oexen, Bad Oeynhausen, Germany
| | - Daniela Kandels
- Swabian Children’s Cancer Center, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Joosse IR, van den Ham HA, Mantel-Teeuwisse AK, Suleman F. The caregiver's experience of childhood cancer treatment in South Africa. J Pharm Policy Pract 2024; 17:2312382. [PMID: 38434724 PMCID: PMC10906129 DOI: 10.1080/20523211.2024.2312382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background This study explored the treatment-related, financial and psychological experiences of caregivers during cancer treatment of their children in South Africa's (SA) public and private sectors. Methods In this exploratory study, three focus groups were conducted with caregivers of children undergoing cancer treatment in SA's public healthcare sector. A fourth small focus group with two parents in the private sector was conducted online. A mixed-methods approach was employed using a combination of thematic analysis and grounded theory. Results Of the 20 public sector caregivers, many expressed frustration at the number of visits to primary healthcare clinics before being referred. Caregivers had difficulties coping with and accepting the diagnosis, alongside managing continued care for the child and other children at home. Support received by family and community members was varied. Financial strain was an important concern. The two private sector parents indicated greater levels of support and no financial hardship, but expressed similar levels of emotional stress. Conclusion These caregiver experiences indicate that improvements are urgently needed in the recognition of childhood cancer symptoms at primary healthcare level in SA. They also highlight a need for increased financial support from government through social grants, travel allowances and nutritional support.
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Affiliation(s)
- I. R. Joosse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - H. A. van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - A. K. Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - F. Suleman
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Nielsen CL, Clemensen J, Callesen MT, Jensen CS, Smith AC, Holm KG. Who is supporting the parents during their child's cancer treatment? A qualitative study through the lens of compassion. Eur J Oncol Nurs 2024; 70:102534. [PMID: 38490044 DOI: 10.1016/j.ejon.2024.102534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/21/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Parents of children/adolescents with cancer are placed in a state of severe suffering due to serious concerns, fears, and radical daily life changes. Human support is an important source of support for successful coping. This study explored fundamental aspects of parents' daily, social, and personal life during their child's treatment to deepen our understanding of 'who' plays a significant role in supporting parents, and how, and to what extent this support is provided. METHODS This qualitative study was undertaken in a compassion paradigm, designed and guided by Heidegger's and Gadamer's philosophy and compassionate methods. Data were generated through ethnographic observations (144 h), focus group interviews (n = 2), and individual/couple interviews (n = 16) at two Danish hospitals. Inductive content analysis was used to analyse data. RESULTS Overall, support from peers, health professionals, and social networks constituted significant sources of support. Especially peers and health professionals had a continuous support role, which was fundamental for establishing interpersonal closeness and relieving suffering. Sharing responsibilities between parents and among social networks seemed to ease the emotional and practical burden. However, to ensure effectiveness, social networks must be available, outreach, and responsive to needs. Moreover, parents disclosed little self-awareness and resources and options for self-care due to a combination of lack of awareness, time, and space in the hospitals. CONCLUSION Safeguarding interpersonal and interparental understanding and closeness in parental care is essential. One way is building resilience and a broader human-to-human-based safety net around the family, including social networks and professional psychosocial support, advantageously using compassion.
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Affiliation(s)
- Camilla Littau Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Centre for Compassion in Healthcare, Department of Clinical Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.
| | - Jane Clemensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Centre for Compassion in Healthcare, Department of Clinical Research, Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | | | - Claus Sixtus Jensen
- Research Centre for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Paediatrics and Adolescent Medicine, Unit for Research and Development in Nursing for Children and Young People, Aarhus University Hospital, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Denmark; Centre for Online Health, The University of Queensland, Australia; Centre for Health Services Research, The University of Queensland, Australia
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
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Guido A, Marconi E, Peruzzi L, Dinapoli N, Tamburrini G, Attinà G, Romano A, Maurizi P, Mastrangelo S, Chiesa S, Gambacorta MA, Ruggiero A, Chieffo DPR. Psychological Experiences of Parents of Pediatric Cancer Patients during and after COVID-19 Pandemic. Cancers (Basel) 2024; 16:891. [PMID: 38473253 DOI: 10.3390/cancers16050891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Family members dealing with the devastating impact of a cancer diagnosis are now facing even greater vulnerability due to the COVID-19 pandemic. Alongside the already overwhelming trauma, they must also bear the distressing burden of the infection risks. The purpose of this study was to examine and explore the effects in parents of pediatric cancer patients two years after the start of the COVID-19 pandemic to compare these data with the previous data. METHODS We conducted a single-center prospective observational study, enrolling 75 parents of 42 pediatric oncology patients. Four questionnaires (IES-R; PSS; STAI-Y and PedsQL) were given to the parents 2 years after the first evaluation. RESULTS The bivariate matrix of correlation found a strong significant positive correlation between IES-R and PSS scores (r = 0.526, p < 0.001) as in T1. Stress symptoms (t = 0.00, p < 0.001) and levels of anxiety (trait) (t = 0.32, p < 0.001) remained unchanged; anxiety state levels appeared to have increased (t = 0.425, p < 0.001); there was a significant decrease in the PedsQL tot (t = 5.25, p < 0.001). CONCLUSIONS The COVID-19 pandemic has influenced the levels of stress and anxiety of parents and the quality of life of patients, also correlating with the traumatic impact of the diagnosis.
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Affiliation(s)
- Antonella Guido
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
| | - Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00128 Rome, Italy
| | - Laura Peruzzi
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
| | - Nicola Dinapoli
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00128 Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00128 Rome, Italy
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Department of Woman and Child Health and Public Health, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Department of Woman and Child Health and Public Health, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Silvia Chiesa
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00128 Rome, Italy
| | - Maria Antonietta Gambacorta
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00128 Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Department of Woman and Child Health and Public Health, Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00128 Rome, Italy
- Department of Life Sciences and Public Health Department, Università Cattolica Sacro Cuore, 00168 Rome, Italy
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11
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Hosseinchi P, Ghalibaf E, Kamyab G, Eghbali A, Khatibi A. Health anxiety and the negative interpretation of children's bodily symptoms in mothers of cancer patients. J Cancer Surviv 2024; 18:157-164. [PMID: 37470950 PMCID: PMC10866749 DOI: 10.1007/s11764-023-01431-z] [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: 11/03/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Fear of progression (FoP) is a substantial concern for family caregivers of cancer survivors and is related to a number of adverse outcomes, including increased mental distress and worse quality of life. Previous research has revealed that health anxiety (HA) contributes to fear of relapse, but cognitive factors underlying establishing and maintaining FoP in mothers of cancer patients have not been examined. In this study, we were looking to investigate this association. METHODS We used the computerized interpretation bias (IB) assessment to investigate the biased interpretation of ambiguous bodily information and its association with FoP through HA among 69 mothers of cancer patients and 42 mothers of healthy kids. RESULTS Mothers of cancer patients interpreted more negatively ambiguous bodily symptoms than mothers of healthy kids. Moreover, they had higher levels of HA and FoP and lower quality of life than the healthy group. Also, among mothers of cancer patients, the relationship between negative IB and FoP is mediated by their HA. CONCLUSIONS The findings of this study imply that negative IB may contribute to increased HA, which in turn contributes to higher levels of FoP among the mothers of cancer patients, which may reduce the quality of life of their children. IMPLICATIONS FOR CANCER SURVIVORS From these findings, we propose that changing HA through modification of IB might lower the FoP in mothers of kids with cancer and improve the mother and child's quality of life.
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Affiliation(s)
| | | | - Golnoosh Kamyab
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
- CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivieres, QC, Canada
| | - Aziz Eghbali
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
- Ali-Asghar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
- Institute for Mental Health, University of Birmingham, Birmingham, UK.
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12
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Dalkner N, Fleischmann E, Borgmann-Staudt A, Fürschuß C, Klco-Brosius S, Kepakova K, Kruseova J, Lackner H, Michel G, Mohapp A, Nagele E, Panasiuk A, Tamesberger M, Reininghaus EZ, Wiegele K, Balcerek M. Parenthood for childhood cancer survivors: unfounded fear of cancer development in offspring and related health behaviors. Front Psychol 2024; 14:1269216. [PMID: 38282841 PMCID: PMC10811955 DOI: 10.3389/fpsyg.2023.1269216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
Current literature reveals no increased risk for adverse non-hereditary health outcomes in the offspring of childhood cancer survivors (CCS), yet survivors reported concerns regarding their offspring's health. To investigate how the fear of cancer development in offspring influences parental behavior related to health and prevention, survey reports from 256 European adult CCS and 256 age- and sex-matched siblings who participated in a multicenter study on offspring health were analyzed in the present study. Analyses of covariance and chi-square tests were conducted to test for differences between CCS and siblings in outcome variables (all related to healthy parenting behavior). CCS reported higher fear levels (p = 0.044, Partial η2 = 0.01) and less alcohol consumption (p = 0.011, Phi = 0.12) and smoking (p = 0.022, Phi = 0.11) during pregnancy than siblings. In survivor families, children were breastfed less often (p < 0.001, Phi = 0.18). Partial correlation analyses showed that CCS' fear levels decreased with increasing age (r = -0.16, p = 0.014), time since oncological therapy (r = -0.19, p = 0.003), and number of children (r = -0.21, p = 0.001). Overall, due to their own experiences with cancer, many CCS harbor misperceptions regarding the health outcomes of their offspring. Although the fear decreases with increasing distance from the active disease, any fear should be taken seriously, even if unfounded, and combated through targeted educational measures.
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Affiliation(s)
- Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anja Borgmann-Staudt
- Department of Pediatric Oncology and Hematology, Charité Berlin, Berlin, Germany
| | - Christine Fürschuß
- Division of Paediatric Haematology/Oncology, Medical University of Graz, Graz, Austria
| | | | - Katerina Kepakova
- Czech Republic and International Clinical Research Center (FNUSA-ICRC), University Hospital Brno, Brno, Czechia
| | - Jarmila Kruseova
- Department of Pediatric Haematology and Oncology, University Hospital Motol Prague, Prague, Czechia
| | - Herwig Lackner
- Division of Paediatric Haematology/Oncology, Medical University of Graz, Graz, Austria
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Andrea Mohapp
- Division of Paediatric Haematology/Oncology, Medical University of Graz, Graz, Austria
| | - Eva Nagele
- Division of Paediatric Haematology/Oncology, Medical University of Graz, Graz, Austria
| | - Anna Panasiuk
- Bone Marrow Transplantation Unit, Medical University of Wroclaw, Wrocław, Poland
| | - Melanie Tamesberger
- Department of Pediatric Oncology, Kepler Universitätsklinikum, Linz, Austria
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Karin Wiegele
- Division of Paediatric Haematology/Oncology, Medical University of Graz, Graz, Austria
| | - Magdalena Balcerek
- Department of Pediatric Oncology and Hematology, Charité Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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13
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Holm M, Lundberg T, Lövgren M, Ljungman L. Parenting a child with cancer and maintaining a healthy couple relationship: Findings from the Family Talk Intervention. Pediatr Blood Cancer 2024; 71:e30709. [PMID: 37817346 DOI: 10.1002/pbc.30709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Despite the challenges that caring for a child with cancer brings for parents, little knowledge is available concerning the effects on the parents' couple relationship. Furthermore, few interventions have been designed to support parents in their couple relationship. The aim of this paper was, therefore, to explore parents' experiences of their couple relationship while having a dependent child with cancer and the support they received from a family-based intervention, the Family Talk Intervention (FTI). METHODS Data for this paper were taken from semi-structured interviews performed in a pilot study of the FTI in the context of pediatric oncology. In total, 22 couples were interviewed after participating in the FTI. The interviews were transcribed and analyzed using qualitative content analysis. RESULTS Parents described how maintaining a couple relationship while living with childhood cancer could be very challenging and was not given the highest priority. The FTI was considered a way of providing important support to the couple and a chance for them to sit down together and listen to each other's perspectives on the situation. Parents described that the FTI had helped them gain an increased mutual understanding, sometimes also helping them to realize that they needed more extensive professional support in their relationship. CONCLUSIONS Living with childhood cancer and upholding a healthy couple relationship is challenging for parents. The FTI has the potential to support couples, mainly by providing opportunities for parents to communicate with each other. However, some couples may be in need of a tailored clinical intervention.
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Affiliation(s)
- Maja Holm
- Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Tina Lundberg
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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14
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Reuther C, Lundgren J, Gottvall M, Ljungberg J, Woodford J, von Essen L. E-therapists' views on the acceptability and feasibility of an internet-administered, guided, low-intensity cognitive behavioural therapy intervention for parents of children treated for cancer: A qualitative study. Digit Health 2024; 10:20552076241260513. [PMID: 38846368 PMCID: PMC11155313 DOI: 10.1177/20552076241260513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Background Childhood cancer treatment completion can be a period of vulnerability for parents and is associated with mental health difficulties such as depression and anxiety. We developed an internet-administered, guided, low-intensity cognitive behavioural therapy-based self-help intervention (EJDeR) for parents delivered on the U-CARE-portal (Portal). The acceptability and feasibility of EJDeR and study procedures were examined using a single-arm feasibility trial (ENGAGE). Results indicated that EJDeR and ENGAGE study procedures are acceptable and feasible, however, a need for clinical and technical modifications to EJDeR and refinements to ENGAGE study procedures was identified. Objectives This study aimed to explore the acceptability and feasibility of EJDeR and ENGAGE study procedures from the perspective of e-therapists to inform clinical and technical modifications to EJDeR and refinements to study procedures prior to progression to a superiority randomised controlled trial. Methods We conducted semi-structured interviews with 10 e-therapists. Data were analysed using manifest content analysis. Results We identified three categories relating to the acceptability and feasibility of EJDeR: (a) Support to e-therapists (subcategories: Clinical supervision and Technical difficulties); (b) Guidance to parents (subcategories: Support protocols and Synchronous communication); and (c) Content (subcategories: Relevancy of the intervention and Pacing of the intervention). We identified four categories relating to the acceptability and feasibility of study procedures: (a) Recruitment and training of e-therapists (subcategories: Definition of the role and Training program); (b) Retention of parents (subcategories: Parent suitability and screening and Frequency of weekly Portal assessments); (c) Retention of e-therapists (subcategories: Administrative requirements and Communication with the research team); and (d) The Portal. Conclusions EJDeR and study procedures were considered acceptable and feasible, however, clinical and technical modifications and refinements to study procedures were suggested to enhance acceptability and feasibility. Results may also inform implementation considerations for both EJDeR and other similar digital psychological interventions. Trial registration number ISRCTN 57233429.
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Affiliation(s)
- Christina Reuther
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Lundgren
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Maria Gottvall
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
| | - Johan Ljungberg
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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15
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Himelhoch AC, Olsavsky AL, Darow EL, Lipak KG, Kenney AE, Fisher RS, Prussien KV, Vannatta KA, Compas BE, Gerhardt CA. Cancer-related stress in childhood cancer survivorship: Prevalence and associations with perceptions of health risks and quality of life. Psychooncology 2024; 33:e6253. [PMID: 38009605 PMCID: PMC10841662 DOI: 10.1002/pon.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Limited research has characterized cancer-related stress (CRS) among families of childhood cancer survivors. We examined the prevalence of CRS among survivors and caregivers, as well as its association with health risk perceptions (i.e., prognosis, risk for diminished quality of life) and views of survivor quality of life (QoL). METHODS At five years post-diagnosis or relapse, survivors (n = 100; Mage = 15.84 years; 89% White), mothers (n = 127), and fathers (n = 59) reported their CRS. Perceived prognosis and risk for diminished QoL were rated on a 0%-100% visual analogue scale, while the PedsQL assessed QoL. RESULTS CRS was low (M = 1.6-1.8, scale: 1-4); mothers reported greater stress than survivors, p = 0.038, d = 0.25. There was an indirect effect of survivors' perceived prognosis on their QoL through CRS, CI = 0.04 to 0.25, R2 = 0.32. Among mothers, there was an indirect effect of perceived prognosis/risk for diminished QoL on their reports of survivor QoL through CRS, CI = 0.03 to 0.23 and -0.15 to -0.03, R2 = 0.28 and 0.32, respectively. There were no indirect effects among fathers. CONCLUSIONS CRS may be an important, modifiable factor that could improve survivors' QoL. Research is needed to examine how CRS changes over time to assess the utility of interventions among female survivors, mothers, and those with lower prognosis estimates.
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Affiliation(s)
- Alexandra C. Himelhoch
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Anna L. Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Eva L. Darow
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Keagan G. Lipak
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Ansley E. Kenney
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Rachel S. Fisher
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
| | - Kemar V. Prussien
- Department of Psychology and Human Development, Vanderbilt
University, Nashville, Tennessee, USA
| | - Kathryn A. Vannatta
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
- Department of Pediatrics and Psychology, The Ohio State
University, Columbus, Ohio, USA
| | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt
University, Nashville, Tennessee, USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
USA
- Department of Pediatrics and Psychology, The Ohio State
University, Columbus, Ohio, USA
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16
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Blundell L, Walker SKL, Ellenbogen S, Giwa S, Hatfield K. Factors that influence families' decision to send their children to a week-long pediatric oncology camp and thoughts about attending camp. Eur J Oncol Nurs 2023; 67:102429. [PMID: 37883908 DOI: 10.1016/j.ejon.2023.102429] [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: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE We sought to understand: families' experience of an overnight pediatric oncology camp open to children with cancer and their siblings aged seven to seventeen (Camp Delight); the considerations that factor into families' decision to attend camp for the first time; and what motivates them to reattend. METHOD Eleven semi-structured interviews were conducted with families who attended Camp Delight during or before August 2020. Thematic analysis was performed using a framework developed by four coders and MaxQDA software. RESULT Six overarching themes were compiled: precipitating experiences, barriers to attending camp, facilitating factors, benefits of camp, pro-return factors, and activities to improve transitioning to camp and reduce uncertainty. CONCLUSION Child and parent hesitancy, travel cost, and distance to camp represent barriers to attendance. Organizers may mitigate these barriers by partnering with trusted health professionals, communicating safeness and benefits of camps, including siblings, implementing strategies for reducing uncertainty, and increasing accessibility.
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Affiliation(s)
- Lisa Blundell
- Janeway Children's Health and Rehabilitation Centre, St. John's, NL, Canada.
| | - Sarah-Kay L Walker
- DeGroote School of Business, Organizational Behaviour and Human Resource Management, McMaster University, Hamilton, ON, Canada.
| | - Stephen Ellenbogen
- School of Social Work, Memorial University of Newfoundland and Labrador, St. John's, NL, Canada.
| | - Sulaimon Giwa
- School of Social Work, Memorial University of Newfoundland and Labrador, St. John's, NL, Canada.
| | - Keeley Hatfield
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, NL, Canada.
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17
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Son H, Oyesanya TO, Brandon D, Docherty SL. Challenges and coping between parents in shared decision-making for children with complex, life-threatening conditions: A qualitative content analysis. J Pediatr Nurs 2023; 73:e93-e99. [PMID: 37516648 PMCID: PMC10818015 DOI: 10.1016/j.pedn.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND & PURPOSE Relatively little is known about the parents' challenges and coping in making decisions for children with complex, life-threatening conditions. Therefore, this secondary analysis aimed to explore the challenges and coping between parents while navigating their decision-making by focusing on their interpersonal relationship. DESIGN & METHOD Data from 38 interviews with parent couples of 20 infants diagnosed with congenital heart disease or receiving hematopoietic stem cell transplantation (HSCT) were analyzed using a conventional content analysis. RESULTS Findings revealed the key challenges between parents in decision-making and how they cope with the challenges together as represented by two main themes of "Challenges faced by parents in making decisions together" and "Parents' collaborative coping with the challenges of making shared decisions." DISCUSSION The majority of challenges that parents face in making decisions were closely related to the nature of the children's complex and life-threatening illness and uncertainty. However, supportive partner helped coping and decision-making, indicating the vital role of spouses in making decisions for their ill child. IMPLICATIONS Assessing parents' marital relationship, providing enough information to ensure that both parents clearly understand the information, and encouraging parents to openly communicate with each other are recommended. Educating healthcare providers to support parents to partner together in shared decision-making is also required. Last, legislating laws that mandate providing psychological counseling services and developments of community-based interventions to support parental relationship would improve parents' shared decision-making. Further research on enhancing parental relationships in the context of a child's illness is required.
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Affiliation(s)
- Heeyeon Son
- College of Nursing, University of Tennessee, Knoxville, TN, USA.
| | | | - Debra Brandon
- School of Nursing, Duke University, Durham, NC 27705, USA
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18
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Beeler D, Christensen V, Parker K, Cottrell E. "The place it puts us in emotionally and relationally with our child, it's damaging": understanding the real-world psychosocial needs of caregivers of childhood cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01461-7. [PMID: 37801177 DOI: 10.1007/s11764-023-01461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Understanding the lived experiences of childhood cancer caregivers can guide the development of effective psychosocial models of care. We conducted this qualitative study to understand triggers that impact the mental health, quality of life, and mental health supportive care needs of caregivers. METHODS A maximum variation sampling strategy was used to recruit study participants for semi-structured interviews. Using a grounded theory approach, transcripts were independently dual-coded using inductive thematic analysis. We conducted a secondary thematic analysis emphasizing the impact of pediatric oncology on caregiver mental health. RESULTS Our findings highlight caregiver experiences connected to their child's appearance, quality of life, or change in behavior. Caregivers reported the need to transition between the role of nurturer and protector and simultaneously be part of the care team, which increased trauma for caregivers and their children. Caregivers noted that the hardest part of being a caregiver is witnessing, participating, and forcing the child to comply with cancer treatment. Caregivers were left wishing there had been more support for these situations. CONCLUSION Our findings reveal real-world experiences that caregivers view as among the most stressful during their child's cancer journey. These events provide insight into the nuanced and most difficult experiences from the caregiver perspective in which emotional support services would be most useful. These insights will inform a future model for mental healthcare. IMPLICATIONS FOR CANCER SURVIVORS Caregivers' treatment-related stress is associated with the quality of life of pediatric cancer patients. Supporting the mental health, quality of life, and mental health supportive care needs of childhood cancer caregivers through supportive care guidelines may positively impact the caregiver-child relationship long into survivorship. Children's and their caregivers' treatment-related stress are indelibly connected to the quality of life concerns throughout the cancer journey. Supporting the mental health, quality of life, and mental health supportive care needs of childhood cancer caregivers through supportive care guidelines will positively impact the caregiver-child relationship long into survivorship.
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Affiliation(s)
- Dori Beeler
- Levine Cancer Atrium Health, Charlotte, NC, USA.
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19
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Jong MC, Dahlqvist H, Lown EA, Schats W, Beckman L, Jong M. A randomized controlled pilot study assessing feasibility and safety of a wilderness program for childhood, adolescent, and young adult cancer survivors: the WAYA study. BMC Public Health 2023; 23:1504. [PMID: 37553637 PMCID: PMC10410899 DOI: 10.1186/s12889-023-16408-x] [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: 12/08/2022] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors suffers from long-lasting health issues following cancer treatment. It is therefore critical to explore effective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors. METHODS Eligible participants were aged 16-39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety. RESULTS Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p = 0.024). Program adherence and data completeness was high (> 90%) in both arms. Adverse Effects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confidence Interval 0.8-1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness significantly increased over time in the wilderness program participants, but not in the holiday program (p < 0.001). No differences were found between the two study arms regarding quality of life, self-esteem, or self-efficacy. CONCLUSION It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the effectiveness of wilderness programs on the health of young cancer survivors. TRIAL REGISTRATION DATE AND NUMBER 18/02/2021, NCT04761042 (clinicaltrials.gov).
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden.
- The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT, Hansine Hansens Veg 18, 9019, Tromsø, Norway.
| | - Heléne Dahlqvist
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
| | - E Anne Lown
- Department of Social & Behavioral Sciences, University of California San Francisco, 490 Illinois Street, SBS, Box 0612, San Francisco, CA, 94143, USA
| | - Winnie Schats
- Scientific Information Service, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lars Beckman
- Department of Oncology, Sundsvall Hospital, 85186, Sundsvall, Sweden
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
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20
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Ilic A, Sievers Y, Roser K, Scheinemann K, Michel G. The information needs of relatives of childhood cancer patients and survivors: A systematic review of qualitative evidence. PATIENT EDUCATION AND COUNSELING 2023; 114:107840. [PMID: 37321115 DOI: 10.1016/j.pec.2023.107840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To synthesize qualitative research on the information needs of relatives of childhood cancer patients and survivors. METHODS Systematic searches of PubMed, PsycINFO, CINAHL, and Scopus identified relevant literature. Extracted data were combined using thematic synthesis. Methodological quality was assessed using the JBI critical appraisal tool for qualitative research. RESULTS The review included 27 publications, with most research focusing on parents or primary caregivers. Five areas of information needs were identified: treatment, medication, and care; general information about cancer; coping and support; follow-up, late effects, and rehabilitation; and parenting and everyday life. Appropriateness of information depended on health care professionals' aptitude, message characteristics, communication setting, and relatives' personal factors. Preferences for form, sources, and timing for information provision varied. CONCLUSION The review identified information needs, communication barriers, and preferences among caregivers and siblings of childhood cancer patients and survivors, highlighting areas requiring further research and clinical consideration in addressing the identified challenges. PRACTICE IMPLICATIONS Caregivers and siblings have unique but similar information needs regarding childhood cancer. To ensure that these needs are met, health care professionals could use eHealth and mHealth technologies, assess each family member's knowledge, and create a safe and supportive environment for questions and feedback.
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Affiliation(s)
- Anica Ilic
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Yara Sievers
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Katrin Scheinemann
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Center for Pediatric Hematology/Oncology, East Swiss Children's Hospital, St. Gallen, Switzerland; Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Canada
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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21
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Christen S, Roser K, Harju E, Gumy-Pause F, Mader L, Vetsch J, von Bueren AO, Michel G. Worries and anxiety in parents of adult survivors of childhood cancer: A report from the Swiss Childhood Cancer Survivor Study-Parents. Pediatr Blood Cancer 2023; 70:e30246. [PMID: 36772880 DOI: 10.1002/pbc.30246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Having a child diagnosed with cancer is distressing for parents. We aimed to compare worries and anxiety in parents of adult childhood cancer survivors with parents of the Swiss general population (GP-parents), and to evaluate characteristics associated with worry in parents of survivors. METHODS We conducted a nationwide, population-based study in parents of survivors (survivors aged ≥20 years at study, ≤16 years at diagnosis, >5 years post diagnosis) and GP-parents (≥1 child aged ≥20 years at study). We used the Worry and Anxiety Questionnaire (WAQ), and computed the WAQ total score (worries; possible range 0-80) and caseness for generalized anxiety disorder (anxiety), cognitive, somatic, and any criteria. We used multilevel, multivariable linear regression to identify characteristics associated with worries in parents of survivors. RESULTS We included 787 parents of 513 survivors (41.0% fathers) and 478 GP-parents (42.3% fathers). Parents of survivors and GP-parents did not differ regarding worries (16.6 vs. 17.1, p = .977), anxiety (2.7% vs. 3.6%, p = .536), cognitive (p = .440), and somatic criteria (p = .067). Less parents of survivors met any criteria (17.7% vs. 24.0%, p = .039). Half of parents reported current cancer-related worries. Higher cancer-related worries were reported by mothers (β = 4.1; 95% CI: 2.0-6.2), parents with one child (β = 5.9; 95% CI: 2.0-9.7), currently experiencing disadvantages because of their child's former disease (β = 7.3; 95% CI: 4.0-10.6), or with support needs (β = 9.0; 95% CI: 3.9-14.2; p = .001). CONCLUSIONS It is encouraging that most parents of adult survivors report similar worries and anxiety as GP-parents, but cancer-related worries are still prevalent. Efforts should be made to empower parents to seek psycho-social support if required.
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Affiliation(s)
- Salome Christen
- Faculty of Health Sciences and Medicine, Department of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Faculty of Health Sciences and Medicine, Department of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Erika Harju
- Faculty of Health Sciences and Medicine, Department of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Fabienne Gumy-Pause
- Pediatric Oncology and Hematology Unit, Department of Women, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
- CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Luzius Mader
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Janine Vetsch
- Department of Health Sciences, Institute of Applied, Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Andre O von Bueren
- Pediatric Oncology and Hematology Unit, Department of Women, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
- CANSEARCH Research Platform for Pediatric Oncology and Hematology, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gisela Michel
- Faculty of Health Sciences and Medicine, Department of Health Sciences, University of Lucerne, Lucerne, Switzerland
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22
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Neves MC, Bártolo A, Prins JB, Sales CMD, Monteiro S. Taking Care of an Adolescent and Young Adult Cancer Survivor: A Systematic Review of the Impact of Cancer on Family Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085488. [PMID: 37107768 PMCID: PMC10138338 DOI: 10.3390/ijerph20085488] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Research usually investigates adolescents and young adults (AYA) with cancer in combination with younger and older cancer patients and survivors. However, AYAs with cancer are a unique group, and their caregivers' experience may also differ from other caregivers of cancer survivors. This systematic review aims to understand the impact of a cancer diagnosis on family caregivers, comparing the experience of caregivers of AYA childhood cancer survivors (AYA CCS) and caregivers of AYA with cancer. Relevant studies were identified through PubMed, Scopus, and Web of Science databases, and their quality was assessed using the Joanna Briggs Institute's critical appraisal checklists. Sixteen studies (17 reports) met the inclusion criteria. Findings were synthesized separately for caregivers of AYA CCS and caregivers of AYA with cancer. Results showed that caregivers in both groups experienced high distress after the diagnosis. Partners of AYAs with cancer experienced diminished quality of life (QoL) and over half reported moderate to high fear of cancer recurrence (FCR). Findings indicated that cancer negatively impacts family caregivers, regardless of the patient's age at diagnosis. However, findings are heterogeneous, and most do not focus on QoL or FCR. More research is needed on the impact of cancer among these family caregivers.
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Affiliation(s)
- Maria Carolina Neves
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
- Correspondence:
| | - Ana Bártolo
- I2P—Portucalense Institute of Psychology, 4200-072 Porto, Portugal
- RECI—Research in Education and Community Intervention, Piaget Institute—ISEIT/Viseu, 3515-776 Viseu, Portugal
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Judith B. Prins
- Department of Medical Psychology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Célia M. D. Sales
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal
| | - Sara Monteiro
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
- Departament of Social Sciences and Management, Open University, 1269-001 Lisboa, Portugal
- Center for Global Studies, Open University, 1269-001 Lisboa, Portugal
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23
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Thiblin E, Woodford J, Reuther C, Lundgren J, Lutvica N, von Essen L. Internet-administered, low-intensity cognitive behavioral therapy for parents of children treated for cancer: A feasibility trial (ENGAGE). Cancer Med 2023; 12:6225-6243. [PMID: 36404407 PMCID: PMC10028033 DOI: 10.1002/cam4.5377] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/05/2022] [Accepted: 10/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Parents of children treated for cancer may experience mental health difficulties, such as depression and anxiety. There is a lack of evidence-based psychological interventions for parents, with psychological support needs unmet. An internet-administered, guided, low-intensity cognitive behavioral therapy-based (LICBT) self-help intervention may provide a solution. METHODS The feasibility and acceptability of such an intervention was examined using a single-arm feasibility trial (ENGAGE). Primary objectives examined: (1) estimates of recruitment and retention rates; (2) feasibility and acceptability of data collection instruments and procedures; and (3) intervention feasibility and acceptability. Clinical outcomes were collected at baseline, post-treatment (12 weeks), and follow-up (6 months). RESULTS The following progression criteria were met: sample size was exceeded within 5 months, with 11.0% enrolled of total population invited, study dropout rate was 24.0%, intervention dropout was 23.6%, missing data remained at ≤10% per measure, and no substantial negative consequences related to participation were reported. Intervention adherence was slightly lower than progression criteria (47.9%). CONCLUSION Findings suggest an internet-administered, guided, LICBT self-help intervention may represent a feasible and acceptable solution for parents of children treated for cancer. With minor study protocol and intervention modifications, progression to a pilot randomized controlled trial (RCT) and subsequent superiority RCT is warranted.
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Affiliation(s)
- Ella Thiblin
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Reuther
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Lundgren
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Nina Lutvica
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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24
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Okada H, Irie W, Sugahara A, Nagoya Y, Saito M, Sasahara Y, Yoshimoto Y, Iwasaki F, Inoue M, Sato M, Ozawa M, Kusuki S, Kamizono J, Ishida Y, Suzuki R, Nakajima-Yamaguchi R, Shiwaku H. Factors associated with employment status among mothers of survivors of childhood cancer: a cross-sectional study. Support Care Cancer 2023; 31:168. [PMID: 36781507 PMCID: PMC9925358 DOI: 10.1007/s00520-023-07623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE To identify the factors associated with employment status among mothers of childhood cancer survivors (CCSs). METHODS We conducted a questionnaire survey on mothers of survivors of childhood cancer to clarify practical factors such as care demands, psychological factors such as motivation to work, and support. After calculating descriptive statistics for all variables, binary logistic regression analysis was performed. RESULTS Of 171 mothers, 129 (75.4%) were employed. The most common form of employment was non-regular (n = 83; 48.5%), including part-time, dispatched, and fixed-term workers. At the time of the survey, compared with nonworking mothers, working mothers tended to be more motivated to work and have lower scores for "Long-term Uncertainty" on the Parent Experience of Child Illness Scale. The results of the binary logistic regression analysis indicated that employment was related to higher motivation to work, the continuation of employment during treatment, more outpatient visits, and a higher amount of support. CONCLUSION As employment of CCSs' mothers is associated with psychological factors such as motivation to work and long-term uncertainty, psychological support for CCSs' mothers might promote employment. In addition, because the continuation of employment during treatment affects the employment of mothers after the end of cancer treatment, a leave system that covers the treatment period for childhood cancer needs to be established.
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Affiliation(s)
- Hiromi Okada
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. .,Faculty of Healthcare, Tokyo Healthcare University, 4-1-17 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8648, Japan.
| | - Wataru Irie
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akiko Sugahara
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuko Nagoya
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Nursing, Miyagi University, Sendai, Miyagi, Japan
| | - Masayo Saito
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Nursing, School of Health Science, Akita University Graduate School of Medicine and Faculty of Medicine, Akita, Akita, Japan
| | - Yoji Sasahara
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Fuminori Iwasaki
- Division of Hematology and Oncology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Maho Sato
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Miwa Ozawa
- Department of Pediatrics, St. Luke's International Hospital, Chuo-Ku, Tokyo, Japan
| | | | - Junji Kamizono
- Children's Medical Center, Kitakyushu City Yahata Hospital, Kitakyushu, Fukuoka, Japan
| | - Yasushi Ishida
- Pediatric Medical Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Ryoko Suzuki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Hitoshi Shiwaku
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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25
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Lundgren J, Thiblin E, Lutvica N, Reuther C, Farrand P, Woodford J, von Essen L. Concerns experienced by parents of children treated for cancer: A qualitative study to inform adaptations to an internet-administered, low-intensity cognitive behavioral therapy intervention. Psychooncology 2023; 32:237-246. [PMID: 36447354 PMCID: PMC10107313 DOI: 10.1002/pon.6074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/25/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Childhood cancer treatment completion is associated with mental health difficulties and negative socioeconomic consequences for parents. However, psychological support needs are often unmet. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy-based self-help intervention (EJDeR) and examined feasibility and acceptability with a single-arm feasibility trial (ENGAGE). Results suggest EJDeR is acceptable, however, adherence, especially for fathers, could be improved. Following the Medical Research Council complex interventions framework, this study explores concerns experienced by parents actively seeking support related to their child's cancer who were recruited into ENGAGE to inform further adaptation of EJDeR. METHOD Seventy-three semi-structured interviews (26 fathers, 47 mothers) were conducted, with data analyzed using manifest content analysis. RESULTS Analysis resulted in seven categories: (1) Feeling lost and lonely in life; (2) Low mood; (3) Parenting difficulties; (4) Productivity difficulties; (5) Relationship challenges; (6) Stress reactions; and (7) Worry. With the exception of subcategories Afraid of not being a good parent, Cancer recurrence, and Child's development and future a somewhat higher percentage of mothers than fathers mentioned all identified concerns. CONCLUSION Parents described experiencing a range of concerns after their child had completed cancer treatment. EJDeR will be adapted to address these concerns and include indirect intervention modules targeting concerns such as stress. Information to support parenting, relationships, finance, and employment difficulties, alongside signposting to inform help-seeking, will be included. Findings also suggest a need to improve the gender-sensitivity of EJDeR.
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Affiliation(s)
- Johan Lundgren
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ella Thiblin
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Nina Lutvica
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Reuther
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Paul Farrand
- Clinical Education, Development, and Research (CEDAR), Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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26
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Cetin N. Examining the Role of Post-Treatment Family Support in Pediatric and Adolescent Cancer Survivors: A Systematic Review. J Adolesc Young Adult Oncol 2023; 12:1-8. [PMID: 35100040 DOI: 10.1089/jayao.2021.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Families play a critical role in the health and well-being of adolescent and young adult (AYA)-aged survivors (13-39 years) of pediatric and AYA cancers during cancer treatment. However, little is known about the roles that families play post-treatment. It is important to expand an understanding on the roles of family support on post-treatment psychosocial health outcomes. This review aims to synthesize the current literature on family support on post-treatment psychosocial health outcomes. Methods: A systematic literature search utilizing PubMed returned n = 15 peer-reviewed journal articles investigating parent and family psychosocial support roles post-treatment. Results: Parental support, family functioning, parental knowledge, and education in survivorship care are critical factors in lowering psychological and emotional distress, increasing identification of long-term risks associated with cancer treatment, and increasing autonomy and psychological growth and development. Conclusion: Results suggest that health care professionals should consider integrating factors such as assessment of family functioning and increasing parent education in post-treatment clinical assessments. Integrating family support when assessing a survivor's post-treatment supportive care needs may strengthen psychosocial survivorship care.
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Affiliation(s)
- Nazan Cetin
- School of Social Work, Portland State University, Portland, Oregon, USA
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27
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van Gorp M, Joosten MMH, Maas A, Drenth BL, van der Aa-van Delden A, Kremer LCM, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Ronckers C, Bresters D, Louwerens M, Neggers SJCCM, van der Heiden-van der Loo M, Maurice-Stam H, Grootenhuis MA. Psychosocial functioning of parents of Dutch long-term survivors of childhood cancer. Psychooncology 2023; 32:283-294. [PMID: 36426662 PMCID: PMC10107521 DOI: 10.1002/pon.6069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe health-related quality of life (HRQoL), post-traumatic stress and post-traumatic growth of parents of long-term survivors of childhood cancer (CCS) and study associated factors. METHODS Parents of survivors of the Dutch Childhood Cancer Survivor Study LATER cohort below 30 years and diagnosed 1986-2001 were invited to complete the TNO-AZL Questionnaire for Adult's HRQoL (e.g., sleep and aggressive emotions), Self-Rating Scale for Post-traumatic Stress Disorder, Post-traumatic Growth Inventory, and Illness Cognition Questionnaire. HRQoL domain scores were compared to references using Mann-Whitney U tests. Correlations between post-traumatic stress, growth and HRQoL were evaluated. Medical characteristics of their child and illness cognitions were studied as associated factors of HRQOL, post-traumatic stress and growth. p < 0.05 was considered statistically significant. RESULTS Parents (n = 661 of n = 448 survivors, 56% female, mean time since child's diagnosis: 21.3 [SD: 3.3] years) reported better HRQoL in social functioning and aggressive emotions than references (r = .08-0.17). Mothers additionally reported better HRQoL in pain, daily activities, sexuality, vitality, positive and depressive emotions (r = .07-0.14). Post-traumatic stress was symptomatic in 3%, and associated with worse HRQoL (r = -0.27-0.48). Post-traumatic growth was positively associated to post-traumatic stress and better HRQoL (r = 0.09-0.12). Cancer recurrence was associated to better HRQoL (β = 0.37-0.46). Acceptance illness cognitions were associated to better (β = 0.12-0.25), and helplessness to worse outcomes (β = 0.14-0.38). CONCLUSIONS HRQoL of parents of young adult survivors of CCS is comparable to references or slightly better. Only a small proportion reports symptomatic post-traumatic stress. Improving acceptance and reducing feelings of helplessness may provide treatment targets for parents with psychosocial problems.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Mala M H Joosten
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Anne Maas
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Babet L Drenth
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Obstetrics and Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of pediatric oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Health Services Research, Carl v Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands.,Willem-Alexander Children's Hospital, Leiden, The Netherlands
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28
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Hsu TW, Liang CS, Tsai SJ, Bai YM, Su TP, Chen TJ, Chen MH. Risk of Major Psychiatric Disorders Among Children and Adolescents Surviving Malignancies: A Nationwide Longitudinal Study. J Clin Oncol 2023; 41:2054-2066. [PMID: 36649568 DOI: 10.1200/jco.22.01189] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Evidence suggests an increased long-term risk of major psychiatric disorders (MPDs) in childhood and adolescent cancer survivors (CACSs). However, definitive conclusions regarding such associations and whether such associations vary for different types of cancers remain unclear. METHODS Using a nationwide data set from 2001 to 2011, we enrolled CACSs and likewise randomly selected individuals without cancer from the general population (1:10 ratio) who were matched to the CACSs with regard to demographic data. We investigated eight organ system-related cancers. The primary outcomes were the risks of seven MPD diagnoses: autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder. RESULTS CACSs (n = 5,121; mean age = 9.08 years) showed increased risks of six MPD diagnoses than controls (n = 51,210), with results as follows (in descending order): ASD (hazard ratio [HR], 10.42; associated 95% CI, 4.58 to 23.69), ADHD (HR, 6.59; 95% CI, 4.91 to 8.86), BD (HR, 2.93; 95% CI, 1.26 to 6.80), MDD (HR, 1.88; 95% CI, 1.26 to 2.79), OCD (HR, 3.37; 95% CI, 1.33 to 8.52), and post-traumatic stress disorder (HR, 6.10; 95% CI, 1.46 to 25.54). CACSs also showed earlier ages at diagnoses of ADHD, schizophrenia, MDD, and OCD than controls. The risks of MPD diagnoses vary according to specific cancer types/categories. Brain cancer and lymphatic/hematopoietic tissue cancer were associated with the greatest number of MPD diagnoses (ie, each was associated with six diagnoses). In addition, ASD and ADHD were associated with most organ system-related cancers (ie, each was associated with five categories). CONCLUSION We found that CACSs were at higher risks of MPD diagnoses than controls. Follow-up care should include psychosocial interventions focusing on early signs of mental health problems and early interventions in this high-risk group.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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29
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Liu Y, Sundquist J, Sundquist K, Zheng D, Ji J. Mental health outcomes in parents of children with a cancer diagnosis in Sweden: A nationwide cohort study. EClinicalMedicine 2023; 55:101734. [PMID: 36419464 PMCID: PMC9676277 DOI: 10.1016/j.eclinm.2022.101734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The diagnosis of paediatric cancer is a crisis for the parents who are the primary caregivers of the affected child. A comprehensive assessment of the longitudinal impact of childhood cancer on parental mental health and the potential sex differences between the parents is lacking. Thus, we aimed to explore the subsequent short- and long-term mental health outcomes among the parents of children with cancer and examine whether the outcomes vary between the mother and father. METHODS By combining several Swedish registers, parents of a child (ages 0-14 years) with a cancer diagnosis between Jan 1, 2006, and Dec 31, 2016 were identified. For each parent of children with cancer, up to five mothers or fathers of cancer-free children were randomly selected and matched, respectively. Hospital contacts for any mental health disorders between 5 years before and 7 years after the diagnosis of childhood cancer were retrieved. An interrupted time series negative binomial regression was performed to assess the short- and long-term impact of a childhood cancer diagnosis on the parents' subsequent mental health outcomes. FINDINGS 16,199 mothers (2852 with a child with cancer and 13,347 without) and 15,708 fathers (2769 with a child with cancer and 12,939 without) were included in this study. Compared with mothers of children without cancer, mothers of children with cancer had higher risks of mental health disorders in the first year after diagnosis (rate ratio [RR] and 95% Confidence Interval [CI], 1.17 (1.03-1.32)), and notably, the adverse impact became more severe over time (RR and 95% CI, 1.36 (1.07-1.74), in the seventh year). For fathers of children with cancer, the risk of mental health disorders was continuously higher compared to matched comparisons (RR and 95% CI, 1.31 (1.01-1.71)). INTERPRETATION Our findings suggested that parental mental health was affected continuously by a diagnosis of childhood cancer in their children. In particular, the mother's mental health was affected more severely. Customised psychological services or interventions are highly needed for the parents of children with cancer. FUNDING Swedish Research Council, Allmänna Sjukhusets i Malmö Stiftelsen för bekämpande av cancer, Swedish Heart-Lung Foundation, ALF funding from Region Skåne and China Scholarship Council.
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Affiliation(s)
- Yishan Liu
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
| | - Deqiang Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Corresponding author.
| | - Jianguang Ji
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden
- Corresponding author.
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Natuhwera G, Ellis P, Wilson Acuda S, Namukwaya E. Psychosocial and emotional morbidities after a diagnosis of cancer: Qualitative evidence from healthcare professional cancer patients. Nurs Open 2022; 10:2971-2982. [PMID: 36539936 PMCID: PMC10077364 DOI: 10.1002/nop2.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
AIM This inquiry aimed to; (1) examine the psychosocial and emotional sequelae associated with cancer patient-hood experience in healthcare professionals (HCPs) in Uganda, (2) generate evidence to inform clinical and nursing practice about the needs of HCP patients with cancer. DESIGN This was a qualitative phenomenological study. METHODS The study was conducted among HCP cancer patients and survivors recruited from oncology and palliative care settings in Uganda. Data were collected via audio-taped, face-to-face or telephone open-ended interviews. Interviews were transcribed verbatim. Thematic analysis was used. RESULTS Eight HCP cancer patients and survivors participated in the study. Their mean age was 56 years, range 29-85 years. Three major themes emerged: (1) From a healthcare provider to a patient, (2) Socioeconomic challenges, and (3) Coping and support strategies.
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Affiliation(s)
| | - Peter Ellis
- CEO Intelligent Care Software Canterbury Christ Church University Canterbury UK
| | - Stanley Wilson Acuda
- Institute of Hospice and Palliative Care in Africa Hospice Africa Uganda Kampala Uganda
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Bretones Nieto B, Pozo Muñoz C, Vázquez López MÁ. Needs Assessment in Parents of Children Affected by Cancer: A Qualitative Perspective. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121957. [PMID: 36553400 PMCID: PMC9776725 DOI: 10.3390/children9121957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/28/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Childhood cancer is a "stressful experience" for parents in their role as caregivers. The aim of this study is to analyze the needs of a group of parents who have children diagnosed with cancer. The assessment looks at all areas of their daily life using a qualitative content analysis approach. METHODS This study uses open questions designed to investigate the main problems faced by the parents of children with cancer. All the answers were analyzed using MAXQDA 20 software. The study was conducted according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS The content analysis of the answers from 13 mothers and 7 fathers is presented. The main themes as priority areas of need were: "informal social support", "coping", "stressors/imbalances" and "health problems". Dissatisfaction with the support provided from the informal network was detected. Although the participants expressed active coping, they also exhibited helplessness, as well as concerns regarding possible sequelae and the impact of this situation on the family's economic/work context. Conciliation problems were a source of stress. All this is consistent with the participants suffering from a variety of health issues. CONCLUSIONS the results show the effect of childhood cancer on different aspects of family life. They provide essential information for designing psychosocial interventions.
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Affiliation(s)
- Blanca Bretones Nieto
- Department of Psychology, University of Almeria, 04120 Almeria, Spain
- Correspondence:
| | - Carmen Pozo Muñoz
- Department of Psychology, University of Almeria, 04120 Almeria, Spain
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Okada H, Maru M, Maeda R, Iwasaki F, Nagasawa M, Takahashi M. The maternal employment status after the completion of their child's cancer treatment: A cross-sectional exploratory study. Nurs Open 2022; 10:1726-1734. [PMID: 36271482 PMCID: PMC9912446 DOI: 10.1002/nop2.1428] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/07/2022] [Accepted: 10/11/2022] [Indexed: 02/11/2023] Open
Abstract
AIM To clarify the details of mothers' employment status after the completion of their child's cancer treatment. DESIGN A cross-sectional exploratory study. METHODS Data are collected from 62 mothers of childhood cancer survivors using self-report questionnaires. Fisher's exact test was used to determine the statistical significance of factors between the mothers who worked and those who did not work after their child's cancer treatment had been completed. RESULTS Thirty-two mothers worked after the completion of their child's cancer treatment. There were significant differences in age, education level, employment status at the diagnosis and time elapsed since the diagnosis between the working mothers and non-working mothers. Twenty-two non-working mothers reported that they had some motivation to work, but the most common reason for not working was "To nurse or care for the child with cancer". Some mothers also stated that they did not work due to anxiety about cancer recurrence.
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Affiliation(s)
- Hiromi Okada
- Faculty of HealthcareTokyo Healthcare UniversityTokyoJapan
| | - Mitsue Maru
- College of Nursing Art and ScienceUniversity of HyogoAkashiJapan
| | - Rumi Maeda
- Nursing Career Pathway Center, Graduate School of Health Care SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Fuminori Iwasaki
- Division of Hematology and OncologyKanagawa Children's Medical CenterYokohamaJapan
| | - Masayuki Nagasawa
- Department of Infection ControlMusashino Red Cross HospitalTokyoJapan,Department of PediatricsMusashino Red Cross HospitalTokyoJapan
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Depressive and Anxiety Disorders of Parents of Children with Cancer. J Clin Med 2022; 11:jcm11195670. [PMID: 36233541 PMCID: PMC9572351 DOI: 10.3390/jcm11195670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
Every year in Poland there are approximately 1200 new cases of malignant tumours in children and adolescents. Leukaemia, CNS tumours, and lymphomas are the most frequently diagnosed cancers. Coping with a child’s illness is challenging, which is why many parents suffer from anxiety, depression disorders, and even PTSD (post-traumatic stress disorder). The aim of this study is to assess the anxiety and depression levels of carers of children with cancer. Method: The study participants were 101 carers of children suffering from cancer. The study was conducted using standardized questionnaires: the Zung ccale, HADS scale, and Karnofsky scale, and three questionnaires designed by the author. Results: According to the results of the Karnofsky scale, carers’ anxiety and depression levels were negatively affected by their children’s poor performance. The younger age of children significantly correlated with the severity of depression in their parents. HADS and Zung scale anxiety levels were observed to have statistically significant effect on the severity of depressive disorders. Conclusions: Receiving a diagnosis of childhood cancer contributes to the incidence of depression and anxiety disorders among carers. Carers’ anxiety and depression levels were strongly associated with their child’s age and their child’s performance.
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Mogensen N, Saaranen E, Olsson E, Klug Albertsen B, Lähteenmäki P, Kreicbergs U, Heyman M, Harila‐Saari A. Quality of life in mothers and fathers of children treated for acute lymphoblastic leukaemia in Sweden, Finland and Denmark. Br J Haematol 2022; 198:1032-1040. [PMID: 35852790 PMCID: PMC9543076 DOI: 10.1111/bjh.18350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
Acute lymphoblastic leukaemia (ALL) has a high survival rate, but treatment is lengthy with risk of severe side‐effects, which may also impact parents' health‐related quality of life (HRQOL). We present data on 526 parents of 310 children treated for ALL according to the NOPHO ALL2008‐protocol, in Sweden, Finland and Denmark. Parents were asked to complete the 36‐Item Short Form Survey (SF‐36) at least 6 months after end of treatment and data were compared with Norwegian reference data. Parental background factors were collected via a study‐specific questionnaire. Participating parents scored significantly lower than the reference population on both physical and mental summary indexes, but only surpassed a minimal clinically important difference for the mental summary index (Mental Component Summary [MCS]). Mothers scored lower than fathers in the MCS and stopped working and took care of the affected child more often than the fathers. Higher mental HRQOL was associated with male gender and living in Finland or Denmark (compared to Sweden). Correlations within spouses in physical and mental scores were weak to moderate. In conclusion, ALL negatively affects parental HRQOL, especially the mental domains, even after treatment. Findings suggest that mothers are more affected than fathers and may require extra support.
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Affiliation(s)
- Nina Mogensen
- Department of Pediatric Oncology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
| | - Ella Saaranen
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Erik Olsson
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine, Faculty of Medicine University of Aarhus Aarhus Denmark
| | - Päivi M. Lähteenmäki
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
- Department of Pediatrics and Adolescent Medicine Turku University Hospital, and Turku University Turku Finland
| | - Ulrika Kreicbergs
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
- Department of Health Care Sciences, Palliative Research Centre Marie Cederschiöld University Stockholm Sweden
| | - Mats Heyman
- Department of Pediatric Oncology Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health, Childhood Cancer Research Unit Karolinska Institutet Stockholm Sweden
| | - Arja Harila‐Saari
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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Parental Sleep, Distress, and Quality of Life in Childhood Acute Lymphoblastic Leukemia: A Longitudinal Report from Diagnosis up to Three Years Later. Cancers (Basel) 2022; 14:cancers14112779. [PMID: 35681759 PMCID: PMC9179657 DOI: 10.3390/cancers14112779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/28/2022] [Accepted: 05/29/2022] [Indexed: 12/13/2022] Open
Abstract
This study assessed sleep, distress and quality of life (QoL) in parents of children with acute lymphoblastic leukemia (ALL) from diagnosis to three years after, and the impact of sleep and distress on QoL. Additionally, this study explored determinants of sleep and distress. Parents completed the MOS Sleep, Distress Thermometer for Parents and SF-12 at four-five months (T0), one year (T1), two years (T2), and three years (T3) after diagnosis. The course of outcomes and longitudinal impact of clinically relevant sleep problems (>1SD above reference’s mean) and clinical distress (score ≥ 4) on QoL Z-scores were assessed with linear mixed-models. Determinants of sleep and distress were assessed with multinomial mixed-models. Parents (81% mothers) of 139 patients (60% males; 76% medium-risk (MR)) participated. Distress and QoL gradually restored from T0 to T3. Sleep problems improved, but were still elevated at T3: 33% reported clinically relevant sleep problems, of which 48% in concurrence with distress. Over time, presence of sleep problems or distress led to lower mental QoL Z-scores (SD-score −0.2 and −0.5, respectively). Presence of both led to a cumulatively lower Z-score (SD-score −1.3). Parents in the latter group were more likely to report insufficient social support, parenting problems, a chronic illness, pain for their child, having a child with MR-ALL, and being closer to diagnosis. In conclusion, parental well-being improves over time, yet sleep problems persist. In combination with ongoing distress, they cumulatively affect QoL. Special attention should be given to parents who are vulnerable to worse outcomes.
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Wikman A, Hovén E, Alvariza A, Lövgren M, Kreicbergs U, Skoglund C, Fransson E, Ljungman G, Ljung R, Ljungman L. Psychotropic medication use in parents of survivors of adolescent cancer: A register-based cohort study. Cancer Med 2022; 11:4341-4353. [PMID: 35474312 DOI: 10.1002/cam4.4780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim was to investigate psychotropic medication use in parents of survivors of adolescent cancer from the acute post-diagnostic phase and up to 2 years following the cancer diagnosis. METHODS This study had a nationwide register-based cohort design comparing psychotropic medication use in parents of adolescent survivors of cancer (n = 2323) to use in parents of cancer-free controls (n = 20,868). Cox proportional hazards models, adjusted for cancer diagnostic group, parents' age, country of birth, education level, marital status and previous mental health problems estimated the risk of use from the time of the cancer diagnosis up to 2 years later. RESULTS During the first 6 months after the cancer diagnosis, both mothers and fathers had an increased risk of use of anxiolytics (mothers: HRadj 1.71, 95% CI 1.30-2.25; fathers: HRadj 1.57, 95% CI 1.10-2.45) and hypnotics/sedatives (mothers: HRadj 1.53, 95% CI 1.23-1.90; fathers: HRadj 1.32, 95% CI 1.00-1.75). For fathers with a prescription of psychotropic medication during the first 6 months after the cancer diagnosis, the risk remained increased after 6 months (HRadj 1.66, 95% CI 1.04-2.65). From 6 months after the cancer diagnosis, only the risk of antidepressant use among mothers was increased (HRadj 1.38, 95% CI 1.08-1.76). Risk factors included being divorced/widowed, born in a non-Nordic country, older age and having had previous mental health problems. CONCLUSION Our study results show that during the immediate post-diagnostic phase, mothers and fathers of survivors of adolescent cancer are at increased risk of use of anxiolytics and sedatives, whereas only mothers are at increased risk of antidepressant use from 6 months until 2 years after the diagnosis. Further, previous mental health problems were shown to be the strongest risk factor for psychotropic medication use in both mothers and fathers, pointing to the particular vulnerability of these parents.
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Affiliation(s)
- Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Hovén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Hagström J, Woodford J, von Essen A, Lähteenmäki P, von Essen L. Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey. BMJ Open 2022; 12:e056758. [PMID: 35365530 PMCID: PMC8977820 DOI: 10.1136/bmjopen-2021-056758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Difficulties with recruitment into clinical trials are common. An opt-out recruitment strategy, whereby potential participants can decline further contact about a study (opt-out), and non-responders are contacted, may facilitate participation. Primary objectives examined opt-out and consent rates, mode and time point of opt-out, and sociodemographic characteristics of those who opted out versus those who chose to participate in a single-arm feasibility trial (ENGAGE) of a guided, internet-administered, cognitive-behavioural therapy-based intervention for parents of children treated for cancer. Secondary objectives examined reasons for non-participation. DESIGN A cross-sectional survey nested within the ENGAGE feasibility trial. SETTING The intervention was delivered from Uppsala University, with parents located throughout Sweden. PARTICIPANTS Potential participants were recruited 3 months-5 years following their child ending treatment for cancer and were identified via their personal identification number (via the Swedish Childhood Cancer Registry and Swedish Tax Agency) and invited via postal invitation packs and could opt out via post, online, telephone or email. Those who did not opt out or consent, within 4 weeks, received up to five telephone calls and/or one postal reminder. RESULTS Of 509 invited, 164 (32.2%) opted out, 78 (47.6%) via post, 53 (32.3%) via telephone, 24 (14.6%) online, and 6 (3.7%) via email, 88 (53.7%) opted out after at least one telephone call and/or postal reminder. There was a trend for parents with lower educational levels to opt out. No need of psychological support, lack of time, and no interest in internet-administered self-help were frequently reported reasons for non-participation. CONCLUSIONS Results emphasise the importance of using different opt-out modes and suggest future research should consider how to widen study participation for parents with lower education levels. Self-identifying a need for psychological support and the acceptability of internet-administered self-help are important factors for participation and should be considered in future research to increase recruitment. TRIAL REGISTRATION NUMBER ISRCTN57233429.
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Affiliation(s)
- Josefin Hagström
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Agnes von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Päivi Lähteenmäki
- Department of Paediatrics and Adolescent Medicine, TYKS Turku University Hospital, Turku, Finland
- Pediatric Oncology and Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Sharp K, Tillery R, Long A, Wang F, Pan H, Phipps S. Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes. Psychol Health 2022; 41:256-267. [PMID: 34855418 PMCID: PMC9809178 DOI: 10.1037/hea0001132] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. METHOD Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. CONCLUSIONS Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Katianne Sharp
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Rachel Tillery
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Fang Wang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
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Makhoul Khoury S, Ben-Zur H. The Effects of Coping Strategies on Distress and Quality of Life among Jewish and Arab Mothers with a child diagnosed with cancer. Eur J Oncol Nurs 2022; 58:102140. [DOI: 10.1016/j.ejon.2022.102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
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Metsä-Simola NS, Remes HM, Hiltunen EM, Martikainen PT. Changes in parents' psychotropic medication use following child's cancer diagnosis: A fixed-effects register-study in Finland. Cancer Med 2022; 11:3145-3155. [PMID: 35345057 PMCID: PMC9385598 DOI: 10.1002/cam4.4662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Symptoms of depression and anxiety are elevated among parents of children with cancer. However, knowledge of parents' psychotropic medication use following child's cancer diagnosis is scarce. METHODS We use longitudinal Finnish register data on 3266 mothers and 2687 fathers whose child (aged 0-19) was diagnosed with cancer during 2000-2016. We record mothers' and fathers' psychotropic medication use (at least one annual purchase of anxiolytics, hypnotics, sedatives, or antidepressants) 5 years before and after the child's diagnosis and assess within-individual changes in medication use by time since diagnosis, cancer type, child's age, presence of siblings, and parent's living arrangements and education using linear probability models with the individual fixed-effects estimator. The fixed-effects models compare each parent's annual probability of psychotropic medication use after diagnosis to their annual probability of medication use during the 5-year period before the diagnosis. RESULTS Psychotropic medication use was more common among mothers than fathers already before the child's diagnosis, 11.2% versus 7.3%. Immediately after diagnosis, psychotropic medication use increased by 6.0 (95% CI 4.8-7.2) percentage points among mothers and by 3.2 (CI 2.1-4.2) percentage points among fathers. Among fathers, medication use returned to pre-diagnosis level by the second year, except among those whose child was diagnosed with acute lymphoblastic leukemia or lymphoblastic lymphoma. Among mothers of children with a central nervous system cancer, medication use remained persistently elevated during the 5-year follow-up. For mothers with other under-aged children or whose diagnosed child was younger than 10 years, the return to pre-diagnosis level was also slow. CONCLUSIONS Having a child with cancer clearly increases parents' psychotropic medication use. The increase is smaller and more short-lived among fathers, but among mothers its duration depends on both cancer type and family characteristics. Our results suggest that an increased care burden poses particular strain to the long-term mental well-being of mothers.
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Affiliation(s)
| | - Hanna M Remes
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Elina M Hiltunen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka T Martikainen
- Population Research Unit, University of Helsinki, Helsinki, Finland.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Laboratory of Public Health, Max Planck Institute for Demographic Research, Rostock, Germany
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Thiblin E, Woodford J, Öhman M, von Essen L. The effect of personalised versus non-personalised study invitations on recruitment within the ENGAGE feasibility trial: an embedded randomised controlled recruitment trial. BMC Med Res Methodol 2022; 22:65. [PMID: 35249543 PMCID: PMC8898447 DOI: 10.1186/s12874-022-01553-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Recruitment into clinical trials is challenging and there is a lack of evidence on effective recruitment strategies. Personalisation of invitation letters is a potentially pragmatic and feasible way of increasing recruitment rates at a low-cost. However, there is a lack of evidence concerning the effect of personalising of study invitation letters on recruitment rates. Methods We undertook a Study Within A Trial (SWAT) to investigate the effect of personalised versus non-personalised study invitation letters on recruitment rates into the host feasibility trial ENGAGE, a feasibility study of an internet-administered, guided, Low Intensity Cognitive-Behavioural Therapy based self-help intervention for parents of children previously treated for cancer. An intervention group (n = 254) received a personalised study invitation letter and the control group (n = 255) received a non-personalised study invitation letter. The primary outcome was the proportion of participants in the intervention group and the control group enrolled into the ENGAGE host feasibility trial. Secondary outcomes relating to the recruitment and screening process, and retention were examined. Differences in proportions between groups for the primary and secondary outcomes were estimated using logistic regression. Results Of the 509 potential participants, 56 (11.0%) were enrolled into the ENGAGE host feasibility trial: personalised: 30/254 (11.8%) and non-personalised: 26/255 (10.2%). No statistically significant effect on personalisation of enrolment was found (OR 1.18, 95% CI 0.68–2.06). No statistically significant differences were found for any secondary outcome. Conclusions Personalisation of study invitations had no effect on recruitment. However, given the small study sample size in the present SWAT, and lack of similar embedded recruitment RCTs to enable a meta-analysis, additional SWATs to examine the personalisation of study invitation letters are warranted. Trial registration ISRCTN57233429; ISRCTN18404129; SWAT 112, Northern Ireland Hub for Trials Methodology Research SWAT repository (2018 OCT 1 1231) (https://www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,939618,en.pdf). Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01553-5.
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von Heymann A, Alef-Defoe S, Salem H, Andersen EAW, Dalton SO, Schmiegelow K, Aw Wadt K, Falck Winther J, Johansen C, Bidstrup PE. Risk of somatic hospitalization in parents after cancer in a child, a nationwide cohort study. Psychooncology 2022; 31:1196-1203. [PMID: 35194898 DOI: 10.1002/pon.5909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/24/2022] [Accepted: 02/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The diagnosis of cancer in a child is a profoundly stressful experience. The impact on parents' somatic health, including lifestyle-related diseases, however, is unresolved. METHODS We conducted a nationwide population- and register-based study with parents of all children under age 20 diagnosed with cancer in Denmark between 1998 - 2013 and parents of cancer-free children, matched (1:10) on child's age and family type. We estimated hazard ratios (HR) with 95% confidence intervals (CI) in Cox proportional hazard models for thirteen major International Classification of Diseases-10 disease-groups, selected stress- and lifestyle-related disease-groups and investigated moderation by time since diagnosis, parental sex, and cancer type. RESULTS Among n=7797 parents of children with cancer compared with n=74,388 parents of cancer-free children (51% mothers, mean age 42), we found no overall pattern of increased risk for 13 broad disease-groups. We found increases in digestive system diseases (HR1.06, 95% CI1.01-1.12), genitourinary system diseases (HR 1.08, 95% CI 1.02-1.14), and neoplasms (HR 1.20, 95% CI 1.13-1.27), the latter attributable mostly to increased rates of tobacco-related cancers and mothers' diet-related cancers. CONCLUSIONS This is the first attempt to document the impact of childhood cancer on parents' somatic health. With the exception of increased risk for neoplasms, likely due to shared genetic or lifestyle factors, our findings offer the reassuring message, that the burden of caring for a child with cancer does not in general increase parents' risk for somatic diseases. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Annika von Heymann
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Cancer Survivorship and Treatment Late Effects, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet
| | - Sierra Alef-Defoe
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen
| | - Hanin Salem
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen
| | | | | | - Kjeld Schmiegelow
- University Hospital Rigshospitalet, Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Karin Aw Wadt
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen.,Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Cancer Survivorship and Treatment Late Effects, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet
| | - Pernille Envold Bidstrup
- Psychological aspects of Cancer, Danish Cancer Society Research Center, Copenhagen.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Lindsay EK, Inagaki TK, Walsh CP, Messay B, Ewing LJ, Marsland AL. Stress-Related Inflammation and Social Withdrawal in Mothers of a Child With Cancer: A 1-Year Follow-Up Study. Psychosom Med 2022; 84:141-150. [PMID: 34935760 DOI: 10.1097/psy.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Acute inflammation-induced sickness behavior involves changes in social behavior that are believed to promote recovery. Whether chronic inflammation can influence social behaviors in ways that promote recovery is unknown. In a sample of mothers of a child with cancer, this report explores the relationship between inflammation that accompanies the stress of diagnosis and changes in social network, cancer-related stress, and inflammation across 1 year. Three hypotheses tested whether a) initial levels of stress associate with initial levels of inflammation, b) initial levels of inflammation predict social network changes over time, and c) social network changes over time buffer changes in stress and inflammation over time. METHODS Cancer-related stress (Impact of Events Scale), social network (social roles and contacts from the Social Network Inventory), and systemic inflammation (circulating interleukin [IL]-6) were assessed in 120 mothers three times after their child's cancer diagnosis: after diagnosis (T1), 6-month follow-up (T2), and 12-month follow-up (T3). RESULTS Consistent with predictions, greater cancer-related stress after diagnosis (T1) was associated with higher IL-6 after diagnosis (T1; b = 0.014, standard error [SE] = 0.01, p = .008). In turn, higher IL-6 after diagnosis (T1) was associated with a decrease in social roles over time (T1 ➔ T3; B = -0.030, SE = 0.01, p = .041). Finally, dropping social roles over time (T1 ➔ T3) was associated with decreases in cancer-related stress (B = 25.44, SE = 12.31, p = .039) and slower increases in IL-6 (B = 1.06, SE = 0.52, p = .040) over time. CONCLUSIONS This study provides a first indication that chronic stress-related systemic inflammation may predict changes in social behavior that associate with stress recovery and slower increases in inflammation in the year after a major life stressor.
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Affiliation(s)
- Emily K Lindsay
- From the University of Pittsburgh (Lindsay, Walsh, Ewing, Marsland), Pittsburgh, Pennslvania; San Diego State University (Inagaki), San Diego, California; and Chalmers P. Wylie VA Ambulatory Care Center (Messay), Whitehall, Ohio
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Moscato E, Patronick J, Wade SL. Family functioning and adaptation following pediatric brain tumor: A systematic review. Pediatr Blood Cancer 2022; 69:e29470. [PMID: 34842339 DOI: 10.1002/pbc.29470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS. METHODS We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions. RESULTS Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs. CONCLUSIONS Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.
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Affiliation(s)
- Emily Moscato
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jamie Patronick
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L Wade
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA.,Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Becker A, Paris C, Roganovic J, Bustos C, Rosas A, Contreras P, Zepeda-Ortega AJ, Bardi E. Childhood leukemia and non-Hodgkin's lymphoma survivors lack knowledge about their past disease and possible late effects. I-BFM ELTEC study with Chilean and Croatian participation. Support Care Cancer 2022; 30:3839-3847. [PMID: 35034196 DOI: 10.1007/s00520-021-06741-5] [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: 09/09/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Late effects in childhood cancer survivors are a major cause of morbidity and mortality. The objective was to establish knowledge about the disease, late effects, self-care practices, application of health knowledge/education, sources of information, and biopsychosocial impact of cancer, and compare the results of Chile and Croatia. METHODS One-hundred-and-seventy-one, 5-year survivors who were treated for leukemia or non-Hodgkin's lymphoma responded to a questionnaire (119 in Chile and 52 in Croatia). The questionnaire was reviewed by BFM-ELTEC. RESULTS Health knowledge about past diagnosis and general treatment had 96% Chilean and 85% Croatian survivors. Ninety percent of Chilean and 73% of Croatian survivors were unaware of possible late effects, and half did not know which specialist to visit for follow-up. Forty-six percent of Chilean and 35% of Croatian survivors knew about healthy lifestyles, but most did not practice them. The 74% of Chileans and 87% of Croatian survivors recalled having received health education during treatment. About 50% of survivors in both groups were afraid or anguish, but it was also a growth experience for 60% of Chilean and 42% of Croatian survivors. Eighty-seven percent Chilean and 77% Croatian survivors considered themselves physically independent, while 76% and 75% felt psychologically independent, respectively. CONCLUSION A significant lack of knowledge about the specific treatment, late effects, and future health in both countries was detected. They did not achieve significant learning with the education received. Psychological sequelae were found that are important to prevent.
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Affiliation(s)
- Ana Becker
- Department of Pediatric Oncology and Hematology, PINDA Group, Hospital Sótero del Río, Unidad de Oncología-Red PINDA, Avenida Concha y Toro 3459, Santiago, 8150000, Puente Alto, Chile.
| | - Claudia Paris
- Department of Pediatric Oncology and Hematology, PINDA Group, Hospital Luis Calvo Mackenna, Santiago, Chile.,Instituto de Pediatría, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | | | - Cristina Bustos
- Department of Pediatric Oncology and Hematology, PINDA Group, Hospital Sótero del Río, Unidad de Oncología-Red PINDA, Avenida Concha y Toro 3459, Santiago, 8150000, Puente Alto, Chile
| | - Amaia Rosas
- Department of Pediatric Oncology and Hematology, PINDA Group, Hospital Sótero del Río, Unidad de Oncología-Red PINDA, Avenida Concha y Toro 3459, Santiago, 8150000, Puente Alto, Chile
| | - Paula Contreras
- Department of Pediatric Oncology and Hematology, PINDA Group, Hospital Sótero del Río, Unidad de Oncología-Red PINDA, Avenida Concha y Toro 3459, Santiago, 8150000, Puente Alto, Chile
| | - Ana J Zepeda-Ortega
- Facultad de Medicina, Escuela de Tecnología Médica, Universidad de Valparaíso, Valparaíso, Chile
| | - Edit Bardi
- St Anna Children's Hospital, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
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Vander Haegen M, Etienne AM. Étude sur les inquiétudes parentales et ses facteurs associés dans le cadre de la rémission d’un cancer pédiatrique. PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2022-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction : Les études sur les inquiétudes et la détresse des parents d’un enfant en rémission de cancer sont moins développées dans la littérature. L’objectif de l’étude est d’examiner l’intensité des inquiétudes ainsi que ses associations avec le facteur d’intolérance à l’incertitude (II) et les symptômes anxiodépressifs.
Méthodes : Soixante et un parents d’enfants en rémission de cancer (de quatre à six ans de rémission) ont participé à l’étude. Les parents ont rempli plusieurs questionnaires évaluant les inquiétudes, l’II et les symptômes anxiodépressifs.
Résultats : Les parents présentent majoritairement des symptômes anxieux et des inquiétudes intenses relatives à l’évolution de la santé de leur enfant en rémission de cancer. Le facteur d’II semble contribuer à expliquer l’intensité des inquiétudes parentales.
Conclusion : Des recommandations ont été publiées concernant la prise en charge des parents d’un enfant en rémission de cancer, mais des études longitudinales centrées sur le parent sont encore nécessaires afin d’améliorer les initiatives de prévention et de prise en charge de ces familles.
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ArpacI T, Altay N. Technology-based psychosocial support for adolescent survivors of leukemia: An example intervention for nurse specialists. JOURNAL OF INTEGRATIVE NURSING 2022. [DOI: 10.4103/jin.jin_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Hong S, Jung J, Ahn J. Development and Evaluation of a Self-Care Program Based on Art Therapy for Mothers Caring for Hospitalized Children with Childhood Cancer: A Pilot Study. ASIAN ONCOLOGY NURSING 2022. [DOI: 10.5388/aon.2022.22.2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sungsil Hong
- Assistant Professor, Department of Nursing, College of Health Science, Kangwon National University, Samcheok, Korea
| | - Jin Jung
- Unit Manager, Department of Nursing, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea
| | - Jeonghee Ahn
- Art Therapist, Art Therapy Studio Soom, Seoul, Korea
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The Psychological Adaptation Process in Chinese Parent Caregivers of Pediatric Leukemia Patients: A Qualitative Analysis. Cancer Nurs 2021; 45:E835-E842. [PMID: 34966062 DOI: 10.1097/ncc.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychological stresses caused by caring for pediatric leukemia patients can affect their parent caregivers' health. How these stressors are successfully managed determines how well these caregivers adapt to the illness situation over time. Previous studies suggest that caregivers will adapt gradually to the adverse consequences of caring for their child with a long-term illness. However, studies of the psychological adaptation process of family caregivers of children with leukemia are limited. OBJECTIVE The aim of this study was to study the psychological adaptation process of the parent caregivers of pediatric leukemia patients. METHODS In this qualitative study, we interviewed 32 caregivers of children with leukemia in China. Data were collected through semistructured interviews and analyzed using the content analysis method. RESULTS The psychological adaptation process in caregivers of pediatric leukemia patients seems to involve 5 stages: initial devastation, accumulation of hope, fluctuation in feelings, integration, and psychological adaptation. Significant emotional changes were observed at each stage. CONCLUSIONS This study identified commonalities in the psychological adaptation process experienced by caregivers of children with leukemia in the Chinese social and cultural context. It also characterized the different emotions that the caregivers had in the 5 stages of adaptation. In addition, our research identified the possible psychological interventions at different stages. IMPLICATIONS FOR PRACTICE The study described the adaptation process of Chinese parents of children with leukemia. The findings of this study will help nurses identify main coping resources, controllable intervention factors, and the timing of intervention for these caregivers of children with leukemia.
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Chodidjah S, Kongvattananon P, Liaw JJ. "Changed our lives": Psychosocial issues experienced by families of early adolescents with leukemia. Eur J Oncol Nurs 2021; 56:102077. [PMID: 34998215 DOI: 10.1016/j.ejon.2021.102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 06/27/2021] [Accepted: 11/20/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This research aimed to explore psychosocial problems experienced by families of early adolescents with leukemia. METHOD This phenomenology research was done during December 2019-August 2020 and involved eighteen families (47 family members) of early adolescents (10-14 years old) with leukemia. Participants were recruited by using purposive sampling and snowball techniques. Data were collected by using in-depth interviews and non-participatory observations until data saturation. Content analysis was used for data analysis. Member checking and triangulation methods were confirmed for trustworthiness. RESULTS The families' perception on psychosocial problem experiences included three themes and nine sub-themes. The first theme was dealing with adolescent' emotional changes with sub-themes, namely, emotional responses to the illness, compensation for the suffering, and self-showing. The second theme was parents' social isolation with sub-themes, namely, cancer-stigma, burden of care, and jealousy to non-cancer families. The last theme was emotional distress struggles with sub-themes, namely, feeling worried, guilty, and depressed. CONCLUSION Leukemia diagnosis in early adolescents causes psychosocial problems affecting the family lives. Health care providers need to concern and support the families and the adolescents so that they can pass through the difficulties with positive adjustments.
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Affiliation(s)
- Siti Chodidjah
- Faculty of Nursing, Thammasat University, Bangkok, Thailand
| | | | - Jen J Liaw
- School of Nursing, National Defense Medical Centre, Taipeh, Taiwan, ROC
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