Steven Simms

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.

Identifying Psychosocial Risk Indicative of Subsequent Resource Use in Families of Newly Diagnosed Pediatric Oncology Patients

PURPOSE The primary purpose of this prospective study was to identify the level of risk for psychosocial distress in families of children newly diagnosed with cancer. Additional study aims were to examine concordance among family and staff reports of psychosocial risk, changes in risk status over time, and to predict the use of psychosocial resources during the first months of treatment. PATIENTS AND METHODS Caregivers of 125 children newly diagnosed with cancer completed the Psychosocial Assessment Tool (PAT) at diagnosis (t1) and 3 to 6 months later (t2). Primary oncologists and nurses completed an analogous measure of perceived family psychosocial risk at t1 and t2. At t2, oncology social workers reported types and intensity of psychosocial interventions provided. RESULTS The PAT identified three subsets of families who presented with increasing levels of psychosocial risk at diagnosis. In general, there was moderate concordance among family, oncologist, and nurse reports of psychosocial risk. PAT scores at t1 predicted t2 PAT scores and psychosocial resource use at t2 beyond demographic or disease factors. CONCLUSION A brief screening tool (PAT) is valuable in identifying psychosocial risk factors at diagnosis and is predictive of later use of psychosocial resources. As a next step in this research, the development of psychosocial interventions to match family risk level may be an effective and cost-efficient approach to working with families to address their concerns and promote short- and long-term adjustment.

Cognitive, behavioral, and social outcome in survivors of childhood stem cell transplantation.

Purpose To evaluate prospectively the cognitive functioning and to obtain ratings of cognitive, behavioral, and social functioning for children receiving stem cell transplantation (SCT). Patients and Methods Forty-seven children treated with SCT for malignant or nonmalignant disorders who had no previous cranial radiation therapy, no central nervous system tumors, and were aged birth to 16 years were administered the Bayley Scales of Infant Development or IQ test before SCT and an intelligence test 1 and 2 years after SCT. Children and parents rated behavior and social functioning, and parents reported on everyday cognitive abilities (including academic ability) 2 to 6 years after SCT. Results There were no statistically significant differences in IQ over the course of time (before SCT to 2 years after SCT). Only parent ratings of academic ability were significantly lower than the normal standardization sample. Mean mental scale scores for children younger than 3 years were lower than mean IQ scores for children older than 3 years at the pre-SCT assessment. Mean test scores not only decreased for younger children but also were 16 points lower than mean scores for older children at 2 years after SCT. Conclusions The cognitive, behavioral, and social functioning of children 3 years and older is not detrimentally affected 2 years after SCT. Parents of older children report no cognitive ability problems but lower academic ability. Children younger than age 3 years may be at risk for decreased cognitive skills.

Neuropsychological outcome of children undergoing bone marrow transplantation

The purpose of the study was to prospectively evaluate the neuropsychological functioning of children and adolescents receiving a bone marrow transplant (BMT). One hundred and twenty-two children with malignant or nonmalignant disorders and no previous cranial radiation therapy received a pre-BMT neuropsychological evaluation. Surviving children received a 1 year post-BMT neuropsychological evaluation. Patients were placed in a chemotherapy only (chemo) or a chemotherapy and total body irradiation (chemo + TBI) group for statistical analysis. The data were analyzed by t-tests for paired samples. There were no statistically significant differences. Regression analysis failed to identify treatment, age and gender effects. The results suggest that global and specific areas of neuropsychological functioning 1 year post-BMT were not detrimentally affected by chemotherapy or chemotherapy with total body irradiation.

Death in the Family: Adapting a Family Systems Framework to the Grief Process

This paper presents a framework for adapting a family systems approach to the grief process. The framework places the bereaved and therapist in the larger context. The therapist builds a relationship around each family members unique experience with death, and uses the grief timeline to facilitate timely systemic interventions. This perspective helps the therapist navigate pitfalls and remainstrategically positioned to address grief sensitively and effectively in psychotherapy.