Lamia P. Barakat

Predicting posttraumatic stress symptoms in mothers and fathers of survivors of childhood cancers.

OBJECTIVE To predict posttraumatic stress symptoms in parents of survivors of childhood cancer, using as predictors the following: personality (trait anxiety); current family and individual variables (perceived life threat, perceived treatment intensity, life events, family functioning, and social support); posttreatment variables (time since treatment ended, child anxiety, medical sequelae); and treatment events (age at diagnosis, radiation therapy, intensity of treatment). METHOD Mothers and fathers of 6- to 20-year-old survivors of childhood cancer (n = 331 families) completed a questionnaire battery in this two-site study. The outcome variable was the Posttraumatic Stress Disorder Reaction Index. Multiple regressions and path analyses were used to test the model. RESULTS For both mothers and fathers, anxiety was the strongest predictor of posttraumatic stress symptoms. The current family and individual variables also contributed significantly, particularly with respect to the individual contributions of perceived life threat, perceived treatment intensity, and social support. Objective medical data did not contribute to posttraumatic stress symptoms. CONCLUSIONS Parental anxiety warrants attention throughout the course of treatment for childhood cancer and after treatment ends. Beliefs about past and present life threats associated with cancer treatment and family and social support are other important targets for intervention.

Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: a randomized clinical trial.

Posttraumatic stress symptoms (PTSS), particularly intrusive thoughts, avoidance, and arousal, are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers. We conducted a randomized wait-list control trial of a newly developed 4-session, 1-day intervention aimed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches--the Surviving Cancer Competently Intervention Program (SCCIP). Participants were 150 adolescent survivors and their mothers, fathers, and adolescent siblings. Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group. A multiple imputations approach was used to address nonrandom missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained. The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family.

Quality of life among adolescents with sickle cell disease: mediation of pain by internalizing symptoms and parenting stress.

BackgroundThis study aimed to clarify associations between pain, psychological adjustment, and family functioning with health-related quality of life (HRQOL) in a sample of adolescents with sickle cell disease (SCD) utilizing teen- and parent-report.MethodsForty-two adolescents (between the ages of 12 and 18) with SCD and their primary caregivers completed paper-and-pencil measures of pain, teens psychological adjustment, and HRQOL. In addition, primary caregivers completed a measure of disease-related parenting stress. Medical file review established disease severity.ResultsPearson correlations identified significant inverse associations of pain frequency with physical and psychosocial domains of HRQOL as rated by the teen and primary caregiver. Generally, internalizing symptoms (i.e. anxiety and depression) and disease-related parenting stress were also significantly correlated with lower HRQOL. Examination of possible mediator models via a series of regression analyses confirmed that disease-related parenting stress served as a mediator between pain frequency and physical and psychosocial HRQOL. Less consistent were findings for mediation models involving internalizing symptoms. For these, parent-rated teen depression and teen anxiety served as mediators of the association of pain frequency and HRQOL.ConclusionResults are consistent with extant literature that suggests the association of pain and HRQOL and identify concomitant pain variables of internalizing symptoms and family variables as mediators. Efforts to improve HRQOL should aim to address internalizing symptoms associated with pain as well as parenting stress in the context of SCD management.

Screening for psychosocial risk in pediatric cancer.

Major professional organizations have called for psychosocial risk screening to identify specific psychosocial needs of children with cancer and their families and facilitate the delivery of appropriate evidence‐based care to address these concerns. However, systematic screening of risk factors at diagnosis is rare in pediatric oncology practice. Subsequent to a brief summary of psychosocial risks in pediatric cancer and the rationale for screening, this review identified three screening models and two screening approaches [Distress Thermometer (DT), Psychosocial Assessment Tool (PAT)], among many more articles calling for screening. Implications of broadly implemented screening for all patients across treatment settings are discussed. Pediatr Blood Cancer 2012; 59: 822–827.

Posttraumatic Stress in Survivors of Childhood Cancer and Mothers: Development and Validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS)

This study presents initial data validating the use of a new instrument, the Impact of Traumatic Stressors Interview Schedule (ITSIS), to assess the occurrence of cancer-related posttraumatic stress in childhood cancer survivors and their mothers. Sixty-six child/adolescent cancer survivors and 64 of their mothers, as well as 130 young adult survivors, completed the ITSIS and other measures of posttraumatic stress and general distress. Five ITSIS factors were identified for the mothers and for the young adult survivors, and three ITSIS factors were identified for the child/adolescent survivors. Factors in all three samples reflected symptoms of posttraumatic distress, concern over medical late effects, communication, and changes in self due to cancer. Only young adult survivors had a factor reflecting a positive engagement with the cancer history. Factors correlated with validation measures in predicted ways. The findings further the conceptualization of posttraumatic stress in pediatric cancer by describing the traumatic experience for survivors and mothers. Comparing factors across samples allows an examination of different influences of cancer within families and over the course of development.

Family psychosocial risk, distress, and service utilization in pediatric cancer: predictive validity of the Psychosocial Assessment Tool.

The way families negotiate diagnosis and early treatment for pediatric cancer sets the stage for their adaptation throughout treatment and survivorship. The Psychosocial Assessment Tool (PAT) is a brief parent‐report screener capable of systematically identifying families at risk for problems of adaptation. The current study evaluated stability and predictive validity of PAT psychosocial risk classification with regard to distress, family functioning, and the use of psychosocial services over the first 4 months of treatment.

Posttraumatic Stress Symptoms and Stressful Life Events Predict the Long-term Adjustment of Survivors of Childhood Cancer and Their Mothers

Objectives: To examine prospectively the impact of posttraumatic stress symptoms (PTSS) in response to childhood cancer and treatment on general adjustment while accounting for the role of other stressful life events and appraisal of life threat and treatment intensity. Methods: As part of a larger study assessing PTSS, 56 childhood cancer survivors, aged 8 to 18, and 65 mothers completed self-report measures of PTSS and appraisal of the intensity and life threat associated with cancer treatment at time 1 and self-report measures of stressful life events and general adjustment at time 2 (approximately 18 months after time 1). Results: For child survivors and their mothers, posttraumatic stress at time 1 significantly predicted general adjustment at time 2, over and above the significant contribution of lifetime stressful events. The life events variable did not function as a mediator in the association of PTSS and general adjustment. Conclusions: Trauma responses to childhood cancer and its treatment have implications for the long-term adaptation of children and their families. Early signs and symptoms of posttraumatic stress and stressful life experiences require early assessment and intervention.

Quality of life of adolescents with cancer: family risks and resources

PurposeThe goal of this study was to evaluate the relative contribution of treatment intensity, family sociodemographic risk, and family resources to health-related quality of life (QOL) of 102 adolescents in treatment for cancer.MethodsAdolescents and parents completed self-report measures of teen QOL, family functioning, and parent-child bonding. Based on parent report of family sociodemographic variables, an additive risk index was computed. A pediatric oncologist rated treatment intensity.ResultsSimultaneous regression analyses demonstrated the significant contribution of roles in family functioning and quality of parent-child relationship to prediction of psychosocial QOL (parent and teen-reported) as well as parent-reported teen physical QOL over and above the contribution of treatment intensity. Family sociodemographic risk did not contribute to QOL in these regression analyses. In additional analyses, specific diagnosis, types of treatment and individual sociodemographic risk variables were not associated with QOL. Parent and teen ratings of family functioning and quality of life were concordant.ConclusionsFamily functioning, including quality of parent-child relationship, are central and potentially modifiable resistance factors in teen QOL while under treatment for cancer. Even more important than relying on diagnosis or treatment, screening for roles and relationships early in treatment may be an important aspect of determining risk for poor QOL outcomes.

A family-based randomized controlled trial of pain intervention for adolescents with sickle cell disease.

The study had 2 aims---to determine the efficacy of a family-based cognitive-behavioral pain management intervention for adolescents with sickle cell disease (SCD) in (1) reducing pain and improving health-related variables and (2) improving psychosocial outcomes. Each adolescent and a family support person were randomly assigned to receive a brief pain intervention (PAIN) (n=27) or a disease education attention control intervention (DISEASE ED) (n=26) delivered at home. Assessment of primary pain and health-related variables (health service use, pain coping, pain-related hindrance of goals) and secondary psychosocial outcomes (disease knowledge, disease self-efficacy, and family communication) occurred at baseline (before randomization), postintervention, and 1-year follow-up. Change on outcomes did not differ significantly by group at either time point. When groups were combined in exploratory analyses, there was evidence of small to medium effects of intervention on health-related and psychosocial variables. Efforts to address barriers to participation and improve feasibility of psychosocial interventions for pediatric SCD are critical to advancing development of effective treatments for pain. Sample size was insufficient to adequately test efficacy, and analyses did not support this focused cognitive-behavioral pain management intervention in this sample of adolescents with SCD. Exploratory analyses suggest that comprehensive interventions, that address a broad range of skills related to disease management and adolescent health concerns, may be more effective in supporting teens during healthcare transition.

Negative thinking as a coping strategy mediator of pain and internalizing symptoms in adolescents with sickle cell disease.

The objective of this study was to examine the role of coping strategies, specifically negative thinking, in mediating the association of pain with symptoms of anxiety and depression in adolescents with sickle cell disease. Fifty-two 12–18-year-old adolescents with sickle cell disease completed a daily pain diary and paper-and-pencil measures of pain, pain coping, depression and anxiety. Symptoms of depression and anxiety were within the non-clinical range. Preliminary analyses indicated that lower family income was associated with higher reports of pain and negative thinking. Mediation regression analyses supported negative thinking as mediating the association of: (1) pain intensity with depression, and (2) pain interference with daily activities with anxiety. Findings highlight negative thinking as a factor compromising adolescents’ adaptation to sickle cell pain; however, further investigation is required to determine the mediating influence of pain coping. Associations for lower income emphasize the multiple risk factors experienced by many of these adolescents.