Quality of life and dyadic adjustment in oral cancer patients and their female partners

The diagnosis of cancer affects not only the lives of patients, but also the lives of their family members. The purpose of this study was to examine the impact of oral cancer on quality of life (QoL), psychological distress and marital satisfaction in a sample of patients and their wives. Thirty-one men treated for oral cancer (mean time since diagnosis 3.7 years) and their female partners ( n  = 31) were assessed by questionnaires with regard to QoL (WHOQOL-BREF), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), quality of relationship (Dyadic Adjustment Scale, DAS) and physical complaints (EORTC QOL-H&N35). Quality of life was remarkably high in patients and their partners. In patients, lower QoL was associated with more physical complaints and higher levels of psychological distress (HADS), whereas in wives, QoL was found to be related to marital quality (DAS) and levels of distress. In couples with highly discrepant ratings of marital satisfaction, wives reported more psychological distress. The findings indicate that overall QoL is considerably high in patients treated for oral cancer and their partners living in stable relationships. Quality of life correlates stronger with the quality of relationship in spouses than in patients. Generally, marital satisfaction appears to be an important moderating factor regarding QoL and psychological distress.     

Change in psychological resources of younger and older cancer patients during chemotherapy

Psychological resources were investigated in 150 recently diagnosed adult cancer patients and in 150 healthy control group members. Before the start of chemotherapy, cancer patients reported higher levels of optimism, purpose in life than their healthy peers, and self-esteem (only younger patients) whereas no between-group differences emerged for internal locus of control. However, the mobilization of psychological resources was limited to younger patients, and varied by item content. Over a 9-month period, most psychological resources of cancer patients showed a small but significant decline, and patients with higher illness-related stressors (e.g. stronger functional impairments, low perceived success of therapy) were more likely to decline in resources. We conclude that in line with cognitive adaptation theory cancer diagnosis leads to an initial mobilization of psychological resources in younger patients, but that over the course of therapy psychological resources decline to a level that would be expected in healthy adults.     

Social Support and Marital Adjustment After Breast Cancer

Interviews were conducted with 78 breast cancer patients and their significant others to assess perceptions of social support following a diagnosis of cancer. Results indicated that supportive close relationships during and after an episode of cancer are associated with positwe patient adjustment. Moreover, the evidence suggests that most cancer patients can expect that support to be Approximately threequarters of the atlents in the reported that their relationships, Including those with family and friends to be warm and helpful after the cancer episode. The remaining one-fourth had at least one troubled relationship, and many more experienced isolated instances of rejection or withdrawal. Strained communication was a common problem in this group, particularly when the patient felt that her fears were discounted by those close to her, especially her spouse. Successful marital adjustment after the cancer episode was more likely when the partners expressed satisfaction w~th the relationship before the episode, when the surge was less severe (i.e., lumpectomy), and when the husband reacte 7 supportively after his wife's cancer. Both patients and their husbands who expressed satisfaction with their marital relationship tended to view the marriage as a communal relationship and to evaluate their spouse in an idealized manner.     

Marital Quality and Quality of Life Among Cancer Patients and Their Spouses

Research on the quality of life of cancer patients has stressed the significance of social support from their marital relationship. In this study, patients and spouses were asked to assess their current marital relationship and how they remembered it as being before the cancer diagnosis. Marital quality was assessed by interactional style, level of intimacy, and coping with problems. Personality was assessed by measuring stage of ego development: preconformist, conformist, and postconformist. The study produced two major findings. First, affiliation with the spouse had the highest correlation with the patients' quality of life, whereas coping with problems had the highest correlation with the spouses' quality of life. Second, patients who were at the postconformist stage of ego development were most likely to report that their marital relationship had become stronger over the course of their illness. The study carries implications for the structuring of differential psychosocial interventions for patients and spouses and for individuals at different levels of ego development.     

A comparison of the incidence of the myelodysplastic syndrome and acute myeloid leukaemia following melphalan and cyclophosphamide treatment for myelomatosis. A report to the Medical Research Council's working party on leukaemia in adults

Twelve of 648 patients in the Medical Research Council's first two trials in myelomatosis have developed myelodysplasia or acute leukaemia. This corresponds to a 5-year actuarial prevalence of 3% and an 8-year prevalence of 10%. Patients were randomised to treatment with either melphalan or cyclophosphamide and the relative capabilities of these two drugs to cause these conditions were examined as a function of duration of treatment. A significant relationship with length of melphalan treatment was found but no relationship was observed for cyclophosphamide treatment. The amount of melphalan treatment given in various intervals before diagnosis of myelodysplasia or leukaemia was studied and it was found that the amount of treatment in the most recent 3-year period was the most important determinant of risk (P = 0.0001). It is estimated that the risk of haemopoietic neoplasia after 10 years of follow-up is about 3% for each year of melphalan treatment and that much of this risk will occur within three years of the last treatment.     

Managing the illness experience of women with advanced breast cancer: hopes and fears of cancer‐related insecurity

The cultural significance of a diagnosis of advanced breast cancer is important in Pakistan particularly due to the high incidence in women, limited breast cancer screening, healthcare resources and cancer educational programmes in Pakistan. The psychological impact of breast cancer is therefore an important concern for women. This qualitative study explored the psychological impact of advanced breast cancer in Pakistani women. Twenty‐one women with advanced breast cancer were interviewed. Women acknowledged feelings related to the insecurity of health, resistance to cancer, the impact of their illness on their physical and emotional well‐being and marital relationships and emotions related to cultural discrimination. The majority of women had metastatic spread to bone, liver or lungs. More effort is needed to educate women on the aetiology of cancer, breast self‐examination and mammographic screening to ensure that all Pakistanis are educated that cancer is not a communicable disease or one that is transmitted by personal contact.     

Cancer-related relationship communication in couples coping with early stage breast cancer

This longitudinal study examined the association between three types of communication strategies couples may use to handle stressors they experience during and after breast cancer treatment and psychological distress and relationship satisfaction of women with early stage breast cancer and their partners. Mutual constructive communication, mutual avoidance, and demand-withdraw communication strategies as well as psychological distress and marital satisfaction were rated by 147 patients and 127 partners during cancer treatment and 9 months later. Mutual constructive communication was associated with less distress and more relationship satisfaction for both patient and partner. Demand-withdraw communication was associated with higher distress and lower relationship satisfaction for both patient and partner. Mutual avoidance was associated with more distress for patient and partner but was not associated with relationship satisfaction. The negative association between mutual constructive communication and patient distress was stronger for patients with more physical impairment. Patients' perceptions of mutual constructive communication and mutual avoidance were associated with partners' distress, and patients' perceptions of mutual constructive and demand/withdraw communication were associated with partners' marital satisfaction. Clinical implications for couple-focused communication skills training for cancer patients and their partners are discussed.     

Parental smoking and alcohol consumption and risk of neuroblastoma.

Previous studies and animal evidence have suggested a relationship between parental tobacco or alcohol use and the risk of some childhood cancers, including neuroblastoma. A case-control study was conducted to investigate the relationship between parental tobacco smoking, alcohol consumption, and risk of neuroblastoma. Cases were children diagnosed with neuroblastoma over the period 1992-1994 at Children's Cancer Group and Pediatric Oncology Group institutions throughout the United States and Canada. One matched control was selected using random-digit dialing. Information on parental smoking and drinking history was obtained from 504 case and 504 control parents by telephone interview. Overall, there was no consistent pattern of association with parental smoking and alcohol consumption. For example, both maternal smoking and drinking during the period from 1 month before pregnancy through breastfeeding had adjusted odds ratios (ORs) of 1.1 [95% confidence interval (CI), 0.8-1.4]. There was no association with paternal smoking (OR, 1.2; 95% CI, 0.8-1.6) or paternal drinking 1 month before conception (OR, 1.0; 95% CI, 0.7-1.4). There was no consistent increase in risk by the amount of smoking or drinking during any time period relative to pregnancy. There was no suggestion of an increased risk when only one parent smoked. Smoking or drinking among both parents did not jointly increase the risk of neuroblastoma in their offspring. The child's age at diagnosis, stage, or MYCN oncogene amplification status did not materially alter the OR estimates. It is concluded that the results from this study do not indicate any evidence for a relationship between neuroblastoma and parental tobacco or alcohol use.     

The impact of childhood cancer on parental working status and income in Denmark: Patterns over time and determinants of adverse changes

Having a child with cancer may affect the socioeconomic situation of the parents. We aimed to assess the impact of childhood cancer on parental working status and income and to identify determinants of adverse changes after the child's cancer diagnosis by calendar period. We conducted a nationwide cohort study using Danish registry data. Parents of children diagnosed with cancer in 1982–2014 (n = 12,418) were matched with comparison parents of cancer-free children (n = 125,014). We analysed annual working status (working/not working) and annual disposable income (lowest quintile/not lowest quintile) of case and comparison parents over a period of 10 years after diagnosis by calendar period (1982–1999 vs. 2000–2014). Logistic regression models were used to identify determinants of adverse changes after diagnosis. Mothers of children diagnosed in 1982–1999 were more likely not working or having a low income than comparison mothers up to 10 years after diagnosis. This risk of not working or low income was lower in mothers of children diagnosed in 2000–2014 compared to 1982–1999 in the first years after diagnosis (p_interaction < 0.05). We observed no consistent patterns among fathers. Low parental education, diagnosis of lymphoid leukaemia and younger age of the child at diagnosis were the main determinants of adverse changes in working status or income after diagnosis. Childhood cancer adversely interfered with parents' socioeconomic situation in the earlier calendar period, particularly among mothers. The absence of such an effect in more recent years emphasises the supportive role of a countries’ welfare system alongside the general advances in childhood cancer treatment.     

Adolescent Adjustment and Maternal Breast Cancer

Abstract

This study investigated the effects of parental functioning on adolescent adjustment during the acute phase of treatment for mothers diagnosed with breast cancer. Data from self-and parent-report questionnaires were obtained in the homes of 87 adolescents and 174 parents within six months of the mother's diagnosis. Associations between adolescent adjustment (self-esteem, behavioral problems, anxiety) and parental functioning (depressed mood, parenting quality, and marital adjustment) were examined when neither, one, or both parents were functioning at compromised levels. When both parents had depressed mood, adolescents tended to show increased behavioral problems; maternal depressed mood was the main source of influence. When the quality of the parenting relationship between the adolescent and both parents was poor, adolescents showed significantly lowered self-esteem and increased anxiety. Marital adjustment did not affect adolescent functioning significantly. Maternal depressed mood and the quality of the parent-child relationship significantly influenced adolescent adjustment during the acute phase of the mother's breast cancer.     

Understanding the Needs of Colorectal Cancer Patients during the Pre-diagnosis Phase

Patients with colorectal cancer (CRC) face a number of challenges leading up to diagnosis; however, research is limited regarding their specific needs during the pre-diagnosis period. A multicenter cross-sectional survey was conducted to elicit information about the CRC experience during the pre-diagnosis phase. Across the three sites, 104 eligible patients were approached, and 82 patients completed the survey, for a total response rate of 78.9 %. The needs most identified by participants during the pre-diagnosis period were informational (31.6 %) and emotional (20.3 %) needs; social needs were rated as the least important need for these patients (7 %). The majority (84.0 %) reported that these needs were met. Participants reported feeling shocked or overwhelmed on learning of their diagnosis (57.1 %) and high levels of anxiety during this time (40.0 %). The majority (77.9 %) of participants reported that they were not directed to any resources to help address their anxiety. Informational and emotional needs are identified as the most important needs during the pre-diagnosis phase, and for most these needs are being met; however, some participants are experiencing high levels of anxiety without access to appropriate resources. Further work is required to understand the optimal mechanisms to address identified needs during this pre-diagnosis period and to assess the potential benefits and costs of addressing these needs.     

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.     

Cancer among children of parents with autoimmune diseases

Many different aetiologies for childhood cancer have been suggested, but few are well established. One is that parental autoimmune disease is linked with susceptibility for haematopoietic malignancies in their offspring during childhood. The present study is the first to investigate this hypothesis using a follow-up design. A cohort of 53,811 children of more than 36,000 patients diagnosed with a systemic, organ-specific or suspected autoimmune disease were followed up for cancer incidence in the Danish Cancer Registry during 1968-1993. The parents were identified through the National Registry of Patients, while their children were traced in the Central Population Register. Cancer incidence among the offspring was compared with that in the corresponding childhood population of Denmark. In total, 115 cancers were observed among children aged 0-19 years, yielding a non-significant standardized incidence ratio of 1.07. Lymphomas contributed 21 cases to the overall number of tumours, 60% more than expected (95% confidence interval (CI) 1.0-2.4); leukaemia contributed 37 cases representing an excess of 30% (95% CI 0.9-1.8). Our results give some support to the hypothesis that parental autoimmune disease is associated with childhood lymphoma and leukaemia.     

Allergy and risk of childhood leukaemia: results from the UKCCS

We investigated the relationship between childhood leukaemia and preceding history of allergy. A nationwide case-control study of childhood cancers was conducted in the United Kingdom with population-based sampling of cases (n = 839) and controls (n = 1,337), matched on age, sex and region of residence. Information about clinically diagnosed allergies was obtained from primary care records. More than a third of subjects had at least one allergy diagnosed prior to leukaemia diagnosis (cases) or pseudo-diagnosis (controls). For both total acute lymphoblastic leukaemia (ALL) and common-ALL/precursor B-cell ALL (c-ALL), a history of eczema was associated with a 30% significant reduction in risk: the odds ratios (OR) and 95% confidence intervals (CI) were 0.70 (0.51-0.97) and 0.68 (0.48-0.98), respectively. Similar associations were observed for hayfever (OR = 0.47; 95% CI: 0.26-0.85 and OR = 0.62; 95% CI: 0.33-1.16 for ALL and c-ALL, respectively). No such patterns were seen either for asthma and ALL, or for any allergy and acute myeloid leukaemia. A comparative analysis of primary care records with parents recall of allergy revealed only moderate agreement with contemporaneous clinical diagnoses for both cases and controls--confirming the unreliability of parental report at interview. Our finding of a reciprocal relationship between allergy and ALL in children is compatible with the hypothesis that a dysregulated immune response is a critical determinant of childhood ALL.     

Two years after cancer diagnosis,which couples become closer?

PRÉAU M., BOUHNIK A.D., REY D., MANCINI J. & THE ALD CANCER STUDY GROUP (2011) European Journal of Cancer Care 20 , 380–388
Two years after cancer diagnosis, which couples become closer? The aim of this study was to determine characteristics of patients who reported a strengthening of their couple relationship 2 years after cancer diagnosis. Using a cross‐sectional design, data were obtained from a representative sample of patients with a primary diagnosis of cancer. Medical and reported data were collected by physicians and a patient telephone interview respectively. Among the 3221 participants who were living with the same partner as at the time of their cancer diagnosis, 32.8% of men and 41.5% of women declared their illness had brought them closer to their partner. The following factors were independently associated with closer couple relationships for women: high monthly monetary resources, chemotherapy treatment, sequelae, increased consumption of psychotropic drugs since cancer diagnosis, satisfaction with information provided by medical staff, specialised psychological support at the time of diagnosis and regular sexual activity. Independently associated factors for men were as follows: younger age, financial difficulties since diagnosis, cancer other than gastrointestinal tract/upper GI tract or lung cancer, progressive disease, satisfaction with information provided by medical staff and specialised psychological support at the time of diagnosis. Our findings underline the importance for healthcare workers to provide adequate information and psychological support in order to help couples facing cancer. Comprehensive care and not simply supplying medicines is crucial in order to better manage their experience.     

Experience of parental cancer in childhood is a risk factor for psychological distress during genetic cancer susceptibility testing.

BACKGROUND: This study explores the effect of age at the time of parental cancer diagnosis or death on psychological distress and cancer risk perception in individuals undergoing genetic testing for a specific cancer susceptibility. PATIENTS AND METHODS: Cancer-related distress, worry and risk perception were assessed in 271 applicants for genetic testing of an identified mutation in BRCA1/2 (BReast CAncer) or a HNPCC (Hereditary Nonpolyposis Colorectal Cancer) related gene before, one week after, and six months after genetic test disclosure. The course of distress and risk perception were compared between individuals having witnessed parental cancer or loss due to cancer in childhood, adolescence, adulthood and having unaffected parents. RESULTS: Individuals with parental cancer in childhood (under age 13) reported the highest level of cancer related distress, worry and risk perception. Women having their mother affected by breast cancer in puberty (aged 10-13 years) perceived higher breast cancer risks than women with an affected mother in adulthood or without an affected mother. Individuals with an affected parent perceived cancer risks as higher than individuals without an affected parent, but were not more distressed. CONCLUSIONS: Experience of parental cancer in childhood is a risk factor for psychological distress during the genetic testing process.     

Remembering ‘bad news’ consultations: An evaluation of tape-recorded consultations

Two groups of women with a diagnosis of breast cancer were interviewed by a consultant surgeon. The consultation was recorded and one group of women were allowed to take the tape away and make reference to it during the preoperative period. Provision of tapes was found to enhance patients' understanding of their treatment and resulted in fewer visits to their general practitioners. Use of tapes did not, however, reduce psychological morbidity. The study also indicated that partners experience comparable degrees of psychological morbidity and that women who undergo wide local excisions remain significantly more anxious postoperatively than women who have mastectomies.     

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.     

Cancer survival in the elderly: effects of socio-economic factors and health care system features (ELDCARE project)

The purpose of the ELDCARE project is to study differences in cancer survival for elderly patients by country, taking into account the socio-economic conditions and the characteristics of health care systems at the ecological level. Fifty-three European cancer registries, from 19 countries, participating in the EUROCARE 3 programme, collected information to compute relative survival on patients aged 65-84 years, diagnosed over the period 1990-1994. National statistics offices provided the macro-economic and labour force indicators (gross domestic product, total health expenditure, and proportion of people employed in the agriculture sector) as well as the features of national health care systems. Survival for several of the cancer sites had high positive Pearson's correlations (r) with the affluence indicators (usually r>0.7), but survival for the poor prognosis cancers (lung, ovary, stomach) and for cervix uteri was not so well correlated. Among the medical resources considered, the number of computed tomography scanners was the variable most related to survival in the elderly; the number of total health practitioners in the country did not show any relationship. Survival was related to the marital status of elderly women more strongly than for men and younger people. The highest correlations of survival with the percentage of married elderly women in the population were for cancers of the rectum (r=0.79) and breast (r=0.66), while survival correlated negatively with the proportion of widows for most cancers. Being married or widowed is for elderly people, in particular elderly women, an important factor influencing psychological status, life habits and social relationships. Social conditions could play a major role in determining health outcomes, particularly in the elderly, by affecting access to health care and delay in diagnosis.     

Survival from childhood acute lymphoblastic leukaemia in West Germany: Does socio-demographic background matter?

BackgroundSex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children.MethodsALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall and event-free survival.ResultsOverall survival was 82.5%, with a higher proportion of girls than boys surviving (85% versus 81%). We found a non-linear relationship between age at diagnosis and survival, with poorer survival in infants and children aged >5 years. There was no association between socio-economic factors and survival or risk of relapse. For five levels of increasing family income, all HRs were close to one. No relationship was seen with parental educational level.ConclusionSocio-economic determinants did not affect ALL survival in West German children, in contrast to studies from some other countries. Dissimilarities in social welfare systems, including access to health care, lifestyle and differences in treatment may contribute to these differences in findings. Our observation of no social inequalities in paediatric ALL survival is reassuring, but needs continued monitoring to assess the potential impact of evolvement of treatment options and changes in paediatric health service.