Psychological adjustment of children with cancer: relapse and survival perspectives / Ajustamento psicológico de crianças com câncer: perspectivas da recidiva e da remissão / Ajuste psicológico de niños con cáncer: perspectivas de recaída y supervivencia

In Brazil, few studies have investigated the psychological aspects of childhood cancer. The aim of this article was to compare the psychological adjustment of children with cancer from different survival perspectives with that of children without cancer, besides examining potential risk factors. The sample consisted of 179 participants (6-14 years-old) recruited in two Brazilian public hospitals and three schools, and divided in three groups (relapsed, survivors and control). Children answered orally the self-reported Behavior Assessment Scale for Children, the Revised Children's Manifest Anxiety Scale and Piers-Harris' Self-Concept Scale. No differences were found between groups regarding school and clinical maladjustment, personal adjustment, emotional symptoms and self-concept. Findings also showed positive associations between psychological maladjustment and gender, younger age, lower household income, single parenthood and lower levels of parental education. Conclusions indicate that children with cancer adapt well to the disease and do not present more psychological problems than controls (AU).

No Brasil, poucos estudos investigaram os aspectos psicológicos do câncer infantil. O objetivo deste artigo foi comparar o ajustamento psicológico de crianças com câncer com diferentes perspectivas de sobrevivência com o de crianças sem câncer, além de examinar potenciais fatores de risco. A amostra consistiu em 179 participantes (6-14 anos de idade) recrutados em dois hospitais públicos e três escolas brasileiras. As crianças responderam oralmente à Escala de Avaliação Comportamental para Crianças, à Escala de Ansiedade Manifesta para Crianças Revisada e à Escala de Autoconceito Piers-Harris. Não foram constatadas diferenças entre os grupos com relação ao desajustamento clínico e escolar, ajustamento pessoal, sintomas emocionais e autoconceito. Os resultados também mostraram associações positivas entre o desajustamento psicológico e gênero, menor idade, menor renda, famílias monoparentais e menor nível educacional parental. As conclusões indicam que crianças com câncer se adaptam bem à doença e não apresentam mais problemas psicológicos que as do grupo controle (AU).

Na Brasil, pocos estudios han investigado los aspectos psicológicos del cáncer infantil. El objetivo de este artículo fue comparar el ajuste psicológico de niños na cáncer na diferentes perspectivas de supervivencia na el de niños sin cáncer, además de examinar los posibles factores de riesgo. La muestra consistió en 179 participantes (6-14 años de edad) reclutados en dos hospitales públicos y tres escuelas brasileñas. Los niños contestaron oralmente a la Escala de Evaluación del Comportamiento del Niño, la Escala Revisada de Ansiedad Manifiesta en Niños y la Escala de Autoconcepto de Piers-Harris. No se constataron diferencias entre los grupos con respeto al desajuste clínico y escolar, el ajuste personal, los síntomas emocionales y el autoconcepto. Los resultados también mostraron asociaciones positivas entre el desajuste psicológico y el género, la menor edad, la menor renta, las familias monoparentales y el nivel educativo parental más bajo. Las conclusiones señalan que niños con cáncer se adaptan bien a la enfermedad y no presentan más problemas psicológicos que los del grupo de control (AU).

Psychological Adjustment of Parents of Children with Different Cancer Prognoses / Ajustamento Psicológico de Pais de Crianças com Diferentes Prognósticos de Câncer / Ajuste Psicológico de Padres de Niños con Distintos Pronósticos de Cáncer

Abstract Little is known about the psychological adjustment of parents of children with cancer relapse or remission. This study investigated differences in the psychological adjustment of caregivers of children with different cancer prognosis, by comparing them with a control group. In total, 183 caregivers participated in this study: those with children in relapse/on treatment (n = 32), remission/off treatment (n = 75), and "healthy" (n = 76). The Beck Depression and Anxiety Inventories, the Symptom Check list-90-R, the Norbeck Social Support Questionnaire-Reviewed and the Family Environment Scale were analyzed with Variance Analysis, Student's t-test, Chi-square and Pearson correlations. The results showed that parents of children with cancer relapse presented less psychological adjustment. Furthermore, a protective effect of family cohesion and possible risk factors related to sociodemographic variables were observed. Conclusions highlight the convenience of developing specific interventions for parents of children with cancer relapse.

Resumo Pouco se sabe sobre o ajustamento psicológico de pais de crianças em recidiva de câncer e em remissão. Este estudo investigou diferenças no ajustamento psicológico de cuidadores de crianças com diferentes prognósticos de câncer, comparando-os com um grupo controle. Os participantes foram 183 cuidadores de crianças em recidiva/tratamento (n = 32), remissão/fora de tratamento (n = 75) e "saudáveis" (n = 76). Os Inventários Beck de Depressão e Ansiedade, a Escala de Avaliação de Sintomas 90-R, o Questionário Norbeck de apoio social-revisado e a Family Environment Scale foram analisados com análises de variância, t de Student, Qui-quadrado e correlações de Pearson. Os resultados mostraram que os pais de crianças em recidiva apresentaram menos ajustamento psicológico. Além disto, observou-se um efeito protetor da coesão familiar e possíveis fatores de risco relacionados a variáveis sociodemográficas. Discute-se a conveniência de desenvolver intervenções psicológicas para pais de crianças em recidiva de câncer.

Resumen Poco se conoce sobre el ajuste psicológico de padres de niños en recidiva de cáncer y en remisión. Este estudio investigó las diferencias en el ajuste psicológico de cuidadores de niños con distintos pronósticos de cáncer, comparándolos con un grupo control. Participaron 183 cuidadores de niños en recidiva/en tratamiento (n = 32), remisión/sin tratamiento (n = 75) y "sanos" (n = 76). Se analizaron los Inventarios de Depresión y Ansiedad de Beck, la Escala de Síntomas 90-R, el Cuestionario Norbeck de Apoyo Social Revisado y la Family Environment Scale mediante análisis de varianza, prueba t de Student, test de chi-cuadrado y correlaciones de Pearson. Los resultados mostraron que los padres de niños en recidiva presentaban menos ajuste psicológico. Además, se observó un efecto protector de la cohesión familiar y posibles factores de riesgo relacionados a variables sociodemográficas. Se discute la conveniencia de desarrollar intervenciones psicológicas para padres de niños en recidiva de cáncer.

Health-related quality of life of latin-american immigrants and spanish-born attended in spanish primary health care: socio-demographic and psychosocial factors.

BACKGROUND: This study compares the health-related quality of life of Spanish-born and Latin American-born individuals settled in Spain. Socio-demographic and psychosocial factors associated with health-related quality of life are analyzed. METHODS: A cross-sectional Primary Health Care multi center-based study of Latin American-born (n = 691) and Spanish-born (n = 903) outpatients from 15 Primary Health Care Centers (Madrid, Spain). The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life. Socio-demographic, psychosocial, and specific migration data were also collected. RESULTS: Compared to Spanish-born participants, Latin American-born participants reported higher health-related quality of life in the physical functioning and vitality dimensions. Across the entire sample, Latin American-born participants, younger participants, men and those with high social support reported significantly higher levels of physical health. Men with higher social support and a higher income reported significantly higher mental health. When stratified by gender, data show that for men physical health was only positively associated with younger age. For women, in addition to age, social support and marital status were significantly related. Both men and women with higher social support and income had significantly better mental health. Finally, for immigrants, the physical and mental health components of health-related quality of life were not found to be significantly associated with any of the pre-migration factors or conditions of migration. Only the variable "exposure to political violence" was significantly associated with the mental health component (p = 0.014). CONCLUSIONS: The key factors to understanding HRQoL among Latin American-born immigrants settled in Spain are age, sex and social support. Therefore, strategies to maintain optimal health outcomes in these immigrant communities should include public policies on social inclusion in the host society and focus on improving social support networks in order to foster and maintain the health and HRQoL of this group.

The Spanish version of the Body Image Scale (S-BIS): psychometric properties in a sample of breast and gynaecological cancer patients.

PURPOSE: The aim of this study is to develop a Spanish version of the Body Image Scale (Hopwood et al. Eur J Cancer 37(2):189-197, 2001) and to analyze its psychometric properties in a sample of women with breast or gynaecological cancer. METHODS: The Spanish version of the Body Image Scale was developed using a forward and backward translation technique. A total sample of 100 women who had undergone radical surgery for breast (n = 50) or gynaecological cancer (n = 50) completed the scale. RESULTS: Factor analysis resulted in a single-factor solution, both in the total sample and in the two subgroups, accounting for >76 % variance. Internal consistency (Cronbach's alpha) was 0.960. The Spanish version of the Body Image Scale correlated negatively with self-esteem (r = -0.733), quality of life (r = -0.632) and age (r = -0.643) and positively with depression (r = 0.832) and anxiety (r = 0.564); all p values < 0.01. CONCLUSIONS: To our knowledge, this is the first study that provides a Spanish version of the Body Image Scale. Our results show a stable factorial structure between samples with a single-factor solution and good psychometric properties, suggesting that it is a suitable tool for measuring body image concerns among Spanish-speaking cancer patients. Its brevity and comprehensibility allow a quick assessment both in clinical and research settings.

Psychological distress in women with breast and gynecological cancer treated with radical surgery.

OBJECTIVES: The objective of this study is to compare psychological distress (body image disturbance,self-esteem, depression, and anxiety) in women with breast or gynecological cancer treated by radical surgery. Additionally, another objective is to analyze the association between psychological distress and sociodemographic characteristics, medical history, and social support to produce a prediction model for the outcome measures. METHODS: A cross-sectional study was carried out with 100 women who had undergone radical surgery for breast or gynecological cancer. Both groups were divided into the following: younger than 50 years old and 50 years old or older. Body Image Scale, Rosenberg's Self-Esteem Scale, Beck Depression Inventory, and Beck Anxiety Inventory were used. RESULTS: Age had a significant main effect on psychological distress but the type of cancer did not.Younger women showed significantly greater distress than older women (p-values<0.001). A significant interaction between age and type of cancer was found, indicating that older women with breast cancer had worse body image and more depression than those with gynecological cancer (p-values 0.001); no significant differences were found between younger groups.The prediction model for increased body image disturbance and depression included the joint effect of the following variables: being younger, inactive occupational status, and post-adjuvant therapy side effects. For lower self-esteem, the variables were: being younger, post-adjuvant therapy side effects,and dissatisfaction with social support. And for higher anxiety, the sole variable included was post-adjuvant therapy side effects. CONCLUSIONS: Both mastectomy and hysterectomy/oophorectomy cause similar psychological distress in younger women, but mastectomy causes greater distress in older women than hysterectomy/oophorectomy.

Psychometric properties of the eight-item modified Medical Outcomes Study Social Support Survey based on Spanish outpatients.

PURPOSE: The aim of this study was to examine the psychometric properties of the modified Medical Outcomes Study Social Support Survey (mMOS-SS) in a primary healthcare setting (PHCS). METHODS: A cross-sectional descriptive study was carried out with Spanish outpatients (N = 903) from a PHCS. Subjects responded to the first eight items of the classic Medical Outcomes Study-Social Support Survey (MOS-SS), in effect the mMOS-SS, and immediately proceeded to give answers to the rest of the scale. Also, sociodemographic, self-reported health status and mood/anxiety disorders data were collected. Factor structure was analyzed using exploratory and confirmatory analysis, internal reliability was determined by Cronbach's standardized alpha, and consistency was evaluated by item-to-total score correlations. Evidences of validity were assessed by Spearman's rank correlations, and using the Mann-Whitney test or Kruskal-Wallis test as appropriate, of differences between the mMOS-SS and the MOS-SS. RESULTS: Mean scores for the MOS-SS (mean = 4.26, SD = 0.78) and mMOS-SS (mean = 4.34, SD = 0.74) are similar. Cronbach's alpha was 0.96 and 0.91, for the MOS-SS and mMOS-SS, respectively. Item-to-total score correlations of the MOS-SS and mMOS-SS are ≥0.64 and ≥0.70, respectively. Exploratory factor analysis (EFA) [56.63% variance, KMO=0.904; χ2=4396.27], and confirmatory factor analysis (CFA) [CFI=0.95; NNFI(TLI)=0.97; SRMR=0.05; χ2=296.81; RMSEA=0.17] showed a one-factor structure. CONCLUSIONS: Psychometric properties of the Spanish version of the mMOS-SS in outpatients attending a PHCS are adequate. Factor analysis confirmed a one-factor model with acceptable fit indices.

Effectiveness of psychological interventions intended to promote adjustment of children with cancer and their parents: an overview / Eficacia de intervenciones psicológicas dirigidas a promover el ajuste de niños con cáncer y de sus padres: una revisión

This article aims at providing a general overview of psychological interventions intended to promote psychological adjustment of children with cancer and their parents. To achieve this goal, we reviewed published articles between 1998-2010, using a combination of the following key-words: psychosocial intervention, psychotherapy, trial, treatment, adjustment, well-being, adaptation, cancer, childhood cancer, pediatric cancer, anxiety and depression in the electronic databases: Psycinfo, Medline, Scielo, Lilacs, Psicodoc and Psyarticles. Fourteen articles were found and analyses show that most interventions had some efficacy in the psychological adjustment of children and their parents; nevertheless, there is a limited number of treatments that can in fact be considered effective. The convenience of psychological interventions is discussed and how they must comprehend strengths and the promotion of psychological health and should not be based solely on deficits and psychopathological models. Possibly, this re-orientation will help fostering significant clinic changes regarding the stress associated to cancer and its treatment

Esta revisión tiene como objetivo ofrecer un panorama general sobre la eficacia de las intervenciones psicológicas destinadas a promover el ajuste psicológico de niños aquejados de cáncer y de sus padres. Con este fin se revisaron los artículos publicados entre 1998-2010, empleando las siguientes palabras-clave: intervención psicosocial, psicoterapia, ensayo, tratamiento, ajuste, bienestar, adaptación, cáncer, cáncer infantil, cáncer pediátrico, ansiedad y depresión (combinándolas entre sí) en las siguientes bases de datos: Psycinfo, Medline, Scielo, Lilacs, Psicodoc y Psyarticles. Se localizaron un total de catorce artículos, de cuyo análisis se concluye que la mayoría de las intervenciones utilizadas resultan de alguna utilidad para mejorar el ajuste psicológico tanto de los niños como de los padres, aunque el número de tratamientos que pueden considerarse realmente eficaces es más limitado. Se discute sobre la conveniencia de que la intervención psicológica dirigida a este tipo de población se centre más en las fortalezas y en la promoción de la salud y deje de apoyarse exclusivamente en modelos de tratamiento basados en déficits y psicopatología. Posiblemente, este cambio de orientación contribuirá a fomentar cambios clínicamente relevantes en relación al estrés que acompaña al cáncer y su tratamiento