The purpose of this study was to investigate family functioning and relationships between family functioning and posttraumatic stress disorder in adolescent survivors of childhood cancer. To assess family functioning, 144 adolescent cancer survivors 1 to 12 years post-cancer treatment (M=5.3 years) and their parents completed the Family Assessment Device (FAD). To assess Posttraumatic Stress Disorder (PTSD), adolescents were administered a structured diagnostic interview. Nearly half (47%) of the adolescents, one-fourth (25%) of mothers, and one-third (30%) of fathers reported poor family functioning, exceeding the clinical cut-off on four or more FAD subscales. Families in which the cancer survivor had PTSD (8% of the sample) had poorer functioning than other families in the areas of problem-solving, affective responsiveness and affective involvement. Three-fourths of the adolescents with PTSD arose from families with categorically poor family functioning. A surprisingly high rate of poor family functioning was reported in these families of adolescent cancer survivors. Adolescents with PTSD were over five times as likely to emerge from a poorly functioning family compared to a well-functioning one. This study provides evidence that family functioning is related to cancer-related posttraumatic reactions in adolescent survivors.
Keywords cancer survivors; adolescents; family functioning; posttraumatic stressChildren with cancer and their family members experience childhood cancer as a highly distressing event. When a child is diagnosed with cancer, it is quickly understood that he or she will die without treatment. Current treatments, while accompanied by high overall success rates (Reis et al., 2008), are very intensive. Typically, treatment protocols require hospitalization, painful and invasive diagnostic and monitoring procedures, and surgery, chemotherapy, and/or radiation therapy. Side effects of the treatment and possible complications (e.g., nausea, loss of appetite, severe fatigue, mouth sores, rashes, infections)Correspondence should be sent to Melissa A. Alderfer, Ph.D. at The Children's Hospital of Philadelphia, Division of Oncology, CHOP North Room 1485, 34 th & Civic Center Blvd., Philadelphia, PA 19104. alderfer@email.chop.edu.. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/fam. may make the child feel and appear more ill during treatment than they were prior to treatment (Keene, 1999). Even if the child does well and establishes remission quickly, treatment is rarely routine and may involve fr...