Psychosocial adjustment in children of mothers with breast cancer

Thirty-five children of 28 mothers diagnosed with breast cancer during the previous year were compared to 34 children of 24 mothers with recent benign breast biopsies. Mothers and children, ages 8-16, completed questionnaires about mood, behavior problems and social functioning to assess whether children of mothers with breast cancer were at increased risk for adjustment problems. Significant differences were not found between children in the breast cancer group and the comparison group on any of the measures, even though mothers with breast cancer reported more psychological distress than mothers with benign biopsies. In addition, children in both groups were functioning better than normative samples on some adjustment measures. Variables measuring the mother's illness and treatment were not significantly related to children's adjustment in the breast cancer group. Findings suggested that some adolescents whose mothers had breast cancer did better in social and academic activities when their mothers were more distressed, while adolescents whose mothers had benign biopsies did less well when their mothers were distressed. The study's small sample size limits conclusions that can be drawn; however, clinical and research implications are discussed, given other reports that some children of parents with cancer may experience adjustment problems.     

Ethnicity moderates the effects of resources on adjustment of Jewish and Arab mothers of children diagnosed with cancer

Objective: The study aimed to explore the adjustment of Jewish and Arab mothers of children diagnosed with cancer. Method: Ninety-seven Jewish and 100 Arab mothers completed questionnaires assessing mastery, social support, and adjustment (psychological distress, quality of life, and future fears and hopes). Results: Arab mothers were higher than Jewish mothers on distress and lower on social support and future hopes). Mastery and social support contributed independently to adjustment indices. Ethnicity moderated the effects of mastery and social support on adjustment. Conclusion: Ethnicity, mastery, and social support are important factors in mothers' adjustment to their child's cancer.     

Predictors of quality of life in newly diagnosed melanoma and breast cancer patients.

BACKGROUND: Quality of life (QoL) is a multidimensional construct, and several psychosocial and medical factors can predict a patient's QoL. We investigated the impact of factors in the psychological stress processes on QoL 3 months after diagnosis of melanoma or breast cancer. PATIENTS AND METHODS: In consecutive melanoma and breast cancer patients with localized disease, cancer-specific social support, coping with cancer, personality trait anger expression, non-cancer stress, sociodemographic variables, cancer and treatment variables, and QoL (evaluated as self-reported psychological and physical symptoms, self-perceived QoL, and depression) were assessed with validated quantitative questionnaires. The associations between QoL and the other factors were investigated with multivariate methods. RESULTS: Only a few factors differed between melanoma and breast cancer, in terms of treatment modalities and gender. The amount of received social support was higher among breast cancer patients. The predicting power of psychological stress factors on all the QoL measures was strong, but differed between the treatment groups (surgery only versus adjuvant treatment). Psychosocial factors were the strongest predictors of QoL, not cancer type or treatment. Behavioral Escape-Avoidance coping was associated with worse QoL. However, non-cancer life stresses showed the strongest QoL-decreasing influence. QoL-enhancing factors, including social support, were seen clearly only within the breast cancer patients receiving adjuvant treatment. CONCLUSIONS: QoL of newly diagnosed cancer patients is highly associated with psychosocial factors. Non-cancer life stresses seem to be very important in the QoL of newly diagnosed cancer patients. Adjuvant treatment may comprise supportive psychosocial factors that enhance QoL in cancer.     

Predictors of affective responses of mothers and fathers of children with cancer.

We investigated predictors of affective responses for 125 parents (77 mothers, 48 fathers) of children with various types of cancer who varied in time of diagnosis from newly diagnosed to 13 years following cancer treatment. The primary rationale of the investigation was to determine whether cognitive appraisals, perceived social supports, and caregivers' perceptions of children's behavior would predict affective responses differentially for mothers and fathers. We defined affectivity as self-reported depressive symptoms, and state and trait anxiety symptoms. Parents did not differ on any of the variables, including affective responses, although differential predictors of affective responses were revealed for mothers and fathers. Affiliation-related attributions were associated with affective responses for mothers, and achievement-related attributions and perceived social support were associated with affective responses for fathers.     

The report of coping strategies and psychosocial adjustment in Korean mothers of children with cancer

Objective: Parents of children with cancer must cope with multiple challenges over time. As most research on parental coping has been conducted in Western countries, little information is available on the parental experience of coping in non‐Western countries. Using a new cultural sample of Korean mothers, this study describes their coping strategies. In addition, the association of particular coping patterns with mothers' report of psychosocial adjustment is investigated. Methods: A total of 200 Korean mothers of children with cancer participated in the study. Coping strategies were measured by the Coping Health Inventory for Parents in the following three categories: Maintaining Family Integration and an Optimistic Outlook for the Situation, Seeking Social Support, and Seeking Information. Maternal psychosocial adjustment was measured by psychological distress, family relationship, and social relationship subscales from the Psychosocial Adjustment to Illness Scale. Results: Korean mothers reported coping strategies related to Maintaining Family Integration and an Optimistic Outlook for the Situation as being most helpful. More frequent use of coping pattern, Maintaining Family Integration and an Optimistic Outlook for the Situation, and less frequent use of coping pattern, Information‐Seeking were significantly associated with lower psychological distress and better family relationship after children's medical and maternal characteristics were controlled for. Coping pattern, Seeking Social Support was only predictive of social relationships. Conclusions: This study suggests that culture may play a significant role in the report of coping among Korean mothers. Future studies should consider culturally preferred coping methods and available resources as they relate to different adjustment outcomes. Copyright © 2008 John Wiley & Sons, Ltd.     

Counseling patients with newly diagnosed prostate cancer

Almost 200,000 men are diagnosed with localized prostate cancer each year. With the burgeoning number of treatment options for this disease, the number of patients seeking second opinions from an increasing variety of medical specialties will continue to increase. In 1999 (and for the foreseeable future), there is no single best treatment for any given patient--only options. Each treatment choice has a variety of advantages, as well as a unique spectrum of complications and side effects, most of which are poorly quantified and difficult to compare among treatments. Much more objective data are available regarding the efficacy and necessity of staging tests for further evaluation of patients after diagnosis. Current information about both staging and treatment alternatives, discussed in this article, should be part of the knowledge base of all physicians treating patients with prostate cancer.     

Attachment orientations and psychological adjustment of parents of children with cancer: A matched-group comparison

Objective: To investigate the impact of childhood cancer on parents' adult attachment, social support, marital adjustment, anxiety, and depression. Methods: 30 parents of children with childhood cancer and 30 matched controls completed the following questionnaires: Experiences in Close Relationships-Revised, Dyadic Adjustment Scale-4, Multidimensional Scale of Perceived Social Support, State-Trait Anxiety Inventory – form Y, and Beck Depression Inventory. Results: Parents of children with childhood cancer had a significantly lower dyadic adjustment than controls, and higher levels of insecure-avoidant attachment, state anxiety, and depression. Conclusion: It is important for health-care personnel to take into account these parents' propensity to show increased levels of avoidant attachment during children's treatment to foster effective communication and supportive relationships between clinicians, pediatric patients, and parents.     

CNS involvement in children with newly diagnosed non-Hodgkin's lymphoma.

PURPOSE: To determine the frequency of CNS involvement at diagnosis of non-Hodgkin's lymphoma (NHL), to characterize its pattern of presentation, and to determine its prognostic significance. PATIENTS AND METHODS: We reviewed the records of 445 children (1975 through 1995) diagnosed with NHL (small noncleaved cell NHL/B-cell acute lymphoblastic leukemia [SNCC NHL/B-ALL], 201 patients; lymphoblastic, 113; large cell, 119; other, 12). Tumor burden was estimated by serum lactate dehydrogenase (LDH) measurement and reclassification of disease stage irrespective of CNS involvement (modified stage). RESULTS: Thirty-six of 445 children with newly diagnosed NHL had CNS involvement (lymphoma cells in the CSF [n = 23], cranial nerve palsy [n = 9], both features [n = 4]), representing 13%, 7%, and 1% of small noncleaved cell lymphoma, lymphoblastic lymphoma, and large-cell cases, respectively. By univariate analysis, CNS disease at diagnosis did not significantly impact event-free survival (P =. 095), whereas stage and LDH did; however, children with CNS disease at diagnosis were at 2.0 times greater risk of death than those without CNS disease at diagnosis. In a multivariate analysis, CNS disease was not significantly associated with either overall or event-free survival, whereas both serum LDH and stage influenced both overall and event-free survival. Among cases of SNCC NHL/B-ALL, CNS disease was significantly associated with event-free and overall survival (univariate analysis); however, in multivariate analysis, only LDH had independent prognostic significance. Elevated serum LDH or higher modified stage were associated with a trend toward poorer overall survival among children with CNS disease. CONCLUSION: A greater tumor burden at diagnosis adversely influences the treatment outcome of children with NHL and CNS disease at diagnosis, suggesting a need for ongoing improvement in both systemic and CNS-directed therapy.     

Information needs of older patients newly diagnosed with cancer

BackgroundUnderstanding what information patients want and need is an important step in optimizing care. Therefore, we set out to collect all available evidence about the information that is most important to older patients with a new cancer diagnosis and whether or not these information needs are sufficiently addressed.MethodA systematic literature review of Embase and Medline.ResultsWe included eighteen studies addressing the importance of a range of information topics and studies addressing the sufficiency of information provided. On a scale from 1 to 10, patients ranked information about prognosis and the chance of cure as the most important category (median ranking 10, interquartile range (IQR) 8–10), followed by information on cancer itself (median 9, IQR 5.5–9), and treatment options (median 8, IQR 8–9). Information on side-effects of treatment (median 7, IQR 6–8), and practicalities (median 6, IQR 5–7.5) were also considered important. Patients rated information about the practicalities of treatment as the most insufficiently addressed (median 9.5), followed by self-care at home (median 9), and information about prognosis and side-effects (median 8 for both).ConclusionThis systematic review demonstrates that information provision about the cancer itself and about treatment options is generally satisfactory to patients, while information about prognosis, practicalities of treatment and self-care at home could be improved. However, there is significant heterogeneity among older patients regarding which information is most important to them, thus requiring an ongoing dialogue between patients and health care providers about which information is most needed at any given time.     

Predictors of caregiver burden in mothers of children with leukemia and cerebral palsy

Objective: Caring for a sick child can lead to considerable burden in the caregiver. Comparative studies of burden in mothers of children with different types of disorders are rare.

Methods: We assessed levels of and risk factors for burden in mothers of children with leukemia (n: 70) or with cerebral palsy (CP) (n: 69). Subjects were recruited from two hospitals in Ankara.

Results: Levels of burden or depression were not different between groups. Burden was predicted by the presence of depression in the mother and severity of illness in both groups. In the leukemia group, mothers reported higher burden if the child was male or younger; no such relationship was observed in the CP group.

Conclusion: Our results show that type of illness has an effect on levels of burden. Mothers of children with leukemia should receive more attention, especially if their child is male or younger, to take preventive measures against burden.     

Sexual quality of life in women with newly diagnosed breast cancer

Sexual quality of life (QOL) is a significant concern for breast cancer survivors. This study investigated sexual quality of life in a sample of 191 newly diagnosed breast cancer patients. Sixty percent of the sample indicated disruption in their sexual quality of life. Sexual QOL during treatment was significantly more disrupted among women who received chemotherapy, were younger, had higher stage of disease, reported more depressive symptoms near time of diagnosis, and underwent a total mastectomy. Hierarchical linear regression was used to model sexual QOL and feelings of sexual attractiveness. Worse physical quality of life, chemotherapy, and depressive symptoms near time of diagnosis were associated with worse sexual QOL during treatment. An interaction between chemotherapy status and type of surgery, for feelings of sexual attractiveness, suggested that chemotherapy affected sexual attractiveness only among women who underwent a lumpectomy. These results add to growing evidence that sexual QOL is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.