Skip to main content

Parental psychological distress and cancer stage: a comparison of adults with metastatic and non-metastatic cancer

Supportive Care in Cancer volume 27, pages 2443–2451 (2019)Cite this article

Abstract

Purpose

Parents with cancer have unique and often under-recognized psychological distress about the impact of their illness on their children. Relatively little is known about how parenting concerns may differ among patients by cancer stage.

Methods

This is a secondary data analysis of 203 adults with cancer who had children < 18 years old from two geographically distinct areas. We used an analysis of covariance to estimate the mean differences in PCQ, depression symptom severity and anxiety symptom severity (Hospital Anxiety and Depression Scale, HADS) scores between participants with metastatic and non-metastatic disease, and Pearson’s correlation coefficients to assess associations between HADS and PCQ scores by cancer stage.

Results

Seventy-two percent of participants (n = 146) had metastatic solid tumor cancer. In adjusted analyses, mean PCQ scores did not significantly differ between parents with metastatic and non-metastatic disease (2.0 vs. 2.2, p = 0.06). Differences in mean PCQ scores were driven by a single question concerning the impact of death on children (2.3 vs. 2.9, p = 0.004). Mean HADS scores did not significantly differ between groups, although PCQ scores explained a greater amount of variance in HADS scores for the metastatic group as compared to the non-metastatic group.

Conclusions

With the exception of concerns about death, intensity of parenting concerns, as measured by the PCQ, was similar between parents with metastatic and non-metastatic cancer. However, parenting concerns may be more strongly linked to overall psychological distress in patients with metastatic disease. Further research is needed to clarify how parenting concerns uniquely relate to advanced stage illness.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Weaver KE, Rowland JH, Alfano CM, McNeel TS (2010) Parental cancer and the family: a population-based estimate of the number of US cancer survivors residing with their minor children. Cancer 116:4395–4401

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ries LA, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg LX, Eisner M, Horner M-J, Howlader N (2006) SEER cancer statistics review, 1975-2003, National Cancer Institute. Bethesda, MD, based on November 2005 SEER data submission, posted to the SEER web site, 2006. http://seer.cancer.gov/csr/1975_2003/. Accessed 27 Nov 2016

  3. Semple CJ, McCance T (2010) Parents' experience of cancer who have young children: a literature review. Cancer Nurs 33:110–118

    Article  PubMed  Google Scholar 

  4. Moore CW, Rauch PK, Baer L, Pirl WF, Muriel AC (2015) Parenting changes in adults with cancer. Cancer 121:3551–3557

    Article  PubMed  PubMed Central  Google Scholar 

  5. Turner J, Clavarino A, Yates P, Hargraves M, Connors V, Hausmann S (2007) Development of a resource for parents with advanced cancer: what do parents want? Palliat Support Care 5:135–145

    Article  PubMed  Google Scholar 

  6. Helseth S, Ulfsaet N (2005) Parenting experiences during cancer. J Adv Nurs 52:38–46

    Article  PubMed  Google Scholar 

  7. Elmberger E, Bolund C, Magnusson A, Lutzen K, Andershed B (2008) Being a mother with cancer: achieving a sense of balance in the transition process. Cancer Nurs 31:58–66

    Article  PubMed  Google Scholar 

  8. Elmberger E, Bolund C, Lutzen K (2000) Transforming the exhausting to energizing process of being a good parent in the face of cancer. Health Care Women Int 21:485–499

    Article  CAS  PubMed  Google Scholar 

  9. Park EM, Check DK, Song MK, Reeder-Hayes KE, Hanson LC, Yopp JM, Rosenstein DL, Mayer DK (2017) Parenting while living with advanced cancer: a qualitative study. Palliat Med 31:231–238

    Article  PubMed  Google Scholar 

  10. Elmberger E, Bolund C, Lutzen K (2005) Experience of dealing with moral responsibility as a mother with cancer. Nurs Ethics 12:253–262

    Article  PubMed  Google Scholar 

  11. Bell K, Ristovski-Slijepcevic S (2011) Metastatic cancer and mothering: being a mother in the face of a contracted future. Med Anthropol 30:629–649

    Article  PubMed  Google Scholar 

  12. Helseth S, Ulfsaet N (2003) Having a parent with cancer: coping and quality of life of children during serious illness in the family. Cancer Nurs 26:355–362

    Article  PubMed  Google Scholar 

  13. Lewis FM, Brandt PA, Cochrane BB, Griffith KA, Grant M, Haase JE, Houldin AD, Post-White J, Zahlis EH, Shands ME (2015) The enhancing connections program: a six-state randomized clinical trial of a cancer parenting program. J Consult Clin Psychol 83:12–23

    Article  PubMed  Google Scholar 

  14. Compas BE, Worsham NL, Epping-Jordan JE, Grant KE, Mireault G, Howell DC, Malcarne VL (1994) When mom or dad has cancer: markers of psychological distress in cancer patients, spouses, and children Health psychology : official journal of the Division of Health Psychology. Am Psychol Assoc 13:507–515

    CAS  Google Scholar 

  15. Thastum M, Watson M, Kienbacher C, Piha J, Steck B, Zachariae R, Baldus C, Romer G (2009) Prevalence and predictors of emotional and behavioural functioning of children where a parent has cancer: a multinational study. Cancer 115:4030–4039

    Article  PubMed  Google Scholar 

  16. Pew Research Center (2015) Parenting in America: outlook, worries, aspirations are strongly linked to financial situation http://www.pewsocialtrends.org/2015/12/17/parenting-in-america. Accessed 8 Jan 2018

  17. Burgoyne MJ, Bingen K, Leuck J, Dasgupta M, Ryan P, Hoffmann RG (2015) Cancer-related distress in young adults compared to middle-aged and senior adults. J Adolesc Young Adult Oncol 4:56–63

    Article  PubMed  Google Scholar 

  18. Inhestern L, Bultmann JC, Beierlein V, Moller B, Romer G, Muriel AC, Moore CW, Koch U, Bergelt C (2016) Psychometric properties of the Parenting Concerns Questionnaire in cancer survivors with minor and young adult children. Psycho-Oncology 25:1092–1098

    Article  PubMed  Google Scholar 

  19. Park EM, Deal AM, Check DK, Hanson LC, Reeder-Hayes KE, Mayer DK, Yopp JM, Song MK, Muriel AC, Rosenstein DL (2016) Parenting concerns, quality of life, and psychological distress in patients with advanced cancer. Psycho-Oncology 25:942–948

    Article  PubMed  Google Scholar 

  20. Osborn T (2007) The psychosocial impact of parental cancer on children and adolescents: a systematic review. Psycho-Oncology 16:101–126

    Article  PubMed  Google Scholar 

  21. Stinesen-Kollberg K, Thorsteinsdottir T, Wilderang U, Steineck G (2013) Worry about one’s own children, psychological well-being, and interest in psychosocial intervention. Psycho-Oncology 22:2117–2123

    Article  PubMed  Google Scholar 

  22. Muriel AC, Moore CW, Baer L, Park ER, Kornblith AB, Pirl W, Prigerson H, Ing J, Rauch PK (2012) Measuring psychosocial distress and parenting concerns among adults with cancer: the Parenting Concerns Questionnaire. Cancer 118:5671–5678

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ernst J, Gotze H, Krauel K, Romer G, Bergelt C, Flechtner HH, Herzog W, Lehmkuhl U, Keller M, Brahler E, von Klitzing K (2013) Psychological distress in cancer patients with underage children: gender-specific differences. Psycho-Oncology 22:823–828

    Article  PubMed  Google Scholar 

  24. Nilsson ME, Maciejewski PK, Zhang B, Wright AA, Trice ED, Muriel AC, Friedlander RJ, Fasciano KM, Block SD, Prigerson HG (2009) Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children. Cancer 115:399–409

    Article  PubMed  PubMed Central  Google Scholar 

  25. Park EM, Deal A, Yopp JM, Edwards T, Resnick SJ, Song MK, Nakamura ZM, Rosenstein DL (2018) Understanding health-related quality of life in adult women with metastatic cancer who have dependent children. Cancer 124:2629–2636

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sarfati D (2012) Review of methods used to measure comorbidity in cancer populations: no gold standard exists. J Clin Epidemiol 65:924–933

    Article  PubMed  Google Scholar 

  27. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  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

    Article  PubMed  Google Scholar 

  29. Bursac Z, Gauss CH, Williams DK, Hosmer DW (2008) Purposeful selection of variables in logistic regression. Source Code Biol Med 3:17

    Article  PubMed  PubMed Central  Google Scholar 

  30. Park EM, Deal AM, Yopp JM, Edwards TP, Wilson DJ, Hanson LC, Rosenstein DL (2016) End-of-life experiences of mothers with advanced cancer: perspectives of widowed fathers. BMJ Support Palliat Care 6:437–444

    Article  PubMed  Google Scholar 

  31. Miniño AM (2013) Death in the United States, 2011 (No. 115) US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics NCHS Data Brief, 1-8

  32. Lamont EB, Landrum MB, Keating NL, Archer L, Lan L, Strauss GM, Lilenbaum R, Niell HB, Maurer LH, Kosty MP, Miller AA, Clamon GH, Elias AD, McClay EF, Vokes EE, McNeil BJ (2010) Differences in clinical trial patient attributes and outcomes according to enrollment setting. J Clin Oncol 28:215–221

    Article  PubMed  Google Scholar 

  33. Hailey CE, Yopp JM, Deal AM, Mayer DK, Hanson LC, Grunfeld G, Rosenstein DL, Park EM (2018) Communication with children about a parent’s advanced cancer and measures of parental anxiety and depression: a cross-sectional mixed-methods study. Support Care Cancer 26:287–295

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to gratefully acknowledge the patients who participated in this study and who gave their time to share their experiences.

Funding

The study was supported by the Doris Duke Charitable Foundation through Grant Number 2015213 (Park), the Foundation of Hope (Park), and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through Grant Award Numbers 1UL1TR001111, 550KR41218, and 1KL2TR001109 (Park) and the NIH through R03 CA126394-01 (Muriel) and 1K07 CA218167-0 (Park).

Author information

Affiliations

  1. Department of Psychiatry, University of North Carolina, 170 Manning Drive, CB #7305, Chapel Hill, NC, 27599, USA

    Eliza M. Park

  2. Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Eliza M. Park

  3. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Eliza M. Park & Allison M. Deal

  4. Department of Psychiatry, Vanderbilt University, Nashville, TN, USA

    Elise M. Stephenson

  5. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Cynthia W. Moore

  6. Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA

    Anna C. Muriel

Authors
  1. Eliza M. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elise M. Stephenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cynthia W. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allison M. Deal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna C. Muriel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eliza M. Park.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Park, E.M., Stephenson, E.M., Moore, C.W. et al. Parental psychological distress and cancer stage: a comparison of adults with metastatic and non-metastatic cancer. Support Care Cancer 27, 2443–2451 (2019). https://doi.org/10.1007/s00520-018-4518-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4518-1

Keywords

  • Cancer
  • Oncology
  • Parents
  • Parenting concerns
  • Psychological distress