Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes.

OBJECTIVE: Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. METHOD: Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. CONCLUSIONS: Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family and parent-child relationship correlates of pediatric cancer survivors' substance use.

OBJECTIVE: The primary aims of this research were to examine substance use among adolescent and young adult survivors of pediatric cancer (AYA survivors) and AYA without a history of chronic or life threatening illness (AYA comparisons) and to explore links between demographic, medical, caregiver-AYA, and family system factors with AYA substance use patterns. METHODS: Participants included 289 AYA (survivors, n = 171; comparisons = 118; 51% female; Mage = 17.15, SDage = 2.86) and their caregivers (Mage = 46.54, SDage = 6.81; 88% mothers). AYA and caregivers completed the family environment scale, and caregivers completed the parenting relationship questionnaire at the initial assessment. Two years later, AYA completed an assessment of substance use. Chi-square and frequency analyses were used to compare differences in substance use among AYA survivors and comparisons. Multivariate analysis of variance was used to examine links between AYA substance use patterns with family and caregiver-AYA system level factors. RESULTS: Patterns of substance use did not differ between AYA survivors and comparisons. AYA survivors were more likely to report polysubstance use if caregivers endorsed problematic caregiver-AYA relationship patterns. Family functioning and caregiver relationship patterns did not predict AYA comparison substance use. CONCLUSION: AYA survivors were just as likely as AYA comparisons to engage in substance use, increasing their vulnerability to problematic health outcomes. Findings indicate that the role caregiver-AYA relationship patterns may have on youth at risk for substance use and potential mechanisms for future intervention.

The Influence of Early Childhood Temperament on Later Social-Emotional Functioning in Youth with Cancer.

OBJECTIVE: One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer. METHODS: Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children's Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale). RESULTS: Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems). CONCLUSIONS: Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.

Profiles of perceived social functioning in adolescent and young adult survivors of childhood cancer.

OBJECTIVES: Social interaction and peer relationships are critical for development, especially for adolescents and young adults (AYA). Cancer treatment may disrupt social functioning and impact quality of life. Prior research into AYA social functioning has primarily been qualitative in nature or assessed via broad measures of functioning. Given the multi-dimensional nature of social functioning, and its importance for AYA, a person-centered approach to analyses is needed. METHODS: AYA survivors of childhood cancer, ages 13 to 23 (n = 192, 51% male) and at least 1 year post-treatment (M = 7.35 ± 4.18 years post), completed measures to assess perceived social functioning, social support, and positive and negative affect. Caregivers also completed a measure of social functioning. Latent profile analysis was used to empirically derive profiles of perceived social functioning using the self-perception profile for adolescents (SPPA). RESULTS: A 3-class solution provided the best fit to the data: 58.9% average, 33.7% high, and 7.5% low functioning. The average group reported mean scores that were similar to normative values available in the SPPA manual. Demographic and medical factors were unrelated to class membership. Social support and positive/negative affect differed significantly by class; caregiver-report of social functioning did not. CONCLUSIONS: Overall, the majority of AYA survivors of childhood cancer are doing well socially, with perceived adequate social functioning associated with both high levels of social support as well as greater perceptions of positive affect. Future work is needed to elucidate longitudinal trajectories of social functioning, as well as to identify and intervene with those survivors who are struggling.

Impact of the parent-child relationship on psychological and social resilience in pediatric cancer patients.

OBJECTIVES: The primary objective of this research was to examine patterns of parent-child relationship functioning among pediatric cancer survivors and their caregivers across a variety of relationship indicators (ie, Involvement, Attachment, Communication, Parenting Confidence, and Relational Frustration), and evaluate how these factors relate to psychosocial outcomes in survivors. METHODS: Young survivors aged 10 to 18 and their caregivers (N = 165) completed measures related to posttraumatic stress and general distress. Caregivers also completed assessments of parent-child relationship functioning, and survivors completed assessments of social functioning. Latent profile analysis was performed to identify patterns of relationship functioning. Medical, demographic, and parent functioning variables were examined as predictors, and youth's psychological and social functioning were examined as outcomes. RESULTS: A three-class solution was the best fit to the data. The struggling parent-child relationship profile (15%) evidenced below average levels of parent-child relationship functioning across several domains. The normative parent-child relationship (60%), was characterized by average levels of parent-child relationship functioning across all domains. Finally, the high-involved parent-child relationship profile (25%) demonstrated above average levels of parent-child relationship functioning in involved activities, communication, and attachment and normative levels of functioning across all other domains. Medical and parent functioning factors predicted profile membership. In turn, profile membership was associated with survivor psychological and social outcomes. CONCLUSION: Findings document the importance of extending existing research to examine patterns of parent-child relationship functioning, which may serve as a clinically relevant target to improve psychological and social outcomes in young survivors of childhood cancer.

Posttraumatic stress in young children with cancer: Risk factors and comparison with healthy peers.

OBJECTIVE: The most commonly occurring childhood cancers are diagnosed during the preschool years; yet limited psycho-oncology research has focused on this developmental time period. The primary objective was to examine rates of posttraumatic stress symptoms (PTSS) in young children with cancer and compare these findings with those of children without a history of serious illness (comparisons). The secondary aim was to examine risk and modifiable factors associated with PTSS. METHOD: Ninety-seven caregivers of patients (n = 50) and comparisons (n = 47) aged three to six years completed diagnostic interviews for the assessment of PTSD. They also completed a survey measure of PTSS adapted from the Child Behavior Checklist (CBCL-PTSD), along with measures of their child's temperament and their own current psychological functioning. RESULTS: On the CBCL-PTSD, no differences in PTSS were observed between children with cancer and comparisons, although many in both groups appeared at risk, with approximately 34% of children with cancer and 27% of comparisons meeting threshold scores for probable PTSD. However, using a "gold-standard" clinical-interview assessment, only three children in the patient group and no children in the comparison group met diagnostic criteria for PTSD. Parental distress and child temperament were significantly associated with PTSS scores. CONCLUSION: Findings indicate PTSD is relatively infrequent in children with cancer, and survey measures may overestimate rates of PTSD in young children. However, other emotional or behavioral issues may be present. Ultimately, screening for potential emotional/behavioral concerns in young children with cancer is indicated, and interventions should continue to target caregiver distress.

Do complementary and integrative medicine therapies reduce healthcare utilization among oncology patients? A systematic review of the literature and recommendations.

PURPOSE: Complementary and integrative medicine (CIM) is frequently used by oncology teams for reducing physical and emotional side-effects related to cancer treatment. In light of the changing healthcare system, evidence is needed regarding the economic implications of these interventions. The purpose of this study was to: (1) systematically examine the literature for links between CIM interventions and healthcare utilization (2) provide recommendations for growing this area of research. METHOD: PubMed and EBSCO databases were reviewed for articles reporting on healthcare utilization associated with CIM therapy use in oncology populations. CIM intervention characteristics and healthcare utilization were extracted and summarized from 7 articles meeting inclusion criteria. RESULTS: Studies included various CIM modalities. Most studies targeted physical symptoms (i.e., pain, infection, nausea/vomiting; n = 4). Healthcare utilization included medication use/cost (n = 4) and hospitalization length/cost (n = 5). All four studies (prospective/retrospective between-group, n = 2; within-subject pre-post, n = 1; RCT, n = 1) examining medication reduction noted decreased medication costs or use. Mixed findings emerged for studies examining hospitalizations (retrospective between-group, n = 2; within-subject pre-post, n = 1; RCT, n = 2), with only one study (retrospective between-group) indicating lower hospitalization duration in the CIM group. CONCLUSIONS: Findings indicate the potential for CIM therapy to reduce healthcare utilization in oncology populations, particularly medication use. However, this research is limited both in size and quality. To increase the uptake of these interventions and to advocate for insurance coverage of CIM interventions, high quality economic evaluations are needed.

Longitudinal examination of family efficacy following pediatric stem cell transplant.

OBJECTIVE: Pediatric stem cell transplant (pSCT) is emotionally demanding for families. Yet, we know little of how the family unit responds to the adversity of pSCT within the first year after transplant. Family efficacy, an indicator of family resilience, is linked to positive parent, child, and family adjustment. Better understanding the factors that promote family efficacy during this difficult time could inform modifiable intervention targets and improve child and parent adjustment. The primary objectives were to examine patterns of family efficacy beliefs and identify factors that promote or hinder family efficacy. METHODS: Ninety caregivers (71% white, 7% black, 3% Hispanic, 4% Asian, 14% multiple ethnicities) of children receiving pSCT completed demographic forms, the Psychosocial Assessment Tool, and the Filial Parental and Collective Family Efficacy Beliefs scale prior to the family's discharge, and 1, 3, 6, and 9 months post-discharge. Latent growth curve modeling was used to examine family efficacy across time. Parent, child, and sibling distress, social support, and demographic factors served as predictors. RESULTS: Latent growth curve modeling demonstrated that family efficacy was stable for 9 months post pSCT discharge. Social support was positively related to family efficacy beliefs. No other variables predicted family efficacy. CONCLUSION: Most families perceive themselves as resilient following pSCT. Social relationships and support are critical in maintaining a family's sense of efficacy during the arduous pSCT course.

Relationship between cancer-related traumatic stress and family milestone achievement in adolescent and young adult survivors of childhood cancer.

Late physical and emotional effects of cancer treatment pose a burden for adolescent and young adult survivors of childhood cancer, including family milestone achievement. This brief report examined links between ongoing cancer-related post-traumatic stress symptoms (CR-PTSS) and family milestone achievement. Survivors (n = 51; Mage  = 24.73, SD = 8.20) completed CR-PTSS and family formation questionnaires. Descriptive statistics, univariate parameter-constraints, and correlation analyses examined relations among study variables. Ongoing intrusive thoughts and hyperarousal were negatively linked to family identity development and family achievement. Findings from the present study provide support that ongoing CR-PTSS may be a barrier to family formation.

Youth's Adjustment to Cancer: Examination of Patterns of Adjustment and the Role of Peer Relations.

Objective: Examine unique forms of peer relations (i.e., peer group vs. friendships) in relation to patterns of youth's resilience and challenge-related growth in the context of cancer. Methods: In all, 279 youth (cancer, n = 156; control, n = 123) completed measures of posttraumatic stress, depression, anxiety, posttraumatic growth (PTG), and perceived positive changes. Youth also reported on their peer relations. Latent profile analysis (LPA) was used to examine patterns of youth's adjustment. Peer relations were examined as predictors of youth's adjustment. Results: LPA revealed three profiles (42.1% resilient high growth, 21.4% resilient low growth, and 36.5% mild distress with growth). Youth's peer relations, demographic factors, and disease-related factors predicted assignment to profiles. Differences in adjustment emerged depending on youth's connection with their peers versus their friends. Summary: Peer relations serve an important role in youth's adjustment to stressful life events. Assessment of peer and friend support may provide a more nuanced understanding of adjustment processes.

Emotion Socialization in the Context of Childhood Cancer: Perceptions of Parental Support Promotes Posttraumatic Growth.

Background: Examined youth's perceptions of parental reactions to youth's cancer and non-cancer event-related distress and the link between perceptions of parental reactions and youth posttraumatic growth (PTG). Method: Participants included 201 youth (8­21 years) with a history of cancer. Participants self-identified their most stressful life event, which were characterized as cancer or non-cancer related, and then completed measures in reference to this event assessing (1) their perceptions of parent reactions to event-related distress and (2) PTG. Results: Youth who identified a cancer-related event perceived their parents as reacting with more support and reassurance/distraction than those who identified a non-cancer event. Perceptions of parental support, reassurance/distraction, and magnification of youth distress were associated with more PTG, with event type (cancer vs. non-cancer) indirectly predicting PTG through perceptions of parental support. Conclusion: Youth perceive their parents as reacting differently to cancer versus non-cancer distress, which is in turn predictive of their perceptions of growth. Findings suggest that parental support and reassurance/distraction are possible mechanisms facilitating resilience and growth in children with cancer.

Effects of Time since Diagnosis on the Association between Parent and Child Distress in Families with Pediatric Cancer.

Although parental distress and child distress have been linked in families of children with cancer, how these associations change over time is unknown. The present study examined how the amount of time elapsed since the child's diagnosis moderates the associations between self-reported parent and child symptoms of depression, anxiety, and post-traumatic stress in 255 parent-child dyads. Time since diagnosis moderated the associations between parental symptoms and child-reported anxiety and post-traumatic stress. Dyads farther out from diagnosis exhibited stronger associations between parental and child symptoms. Findings suggest the importance of monitoring the psychological adjustment of parents and children over time.

Profiles of Dispositional Expectancies and Affectivity Predict Later Psychosocial Functioning in Children and Adolescents With Cancer.

OBJECTIVE: Examined how individual differences in disposition among pediatric cancer patients predict their later psychosocial functioning. METHODS: Patients aged 8-17 years (N = 223) reported on their disposition at baseline. One and three years later, self-reports and parent reports of patient psychosocial functioning were obtained. Latent profile analysis was used to identify subgroups that differed on baseline disposition and to compare them on later outcomes. ESULTS: Three groups were identified: The "Positive" group (59%) had high optimism and positive affectivity and low pessimism and negative affectivity; the "Moderate" group (39%) had a similar profile, with less exaggerated scores; a small, "Negative" group (2%) had the opposite profile (low optimism/positive affectivity; high pessimism/negative affectivity). These groups differed in psychosocial functioning at follow-up, generally in expected directions. CONCLUSIONS: Most patients have a disposition that may be protective. A small minority at high risk for maladjustment is distinguished by their disposition.

Relations Between Baseline and Nonlinear Longitudinal Changes in Children's Body Mass Index and Internalizing Symptoms.

OBJECTIVE: To determine whether initial body mass index for age (zBMI) and internalizing symptoms predict longitudinal changes in zBMI and internalizing symptoms-and the extent to which sex and race moderate these relations. METHODS: Participants included 12,674 (51% male) youth from the Early Childhood Longitudinal Study, Kindergarten Class 1998-1999. Data were collected in kindergarten, 1st, 3rd, 5th, and 8th grades. Teacher-reported internalizing symptoms were measured with the Social Rating Scale. RESULTS: Internalizing symptoms followed a quadratic growth trajectory, with initial low levels of symptoms that gradually increased over time and eventually leveled. zBMI followed a piecewise growth trajectory, with a transition in slope at 1st grade. Interactions emerged between zBMI and internalizing symptoms for White males. CONCLUSIONS: Associations between internalizing symptoms and BMI begin in early childhood for White males, and changes in zBMI are a function of the interactive effect of initial levels of internalizing difficulties and adiposity status.

Profiles of Resilience and Growth in Youth With Cancer and Healthy Comparisons.

OBJECTIVE: Inconsistent links between posttraumatic stress symptoms (PTS) and posttraumatic growth (PTG) in youth following a stressful life event have been observed in previous literature. Latent profile analysis (LPA) provides a novel approach to examine the heterogeneity of relations between these constructs. METHOD: Participants were 435 youth (cancer group=253; healthy comparisons = 182) and one parent. Children completed measures of PTS, PTG, and a life-events checklist. Parents reported on their own PTS and PTG. LPA was conducted to identify distinct adjustment classes. RESULTS: LPA revealed three profiles. The majority of youth (83%) fell into two resilient groups differing by levels of PTG. Several factors predicted youth's profile membership. CONCLUSIONS: PTS and PTG appear to be relatively independent constructs, and their relation is dependent on contextual factors. The majority of youth appear to be resilient, and even those who experience significant distress were able to find benefit.

Profiles of Connectedness: Processes of Resilience and Growth in Children With Cancer.

OBJECTIVE: Identified patterns of connectedness in youth with cancer and demographically similar healthy peers. METHOD: Participants included 153 youth with a history of cancer and 101 youth without a history of serious illness (8-19 years). Children completed measures of connectedness, posttraumatic stress symptoms (PTSS), and benefit-finding. Parents also reported on children's PTSS. RESULTS: Latent profile analysis revealed four profiles: high connectedness (45%), low connectedness (6%), connectedness primarily to parents (40%), and connectedness primarily to peers (9%). These profiles did not differ by history of cancer. However, profiles differed on PTSS and benefit-finding. Children highly connected across domains displayed the lowest PTSS and highest benefit-finding, while those with the lowest connectedness had the highest PTSS, with moderate PTSS and benefit-finding for the parent and peer profiles. CONCLUSION: Children with cancer demonstrate patterns of connectedness similar to their healthy peers. Findings support connectedness as a possible mechanism facilitating resilience and growth.

Adolescent Reactions to Maternal Responsiveness and Internalizing Symptomatology: A Daily Diary Investigation.

A daily diary methodology was employed to gather teens' perceptions of maternal responsiveness to daily stressful events and teens' reactions to maternal responsiveness in a diverse sample (792 entries from 104 teens; 81% African American, mean age 13.7 years). Additionally, parents and teens completed baseline reports of internalizing symptoms. Diary findings were congruent with prior studies employing self-report measures of global maternal responses to emotion (e.g., higher probability of Accepting reactions to supportive responses, higher probabilities of Attack, Avoid-Withdraw reactions to non-supportive responses). Elevated baseline internalizing symptoms were related to perception of elevated Punish and Magnify responses during the week, and more Avoidant (Avoid-Withdraw and Avoid-Protect) reactions to responsiveness. Results are discussed in the context of reciprocal emotion socialization processes.

Child perceptions of parental care and overprotection in children with cancer and healthy children.

The primary aims of this study were to: (a) examine child perceptions of overprotection; and (b) explore how these perceptions relate to child health and adjustment. Children with a prior diagnosis of cancer (n = 205) and children without a history of serious illness (n = 76) reported on parental overprotective and caring behaviors. Children with cancer were recruited from one of four strata based on the elapsed time since their cancer diagnosis (1-6 months; 6-24 months; 2-5 years; >5 years) Children also reported on symptoms of depression, anxiety, and posttraumatic stress. Children with cancer did not differ from healthy children in their perceptions of parental care or overprotection. Child distress was more strongly related to perceptions of care and overprotection than child's health status. Children with cancer do not report their parents approach to care and protection differently than children without a cancer history. These findings mirror prior research examining parental perceptions of overprotection and suggest that, despite the challenges of parenting a child with serious illness, parental protection is not significantly altered.