Stress response symptoms in adolescent and young adult children of parents diagnosed with cancer

The aim of this study was to assess stress response symptoms in children of parents diagnosed with cancer 1-5 year prior to study entry. The impact of event scale was used to measure stress response symptoms in terms of intrusion and avoidance; the youth self-report assessed emotional and behavioural functioning; the state-trait anxiety inventory for children measured trait-anxiety. Participants included 220 adolescents (aged 11-18 years) and 64 young adults (aged 19-23 years) from 169 families. Twenty-one percent of the sons and 35% of the daughters reported clinically elevated stress response symptoms. Daughters, particularly those whose mothers were ill, reported significantly more intrusion and avoidance than did sons. Intrusion among daughters was positively related to age. Stress response symptoms in both sons and daughters were significantly associated with trait anxiety, but not with intensity of treatment or time since diagnosis. Daughters whose parents suffered from recurrent illness reported more symptoms than did daughters whose parents had a primary disease. Children (daughters in particular) with clinically elevated stress response symptoms reported significantly more problems of internalising and cognition than did their norm group peers. One-fifth of the sons and more than one-third of the daughters expressed clinically elevated stress response symptoms. These children also reported internalising and cognitive problems. Daughters appeared to be more at risk than sons.     

Emotional and behavioural functioning of children of a parent diagnosed with cancer: a cross-informant perspective

This study investigates emotional and behavioural problems in children of parents diagnosed with cancer and examines the relationship with demographic and illness-related variables. Furthermore, agreement and differences between informants regarding child's functioning were examined. Members of 186 families in which a parent had been diagnosed with cancer participated. More emotional problems were reported for latency-aged sons (ill parents) and adolescent daughters (ill parents; self-reports), whereas also better functioning was reported in adolescent children (spouses), compared to the norm group. Age and gender-effects were found: latency-aged sons were perceived as having more emotional problems than adolescent sons (ill parents); adolescent daughters as having more emotional and behavioural problems than adolescent sons (ill parents; self-reports). Results indicated a higher prevalence of problems when the father was ill than when the mother was (spouses and self-reports). The treatment intensity affected adolescent daughter's functioning (spouses), whereas adolescent son's functioning was affected by relapsed disease (self-reports). Adolescents and mothers perceived comparable levels of problems, but fathers perceived problems in children to be less prevalent. Findings suggest that adolescent daughters and latency-aged sons are at risk for emotional problems following the diagnosis of cancer in a parent. The perception of child's functioning and potential influencing variables varied according to informant.     

Posttraumatic stress symptoms during treatment in parents of children with cancer.

PURPOSE: The conceptualization of childhood cancer and its treatment as traumatic has gained increasing support in the growing literature on medically related posttraumatic stress. Posttraumatic stress symptoms (PTSS) such as intrusive thoughts, physiologic arousal, and avoidance have been documented in mothers and fathers of childhood cancer survivors. In this study we investigated the presence of PTSS in parents of children currently in treatment and their association with treatment intensity and length of time since diagnosis. METHODS: Mothers (N = 119) and fathers (N = 52) of children currently in treatment for a childhood malignancy completed questionnaire measures of PTSS. Outcomes on these measures were compared with a sample of parents of childhood cancer survivors from our hospital. Oncologist ratings of treatment intensity were obtained based on diagnosis, treatment modalities, and protocol number. RESULTS: All but one parent reported PTSS. Mean scores indicated moderate PTSS for both mothers and fathers. In families with two participating parents, nearly 80% had at least one parent with moderate-to-severe PTSS. There were minimal associations between PTSS and length of time since diagnosis. CONCLUSION: PTSS are common among parents of children currently undergoing cancer treatment. Trauma-informed psychosocial interventions can be used to help patients and families, including normalizing the experience as potentially traumatic and using evidence-based interventions that are emerging to facilitate long-term well-being.     

Differences in Emotional Well-Being and Communication Styles Between Mothers and Fathers of Pediatric Cancer Patients

This study investigated 26 pairs of mothers and fathers of pediatric cancer patients to explore the relationship between parental communication patterns and parental psychological wellbeing as well as the possible differences between the communication styles of mothers and fathers. For mothers, open and frequent communication had a positive effect on emotional well-being, and spousal communication was particularly important. In comparison with fathers, mothers had significantly more positive perceptions of the family's overall emotional climate, evaluated the patient as significantly better adjusted, and communicated significantly more often and openly with the patient.     

Parental cancer: characteristics of parents as predictors for child functioning

BACKGROUND: The vulnerability of children when a parent is diagnosed with cancer may depend on a variety of variables. The current study examined the impact of characteristics of 180 parents diagnosed with cancer, along with 145 spouses, on the prevalence of emotional and behavioral problems in children. METHODS: Ill parents provided information on sociodemographics and illness-related variables and on the prevalence of problems in children by using the Child Behavior Checklist (CBCL). Both parents completed the two subscales that measure physical functioning and mental health of the RAND-36. RESULTS: The family situation (single parents, no or few siblings, oldest child) was one of the most important predictors of reported problems in primary school children, whereas adolescents were reported as having more problems when parents experienced treatment complications. A decrease in ill parents' physical functioning affected primary school daughters and adolescents, and both age groups were affected by the mental health of ill parents. Problems of ill fathers did not have a different impact on children from those of ill mothers. Spouses' physical limitations were indicative for problems in primary school children, whereas a worsening parental mental health was indicative for problems in adolescents. CONCLUSIONS: Findings illustrated that parents' characteristics must be taken into account when assessing vulnerability of children in this situation. Which variables particularly heighten the risk for problems depend on children's ages.     

Mothers’ screening histories influence daughters’ vaccination uptake: An analysis of linked cervical screening and human papillomavirus vaccination records in the North West of England

AimAchieving high human papillomavirus (HPV) vaccine coverage is important because cervical screening coverage is declining. As key decision makers, mothers’ experiences of, and participation in, the cervical screening programme could affect vaccination consent. We investigate whether mother’s screening history influences daughter’s participation in the HPV vaccination programme.MethodsMothers’ cervical screening records from the National Health Authority Information System were linked to the daughters’ HPV vaccination records from the Child Health System in North West England by address. Odds ratios for daughter’s vaccination were computed using Logistic Regression, adjusting for age, Primary Care Trust and vaccine cohort (AOR).ResultsDaughters in both the routine and catch up programmes were more likely to have initiated vaccination and completed the course if their mothers had attended screening. The association was strongest when mothers had attended within the last 5 years (AOR in routine group: 3.5 (95% confidence interval (CI) 3.1–4.0) for initiation and 2.2 (1.6–2.9) for retention). Mothers who had personally decided to cease screening were less likely to have vaccinated daughters than those who had ceased for medical indications. Daughters were more likely to have been vaccinated if their mothers had received an abnormal smear result.ConclusionsDaughter’s HPV vaccination uptake was associated with mother’s cervical screening attendance. Daughters of mothers who are not engaged with preventive services are less likely to be vaccinated and may be less likely to engage with screening. This makes mothers central to health interventions to promote both cervical screening and HPV vaccination.     

Risk of Malignancy Associated with a Maternal Family History of Cancer

This study was conducted in order to obtain a screening and early detection reference for children whosemothers had been diagnosed with cancer. Data for 276 mother-child pairs with malignant tumors were analyzed.The distribution of cancers in affected families was generally similar to that of the general Chinese population,and correspondingly breast cancer was the most common malignancy amongst daughters whose mother hadcancer (32.7%). The most prevalent cancer amongst sons with affected mothers was gastric cancer, rather thanlung cancer. Daughters were more likely to have the same kind of malignant tumor as their mother (P<0.05),and were more likely to develop breast cancer than any other malignant disease if their mother had a breasttumor (P<0.0001). Likewise, if the mother was diagnosed with breast or gynecological cancer, the daughter wasmore likely to be diagnosed with breast or gynecological cancer than any other cancer (P<0.01). Daughters andsons developed malignant diseases 11 and 6.5 years earlier than their mothers, respectively (P<0.0001).Womenwith a mother who suffered cancer should be screened for malignancy from 40 years of age especially for breast,lung, and gynecological cancers. For men with affected mothers, screening should start when they are 45 yearsold focusing particularly on lung and digestive system cancers.     

Effects of psychological distress on quality of life of adult daughters and their mothers with cancer

Introduction: As the population continues to age, adult daughters are more likely to be involved in caregiving. Given the fact that sharing emotional experiences is common in female relationships, (dis)similarity between mothers with cancer and their adult caregiving daughters is expected. However, the extent to which the (dis)similarity in psychological distress influences the quality of life of each person remains unknown. Method: This study aims at addressing this concern, using a total of 98 mother–daughter dyads participating in the American Cancer Society's Study of Cancer Survivors‐I and Quality of Life Survey for Caregivers. Results: Using the Actor Partner Interdependence Model, the results showed that although each person's psychological distress is the strongest predictor of their own quality of life, a mother's distress also plays a significant role in the daughter's quality of life. Specifically, when mothers experienced greater levels of psychological distress, the daughters reported better mental health but poorer physical health. Conclusions: Our findings on the disproportionately strong association between psychological distress of mothers with cancer and their adult caregiving daughters' quality of life suggest that caregiving daughters may benefit from programs designed to assist them to cope better with their mothers' psychological distress when both are living with cancer. Copyright © 2008 John Wiley & Sons, Ltd.     

Is there a genetic anticipation in breast and/or ovarian cancer families with the germline c.3481_3491del11 mutation?

The aim of the current analysis is to evaluate any differences of breast or ovarian cancer age at diagnosis between mothers and daughters carrying the c.3481_3491del11 mutation in the BRCA1 gene. A study cohort of 38 women carrying the c.3481_3491del11 mutation and affected by first breast or ovarian cancer who reported a first breast or ovarian cancer in their mother carrying the c.3481_3491del11 mutation, was identified in 37 different families including members with breast and/or ovarian cancer at the Oncology Institute of Lorraine. Twelve mothers underwent genetic testing. Twenty-five pairs of the 38 mothers-daughters pairs with c.3481_3491del11 mutation were affected by breast cancer and 13 pairs by ovarian cancer. Clinical and genetic data were collected from medical files and family pedigrees. Analyses were conducted for each cancer type. We investigated an early breast cancer detection effect due to early screening programs and also an increased breast tumor aggression. Since major improvements in breast cancer clinical management and imaging techniques appeared after 1980, we compared the age at breast cancer diagnosis and the age at death in mothers and daughters before and after 1980, first, in the group of women including mothers and daughters taken together and then in mothers and daughters separately. The mean age at breast cancer diagnosis was 45.28?±?10.27 years in mothers and 39.80?±?7.79 years in daughters (p?=?0.026). The difference of age at ovarian cancer diagnosis in mother-daughter pairs was 8.62?±?12.76 years (p?=?0.032). When considering the group of women including mothers and daughters taken together, no significant difference of age at breast cancer diagnosis was found between women affected before 1980 and those affected after 1980 (p?=?0.577). However, the age at death increased in these women after 1980 (p?=?0.026). Comparison of age at breast cancer diagnosis in mothers and daughters separately, showed that daughters were affected at an earlier age after 1980 (p?=?0.002). Daughters had a poor prognosis and died earlier than mothers after 1980. Our results may have reflected genetic anticipation in c.3481_3491del11 mutation breast and ovarian cancer families. In order to confirm our findings, a larger cohort would provide more precision to the difference of ages at breast or ovarian cancer diagnosis between mothers and daughters and more powerful statistical analyses. Increased aggression in daughters’ tumors compared to those of mothers could be also considered as a parameter of genetic anticipation. Complete information on tumor profile and proliferation would allow us to study genetic anticipation by comparing the tumor phenotypes between mothers and daughters in the future.     

Modeling the dyadic effects of parenting,stress, and coping on parent–child communication in families tested for hereditary breast-ovarian cancer risk

Genetic testing for BRCA genes, associated with hereditary breast-ovarian cancer risk, is an accepted cancer control strategy. BRCA genetic testing has both medical and psychosocial implications for individuals seeking testing and their family members. However, promoting open and adaptive communication about cancer risk in the family is challenging for parents of minor children. Using prospective data collected from mothers undergoing BRCA genetic testing and their untested co-parents (N = 102 parenting dyads), we examined how maternal and co-parent characteristics independently and conjointly influenced the overall quality of parent–child communication with minor children. Statistical associations were tested in accordance with the Actor–Partner Interdependence Model. Significant Actor effects were observed among mothers, such that open parent–child communication prior to genetic testing was positively associated with open communication 6 months following receipt of genetic test results; and among co-parents, more open parent–child communication at baseline and greater perceived quality of the parenting relationship were associated with more open parent–child communication at follow-up. Partner effects were also observed: co-parents’ baseline communication and confidence in their ability to communicate with their minor children about genetic testing was positively associated with open maternal parent–child communication at follow-up. These results demonstrate that for families facing the prospect of cancer genetic testing, perceptions and behaviors of both members of child-rearing couples have important implications for the overall quality of communication with their minor children, including communication about cancer risk.     

Emotional and behavioral problems in children of parents recently diagnosed with cancer: a longitudinal study

This study examines the prevalence of problems in children within four months after a parent's cancer diagnosis (T1) and six (T2) and twelve months (T3) afterwards. Sixty-nine ill parents and 57 spouses completed the Child Behavior Checklist for 57 primary school (aged 4-11 years) and 66 adolescent children (aged 12-18 years). Adolescents completed the self-report version. Children's functioning was compared to that of the norm group and a sample of families that were confronted with parental cancer between one to five years before study participation (retrospective study). Most children were reported as having a similar level as or fewer problems than was reported in the norm and retrospective studies. Reported problems decreased with time, but children who initially had more problems remained vulnerable during the year. Fathers and mothers highly agree in their perception of children's behavior, with the exception of adolescent daughters' behavior. Agreement between mothers and adolescent daughters was high, whereas agreement between fathers and adolescent sons and daughters, and mothers and adolescent sons was low to moderate. The outcomes suggest that most children do not experience problems shortly after the parent's diagnosis and were functioning over time on a level equal to or better than that of their peers. Differences in informant's perceptions appear and remain of interest.     

Eliciting Adaptive Emotion in Conversations with Parents of Children Receiving Therapy for Leukemia

Clinician–parent communication may often be difficult, especially soon after the diagnosis. The aims of this article are to identify the communication strategies associated with expressions of adaptive emotions in parents and to explore the effect of the type of leukemia and of parent's gender on parents’ expressions of emotions. The data are obtained from 4.622 conversational turns of 20 videotaped interviews with 10 mothers and 10 fathers of children at their first hospitalization for leukemia. A coding scheme for parent emotional expressions was reliably applied by two independent judges. An original self-report questionnaire on parents’ emotional states was used before and after the interview. Positive politeness of interviewer elicits adaptive emotional expressions in parents. Mothers of children with acute myeloid leukemia and fathers of children with acute lymphoblastic leukaemia appear more distressed during the interview. This interview can be identified as an innovative technique of communication with parents of children with cancer.     

Existential plight of adult daughters following their mother's breast cancer diagnosis

Daughters caring for a mother with breast cancer represent a vulnerable population. They are confronted with having to integrate their emotional reactions to their mother's illness while simultaneously processing concerns about their own personal susceptibility. Through their caregiving, daughters obtain intimate knowledge of their mother's breast cancer experience. As part of a study of breast cancer survivorship and the family, in-depth interviews were conducted with a diverse sample of adult daughters caring for their mother with breast cancer. Analysis of the daughters' narratives documents that their mother's cancer diagnosis subjects them to a period of crisis fraught with severe emotional distress and life and death concerns that parallels the 'existential plight' that patients encounter following the cancer diagnosis and inception of treatment. Specifically, the daughters' accounts demonstrate that the diagnosis intensified their bond with their ill mother, while also presenting challenges in their relationship. It precipitated a re-definition of personal values and altered their perceived future. Their mother's illness prompted recognition of increased family risk and rendered daughters with a heightened sense of personal vulnerability. Clinicians need to appreciate the extent to which daughters can be impacted by their mother's cancer experience.     

Symptoms of post‐traumatic stress in children with cancer: does personality trump health status?

Objective: To examine the symptoms of post‐traumatic stress (PTSS) in children as a function of health status (cancer vs healthy) and adaptive style. Methods: Children with cancer (N=199) and healthy acquaintance control children (N=108) completed a standardized measure of PTSS. Measures of trait anxiety and defensiveness were obtained to characterize the adaptive style of respondents. Results: Within the cancer group, levels of PTSS did not differ as a function of diagnosis, time since diagnosis, or whether children were on‐ or off‐treatment. The only cancer‐related factor associated with elevated PTSS was a history or relapse or recurrence. Children with cancer reported significantly fewer symptoms of re‐experiencing/intrusion than did healthy children, but also reported greater symptoms of numbing/avoidance. However, there were no differences in total PTSS scores between children with cancer and controls. In contrast, a significant effect of adaptive style on PTSS was observed, with children identified as repressors or low anxious obtaining lower scores on total PTSS and all PTSS subscales than high‐anxious children, regardless of health status. Estimates of the number of children meeting criteria for post‐traumatic stress disorder did not differ between children with cancer and healthy children, and were low in both groups. Conclusions: Children with cancer report levels of PTSS that are not higher than that of their healthy peers. Personality factors such as adaptive style are a much more salient determinant of PTSS than is health history. These findings raise further questions regarding the value of a traumatic stress model for understanding the experiences of children with cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

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.     

Parental age at birth and risk of breast cancer in daughters: a prospective study among US women

We examined the relation between parental age at birth and risk of breast cancer among daughters in a population of 118,309 US women who were 30 to 55 years of age in 1976 and without prior diagnosis of cancer. During 1,140,239 person-years of follow-up, we documented 1,799 incident cases of breast cancer in this population. After adjusting for established breast cancer risk factors, we observed only a weak and nonsignificant trend in risk of breast cancer with increasing maternal age at birth and no relation for paternal age. After adjusting for other risk factors, the chi trend was 1.10, P=0.27 for increasing maternal age at birth. Daughters born to mothers 30 to 34 years of age had an age-adjusted relative risk of breast cancer of 1.11 (95% confidence interval: 0.89, 1.37) compared to daughters born to mothers less than 20 years of age. The weak positive trend in risk with increasing maternal age was present among both pre-and postmenopausal women. These findings suggest that there is little or no association between maternal age and risk of breast cancer, and that paternal age is not related to risk of breast cancer.This research was supported by Public Health Service grants CA40935 and CA40356 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services.     

Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer

BACKGROUND:

This study aimed to evaluate prevalence and risk factors for emotional and behavioral problems in dependent children of cancer patients using a multinational research design.

METHODS:

The sample comprised 350 ill parents, 250 healthy partners, and 352 children. Parents assessed the child's psychological functioning using the Child Behavior Checklist, parental depression using the Beck Depression Inventory, family functioning using the General Functioning subscale of the Family Assessment Device, quality of life using short‐form questionnaire, and adolescents (N = 168) self‐reported psychological functioning using the Youth Self Report.

RESULTS:

Children and adolescents, in particular latency‐aged boys and adolescent girls, were of higher risk of psychosocial problems than norms. There was a higher risk of problems when the father was ill than when the mother was ill, but it remains unclear whether this difference was due to the different diagnoses of fathers and mothers, gender or other factors. The best predictor of internalizing problems in children and adolescents was parental depression, and the best predictor of externalizing problems in children and adolescents was family dysfunction.

CONCLUSIONS:

The results indicate the need for a family‐oriented approach to psychological support of cancer patients. Cancer 2009. © 2009 American Cancer Society.     

Eliciting adaptive emotion in conversations with parents of children receiving therapy for leukemia

Clinician-parent communication may often be difficult, especially soon after the diagnosis. The aims of this article are to identify the communication strategies associated with expressions of adaptive emotions in parents and to explore the effect of the type of leukemia and of parent's gender on parents' expressions of emotions. The data are obtained from 4.622 conversational turns of 20 videotaped interviews with 10 mothers and 10 fathers of children at their first hospitalization for leukemia. A coding scheme for parent emotional expressions was reliably applied by two independent judges. An original self-report questionnaire on parents' emotional states was used before and after the interview. Positive politeness of interviewer elicits adaptive emotional expressions in parents. Mothers of children with acute myeloid leukemia and fathers of children with acute lymphoblastic leukaemia appear more distressed during the interview. This interview can be identified as an innovative technique of communication with parents of children with cancer.     

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.