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A cross-sectional examination of caregiver mental health and childhood cancer survivors’ tobacco, alcohol, and marijuana use

Supportive Care in Cancer volume 29, pages 3649–3656 (2021)Cite this article

Abstract

Purpose

As childhood cancer survivors (CCS) age, they face numerous long-term consequences, or late effects, from their cancer treatments. Late effects may be mitigated by health-promoting behaviors, including the avoidance of substance use. CCS with greater depression symptomology have reported greater substance use, but whether their habits are associated with the mental health of their caregivers is unknown. The aim of this study was to examine caregiver psychosocial correlates of CCS substance use.

Methods

This study utilizes data from the Project Forward pilot study, which collected data from 129 CCS-caregiver dyads (CCS mean age = 19.43, SD = 2.78; years since diagnosis = 7.62, SD = 2.06) from two large hospitals in Los Angeles County. CCS provided self-reported information on substance use, while caregivers self-reported on posttraumatic stress symptomatology (PTSS) associated with their child’s cancer and current depressive symptoms.

Results

Among CCS, prior 30-day tobacco, marijuana, binge drinking, and polysubstance use were 12.50%, 14.17%, 13.18%, and 12.40%. In multivariable logistic regression models, caregiver PTSS was independently positively associated with CCS tobacco use. No other significant relationships between caregiver mental health (PTSS or depressive symptoms) and CCS substance use were observed.

Conclusion

These findings suggest that caregiver PTSS is partially associated with CCS behavioral health. Survivorship care may improve tobacco use prevention efforts by incorporating family or caregiver mental health needs. Future research should examine the potential mediating effect of CCS mental health, including depressive symptoms, on this relationship.

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References

  1. The American Cancer Society (2016 Key statistics for childhood cancers. Retrieved from https://www.cancer.org/cancer/cancer-in-children/key-statistics.html.

    Google Scholar 

  2. Friend A, Feltbower R, Hughes E, Dye K, Glaser A (2018) Mental health of long term survivors of childhood and young adult cancer: a systematic review. Int J Cancer 143:1279–1286

    CAS  Article  Google Scholar 

  3. Kadan-Lottick NS, Zeltzer LK, Liu Q, Yasui Y, Ellenberg L, Gioia G, Robison LL, Krull KR (2010) Neurocognitive functioning in adult survivors of childhood non-central nervous system cancers. J Nat Cancer Inst 102(12):881–893

    Article  Google Scholar 

  4. Reinmuth S, Hohmann C, Rendtorff R, Balcerek M, Holzhausen S, Müller A, Henze G, Keil T, Borgmann-Staudt A (2013) Impact of chemotherapy and radiotherapy in childhood on fertility in adulthood: the FeCt—survey of childhood cancer survivors in Germany. J Cancer Res Clin Oncol 139(12):2071–2078

    CAS  Article  Google Scholar 

  5. Van Laar M, Feltbower RG, Gale CP, Bowen DT, Oliver SE, Glaser A (2014) Cardiovascular sequelae in long-term survivors of young peoples’ cancer: a linked cohort study. Br J Cancer 110(5):1338–1341

    Article  Google Scholar 

  6. Lackner H, Benesch M, Schagerl S, Kerbl R, Schwinger W, Urban C (2000) Prospective evaluation of late effects after childhood cancer therapy with a follow-up over 9 years. Eur J Pediatr 159(10):750–758

    CAS  Article  Google Scholar 

  7. National Institute on Drug Abuse (2017), Health consequences of drug misuse. Retrieved from https://www.drugabuse.gov/related-topics/health-consequences-drug-misuse.

    Google Scholar 

  8. Schulte MT, Hser YI (2014) Substance use and associated health conditions throughout the lifespan. Public Health Rev 35(2)

  9. Children's Oncology Group. (2018). Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers: Version 5.0. Retrieved from http://www.survivorshipguidelines.org/pdf/2018/COG_LTFU_Guidelines_v5.pdf.

  10. Mulder RL, Kremer LC, Koot BG, Benninga MA, Knijnenburg SL, van der Pal HJ et al (2013) Surveillance of hepatic late adverse effects in a large cohort of long-term survivors of childhood cancer: prevalence and risk factors. Eur J Cancer 49(1):185–193

    Article  Google Scholar 

  11. Cantrell MA, Posner MA (2016) Engagement in high-risk behaviors among young adult survivors of childhood cancer compared to healthy same-age peers surveyed in the National Longitudinal Study of Adolescent Health. J Adolesc Young Adult Oncol 5(2):146–151

    Article  Google Scholar 

  12. Kasteler R, Belle F, Schindera C, Barben J, Gumy-Pause F, Tinner EM et al (2019) Prevalence and reasons for smoking in adolescent Swiss childhood cancer survivors. Pediatr Blood Cancer 66(1):e27438

    Article  Google Scholar 

  13. Klosky J, Howell C, Li Z, Foster R, Mertens A, Robison L, Ness K (2012) Risky health behavior among adolescents in the childhood cancer survivor study cohort. J Pediatr Psychol 37(6):634–646

    Article  Google Scholar 

  14. Marjerrison S, Hendershot E, Empringham B, Nathan PC (2016) Smoking, binge drinking, and drug use among childhood cancer survivors: a meta-analysis. Pediatr Blood Cancer 63(7):1254–1263

    Article  Google Scholar 

  15. Lowe K, Escoffery C, Mertens AC, Berg CJ (2016) Distinct health behavior and psychosocial profiles of young adult survivors of childhood cancers: a mixed methods study. J Cancer Surviv 10(4):619–632

    Article  Google Scholar 

  16. Lown EA, Goldsby R, Mertens AC, Greenfield T, Bond J, Whitton J, Korcha R, Robison LL, Zeltzer LK (2008) Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction 103(7):1139–1148

    Article  Google Scholar 

  17. Milam J, Slaughter R, Meeske K, Ritt-Olson A, Sherman-Bien S, Freyer D et al (2016) Substance use among adolescent and young adult cancer survivors. Psycho-oncology 25(11):1357–1362

    Article  Google Scholar 

  18. Slaughter RI, Hamilton AS, Cederbaum JA, Unger JB, Baezconde-Garbanati L, Milam JE (2020) Relationships between parent and adolescent/young adult mental health among Hispanic and non-Hispanic childhood cancer survivors. J Psychosoc Oncol:1–15. https://doi.org/10.1080/07347332.2020.1815924

  19. Meeske KA, Sherman-Bien S, Hamilton AS, Olson AR, Slaughter R, Kuperberg A, Milam J (2013) Mental health disparities between Hispanic and non-Hispanic parents of childhood cancer survivors. Pediatr Blood Cancer 60(9):1470–1477

    Article  Google Scholar 

  20. Norberg AL, Boman KK (2009) Parent distress in childhood cancer: a comparative evaluation of posttraumatic stress symptoms, depression and anxiety. Acta Oncol 47(2):267–274

    Article  Google Scholar 

  21. Pelcovitz D, Goldenberg B, Kaplan S, Weinblatt M, Mandel F, Meyers B, Vinciguerra V (1996) Posttraumatic stress disorder in mothers of pediatric cancer survivors. Psychosomatics 37(2):116–126

    CAS  Article  Google Scholar 

  22. Schulz R, Sherwood PR (2008) Physical and mental health effects of family caregiving. Am J Nurs 108(9 Suppl):23–27

    Article  Google Scholar 

  23. Morris A, Gabert-Quillen C, Delahanty D (2012) The association between parent PTSD/depression symptoms and child PTSD symptoms: a meta-analysis. J Pediatr Psychol 37(10):1076–1088

    Article  Google Scholar 

  24. Hamilton AS, Zhuang X, Modjeski D, Slaughter R, Ritt-Olson A, Milam J (2019) Population-based survey methods for reaching adolescent and young adult survivors of pediatric cancer and their parents. J Adolesc Young Adult Oncol 8(1):40–48

    Article  Google Scholar 

  25. Werba BE, Hobbie W, Kazak AE, Ittenbach RF, Reilly AF, Meadows AT (2007) Classifying the intensity of pediatric cancer treatment protocols: the intensity of treatment rating scale 2.0 (ITR-2). Pediatr Blood Cancer 48(7):673–677

    Article  Google Scholar 

  26. Radloff LS (1977) The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401

    Article  Google Scholar 

  27. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB (1997) Center for Epidemiological Studies-Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging 12:277–287

    CAS  Article  Google Scholar 

  28. Blank K, Gruman C, Robison JT (2004) Case-finding for depression in elderly people: balancing ease of administration with validity in varied treatment settings. J Gerontol Ser A Biol Med Sci 59(4):M378–M384

    Article  Google Scholar 

  29. Wada K, Tanaka K, Theriault G, Satoh T, Mimura M, Miyaoka H, Aizawa Y (2007) Validity of the Center for Epidemiologic Studies Depression Scale as a screening instrument of major depressive disorder among Japanese workers. Am J Ind Med 50(1):8–12

    Article  Google Scholar 

  30. Weiss DS, Marmar CR (1996) The Impact of Event Scale - Revised. In: Wilson J, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford, New York, pp 399–411

    Google Scholar 

  31. Creamer M, Bell R, Failla S (2003) Psychometric properties of the impact of event scale—revised. Behav Res Ther 41(12):1489–1496

    Article  Google Scholar 

  32. Centers for Disease Control and Prevention. 2009 Youth Risk Behavior Survey Questionnaire. Available at: www.cdc.gov/yrbs.

  33. Hill KG, White HR, Chung IJ, Hawkins JD, Catalano RF (2000) Early adult outcomes of adolescent binge drinking: person-and variable-centered analyses of binge drinking trajectories. Alcohol Clin Exp Res 24(6):892–901

    CAS  Article  Google Scholar 

  34. Schulenberg J, O’Malley PM, Bachman JG, Wadsworth KN, Johnston LD (1996) Getting drunk and growing up: trajectories of frequent binge drinking during the transition to young adulthood. J Stud Alcohol 57(3):289–304

    CAS  Article  Google Scholar 

  35. American Cancer Society. (2020). Alcohol use and cancer. Retrieved from https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/alcohol-use-and-cancer.html.

  36. Greening L, Stoppelbein L (2007) Brief report: pediatric cancer, parental coping style, and risk for depressive, posttraumatic stress, and anxiety symptoms. J Pediatr Psychol 32(10):1272–1277

    Article  Google Scholar 

  37. Trask P, Paterson A, Trask C, Bares C, Birt J, Maan C (2003) Parent and adolescent adjustment to pediatric cancer: associations with coping, social support, and family function. J Pediatr Oncol Nurs 20(1):36–47. https://doi.org/10.1053/jpon.2003.5

    Article  PubMed  Google Scholar 

  38. Cox C, Mclaughlin R, Steen B, Hudson M (2006) Predicting and modifying substance use in childhood cancer survivors: application of a conceptual model. Oncol Nurs Forum 33(1):51–60. https://doi.org/10.1188/06.ONF.51-60

    Article  PubMed  Google Scholar 

  39. National Institute on Drug Abuse (2017). Monitoring the future study: trends in prevalence of various drugs. Retrieved from https://www.drugabuse.gov/trends-statistics/monitoring-future/monitoring-future-study-trends-in-prevalence-various-drugs.

  40. Acierno R, Kilpatrick DG, Resnick H, Saunders B, Arellano MD, Best C (2000) Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: Findings from the national survey of adolescents. J Trauma Stress 13(3):381–396. https://doi.org/10.1023/a:1007772905696

    CAS  Article  PubMed  Google Scholar 

  41. Birdsall SM, Birdsall TC, Tims LA (2016) The use of medical marijuana in cancer. Curr Oncol Rep 18(7):40

    Article  Google Scholar 

  42. Feldner M, Babson K, Zvolensky M, Vujanovic A, Lewis S, Gibson L et al (2007) Posttraumatic stress symptoms and smoking to reduce negative affect: an investigation of trauma-exposed daily smokers. Addict Behav 32(2):214–227. https://doi.org/10.1016/j.addbeh.2006.03.032

    Article  PubMed  Google Scholar 

  43. Centers for Disease Control and Prevention. (2019) Binge drinking is a serious but preventable problem of excessive alcohol use. Retrieved October 10, 2020, from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm.

    Google Scholar 

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Funding

This work was supported in part by the Whittier Foundation, grant R01MD007801 from the National Institute on Minority Health and Health Disparities of the National Institutes of Health, P30CA014089 and T32CA009492 from the National Cancer Institute of the National Institutes of Health, and 28IR-0052 from Tobacco-Related Diseases Research Program from The Regents of the University of California, Research Grants Program Office. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors and not those of the funders.

Author information

Author notes

  1. Caitlin M. Fischer

    Present address: University of Texas at Austin, Austin, TX, USA

  2. Joel Milam

    Present address: University of California, Irvine, CA, USA

Affiliations

  1. University of Southern California, 2001 N. Soto Street (SSB), Los Angeles, CA, 90032, USA

    Caitlin M. Fischer

  2. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street (SSB), Los Angeles, CA, 90032, USA

    Ann S. Hamilton, Rhona I. Slaughter & Joel Milam

Authors
  1. Caitlin M. Fischer
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  2. Ann S. Hamilton
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  3. Rhona I. Slaughter
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  4. Joel Milam
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Corresponding author

Correspondence to Caitlin M. Fischer.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the California Committee for the Protection of Human Subjects, the California Cancer Registry, and the Institutional Review Boards at the University of Southern California, Children’s Hospital Los Angeles, and Miller Children’s Hospital in Long Beach. This study certifies that it was conducted in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants over the age of 18 years old included in the study. Informed consent for participants under 18 years old was obtained by their parents. Assent was also obtained from participants under 18 years old.

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Fischer, C.M., Hamilton, A.S., Slaughter, R.I. et al. A cross-sectional examination of caregiver mental health and childhood cancer survivors’ tobacco, alcohol, and marijuana use. Support Care Cancer 29, 3649–3656 (2021). https://doi.org/10.1007/s00520-020-05861-8

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  • DOI: https://doi.org/10.1007/s00520-020-05861-8

Keywords

  • Childhood cancer survivors
  • Caregiver and CCS mental health
  • Substance use
  • CCS follow-up care
  • Childhood cancer survivorship