End Of Successful Treatment Research Articles

Impressions That Last: Particularly Negative and Positive Experiences Reported by Parents Five Years after the End of a Child’s Successful Cancer Treatment or Death

ObjectiveTo describe the experience of parenting a child diagnosed with cancer by examining particularly negative and positive experiences reported by parents of childhood cancer survivors and parents of children lost to cancer.Methods168 parents (88 mothers, 80 fathers) participated. Data were collected five years after the end of successful treatment or the child’s death. The parents’ experiences were identified by open-ended semi-structured questions about particularly negative and positive experiences of the child’s cancer. An inductive approach was used in which the manifest verbal content of the answers was analysed using content analysis.ResultsThe analysis revealed eight categories of negative experience (child late effects; distressing events; healthcare; impaired relationships; long-term psychological consequences; own reactions; surrounding institutions; the fact that the child got cancer) and seven categories of positive experience (healthcare; improved relationships; long-term consequences for the child; personal development; support systems; treatment outcome; unexpected joy). The categories were related to past events or to the present situation. The findings indicate variations in experiences between parents of survivors and bereaved parents, and between fathers and mothers, as some experiences were only reported by parents of survivors and some experiences were only reported by mothers.ConclusionsThe results highlight the importance of past and present events to parents, and accordingly the long-lasting impact of paediatric cancer on parents. The results also point to the wide range of negative as well as positive experiences involved in parenting a child diagnosed with cancer, and provide a comprehensive understanding of the overall experience for parents of children with cancer. Specifically, the findings give guidance to healthcare providers by illustrating the need to provide healthcare personnel with continuous training in communication skills, offering parents opportunities to meet other parents in the same situation and increasing the access to psychosocial supportive services and psychological care.

Factors related to parents' resilience when their child is suffering from cancer

s / European Journal of Oncology Nursing 17 (2013) 892–899 896 Materials and methods One hundred sixty parents (49% fathers) of 89 children answered a modified version of the Memorial Assessment Symptom Scale (MSAS) 1018 at six different time points from one week after the child's diagnosis (T1) to 12-18 months after the end of successful treatment (T6).

Parents' Perceptions of Their Child's Symptom Burden During and After Cancer Treatment

ContextPreviously reported studies of children with cancer mostly provide cross-sectional knowledge of the prevalence of symptoms but do not show when during the disease trajectory and after the end of successful treatment certain symptoms are most prevalent and/or distressing. ObjectivesThe aim was to describe parents' perceptions of their child's symptom burden longitudinally during and after cancer treatment and to investigate whether parents' perceptions vary with child characteristics and parent gender. MethodsOne hundred sixty parents (49% fathers) of 89 children answered a modified version of the Memorial Symptom Assessment Scale (MSAS) 10–18 at six different time points from one week after the child's diagnosis (T1) to 12–18 months after the end of successful treatment (T6). ResultsFeeling drowsy, pain, and lack of energy are initially the most prevalent symptoms. During treatment, the most prevalent symptom is less hair than usual. Pain, feeling sad, and nausea are initially the most distressing symptoms. Pain is both prevalent and distressing throughout the treatment. The child's symptom burden decreases over time. There is no difference regarding the reported symptom burden between the parents of a daughter or a son, or parents of a child older or younger than seven years of age. Mothers' and fathers' assessments of the symptom number, total MSAS and the subscales, are associated, but mothers' assessments are often higher than fathers' assessments. ConclusionThe prevalence and distress of symptoms and symptom burden decrease over time. However, even though the cancer is cured, feeling sad is reported as being prevalent and psychological distress is an issue. A dialogue between staff and the family about distressing symptoms and when they can be expected may increase acceptance and adaptation in children and parents during the disease trajectory.

Adolescents' struggle against bone cancer: an explorative study on optimistic expectations of the future, resiliency and coping strategies

The present study aims to assess adolescents' expectations of the future after bone cancer treatment and to investigate in greater depth the relationship between expectations of the future, resilience and coping strategies. Thirty-two adolescents with cancer experience (11-20 years old), who had a complete first remission at least 1 month after the end of successful treatment, were requested to respond to the Expectations for Future Scale, the Ego-Resiliency Scale and Coping Strategy Indicators. Forty-eight gender- and age-matched control adolescents were randomly selected from a normative sample (NORMs). Adolescents with cancer experience had more optimistic expectations of the future and were less open to experience compared to NORMs. They had lower global ego-resiliency, higher impulse control and tended to use more avoidance strategies than NORMs. In adolescents with cancer experience, expectations of the future were negatively related to global ego-resiliency and positively related to impulse control and avoidance. Expectations of the future were positively correlated with global ego-resiliency and openness to new experience and negatively correlated with impulse control in NORMs. Patients' positive expectations of the future may relate to positive adjustment to cancer events; however, they could also express unrealistic optimism.

Longitudinal assessment of health‐related quality of life in preschool children with non‐CNS cancer after the end of successful treatment

The aim of the study was to access Health Related Quality of Life (HRQoL) in preschool cancer survivors during the first 3 years of continuous remission after the end of successful treatment, and to identify predictors of HRQoL. Parent-reported HRQoL was assessed in 53 preschool children treated successfully for cancer, using the TAPQOL and compared with norm data. Longitudinal mixed models analyses were performed to investigate to what extent demographic and medical variables and parental psychological distress were predictive of HRQoL over time. Two months after the end of successful cancer treatment, survivors showed significantly (P < 0.01) more problem behavior and anxiety, and scored significantly worse (P < 0.01) on sleeping, motor functioning, positive mood and liveliness than the norm. One year after the end of treatment survivors still showed significantly (P < 0.01) more anxiety and worse motor functioning. The level of HRQoL in survivors had normalized 2 and 3 years after the end of treatment. Longer duration of treatment, bad prognosis and greater parental psychological distress were associated with worse scores on the Physical Component Score of the TAPQOL. Medical variables and parental psychological distress were not associated with the Mental Component Score. Survivors adjusted well to the cancer experience and HRQoL improved with time. Despite overall resilience in survivors over time, physical as well as psychosocial monitoring in follow-up is recommended. Standard aftercare should preferably include psychosocial screening, education, and counseling directed at both survivors and parents.

Psychosocial Indicators of Health-Related Quality of Life in Children With Cancer 2 Months After End of Successful Treatment

The purpose of the study was to identify psychosocial correlates of Health-Related Quality of Life (HRQoL) in pediatric cancer patients after completion of cancer treatment. Multiple regression analyses were performed to predict self-reported HRQoL of 52 patients aged 8 to 15 years, and parent-reported HRQoL of 54 patients aged 1 to 5 years. Cognitive coping, family functioning, parental emotional reactions, communication about the disease, and several medical variables were included in the regression models. Better HRQoL was especially associated with more positive expectations of the further course of the disease and less frequent parental asking after disease-related emotions of the child. Interventions should include "positive thinking" as a coping strategy. Several other psychosocial variables were indicative of better HRQoL but further research is needed to confirm and to understand the relationship between psychosocial variables and HRQoL.

Health‐related quality of life in children and emotional reactions of parents following completion of cancer treatment

Completing therapy is one of the major transitions in care in the practice of pediatric oncology and, therefore, deserves special consideration. The purpose of the study was to investigate health-related quality of life (HRQOL) of pediatric patients, and emotional reactions of their parents, shortly after the end of successful treatment. HRQOL of 126 patients, aged 1-15 years, on average 2 months after the end of successful treatment, was assessed with the TNO-AZL Pre-school Quality of life Questionnaire and the TNO-AZL Children's Quality of life Questionnaire. Emotional adjustment of 124 mothers and 111 fathers was assessed with the General Health Questionnaire and the Situation Specific Emotional Reaction Questionnaire. The outcomes of the patients and parents were compared with norm data by means of one sample t-tests, one sample sign-tests or binomial tests. All age groups, except patients aged 8-11 years, experienced worse HRQOL than the norm with respect to motor functioning. In addition, pre-school patients were rated worse on sleeping, appetite, stomach, skin, problem behavior, anxiety, and liveliness, and patients aged 6-7 years on autonomy and cognitive functioning. Parents reported more psychological distress than the norm. Compared to parents whose children were 1-5 years after cancer treatment, they suffered more from feelings of loneliness, helplessness, and uncertainty. A few months after the end of successful cancer treatment, both patients and parents appeared to experience worse well-being than the norm to a clinically relevant extent. Supporting patients and parents should not stop when treatment ends.

Post‐traumatic stress after childhood cancer II: A family model

AbstractRecent studies have suggested that parental responses to pediatric cancer can include symptoms of post‐traumatic stress even years after the end of successful treatment. This paper proposes a family model, based on data about the relationship between post‐traumatic stress symptoms in parents of cancer survivors and the child's perceptions, symptoms and treatment. Parents of 30 childhood cancer survivors 8–19 years old, who were at least 22 months off treatment and disease free after a malignancy, were evaluated using self‐report questionnaires. Neither diagnostic category (leukemia versus solid tumor), nor time since completion of treatment significantly correlated with severity of post‐traumatic stress symptoms reported by parents. Although there was a significant correlation between symptom severity of mothers and fathers, neither mothers nor fathers' scores were significantly correlated with the survivors'. Maternal symptoms were significantly correlated with mothers' trait anxiety, survivors' appraisal of treatment intensity, and with duration of treatment. Further study of the interaction of family variables in parental post‐traumatic response to pediatric illness appears to be indicated.

Psychosocial impact of persistent trophoblastic disease.

The female identity of women who suffer from hydatidiform mole developing into persistent trophoblastic disease is threatened in two ways. The reproductive failure is shortly followed by a disease originating in the uterus requiring chemotherapy. Although somatic treatment results are excellent, the psychological effects may be severe and protracted. We conducted a study of 22 women who were between 6 months and 5 years after the end of successful treatment. It appeared that 19 women suffered from psychological sequelae. The three oldest women of the study group, 50 years or older, belonged to the group of women demonstrating signs of prolonged psychological effects.