Treatment of Posttraumatic Stress Symptoms in Adolescent Survivors of Childhood Cancer and Their Families: A Randomized Clinical Trial.

Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA 19104-4399, USA.
Journal of Family Psychology (Impact Factor: 1.89). 10/2004; 18(3):493-504. DOI: 10.1037/0893-3200.18.3.493
Source: PubMed


Posttraumatic stress symptoms (PTSS), particularly intrusive thoughts, avoidance, and arousal, are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers. We conducted a randomized wait-list control trial of a newly developed 4-session, 1-day intervention aimed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches--the Surviving Cancer Competently Intervention Program (SCCIP). Participants were 150 adolescent survivors and their mothers, fathers, and adolescent siblings. Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group. A multiple imputations approach was used to address nonrandom missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained. The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family.

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    • "Kazak (2005) found that parents of newly diagnosed children reported significantly higher levels of PTSS than parents of long-term cancer survivors. Such findings are supported by other research indicating that both mothers and fathers may experience moderate to severe PTSS at time of diagnosis in comparison with caregivers of long-term cancer survivors (Bruce, 2006; Cabizuca, Marques-Portella, Mendlowicz, Coutinho, & Figueira, 2009; Dunn et al., 2012; Kazak et al., 2004; Phipps et al., 2005). In fact, >40% of caregivers of children with cancer meet diagnostic criteria for acute distress disorder, a common precursor to PTSD, within the first 2 weeks following their child's diagnosis of cancer, with these symptoms continuing throughout their child's treatment (Patiñ o-Ferná ndez et al., 2008). "
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    ABSTRACT: Objective: To investigate the relationship of illness uncertainty (IU) to global psychological distress (GPD) and posttraumatic stress symptomatology (PTSS) using a path analysis approach. Methods: Participants were 105 caregivers (MAge = 36.9 years, standard deviation [SD] = 8.7) of children (MAge = 8.6 years, SD = 5.0) with newly diagnosed cancer. A path analysis model examined the indirect and direct effects of each IU subscale on PTSS through GPD. RESULTS: The final model accounted for 47.30% of the variance in PTSS, and the ambiguity facet of IU had a significant indirect effect on PTSS through GPD. Lack of clarity and unpredictability were not significant predictors. CONCLUSIONS: Ambiguity experienced by parents may be salient in the development of PTSS. Future research should examine these relationships longitudinally in larger samples to better understand adjustment in parents of children with cancer.
    Journal of Pediatric Psychology 10/2015; DOI:10.1093/jpepsy/jsv093 · 2.91 Impact Factor
    • "Family problem-solving interventions in pediatric diabetes (Wysocki et al., 2006), childhood traumatic brain injury (Wade, Walz, Carey, & Williams, 2009), asthma (Seid, Varni, Gidwani, Gelhard, & Slymen, 2010), and pediatric pain (Palermo, Law, Essner, Jessen-Fiddick, & Eccleston, 2014) have found significant improvements in psychosocial functioning (adherence , self-management, and HRQL, respectively). The pediatric literature also reports the potential efficacy of brief, family problemsolving methods (Kaslow et al., 2000; Kazak et al., 2004; Sahler et al., 2005). Although mechanisms of change have not been formally explored in prior studies, we hypothesized that by improving family problem-solving skills to address school-related challenges that child HRQL and academic outcomes may improve. "
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    ABSTRACT: Objective: Tested a family-based group problem-solving intervention, "Families Taking Control," (FTC) to improve school functioning and health-related quality of life (HRQL) for children with sickle cell disease. METHOD: Children and caregivers completed questionnaires assessing HRQL and school functioning and children completed performance-based measures of IQ and achievement at baseline and 6 months later. Families were randomized to the intervention (FTC, n = 42) or delayed intervention control (DIC, n = 41) group. FTC involved a full-day workshop followed by 3 booster calls. RESULTS: There were no differences between FTC completers (n = 24) and noncompleters (n = 18). FTC group (n = 24) and DIC group (n = 38) did not differ significantly on primary outcomes at follow-up: number of formal academic and disease-related accommodations, individualized education plan/504 service plan, school absences, school HRQL, or academic skills. CONCLUSIONS: Although families found FTC to be acceptable, there were no intervention effects. Challenges of the trial and implications for future research are discussed.
    Journal of Pediatric Psychology 06/2015; 40(10). DOI:10.1093/jpepsy/jsv063 · 2.91 Impact Factor
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    • "Reported reasons for parents to decline their AYA's involvement in studies have included: (a) risk of randomization to an undesired treatment group (Bleyer et al., 2006; Hinds et al., 2000); (b) inconvenience of participation (Harth, 1995; Hayman, Taylor, Peart, Galland, & Sayers, 2001; Hinds et al., 2002; Kazak et al., 2004); (c) safety concerns (Caldwell, Butow, & Craig, 2003; Harth, 1995; Hayman et al., 2001); and (d) potential adverse effects of proposed treatments (Bowman, Vidsten, Kogner, & Samuelsson, 2004; Hendricks-Ferguson, 2006). Also, AYA decline participation because of: (a) lack of interest or perceived benefit (Gattuso et al., 2006; Hinds et al., 2002; Ruffin & Baron, 2000); (b) symptom distress (Crowley & Casarett, 2003; Gattuso et al., 2006; Hendricks- Ferguson, 2006; Hinds et al., 2000; Kyngas et al., 2001); (c) engagement in other activities, such as homework or video games (Ward-Smith, Hamlin, Bartholomew, & Stegenga, 2007); and (d) not wanting to revisit their cancer experience (Kazak et al., 2004). "

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