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1.
Br J Cancer ; 109(5): 1373-81, 2013 Sep 03.
Article in English | MEDLINE | ID: mdl-23880828

ABSTRACT

BACKGROUND: This study investigated longitudinal patterns of psychological distress in adult survivors of childhood cancer. METHODS: Participants included 4569 adult survivors in the Childhood Cancer Survivor Study Cohort (CCSS) who completed the Brief Symptom Inventory-18 on three occasions between 1994 and 2010. Longitudinal latent class analysis was used to identify discrete classes of psychological distress. Predictors of class membership were examined through logistic regression modelling with odds ratios (ORs) and 95% confidence intervals (CIs) reported. RESULTS: Survivors were a median of 39 years of age and 30 years from diagnosis at the most recent follow-up. Most survivors reported few or no symptoms of distress over time, although subsets of survivors reported persistently elevated (depression: 8.9%; anxiety: 4.8%; somatisation: 7.2%) or significant increases in distress symptoms over the follow-up period (depression: 10.2%; anxiety: 11.8%; somatisation: 13.0%). Increasing distress symptoms were predicted by survivor perception of worsening physical health over time (depression: OR=3.3; 95% CI=2.4-4.5; anxiety: OR=3.0; 95% CI=2.2-4.0; somatisation: OR=5.3; 95% CI=3.9-7.4). Persistent distress symptoms were also predicted by survivor perception of worsening physical health over time, as well as by worsening pain and ending analgesic use. CONCLUSION: Subgroups of adult survivors are at-risk for chronic distress or significant increases in distress decades following their original cancer diagnosis. Routine screening of psychological distress in adult survivors of childhood cancer is warranted, especially for survivors who experience physical health morbidities.


Subject(s)
Anxiety , Depression , Neoplasms/psychology , Stress, Psychological , Survivors/psychology , Adult , Female , Health Status , Humans , Male , Middle Aged , Quality of Life , Surveys and Questionnaires
2.
Pain Res Manag ; 13(3): 211-8, 2008.
Article in English | MEDLINE | ID: mdl-18592057

ABSTRACT

Previous research has established links between parent and child pain. However, little is known about sex-specific parent-child pain relationships in a nonclinical population. A sample of 186 children aged eight to 18 years (49% female) provided information on maternal and self bodily pain, assessed by asking children about the presence and location of bodily pain experienced. Children also completed three laboratory pain tasks and reported on cold pressor pain intensity, pressure pain intensity and heat pain intensity. The presence of child-reported maternal pain was consistently correlated with daughters' bodily and laboratory pain, but not with sons' pain in bivariate analyses. Multivariate analyses controlling for child age and maternal psychological distress indicated that children of mothers with bodily pain reported more total bodily pain sites as well as greater pressure and cold pain intensity, relative to children of mothers without bodily pain. For cold pain intensity, these results differed for boys versus girls, in that daughters reporting maternal pain evidenced significantly higher cold pain intensity compared with daughters not reporting maternal pain. No such differences were found for boys. The findings suggest that children's perceptions of maternal pain may play a role in influencing children's own experience of pain, and that maternal pain models may affect boys and girls differently.


Subject(s)
Family Relations , Mothers , Pain/psychology , Adult , Analysis of Variance , Child , Cold Temperature , Female , Hot Temperature , Humans , Male , Pain Management , Pain Measurement , Pressure , Sex Characteristics , Socioeconomic Factors , Surveys and Questionnaires , Treatment Outcome
3.
Br J Cancer ; 91(11): 1858-65, 2004 Nov 29.
Article in English | MEDLINE | ID: mdl-15534610

ABSTRACT

Limb-sparing surgeries have been performed more frequently than amputation based on the belief that limb-sparing surgeries provide improved function and quality-of-life (QOL). However, this has not been extensively studied in the paediatric population, which has unique characteristics that have implications for function and QOL. Using the Childhood Cancer Survivor Study, 528 adult long-term survivors of pediatric lower extremity bone tumours, diagnosed between 1970 and 1986, were contacted and completed questionnaries assessing function and QOL. Survivors were an average of 21 years from diagnosis with an average age of 35 years. Overall they reported excellent function and QOL. Compared to those who had a limb-sparing procedure, amputees were not more likely to have lower function and QOL scores and self-perception of disability included general health status, lower educational attainment, older age and female gender. Findings from this study suggest that, over time, amputees do as well as those who underwent limb-sparing surgeries between 1970 and 1986. However, female gender, lower educational attainment and older current age appear to influence function, QOL and disability.


Subject(s)
Bone Neoplasms/psychology , Osteosarcoma/psychology , Quality of Life , Sarcoma, Ewing/psychology , Survivors/psychology , Adolescent , Adult , Amputees , Bone Neoplasms/diagnosis , Bone Neoplasms/epidemiology , Child , Child, Preschool , Cohort Studies , Education , Female , Follow-Up Studies , Humans , Infant , Lower Extremity/pathology , Male , Osteosarcoma/diagnosis , Osteosarcoma/epidemiology , Pelvis/pathology , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/epidemiology , Survivors/statistics & numerical data
4.
Int J Clin Exp Hypn ; 49(4): 305-19, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11596826

ABSTRACT

In this study, the Stanford Hypnotic Clinical Scale for Children was administered to 52 healthy children and 47 children and adolescents with cancer. Responses to the dream item of this scale were analyzed for the type and detail of imagery. The hypnotizability scores of both groups were similar. However, children with cancer reported more pleasant than unpleasant fantasy in their hypnotic dreams, and their dream reports tended to contain less fantasy and detail overall. Rescoring the dream item based on extent of fantasy and detail resulted in a lower pass rate for that item, especially for children with cancer. Regardless of health status, older children experienced more self-involvement in their hypnotic dreams compared to younger children.


Subject(s)
Dreams , Hypnosis , Neoplasms/psychology , Child , Female , Humans , Male
8.
Child Dev ; 71(4): 933-47, 2000.
Article in English | MEDLINE | ID: mdl-11016557

ABSTRACT

Children (ages 3 to 18, N = 55) diagnosed with leukemia were tested for their memories of lumbar punctures (LPs), a repeated and painful part of the cancer treatment protocol. Memory for both event details and the child's emotional responses was assessed one week after the LP. Children of all ages displayed considerable accuracy for event details, and accuracy increased with age. Overall recall accuracy for event details and emotional responses was similar. Recall among children given oral Versed was similar to that among children not given Versed. Finally, higher distress predicted greater exaggerations in negative memory 1 week later (although controlling for age weakened this relationship); moreover, greater exaggerations in negative memory predicted higher distress at a subsequent LP. These results indicate that children's memories play an important role in their experience of distress during repeated stressful events.


Subject(s)
Mental Recall , Neoplasms/psychology , Neoplasms/therapy , Pain/psychology , Spinal Puncture/psychology , Stress, Psychological , Adolescent , Age Factors , Analysis of Variance , Anti-Anxiety Agents/pharmacology , Anxiety/psychology , Child , Child, Preschool , Confounding Factors, Epidemiologic , Female , Humans , Interview, Psychological , Male , Memory , Mental Recall/drug effects , Midazolam/pharmacology , Pain/etiology , Pain Measurement/methods
9.
Pediatr Clin North Am ; 47(3): 513-25, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10835988

ABSTRACT

A wide range of behavioral and cognitive techniques have been found to be efficacious for helping children to cope with acute pain. Research into the clinical applicability of these interventions is at an early stage but increasingly is being recognized as an important future direction. Many existing interventions and assessment tools are reasonably easy to use, allowing practitioners to have the tools to identify children most vulnerable to pain and to significantly reduce pain-related distress in these children. For additional information from the Internet, please visit the UCLA Pediatric Pain Program Web site: http:¿members.xoom.com/UCLAPAIN/.


Subject(s)
Cognitive Behavioral Therapy/methods , Pain Management , Acute Disease , Adaptation, Psychological/physiology , Child , Child, Preschool , Humans , Hypnosis/methods , Infant , Pain/psychology , Reinforcement, Psychology , Relaxation
10.
J Pediatr Psychol ; 25(4): 269-78, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10814693

ABSTRACT

OBJECTIVE: To evaluate the relationship between pain sensitivity and children's distress during lumbar punctures (LPs), and whether pain sensitivity functions as a moderator of children's responses to a psychological intervention aimed at reducing LP distress. METHOD: Fifty-five children with acute lymphoblastic leukemia (ages 3 to 18) and their parents completed a questionnaire measure of pain sensitivity. Self-report, physiological, and observed measures of distress were collected during the study baseline LP. Children were then randomized into a psychological intervention or an attention control group. Postintervention and follow-up LPs were observed. RESULTS: Higher levels of pain sensitivity were associated with greater anxiety and pain, both prior to and during the LP. Preliminary analyses indicated that pain sensitivity moderated the effects of intervention on distress. Children who were more pain-sensitive and who received no intervention showed greater increases in LP distress over time. In contrast, children who were more pain-sensitive and who received intervention showed greater decreases in LP distress over time. CONCLUSIONS: A measurement of pain sensitivity may be useful in pediatric oncology settings for effectively targeting pain-vulnerable children for psychological intervention. Preliminary analyses indicate that an empirically-supported intervention for procedural distress is efficacious for those children who are most pain-sensitive.


Subject(s)
Cognitive Behavioral Therapy/methods , Pain/psychology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Spinal Puncture/psychology , Temperament , Adaptation, Psychological , Adolescent , Anxiety/etiology , Anxiety/psychology , Child , Child, Preschool , Female , Humans , Male , Mental Recall , Pain/complications , Pain Measurement/methods
12.
J Consult Clin Psychol ; 67(4): 481-90, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10450618

ABSTRACT

The present study sought to reduce children's distress during aversive medical procedures using a brief, cost-effective intervention aimed at reframing memory. Fifty children diagnosed with leukemia (25 treatment, 25 attention control, aged 3-18) were observed as they underwent 3 consecutive lumbar punctures (LPs; baseline, postintervention, and follow-up). Self-report, physiological, and observable distress measures were collected before and after each LP. At posttreatment, children in the intervention group showed reductions in anticipatory physiological and self-report ratings relative to the control group. At follow-up, these effects generalized to reductions in procedural distress. These results suggest that (a) a simple memory-based intervention is efficacious at reducing children's distress and (b) benefits from this intervention are maintained over 1 week even without continued intervention.


Subject(s)
Cognitive Behavioral Therapy , Mental Recall , Precursor Cell Lymphoblastic Leukemia-Lymphoma/psychology , Sick Role , Spinal Puncture/psychology , Suggestion , Adaptation, Psychological , Adolescent , Child , Child, Preschool , Cognitive Behavioral Therapy/economics , Conditioning, Classical , Defense Mechanisms , Female , Humans , Male , Retention, Psychology
16.
J Natl Cancer Inst ; 90(3): 219-25, 1998 Feb 04.
Article in English | MEDLINE | ID: mdl-9462679

ABSTRACT

BACKGROUND: Health-related behaviors are of particular concern in survivors of childhood cancer as they are at increased risk for second cancers and long-term organ dysfunction. The purpose of this study was to compare the smoking behavior and associated factors in young-adult survivors of childhood acute lymphoblastic leukemia (ALL) with those in sibling controls. METHODS: A telephone interview that surveyed smoking behavior was conducted with 592 young-adult survivors, treated before age 20 years on Children's Cancer Group ALL protocols, and 409 sibling controls. Using stratified chi-squared analyses and Cox proportional hazards models, we compared the rates of smoking initiation and smoking cessation between survivors and control subjects. Demographic characteristics (age, sex, race, and education) and psychological factors (mood and self-concept) were examined as predictors interacting with survivorship in logistic regression analyses to try to distinguish a subgroup of survivors who may be at greater risk for smoking. RESULTS: Survivors were significantly less likely to have ever smoked (23.0% versus 35.7%; P<.0001) and thus were less likely to ever be regular, daily smokers than sibling controls (19.1% versus 31.3%; P<.0001). Survivors were less likely to quit smoking than sibling controls (26.6% versus 35.2%), although this result was not statistically significant. There were no interactions between survivor status and either demographic or psychological features on smoking behavior. CONCLUSIONS: Young-adult survivors of childhood ALL are less likely to experiment with smoking but, once having started, are at similar risk for becoming habitual, persistent smokers as sibling controls.


Subject(s)
Precursor Cell Lymphoblastic Leukemia-Lymphoma , Smoking , Actuarial Analysis , Adult , Chi-Square Distribution , Female , Humans , Logistic Models , Male , Middle Aged , Prevalence , Proportional Hazards Models , Smoking Cessation , Survivors
17.
J Health Psychol ; 3(1): 23-38, 1998 Jan.
Article in English | MEDLINE | ID: mdl-22021340

ABSTRACT

To determine the pathways between treatment intensity (age at diagnosis, dosage of chemotherapy [intrathecal methotrexate; IT-MTX] and cranial radiation [CRT]) and various psychosocial outcomes, review of medical records and structured interviews were carried out in 510 adult survivors of childhood leukemia. Structural equation modeling revealed that higher treatment intensity during childhood (indicated by treatment with high-dose CRT, low-dose IT-MTX, and adjusted by younger age at diagnosis) predicted more health- compromising behaviors as adults through lower educational achievement. Additionally, higher childhood treatment intensity predicted current negative mood both directly and via changes in perceived limitations. The present study's findings suggest that higher treatment intensity during childhood may serve as a risk factor for adult survivors' health-compromising behaviors through neuropsychological deficits that arise from cancer treatment.

19.
J Dev Behav Pediatr ; 18(4): 233-43, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9276830

ABSTRACT

This multi-institutional study investigated the association of behavioral/emotional adaptation among siblings of children with cancer with maternal general well-being, physical health, and resource use. One hundred seventy siblings and mothers completed standardized interviews and self-report measures 6 to 42 months after the cancer was diagnosed. As a group, mothers of children with cancer reported significantly lower levels of well-being than matched controls. When stratified according to the level of the sibling's behavioral/emotional adaptation, mothers of siblings in the Dysfunctional group (1) reported the lowest levels of well-being; (2) during the preceding year, were more likely to have sought professional services than mothers of children in the Resilient group; and (3) were least likely to have found social support helpful. Our results support an association between maternal well-being and sibling adjustment but show it is unlikely that nonspecific social support will improve adjustment. The rationale for problem-solving training for mothers is provided.


Subject(s)
Adaptation, Psychological , Family Health , Mothers/psychology , Neoplasms/psychology , Sibling Relations , Adult , Analysis of Variance , Case-Control Studies , Chi-Square Distribution , Child , Cross-Sectional Studies , Female , Health Services/statistics & numerical data , Health Status , Humans , Male , Mental Health , Middle Aged , Nuclear Family/psychology , Nutrition Surveys , Patient Acceptance of Health Care , Sampling Studies , Social Support
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