Family functioning and posttraumatic stress disorder in adolescent survivors of childhood cancer.

Abstract

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...

Psychosocial Barriers and Facilitators to Clinical Trial Enrollment and Adherence for Adolescents With Cancer

“…Adolescent cancer survivors are at risk for experiencing cognitive late effects, high-risk health behaviors, and increased rates of family stress, anxiety, and posttraumatic stress disorder compared with children and older adults. 56,57 It is possible that these cognitive, emotional, behavioral, and family dynamic concerns may be associated with adherence. 36,56,[58][59][60][61][62] The influence of peer relationships on adherence, compared with those with parents and providers, should also be further examined for adolescents diagnosed with cancer.…”

“…56,57 It is possible that these cognitive, emotional, behavioral, and family dynamic concerns may be associated with adherence. 36,56,[58][59][60][61][62] The influence of peer relationships on adherence, compared with those with parents and providers, should also be further examined for adolescents diagnosed with cancer. Adolescents may be positively or negatively motivated to engage in certain behaviors based on the need for acceptance by their peer groups.…”

Evaluation of posttraumatic stress disorder in childhood cancer survivors

“…Os índices de TEPT, variaram de 9,2% a 18,5% dependendo do instrumento e critério de avaliação utilizado, e são comparáveis aos encontrados na literatura internacional com sobreviventes de câncer infantil em países desenvolvidos, que variaram de 8% (Ganz, Raz, Gothelf, Yaniv & Buchval, 2010) a 29% (Aldelfer, Navsaria & Kazak, 2009). Esses índices são considerados altos em relação à população em geral, que é de 6,8%, em um estudo conduzido nos Estados Unidos (Kessler et al, 2005).…”

A narrative review of the occurrence of posttraumatic stress responses in adolescent and young adult cancer survivors

“…29 With regard to the heterogeneity of diagnoses, the majority of studies examined survivors of all cancers, with seven studies excluding central nervous system malignancies, 17,19,22,25,31,34,38 and only one focusing on Hodgkin's lymphoma survivors. 29 The majority (number [n] =14) of studies examined both PTSS and PTSD outcomes; five assessed PTSD alone 16,18,25,36,37 and four evaluated PTSS alone. 22,27,34,38 Sample sizes ranged from 23-6,542, with ten samples of less than 100, 17,19,[23][24][25][30][31][32]36 eleven samples between 100 and 350, 18,20,22,26,29,[33][34][35]37,38 and two samples exceeding 6,500.…”

“…Of the 23 studies reviewed, five studies focused on adolescent cancer survivors, [18][19][20][21][22] ten focused on adult (18 years and older) survivors of pediatric or AYA cancers, [16][17][23][24][25][26][27][28][29][30] and eight focused on both. [31][32][33][34][35][36][37][38] The reported ages of participating survivors ranged from 7 years 21 to 71 years.…”