Single fatherhood due to cancer

Cancer is a leading cause of widowed fatherhood in the USA. Fathers whose spouses have died from cancer constitute a potentially vulnerable population as they adjust to their role as sole or primary caregiver while managing their own grief and that of their children. The importance of addressing the psychological needs of widowed fathers is underscored by data showing that father's coping and emotional availability are closely tied to their bereaved children's mental health. Surprisingly, scant attention has been given to the phenomenon of widowed fatherhood with virtually no clinical resources or research studies devoted to fathers who have lost their wives to cancer. This commentary highlights key challenges facing this underserved population of widowers and calls for development of research agendas and clinical interventions for single fathers due to cancer. Copyright © 2011 John Wiley & Sons, Ltd.     

The Influence of Relational Factors on Men's Adjustment to Their Partners' Newly-Diagnosed Breast Cancer

Abstract

Steadily rising breast cancer rates in America's women are forcing more men to confront challenges of living with a partner afflicted with this disease. This study assesses teh impact of mutual emotional support as perceived by male partners on their adjustment to the diagnosis and the illness and on interactions between their perceied emotional support nd their coping methods. Seventy-one male partners of newly-diagnosed breast cancer patients completed standardized instruments that measured emotional wellbeing, illness intrusiveness, emotional support, dyadic coping styles and demographic factors. Regression analysis revealed significant associations between perceived emotional support and men's coping strategies, and between coping styles and illness intrusiveness. Also, a history of depression predisposes men to poorer adjustment and affects their coping patterns. Findings suggest that as the health care system continues to relocate burden of care to partners and families, social workers must increase their understanding of how to effectively assist patients' partners. This study emphasizes the need to work with patients and partners to develop positive coping strategies as a couple.     

Interaction patterns between parents with advanced cancer and their adolescent children

Objective: Advanced cancer profoundly affects those with the illness and their families. The interaction patterns between parents with advanced cancer and their adolescent children are likely to influence how a family experiences a parent's dying process. There is little information on such interactions. This study aimed to develop an explanatory model that explains interaction patterns between parents with advanced cancer and their adolescent children and to identify strategies to prepare children for their lives after a parent dies. Methods: Semi‐structured interviews were conducted with 9 parents with advanced cancer, 7 of their spouses/partners, and 10 of their adolescent children. The interviews were recorded, transcribed verbatim, and analyzed using a constructionist grounded theory approach. Results: Twenty‐six family participants were interviewed. Their main concern was not having enough time together. In response, they described a four‐stage process for optimizing the time they had left together: coming to know our time together is limited, spending more time together, extending our time together, and giving up our time together to end the suffering. The adolescents and their ill parents did not change their interaction patterns until they realized their time together was limited by the advanced cancer. Then they spent more time together to make things easier for each other. Conclusions: Time was of great importance to the parents and adolescents; all the participants structured their stories in relation to the concept of time. The model reflects the dynamic process by which families continuously adapt their relationships in the face of advanced cancer. Copyright © 2010 John Wiley & Sons, Ltd.     

Children's understanding of cancer

Explanations of cancer need to take into account developmental changes in children's cognitive and emotional abilities to understand illness. Children below 5 years of age are usually informed by parents, and older children by medical staff. Information tends to focus on details of treatments and procedures, and less on the seriousness of the disease and length of time involved. There are indications that early and honest information is associated with better behaviour and adjustment in the child, communication within the family and compliance with treatment, although methodological inadequacies in assessment of adjustment and knowledge of cancer limit the ability to generalize these findings. Communication with children should take into account developmental changes in children's ability to understand illness information. Communicators should also provide emotional support to deal with the threatening nature of this information.     

Fatherhood and cancer: a commentary on the literature

When a parent is diagnosed with cancer it may create a multitude of concerns and worries, which can be enormously challenging. Despite the increase in research pertaining to parental cancer, there is a paucity of knowledge addressing the impact of cancer on fathers. Fathers' roles are evolving, becoming increasingly diverse and multidimensional. This paper aims to uncover some issues that may be relevant for fathers with cancer. A cancer diagnosis may not solely impact on a man's identity but also on the lives of his children given the contemporary shift from patriarch to more diverse roles. Men and women may share commonalities when diagnosed with cancer but they also experience differences emphasising the need for gender‐sensitive care. This paper highlights the significant role and function that fathers have in their children's lives. It is important that healthcare professionals are aware and pay attention to how gendered responses shape fathers' masculinity and consequently the cancer experience and parenting role. Furthermore this paper highlights the need to gather additional evidence on fathers' experiences when diagnosed and living with cancer. This knowledge can then be used to inform healthcare policy to target fathers, which will benefit both fathers and their children.     

Healthy women from suspected hereditary breast and ovarian cancer families: the significant others in their lives

This paper investigates communication and interactions between healthy women from families with a history of breast/ovarian cancer and five statuses of significant others: (1) women friends; (2) sisters; (3) brothers; (4) male partners; and (5) children in order to better understand the way the family deals with cancer genetics risk information and the extent of social support available to its members. We conducted a research ethics committee reviewed exploratory, qualitative study at a major clinical and research cancer centre in the United Kingdom from January to June 2000. Twenty-one semi-structured, in-depth interviews were conducted using a purposive sample of women coming to the cancer genetics risk clinic for the first time, supplemented by 5 months of participant observation. On the whole, women friends consistently provided strong social support. Sisters were usually close, but communication about the breast/ovarian cancer in their family in some cases was quite limited and fraught with emotional overtones. Brothers were the most difficult to relate to regarding cancer in the family and seemed almost to exist in a different 'interrelational space'. The women claimed that their male partners were supportive, but with caveats. Mothers worried about how much information and at what age they should inform their children about the specifics of the family history of breast/ovarian cancer and tried to protect them when they were young. The women were very concerned about their daughters and granddaughters, but were far less concerned about the impact on their sons.     

Relationship vulnerabilities during breast cancer: patient and partner perspectives

Objective: Close interpersonal relationships play a crucial role in a woman's adjustment to breast cancer. To date, the literature has focused primarily on characteristics or behaviors of the well spouse that influence a woman's adaptation to the illness. The present qualitative investigation extended this literature by adopting an interactional perspective based on the underlying assumption that relationship partners' coping and distress is mutually influential. The focus of the analysis was patient and partner perceptions of relationship strife or tension over the course of the illness based on the notion that such interactions may be as or more harmful to relationships than supportive exchanges are helpful. Method: Nineteen women (at different stages of the illness) and eleven male spouses were interviewed about their experiences in relation to breast cancer. Nine of the men and nine of the women were relationship partners. Interview text was subjected to a thematic analysis and informed by grounded theory principles. Results: Two higher‐order categories of Personal Characteristics (both patient and partner) and Relationship Dynamics that impeded couple adjustment defined the overall theme of Relationship Vulnerabilities. Conclusions: Findings from this study are situated within a broader developmental framework wherein breast cancer is considered a catastrophic life event that challenges the assimilation and accommodation processes of both partners in the relationship. For couples that are able to overcome the relationship challenges associated with the illness, there is the potential for mutual growth, and a deepening and strengthening of the relationship. Implications for clinical practice are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

The Influence of relational factors on men's adjustment to their partners' newly-diagnosed breast cancer

Steadily rising breast cancer rates in America's women are forcing more men to confront challenges of living with a partner afflicted with this disease. This study assesses teh impact of mutual emotional support as perceived by male partners on their adjustment to the diagnosis and the illness and on interactions between their perceived emotional support nd their coping methods. Seventy-one male partners of newly-diagnosed breast cancer patients completed standardized instruments that measured emotional wellbeing, illness intrusiveness, emotional support, dyadic coping styles and demographic factors. Regression analysis revealed significant associations between perceived emotional support and men's coping strategies, and between coping styles and illness intrusiveness. Also, a history of depression predisposes men to poorer adjustment and affects their coping patterns. Findings suggest that as the health care system continues to relocate burden of care to partners and families, social workers must increase their understanding of how to effectively assist patients' partners. This study emphasizes the need to work with patients and partners to develop positive coping strategies as a couple.     

Coping in men with prostate cancer and their partners: a quantitative and qualitative study

GREEN H.J., WELLS D.J.N. & LAAKSO L. (2010) European Journal of Cancer Care 20 , 237–247 Coping in men with prostate cancer and their partners: a quantitative and qualitative study This study investigated coping and quality of life in men with prostate cancer (n= 105, 48–86 years of age) and their partners (n= 85, 48–84 years). Participants completed the Abbreviated Dyadic Adjustment Scale, Brief COPE, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ‐C30) and open‐ended questions on appraisal and coping. Multivariate analyses showed that better quality of life was associated with higher education levels (role functioning and fatigue), lower avoidant coping (emotional, social, and physical functioning and fatigue), and higher relationship satisfaction (emotional functioning). Use of medication or combined treatments was associated with worse physical and role functioning. Partners reported similar quality of life for patients as the patient ratings, except that partners reported patients' emotional functioning as significantly worse and social functioning as significantly better than the patients' own ratings. Patients and partners reported both positive and negative aspects to prostate cancer, and mentioned a range of coping strategies. Similarities between patients and partners in their responses to prostate cancer were identified using both quantitative and qualitative methods. Some differences within dyads were also noted and previous suggestions to incorporate partners and significant others in education and treatment were supported.     

Emotional functioning of parents of children with cancer: the first five years of continuous remission after the end of treatment

Objectives: The aim of this study is to investigate parental emotional functioning during the first five years of continuous remission after the end of their child's treatment and to identify predictors of parental emotional functioning. Methods: Psychological distress and situation‐specific emotional reactions were assessed in 122 mothers and 109 fathers from 130 families. Longitudinal mixed model analyses were performed to investigate to what extent generic and disease‐related coping, family functioning and social support were predictive of parental emotional functioning over time. Results: Initial elevated levels of distress, disease‐related feelings of uncertainty and helplessness returned to normal levels during the first two years after the end of treatment. Being more optimistic about the further course of the child's disease (predictive control) was correlated with lower psychological distress and less negative disease‐related feelings, while more passive reaction patterns were correlated with higher psychological distress and more negative disease‐related feelings. Conclusions: Although in general the parents of children with successfully treated cancer showed adequate emotional resilience, support for these parents should not stop when treatment ends. Parents in need of help can be identified on the basis of their coping abilities. Copyright © 2007 John Wiley & Sons, Ltd.     

Sexual dysfunction and spousal communication in couples coping with prostate cancer

Objective: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns. Methods: In this cross‐sectional study, 116 prostate cancer patients and their partners completed psychosocial questionnaires. Results: Patients and partners reported high rates of sexual dysfunction. Within couples, patients' and their partners' sexual function was moderately to highly correlated (r=0.30–0.74). When patients had poor erectile function, their partners were more likely to report that the couple avoided open spousal discussions; this in turn was associated with partners' marital distress (Sobel's Z=12.47, p=0.001). Patients and partners who reported high levels (+1SD) of mutual constructive communication also reported greater marital adjustment, regardless of their own sexual satisfaction. In contrast, greater sexual dissatisfaction was associated with poorer marital adjustment in patients and partners who reported low levels (?1SD) of mutual constructive communication (p<0.05). Conclusion: Our findings underscore the need for psychosocial interventions that facilitate healthy spousal communication and address the sexual rehabilitation needs of patients and their partners after prostate cancer treatment. Although some couples may be reluctant to engage in constructive cancer‐related discussions about sexual problems, such discussions may help alleviate the negative impact that sexual problems have on prostate cancer patients' and their partners' marital adjustment. Copyright © 2008 John Wiley & Sons, Ltd.     

Family life when a parent is diagnosed with cancer: impact of a psychosocial intervention for young children

When a parent is diagnosed with cancer it can have a profound impact on the family, especially the children. This paper reports on the experience of parental cancer for parents' and their children and the impact of a psychosocial intervention for young children whose parent has cancer. Using a qualitative design, data were generated from separate focus groups with children (n = 7) and parents (n = 6). One‐to‐one interviews were conducted with professionals delivering the intervention (n = 2). Findings indicated that parents are often the gatekeeper to how, when and the context in which children learn about parental cancer. Many parents expressed a lack of confidence and skills as they considered communicating with their children about cancer. Parents stated the need for professional input mainly due to changes in their children's behaviour. Children had a number of fantasies and misconceptions surrounding cancer. This psychological intervention normalized their experience of parental cancer. It also improved children's understanding of cancer and equipped them with coping strategies. Professionals perceived the intervention led to improved family communication and promoted discussion of emotions. Open communication is pivotal for children whose parents have cancer but parents need supported and resourced to promote family coping when diagnosed with cancer.     

The role of illness representations in coping and health of patients treated for breast cancer

Objective: The present study examined the relation of cognitive and emotional representations of illness specified by the Common Sense Model of Illness Cognition (Handbook of Psychology and Health: Social Psychological Aspects of Health. Earlbaum, Hillsdale: New York, 1984; 219–252) with the coping strategies and perceived health of patients who were treated for breast cancer. Methods: Participants were 119 women within 2 years after their diagnosis of breast cancer, who completed a questionnaire containing measures of illness representations, coping strategies and perceived physical and mental health. Results: Breast cancer patients differ in the subjective perception of their disease. Patients who view their illness as a condition with serious symptoms and consequences, patients who believe their illness is chronic and patients who consider their illness uncontrollable were found to report worse physical and mental health than those who believed the opposite. Regression analysis showed that, after controlling for external variables, the cognitive illness representations identity and consequences explained 57% of variance in physical health, whereas emotional illness representation and treatment control explained 47% of variance in mental health. Conclusion: Results provide some support for the hypotheses of the Common Sense Model of Illness Cognition. Illness representations seem to play an important role in perceived health in breast cancer. The implications of these findings for the design of health‐care‐related interventions for breast cancer patients are discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

A multisite evaluation of summer camps for children with cancer and their siblings

ABSTRACT

Summer camps for pediatric cancer patients and their families are ubiquitous. However, there is relatively little research, particularly studies including more than one camp, documenting outcomes associated with children's participation in summer camp. The current cross-sectional study used a standardized measure to examine the role of demographic, illness, and camp factors in predicting children's oncology camp-related outcomes. In total, 2,114 children at 19 camps participated. Campers were asked to complete the pediatric camp outcome measure, which assesses camp-specific self-esteem, emotional, physical, and social functioning. Campers reported high levels of emotional, physical, social, and self-esteem functioning. There were differences in functioning based on demographic and illness characteristics, including gender, whether campers/siblings were on or off active cancer treatment, age, and number of prior years attending camp. Results indicated that summer camps can be beneficial for pediatric oncology patients and their siblings, regardless of demographic factors (e.g., gender, treatment status) and camp factors (e.g., whether camp sessions included patients only, siblings only, or both). Future work could advance the oncology summer camp literature by examining other outcomes linked to summer camp attendance, using longitudinal designs, and including comparison groups.     

The trajectory of religious coping across time in response to the diagnosis of breast cancer

Objectives: This study investigates the mobilization of religious coping in women's response to breast cancer. Methods: Ninety‐three breast cancer patients and 160 women with a benign diagnosis participated. Breast cancer patients were assessed on their use of religious coping strategies and their level of emotional distress and well‐being at pre‐diagnosis, 1 week pre‐surgery, and 1 month, 6 months, 1 year, and 2 years post‐surgery. Results: In general, breast cancer patients used religious strategies more frequently than women with a benign diagnosis; however, the patterns of use were similar across time for the majority of strategies. Results showed that religious coping strategies are mobilized early on in the process of adjustment to breast cancer. Breast cancer patients' use of support or comfort‐related strategies peaked around surgery and then declined, while the use of strategies that reflected more a process of meaning‐making remained elevated or increased into the long‐term. Positive and negative forms of religious coping were predictive of concurrent distress and emotional well‐being. As well, there was evidence that the mobilization of religious coping was predictive of changes in distress and well‐being across time. For example, women's increased use of active surrender coping from 1 to 6 months post‐surgery was related to a concomitant decrease in emotional distress and increase in emotional well‐being. Conclusions: Notably the nature of the relationship between religious coping and emotional adjustment depended on the type of religious coping strategy as well as the specific time of assessment. Specificity of information in the use of religious coping can allow health‐care professionals to better identify resources and address potential points of difficulty during the process of women's adjustment to breast cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Information satisfaction in breast and prostate cancer patients: implications for quality of life

Objectives: This study aimed to assess information needs and levels of information satisfaction in breast and prostate cancer patients. It further examined relationships between information satisfaction and multi‐dimensional quality of life (QoL). Methods: An adapted Information Satisfaction Questionnaire (ISQ, 2004) and the Functional Assessment of Cancer Therapy QoL questionnaire (FACT‐G, 1993) were randomly distributed to cancer patients during oncology clinic visits (breast cancer, n=102; prostate cancer, n=112). Hierarchal regression analyses examined information satisfaction as a predictor of global QoL and its four dimensions (i.e. physical, social, emotional, and functional well‐being). Results: High levels of information needs and desire for decision involvement were identified, with patients expressing a considerable degree of information satisfaction. After controlling for demographic and illness factors, information satisfaction explained 21% of the variance in global QoL, 12% in physical well‐being, 13% in social well‐being, 8% in emotional well‐being, and 10% in functional well‐being (all p<0.001). Conclusions: This study highlights the importance of information satisfaction for perceived QoL in individuals with cancer. It is clearly important to identify specific information requirements during the diagnosis and treatment process in order to provide information that is congruent with patients' needs. Copyright © 2007 John Wiley & Sons, Ltd.     

Common‐sense beliefs about cancer and health practices among women completing treatment for breast cancer

Objective: Following the end of adjuvant treatment, breast cancer survivors must cope with uncertainty related to the possibility of recurrence and the loss of the ‘safety net’ treatment provides. This study examined breast cancer survivors' efforts to manage uncertainty by making lifestyle changes, such as improvement in diet and exercise. We further investigated the role of women's common‐sense beliefs about their cancer, as described by Leventhal's self‐regulation theory, in explaining post‐treatment changes. Method: At 3 weeks and 3 months post‐treatment, 79 women who received adjuvant chemotherapy and/or radiation therapy for stages 0–III breast cancer (mean age=55 years) completed assessments of changes in health practices and other behaviors. Participants also completed measures of beliefs about the causes, course, personal control, and consequences of their cancer. Results: Survivors reported behavior changes directed toward improving physical, emotional, and spiritual well‐being. Results further indicated that women who believed their cancer had more severe consequences and those who attributed the development of cancer or the prevention of recurrence to health behaviors or stress were most likely to report improvement in diet or physical activity and reduction in alcohol use or stress. Conclusions: Findings suggest that breast cancer survivors are poised to make lifestyle changes after treatment ends, creating an opportune time for health promotion interventions. Understanding women's cancer beliefs could help guide the development of tailored, proactive interventions to improve the health and well‐being of breast cancer survivors. Copyright © 2010 John Wiley & Sons, Ltd.