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Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial

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Abstract

Objective

In adolescents and young adults (AYAs) with cancer, we examined (1) the distribution and type of traumatic events (TEs) experienced prior to baseline assessment and (2) how a resilience intervention, Promoting Resilience in Stress Management (PRISM), impacted changes in patient-reported outcomes (PROs) for AYAs with and without TEs.

Methods

AYAs (12–25 years) within 1–10 weeks of diagnosis of new malignancy or ever diagnosed with advanced cancer were enrolled and randomly assigned to usual care (UC) with or without PRISM. To assess TEs, we screened medical records for traditionally defined adverse childhood experiences (ACEs) and medical traumatic events. Age-validated PROs assessed resilience, benefit-finding, hope, generic health-related quality of life (QoL), cancer-specific QoL, depression, and anxiety at enrollment and 6 months later. We calculated effect sizes (Cohen’s d) for PRISM vs. UC effect on PRO score change at 6 months for 1+ TEs and 0 TE groups.

Results

Ninety-two AYAs enrolled and completed baseline surveys (44-UC, 48-PRISM; N = 74 at 6 months, 38-UC, 36-PRISM); 60% experienced 1+ TEs. PROs at baseline were similar across groups. PRISM’s effect on score change was greater (Cohen’s d ≥ 0.5) for the 1+ TE group on domains of benefit-finding and hope; and similar (d < 0.5) on domains of resilience, depression, anxiety, and both generic and cancer-specific QoL.

Conclusions

In AYAs with cancer, TEs occurred at similar rates as the general population. PRISM may be particularly helpful for improving benefit-finding and hope for those who have experienced TEs.

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Data availability

The data that support the findings of this study may be available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Kwak M, Zebrack BJ, Meeske KA, Embry L, Aguilar C, Block R, Hayes-Lattin B, Li Y, Butler M, Cole S (2013) Trajectories of psychological distress in adolescent and young adult patients with cancer: a 1-year longitudinal study. J Clin Oncol 31:2160–2166. https://doi.org/10.1200/JCO.2012.45.9222

    Article  PubMed  Google Scholar 

  2. Flaherty EG, Thompson R, Litrownik AJ, Zolotor AJ, Dubowitz H, Runyan DK, English DJ, Everson MD (2009) Adverse childhood exposures and reported child health at age 12. Acad Pediatr 9:150–156. https://doi.org/10.1016/j.acap.2008.11.003

    Article  PubMed  Google Scholar 

  3. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. Am J Prev Med 56:774–786. https://doi.org/10.1016/j.amepre.2019.04.001

    Article  Google Scholar 

  4. Sharkey CM, Espeleta HC, Bakula DM, Roberts CM, Ruppe NM, Marissa Baudino BS, Clawson AH, Chaney JM, Mullins LL (2020) Adverse childhood experiences: non-medical trauma in the context of pediatric chronic illness. Child Health Care 49:40–54. https://doi.org/10.1080/02739615.2018.1553677

    Article  Google Scholar 

  5. Rosenberg AR, Bradford MC, McCauley E, Curtis JR, Wolfe J, Baker KS, Yi-Frazier JP (2018) Promoting resilience in adolescents and young adults with cancer: results from the PRISM randomized controlled trial. Cancer 124:3909–3917. https://doi.org/10.1002/cncr.31666

    Article  PubMed  Google Scholar 

  6. Rosenberg AR, Bradford MC, Barton KS, Etsekson N, McCauley E, Curtis JR, Wolfe J, Baker KS, Yi-Frazier JP (2019) Hope and benefit finding: results from the PRISM randomized controlled trial. Pediatr Blood Cancer 66:e27485. https://doi.org/10.1002/pbc.27485

    Article  PubMed  Google Scholar 

  7. Steineck A, Bradford MC, Lau N, Scott S, Yi-Frazier JP, Rosenberg AR (2019) A psychosocial intervention’s impact on quality of life in AYAs with cancer: a post hoc analysis from the Promoting Resilience in Stress Management (PRISM) Randomized Controlled Trial. Children 6:124. https://doi.org/10.3390/children6110124

    Article  PubMed Central  Google Scholar 

  8. Lau N, Bradford MC, Steineck A, Scott S, Bona K, Yi-Frazier JP, McCauley E, Rosenberg AR (2019) Examining key sociodemographic characteristics of adolescents and young adults with cancer: a post hoc analysis of the Promoting Resilience in Stress Management randomized clinical trial. Palliat Med 34:026921631988621–026921631988348. https://doi.org/10.1177/0269216319886215

    Article  Google Scholar 

  9. Rosenberg AR, Junkins CC, Sherr N, Scott S, Klein V, Barton KS, Yi-Frazier JP (2019) Conducting psychosocial intervention research among adolescents and young adults with cancer: lessons from the PRISM randomized clinical trial. Children 6:117. https://doi.org/10.3390/children6110117

    Article  PubMed Central  Google Scholar 

  10. Rosenberg AR, Yi-Frazier JP, Eaton L, Wharton C, Cochrane K, Pihoker C, Baker KS, McCauley E (2015) Promoting resilience in stress management: a pilot study of a novel resilience-promoting intervention for adolescents and young adults with serious illness. J Pediatr Psychol 40:992–999. https://doi.org/10.1093/jpepsy/jsv004

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rosenberg AR, Yi-Frazier JP, Wharton C, Gordon K, Jones B (2014) Contributors and inhibitors of resilience among adolescents and young adults with cancer. J Adolesc Young Adult Oncol 3:185–193. https://doi.org/10.1089/jayao.2014.0033

    Article  PubMed  PubMed Central  Google Scholar 

  12. Burke NJ, Hellman JL, Scott BG, Weems CF, Carrion VG (2011) The impact of adverse childhood experiences on an urban pediatric population. Child Abuse Negl 35:408–413. https://doi.org/10.1016/j.chiabu.2011.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  13. Monroe SM (2008) Modern approaches to conceptualizing and measuring human life stress. Annu Rev Clin Psychol 4:33–52. https://doi.org/10.1146/annurev.clinpsy.4.022007.141207

    Article  PubMed  Google Scholar 

  14. Finkelhor D, Shattuck A, Turner H, Hamby S (2013) Improving the adverse childhood experiences study scale. Arch Pediatr Adolesc Med 167:70–75. https://doi.org/10.1001/jamapediatrics.2013.420

    Article  Google Scholar 

  15. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. Arlington, VA

  16. Finkelhor D (2018) Screening for adverse childhood experiences (ACEs): cautions and suggestions. Child Abuse Negl 85:174–179. https://doi.org/10.1016/j.chiabu.2017.07.016

    Article  PubMed  Google Scholar 

  17. Afifi TO, Ford D, Gershoff ET et al (2017) Spanking and adult mental health impairment: the case for the designation of spanking as an adverse childhood experience. Child Abuse Negl 71:24–31. https://doi.org/10.1016/j.chiabu.2017.01.014

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dalton HJ, Slonim AD, Pollack MM (2003) Multicenter outcome of pediatric oncology patients requiring intensive care. Pediatr Hematol Oncol 20:643–649. https://doi.org/10.1080/08880010390243095

    Article  PubMed  Google Scholar 

  19. Connor KM, Davidson JRT (2003) Development of a new resilience scale: the Connor-Davidson Resilience scale (CD-RISC). Depress Anxiety 18:76–82. https://doi.org/10.1002/da.10113

    Article  PubMed  Google Scholar 

  20. Campbell-Sills L, Cohan SL, Stein MB (2006) Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behav Res Ther 44:585–599. https://doi.org/10.1016/j.brat.2005.05.001

    Article  PubMed  Google Scholar 

  21. Scali J, Gandubert C, Ritchie K, Soulier M, Ancelin ML, Chaudieu I (2012) Measuring resilience in adult women using the 10-items Connor-Davidson resilience scale (CD-RISC). Role of trauma exposure and anxiety disorders. PLoS One 7:e39879. https://doi.org/10.1371/journal.pone.0039879

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST, Yoshinobu L, Gibb J, Langelle C, Harney P (1991) The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol 60:570–585. https://doi.org/10.1037//0022-3514.60.4.570

    Article  CAS  PubMed  Google Scholar 

  23. Phipps S, Long AM, Ogden J (2007) Benefit finding scale for children: preliminary findings from a childhood cancer population. J Pediatr Psychol 32:1264–1271. https://doi.org/10.1093/jpepsy/jsl052

    Article  PubMed  Google Scholar 

  24. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life the remarkable universality of half a standard deviation. Med Care 41:582–592. https://doi.org/10.1097/00005650-200305000-00004

    Article  PubMed  Google Scholar 

  25. Chan KS, Mangione-Smith R, Burwinkle TM, Rosen M, Varni JW (2005) The PedsQLTM: reliability and validity of the short-form generic core scales and asthma module. Med Care 43:256–265. https://doi.org/10.1097/00005650-200503000-00008

    Article  PubMed  Google Scholar 

  26. Varni JW, Limbers CA (2009) The PedsQLTM 4.0 generic core scales young adult version: feasibility, reliability and validity in a university student population. J Health Psychol 14:611–622. https://doi.org/10.1177/1359105309103580

    Article  PubMed  Google Scholar 

  27. Varni JW, Burwinkle TM, Katz ER, Meeske K, Dickinson P (2002) The PedsQLTM in pediatric cancer. Cancer 94:2090–2106. https://doi.org/10.1002/cncr.10428

    Article  PubMed  Google Scholar 

  28. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 52:69–77. https://doi.org/10.1016/S0022-3999(01)00296-3

    Article  PubMed  Google Scholar 

  29. Hedström M, Ljungman G, Von Essen L (2005) Perceptions of distress among adolescents recently diagnosed with cancer. J Pediatr Hematol Oncol 27:15–22

    Article  PubMed  Google Scholar 

  30. Sawilowsky SS (2009) New effect size rules of thumb. J Mod Appl Stat Methods 8:597–599. https://doi.org/10.22237/jmasm/1257035100

    Article  Google Scholar 

  31. Hodges M, Godbout N, Briere J, Lanktree C, Gilbert A, Kletzka NT (2013) Cumulative trauma and symptom complexity in children: a path analysis. Child Abuse Negl 37:891–898. https://doi.org/10.1016/j.chiabu.2013.04.001

    Article  PubMed  Google Scholar 

  32. Kira IA, Ashby JS, Omidy AZ, Lewandowski L (2015) Current, continuous, and cumulative trauma-tocused cognitive behavior therapy: a new model for trauma counseling. J Ment Health Couns 37:323–340. https://doi.org/10.17744/mehc.37.4.04

    Article  Google Scholar 

  33. Steinke CM, Derrick RM (2018) An exploration of the role of adverse childhood experiences (ACEs) on youth engagement in residential treatment. Child Youth Serv Rev 89:355–363. https://doi.org/10.1016/j.childyouth.2018.04.039

    Article  Google Scholar 

  34. Michael ST, Snyder CR (2005) Getting unstuck: The roles of hope, finding meaning, and rumination in the adjustment to bereavement among college students. Death Stud 29:435–458. https://doi.org/10.1080/07481180590932544

    Article  PubMed  Google Scholar 

  35. Greup SR, Kaal SEJ, Jansen R, Manten-Horst E, Thong MSY, van der Graaf WTA, Prins JB, Husson O (2018) Post-traumatic growth and resilience in adolescent and young adult cancer patients: an overview. J Adolesc Young Adult Oncol 7:1–14. https://doi.org/10.1089/jayao.2017.0040

    Article  PubMed  Google Scholar 

  36. Meyerson DA, Grant KE, Carter JS, Kilmer RP (2011) Posttraumatic growth among children and adolescents: a systematic review. Clin Psychol Rev 31:949–964. https://doi.org/10.1016/j.cpr.2011.06.003

    Article  PubMed  Google Scholar 

  37. Rutter M (1987) Psychosocial resilience and protective machanisms. Am J Orthop 57:316–331

    Article  Google Scholar 

  38. Owens GP, Dashevsky B, Chard KM, Mohamed S, Haji U, Heppner PS, Baker DG (2009) The relationship between childhood trauma, combat exposure, and posttraumatic stress disorder in male veterans. Mil Psychol 21:114–125. https://doi.org/10.1080/08995600802574530

    Article  Google Scholar 

  39. Stein AL, Tran GQ, Lund LM, Haji U, Dashevsky BA, Baker DG (2005) Correlates for posttraumatic stress disorder in Gulf War veterans: a retrospective study of main and moderating effects. J Anxiety Disord 19:861–876. https://doi.org/10.1016/j.janxdis.2004.09.006

    Article  PubMed  Google Scholar 

  40. Conrad D, Wilker S, Pfeiffer A, Lingenfelder B, Ebalu T, Lanzinger H, Elbert T, Kolassa IT, Kolassa S (2017) Does trauma event type matter in the assessment of traumatic load? Eur J Psychotraumatol 8:1344079. https://doi.org/10.1080/20008198.2017.1344079

    Article  PubMed  PubMed Central  Google Scholar 

  41. Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R (2005) Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics 116:575–579. https://doi.org/10.1542/peds.2005-0521

    Article  PubMed  Google Scholar 

  42. Ellenberg L, McComb JG, Siegel SE, Stowe S (1987) Factors affecting intellectual outcome in pediatric brain tumor patients. Neurosurgery 21:638–644. https://doi.org/10.1227/00006123-198711000-00006

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank patients and their families for their participation in this study. We also thank Michele Shaffer for her contributions to the statistical design of this trial, and Claire Wharton, Lauren Eaton, Victoria Klein, and Stacy Garcia for their efforts on patient enrollment, data collection and management, intervention administration, and administrative support. We also thank the University of Denver’s Psychology Department Writing Group for their review of early manuscript drafts.

Funding

This work was supported by grants from the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421) and CureSearch for Children’s Cancer awarded to Dr. Rosenberg.

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Authors and Affiliations

  1. Palliative Care & Resilience Lab, Seattle Children’s Research Institute, Seattle, WA, USA

    Samantha R. Scott, Alison G. O’Daffer, Kaitlyn Fladeboe, Nancy Lau, Angela Steineck, Mallory Taylor, Joyce P. Yi-Frazier & Abby R. Rosenberg

  2. Department of Psychology, University of Denver, Denver, CO, USA

    Samantha R. Scott

  3. Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, WA, USA

    Miranda C. Bradford

  4. University of Washington School of Medicine, Seattle, WA, USA

    Angela Steineck, Mallory Taylor & Abby R. Rosenberg

  5. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Angela Steineck, Mallory Taylor & Abby R. Rosenberg

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  1. Samantha R. Scott
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Contributions

S.R.S. conceptualized and designed the post hoc analysis, drafted the initial manuscript, and reviewed and revised the manuscript. A.G.O. double coded a subsection of medical chart data to reliability, contributed to the post hoc analysis conception and design and data interpretation, critically reviewed and revised the manuscript, and provided approval of the submitted product. M.C.B. conducted the statistical analyses, critically reviewed and revised the manuscript, and approved the submitted product. K.F., N.L., A.S., M.T., J.P.Y.-F., and A.R.R. contributed to the post hoc analysis conception and design and data interpretation, critically reviewed and revised the manuscript, and provided approval of the submitted product. In addition, A.R.R. is the Principal Investigator of the Promoting Resilience in Stress Management (PRISM) randomized clinical trial.

Corresponding author

Correspondence to Abby R. Rosenberg.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the SCH Institutional Review Board (IRB; Protocol No. 15300). This trial is registered at ClinicalTrials.gov (NCT02340884).

Consent to participate

Researchers obtained informed consent from all participants. In cases where participants were under the age of 18, informed consent was obtained from parents/legal guardians and informed assent was obtained from the participant.

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While all data is anonymized, participants provided informed consent for publication of their data.

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Scott, S.R., O’Daffer, A.G., Bradford, M.C. et al. Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial. Support Care Cancer 29, 3773–3781 (2021). https://doi.org/10.1007/s00520-020-05888-x

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