Patients with advanced cancer and their spouses parenting minor children: The role of the relationship context in parenting concerns.

OBJECTIVE: Patients with advanced cancer who parent minor children report parenting concerns and increased psychological distress. This cross-sectional study seeks to understand parenting-related issues in patients and spousal caregivers from a relationship perspective. METHODS: Patients with a metastatic solid malignancy and their spouses independently completed cross-sectional assessments of psychological distress (Hospital Anxiety and Depression Scale), parenting concerns (Parenting Concern Questionnaire) and efficacy (Cancer-Related Parenting Self-Efficacy Scale), and relationship measures (DAS-7, Couples' Illness Communication Scale, and Family Relationship Index). RESULTS: Of the 51 patients (57% female, 49% NHW, mean age 42 years) and spouses (43% female, 43% NHW, mean age of 42 years), approximately 50% couples endorsed psychological distress and were at risk for family dysfunction. Spouses reported significantly higher levels of parenting-related concerns (t = -2.0, p < 0.05) and anxiety (t = -2.8, p < 0.001) than patients. Parenting concerns were significantly associated with illness communication (r = -0.56, p < 0.001) and family function (r = -0.38, p < 0.001). Although the expected interactions between parenting concerns and relationship variables (i.e., illness communication, dyadic adjustment, and family function) were significant for depressive symptoms at p < 0.05, the associations were not in the expected direction. Relationship function buffered against depressive symptoms for those with low rather than high parenting concerns. CONCLUSIONS: Not only patients but also spouses report cancer-related parenting concerns. The associations between parenting concerns and distress were stronger for spouses than patients. Dual caregiving appears to be a particularly stressful role. Because relationship function was associated with parenting concerns, we suggest that parent support programs that are couple-based and include both parenting-specific and relationship-specific content may be most effective in reducing distress for this vulnerable population.

Síndromes paraneoplásicos neurológicos / Neurologic paraneoplasic syndromes

Los síndromes paraneoplásicos neurológicos son un grupo de entidades causadas por los efectos a distancia de un tumor, y dado que pueden afectar cualquier porción del sistema nervioso, se presentan como cuadros neurológicos. Estas entidades son condiciones poco frecuentes causadas por respuestas inmunes contra antígenos tumorales que tienen una reacción cruzada con antígenos neuronales. En esta revisión se estudian los mecanismos propuestos para explicar su etiopatogenia, haciendo hincapié en la reacción autoinmune hacia antígenos onconeurales. En esta revisión se analizan las manifestaciones clínicas de los síndromes paraneoplásicos neurológicos, las neoplasias a las que se asocian así como la importancia de establecer un diagnóstico; tratamos de recalcar el valor de estudio de los mismos, pues pueden ser la primera manifestación de malignidad.