Cancer families with children: factors associated with family functioning--a comparative study in Finland

Objective: The objective is to examine the factors associated with family functioning in families with children where a parent has cancer in comparison to families without cancer. Sample and methods: Eighty‐five families including 85 cancer patients, 61 healthy spouses and 68 children between 11 and 17 years of age, and a control group of 59 families including 105 adults and 65 children were given a set of questionnaires including a background variable questionnaire, the Family Assessment Device, the Beck Depression Inventory and the Sense of Coherence (SOC). A statistical multilevel model allowing the use of data from several informants belonging to the same family was constructed for the analysis of associations between variables. Results: Maternal depression and SOC of family members were associated with family functioning; maternal depression impaired family functioning and family members' SOC improved it. No difference was found between the clinical group and the control group. Conclusion: In clinical work with cancer families with children, maternal depression and SOC should be focused on. Copyright © 2007 John Wiley & Sons, Ltd.     

The Effects of Breast Cancer on the Family

The literature was reviewed to identify coping issues and factors associated with family functioning when a family member has cancer and to related these to specfic issues that arise when breast cancer occurs. The approaches to assessment and intervention also were examined. Most studies placed primary emphasis on the patient's problems rather than on the family's, and assessment and intervention models were generally aimed toward chronic illness and all cancers. There is a need to understand how the specific factors affect families and to identify high-risk families who cannot adjust successfully. Further research should compare families who enhance their lives by coping well with those who cope dysfunctionally.     

Psychological distress related to patterns of family functioning among Japanese childhood cancer survivors and their parents

Objective: Family functioning appears to be a predictor of psychological distress among childhood cancer survivors and their family members; however, relatively little is known about patterns in those families that are psychologically at‐risk. The purpose of this study was to identify distinct clusters of families that include childhood cancer survivors, and to evaluate differences between the clusters with respect to anxiety, depression, and post‐traumatic stress symptoms (PTSS). Methods: Childhood cancer survivors and their parents (247 individuals: 88 adolescent cancer survivors, 87 mothers, and 72 fathers) completed self‐report questionnaires. Perceptions of family functioning were assessed using the Family Relationship Index and its three dimensions (cohesiveness, expressiveness, and conflict), and individuals were classified into groups via a cluster analytic approach. State‐trait anxiety, depression, and PTSS were assessed to all of the participants. Results: The individuals were classified into three types: One cluster featured high cohesiveness, high expressiveness, and low conflict (‘Supportive‐type’, n=102); a second cluster featured low cohesiveness, low expressiveness, and high conflict (‘Conflictive‐type’, n=32); and a third cluster had moderate cohesiveness, moderate expressiveness, and moderate conflict (‘Intermediate‐type’, n=113). Among the three types, an analysis of variance revealed that ‘Conflictive‐type’ members had the highest levels of PTSS, depression, and state–trait anxiety. Conclusions: These findings suggest that perceptions of family functioning are related to psychological distress in family members of childhood cancer survivors. A family‐focused intervention might be a useful approach to targeting emotional distress in these families, particularly for families with a ‘Conflictive‐type’ family member. Copyright © 2009 John Wiley & Sons, Ltd.     

死亡教育在临终关怀科癌症患者中的应用

目的:通过对临终关怀科癌症患者及其家属的死亡知识认知度的调查并进行死亡教育,指导患者及家属正确讨论、面对死亡,克服对死亡的恐惧心理,以提高患者的生命质量,使患者的临终意愿得到尊从,达到真正的优死.方法:以2014年6月1日至2015年5月31日临终关怀科收治的癌症患者及直系家属或直接照顾者为研究对象.在入院时及进行死亡教育后一周、二周后自行填写死亡教育知识调查问卷,进行死亡教育前后的对照分析研究.结果:死亡教育后患者及其家属的死亡焦虑状况均有明显缓解;满意度从95.6％提升至98％.但患者生活质量改善无统计学差异,部分患者自我评价生活质量较前下降.结论:死亡教育在临终关怀工作中具有极其重要的作用及意义.     

The validity of the family relationships index as a screening tool for psychological risk in families of cancer patients

The Family Relationships Inventory (FRI) has been proposed as a measure of psychological risk however its validity has only been tested in one cross-sectional study against another measure of family functioning where patients had less than six months to live. The current study presented longitudinal data on the validity of the FRI in identifying family dysfunction, and clinical levels of depression and anxiety in 48 families where the patient had been recently diagnosed. Over the three phases, the FRI identified all families at risk of family dysfunction, 88% or more families with one or more members with clinical depression and 78% or more with a member with clinical levels of anxiety. The FRI was also far more sensitive in identifying families with a member with clinical levels of depression and anxiety than the General Functioning (FAD-GF) scale of the Family Assessment Device. Although other measures of screening adequacy (such as specificity), suggested that the FRI identified too many false positives, the higher sensitivity of the FRI makes it preferable to the FAD-GF as a screening measure for families at risk of a poor psychological outcome in the oncology setting. However, because of the FRI's poor specificity, further follow-up of those families that are identified as being at some risk of a poor psychological outcome should be undertaken before referral to a mental health professional is warranted.     

Investigation of an interaction of alcohol intake and family history on breast cancer risk in the Minnesota Breast Cancer Family Study

BACKGROUND: One explanation for the variability in results in studies of alcohol consumption and breast cancer could be the presence of effect modifiers, such as genetic susceptibility. The authors examined the interaction of alcohol and family history of breast cancer on breast cancer risk in a population-based family study of 426 multigenerational breast cancer families. The authors evaluated whether alcohol use was a stronger risk factor for breast cancer among sisters, daughters, nieces, and granddaughters of breast cancer probands than among women who married into these families. METHODS: Analyses were performed on surrogate and self-reported data combined and on self-reported data alone. To evaluate the interaction of alcohol and breast cancer risk among women with a family history of breast cancer, the authors performed analyses on all 426 families and on a subset of 132 families that had 3 or more breast and/or ovarian cancers in their family. RESULTS: A total of 9032 blood relatives and marry-ins and 558 breast cancer cases were available for analysis. In the entire 426 families, there was a suggestion of an interaction of relationship to the proband and frequency of alcohol consumption on breast cancer risk (P(interaction) = 0.14) for surrogate and self-reported information combined. Among first-degree relatives of the proband, daily drinkers had a significantly increased risk of breast cancer compared with never drinkers (RR = 2.45 [1.20, 5.02]), but this increase was less evident among second-degree relatives who reported daily alcohol intake (RR = 1.27 [0.73, 2.22]) and was not evident in marry-ins who reported daily use of alcohol (RR = 0.90 [0.42, 1.90]). The findings based on the subset of 132 high-risk families with 3 or more breast and/or ovarian cancers were similar to findings based on all 426 families (P(interaction) = 0.07). An interaction of family history with alcohol use was also suggested when the analyses were restricted to self-respondents, although the interaction test P-value was no longer of borderline significance. CONCLUSION: An increased risk of breast cancer due to an increased frequency of alcohol consumption may be limited to women with a family history of breast cancer.     

Psychometric Validation of the Malaysian Chinese Version of the EORTC QLQ-C30 in Colorectal Cancer Patients

Background and Aims: Colorectal cancer is the second most frequent cancer in Malaysia. We aimed to assess the validity and reliability of the Malaysian Chinese version of European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire core (QLQ-C30) in patients with colorectal cancer. Materials and Methods: Translated versions of the QLQ-C30 were obtained from the EORTC. A cross sectional study design was used to obtain data from patients receiving treatment at two teaching hospitals in Kuala Lumpur, Malaysia. The Malaysian Chinese version of QLQ-C30 was self administered in 96 patients while the Karnofsky Performance Scales (KPS) was generated by attending surgeons. Statistical analysis included reliability, convergent, discriminate validity, and known-groups comparisons. Statistical significance was based on p value ≤0.05. Results: The internal consistencies of the Malaysian Chinese version were acceptable [Cronbach’s alpha (α≥ 0.70)] in the global health status/overall quality of life (GHS/QOL), functioning scales except cognitive scale (α≤0.32) in all levels of analysis, and social/family functioning scale ( =0.63) in patients without a stoma. All questionnaire items fulfilled the criteria for convergent and discriminant validity except question number 5, with correlation with role (r = 0.62) and social/family (r = 0.41) functioning higher than with physical functioning scales (r = 0.34). The test-retest coefficients in the GHS/QOL, functioning scales and in most of the symptoms scales were moderate to high (r = 0.58 to 1.00). Patients with a stoma reported statistically significant lower physical functioning (p=0.015), social/family functioning (p=0.013), and higher constipation (p=0.010) and financial difficulty (p=0.037) compared to patients without stoma. There was no significant difference between patients with high and low KPS scores. Conclusions:Malaysian Chinese version of the QLQ-C30 is a valid and reliable measure of HRQOL in patients with colorectal cancer.     

Quality of Life of Family Members Living with Cancer Patients

Background: Due to the rapid progress of industrialization, the expansion of the nuclear family, and anincrease in women’s social activities, the burden of care of cancer patients has increased, so that all familymembers are now involved in care. We compared the health-related quality of life (HRQOL) between membersof families of cancer patients (hereafter, cancer families) and members of cancer-free families (non-cancerfamilies). Materials and Methods: The data were from the Community Health Survey (2012). The studypopulation included respondents at least 30 years of age. Data were adjusted for the following covariates:sex, age, education, marital status, household income, economic activity, household type, chronic disease, andperceived health status. Frequency analysis, analyses of variance, and multiple linear regression analysis wereperformed. Results: Among 163,495 respondents, 3,406 (2.1%) were part of a cancer family and 160,089 (97.9%)were part of a non-cancer family. Cancer families had lower EQ-5D scores than non-cancer families. However,by subgroup, the scores had significant association between cancer and non-cancer families only for females andfor those who worked. Conclusions: There was a significant relationship between HRQOL scores and being afamily member of a cancer patient. This indicates that the responsibility for care has been extended to the entirefamily, not only the primary caregiver.     

The impact of parental cancer on children and the family: a review of the literature

OBJECTIVE: Children of cancer patients may go through a distressing time. The aim of this review was to survey present knowledge on the impact of parental cancer on children and the family. DESIGN: Studies published between January 1980 and March 2004 addressing emotional, social, behavioural, cognitive and physical functioning of children of a parent diagnosed with cancer, as well as the association with child, parental and familial variables were reviewed. RESULTS: Fifty-two studies were found. Emotional problems in school-aged children (11 years) were reported in several qualitative studies, but in only one quantitative study. Quantitative and qualitative studies reported anxiety and depression in adolescents (12 years), in particular in adolescent daughters of ill mothers. Quantitative studies generally showed no behavioural and social problems in school-aged children and adolescents. One quantitative study found physical complaints in school-aged children. However, qualitative studies revealed behavioural problems in school-aged children and also described restrictions in cognitive and physical functioning in children of all ages. The most consistent variables related to child functioning appeared to be parental psychological functioning, marital satisfaction and family communication. Intervention studies directed to the needs of children and their families reported positive effects. CONCLUSION: While quantitative studies reported especially disturbed emotional functioning, qualitative studies reported problems in all domains of child functioning. Well-designed studies are needed to gain more insight into the psychosocial functioning of children of cancer patients in order to develop tailored care.     

The family with cancer

The purpose of this article is to describe what it is like to live with cancer from the perspective of the family: to explore the challenges that families face when a member has cancer; to consider how families influence the experience of the person diagnosed with cancer; and to describe how families cope with a cancer diagnosis.     

High detection rate for BRCA2 mutations in male breast cancer families from North West England

33 families with a history of male breast cancer aged 60 or less or with a family history of male and female breast cancer were screened for the presence of BRCA2 mutations. 12 pathogenic BRCA2 mutations were identified (36%) in samples from an affected family member. All mutations segregated with disease where it was possible to check. Of the 14 families fulfilling BCLC criteria, 9 (64%) had mutations whilst only 3/16 (19%) of male breast cancer patients with less significant female breast cancer family history having a mutation. All 3 families with ovarian cancer and 3 families with multiple male breast cancer cases had BRCA2 mutations. These data are a further guide to how to prioritise samples for BRCA2 mutation analysis.     

Family history of cancer predicts Papanicolaou screening behavior for African American and white women

BACKGROUND:

Understanding women's motivations for getting Papanicolaou (Pap) screening has the potential to impact cancer disparities. This study examined whether having a family history of cancer was a predictor for Pap screening.

METHODS:

By using the National Health Interview Survey 2000 Cancer Control and Family modules, we identified a subsample (n=15,509) of African American (n=2774) and white women (n=12,735) unaffected by cancer, with and without a family history of cancer. Data were analyzed using logistic regression models.

RESULTS:

African American and white women with a positive family history of cancer were 42% (P < .0001) more likely to have had a recent Papanicolaou (Pap) test than their counterparts without a family history of cancer. Among African American women, those with a positive family history of cancer were 53% more likely to have had a recent Pap test, whereas among white women those with a positive family history of cancer were 41% more likely to have received a Pap test. African American women with a family history of cancer were more likely to have had a recent Pap test than white women with or without a family history of cancer.

CONCLUSIONS:

This study presents a unique perspective on Pap screening behavior. Having an immediate family member with any cancer statistically predicted having a recent Pap test for both African American and white women. Because these results demonstrated that regardless of the cancer type, having an immediate affected family member is a motivator for cervical cancer screening behavior, healthcare providers managing cancer treatment patients have a teachable opportunity that extends beyond the patient. Cancer 2009. © 2008 American Cancer Society.     

The attitudes of cancer patients and their families toward the disclosure of terminal illness.

PURPOSE:To ascertain the attitude of cancer patients and their families toward disclosure of terminal illness to the patient. PATIENTS AND METHODS: We constructed a questionnaire that included demographic and clinical information and delivered it to 758 consecutive individuals (433 cancer patients and 325 families that have a relative with cancer) at seven university hospitals and one national cancer center in Korea. RESULTS: 380 cancer patients and one member from each of 281 families that have a relative with cancer completed the questionnaire. Cancer patients were more likely than family members to believe that patients should be informed of the terminal illness (96.1% v 76.9%; P <.001). Fifty percent of the family members and 78.3% of the patients thought that the doctor in charge should be the one who informs the patient. Additionally, 71.7% of the patients and 43.6% of the family members thought that patients should be informed immediately after the diagnosis. Stepwise multiple logistic regression indicated that the patient group was more likely than the family group to want the patient to be informed of the terminal illness (odds ratio [OR], 9.76; 95% CI, 4.31 to 22.14), by the doctor (OR, 4.00; 95% CI, 2.61 to 6.11), and immediately after the diagnosis (OR, 3.64; 95% CI, 2.45 to 5.41). CONCLUSION: Our findings indicated that most cancer patients want to be informed if their illness is terminal, and physicians should realize that the patient and the family unit may differ in their attitude toward such a disclosure. Our results also reflect the importance of how information is given to the patient.     

Web-based counseling for families with parental cancer: Baseline findings and lessons learned

Abstract

Purpose: This is the first study in Switzerland to report on psychological adjustment in children of a parent with cancer using a web-based intervention during cancer therapy.

Design/Sample: Twenty-two families participated in this randomized controlled web-based intervention program.

Methods: Quality of life and emotional–behavioral well-being of children were examined using child self-reports, and parent proxy-reports. Furthermore, family communication and satisfaction and feedback on the web-based program were assessed.

Findings: Children’s first stage adjustment to parental cancer did not show detrimental patterns. The “lesson learned” in this setting emphasizes the challenge to reach families in need. The web-based program was appreciated as an additional source of information and support in this mostly highly functioning population.

Conclusion: While feasibility was shown, it remains unclear how to contact families with lower psychosocial functioning.     

Coping strategies of family caregivers in hospice homecare.

Although stresses associated with family caregiving during illness have been well-documented, little attention has been focused on how families cope with hospice home care of a relative with advanced cancer. A longitudinal, qualitative study examined the experiences of hospice caregiving families. This article focuses on coping strategies identified by hospice families caring for their dying relative at home. Semistructured interviews and observations were conducted with 14 individuals from 10 families. Fifty-five interviews were audiotaped and transcribed. Constant comparative analysis was used to search inductively for recurrent themes. Specific coping strategies were used with each of the three areas of stress identified by families. "Windows of time," social comparison, cognitive reformulation, and avoidance were used to cope with the overall caregiving experience. "Taking one day at a time" helped to manage uncertainty. Acceptance and rationalization helped families to deal with changes in a relative's mental status. Social support was used with all three areas of stress. Identifying effective coping strategies that families are using directs the development, testing, and implementation of nursing interventions that enhance coping of hospice caregiving families.     

Opinion survey among nursing students on family

Earlier discharges of patients from hospital are increasing needs for supports for home medical care, which is causing changes in the activities of medical providers for patients and family members. Meanwhile, it is suggested that the younger generation is more indifferent to family members along with the increase of nuclear families or households consisting of only one member. This time, the author conducted an opinion survey among nursing students for the purpose of understanding how nursing students think of the family and using the data as a reference for the education. The survey was conducted in FY2000 and FY2001 for the questions selected from the "National Lifestyle Popularity Survey". The results indicate that nursing students intend to have families while keeping working and are willing to fulfill their responsibilities as a family member of which relation is close. It is considered possible to guide nursing students to practice nursing respecting the position and feeling of the patient by letting them understand social changes and the individuality of the patient based on the way nursing students think of the family.     

Hereditary nonpolyposis colorectal carcinoma (HNPCC) and HNPCC-like families: Problems in diagnosis, surveillance, and management

BACKGROUND: To the authors' knowledge, hereditary nonpolyposis colorectal carcinoma (HNPCC) is the most commonly occurring hereditary disorder that predisposes to colorectal carcinoma (CRC), accounting for approximately 2-7% of all CRC cases diagnosed in the U.S each year. Its diagnosis is wholly dependent on a meticulously obtained family history of cancer of all anatomic sites, with particular attention to the pattern of cancer distribution within the family. METHODS: The objective of the current study was to illustrate various vexing problems that can deter the diagnosis of HNPCC and, ultimately, its management. This was an observational cohort study. Sixteen HNPCC and HNPCC-like families were selected from a large resource of highly extended HNPCC families. High-risk patients were selected from these HNPCC families. An ascertainment bias was imposed by the lack of a population-based data set. Personal interviews and questionnaires were used for data collection. RESULTS: There was an array of difficulties highlighted by limitations in compliance, lack of a clinical or molecular basis for an HNPCC diagnosis, ambiguous DNA findings, problems in genetic counseling, failure to meet Amsterdam or Bethesda criteria, small families, lack of medical and pathologic documentation, poor cooperation of family members and/or their physicians, cultural barriers, economic stress, frequent patient fear and anxiety, perception of insurance discrimination, and limited patient and/or physician knowledge regarding hereditary cancer. CONCLUSIONS: The diagnosis and management of HNPCC is predicated on physician knowledge of its phenotypic and genotypic heterogeneity, in concert with the multifaceted problems that impact on patient compliance.     

The inherited nature of lung cancer: a pilot study

The role of both primary and secondary cigarette smoke exposure in the causation of lung cancer appears certain. An estimated 90% of lung cancer is attributed to cigarette smoke. Remarkably, however, less then 20% of cigarette smokers develop lung cancer. Investigators have suggested that a genetic predisposition to lung cancer may contribute to familial aggregation of this cancer. To understand the contribution of familial aggregation to this type of cancer and potentially identify individuals and families, which may be important in identifying gene(s) responsible for lung cancer, we developed criteria for identification of high-risk families. We have tested the feasibility and utility of these criteria at three Denver, CO hospitals with very different patient populations. Four hundred eighteen individuals were diagnosed with lung cancer at these three hospitals between 1/1/95 and 8/31/95. Twenty-nine percent of individuals expired prior to the time of initial contact. Family history data were obtained on 182 individuals. To be considered positive (suggesting possible autosomal dominant inheritance of lung cancer), families must have at least two first-degree relatives with lung cancer, one of which must be diagnosed before the age of 55. Seventeen of 182 (9.3%) families in the study population met these criteria. We reviewed the remaining family histories that did not meet the established criteria and identified another 2.3% (5/182) of families had evidence for autosomal dominant transmission of lung cancer. An additional 15% (23/182) of families had histories which could not be classified without further information. This study suggests that at least 11.6% of individuals diagnosed with lung cancer will have a positive family history of lung cancer. Use of the criteria developed for this study may lead to an underestimation of the inherited etiology of lung cancer.     

Consanguinity and family history of cancer in children with leukemia and lymphomas.

BACKGROUND: In native population of the United Arab Emirates (UAE), the rate of consanguineous marriages is 50.5%. This study was designed to determine whether the rates of consanguinity and family history of cancer among the families of children with lymphoid malignancy are different from those in the general population. METHODS: The study comprised 117 patients from the whole of the country with acute lymphocytic leukemia (ALL) and Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), ranging in age from 2 to 14 years. The consanguinity rate in the study group was compared with the rate in the general population. To study family history of cancer, the authors matched patients with 117 controls. In a telephone interview, each mother was asked to provide data regarding the biologic relationship between her and her husband as well as that between both sets of grandparents; each was also asked whether any family relative had a cancer and, if so, of what type. RESULTS: Among the 69 ALL cases, 80% of families were consanguineous and 20% were nonconsanguineous. Among the 26 NHL and 22 HL cases, each group included 3 consanguineous families, 12% and 14%, respectively. The consanguinity rates for ALL, NHL, and HL were all significantly different from the 50.5% consanguinity rate in the UAE population (all three P values < 0.0001). The family history of cancer was more often positive in ALL patients than in controls (odds ratio, 2.14; confidence interval, 1.01--4.53). Overall and for each lymphoid malignancy, there was no difference in family history of cancer between consanguineous and nonconsanguineous groups of cases. CONCLUSIONS: The consanguinity rate in the families of patients with ALL is significantly higher and in those with NHL and HL significantly lower than that in the UAE population. The family history of cancer is more often positive among ALL cases than controls--consanguinity having no effect.