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Emotional adjustment among parents of adolescents and young adults with cancer: the influence of social constraints on cognitive processing and fear of recurrence

Abstract

Parents of adolescents and young adults (AYAs) with cancer experience distress comparable to other caregiver populations, but remain understudied. This study tested the social cognitive processing model of emotional adjustment to cancer. We hypothesized that social constraints on emotional disclosure would inhibit cognitive processing and be related to greater fear of cancer recurrence (FCR), potentially negatively influencing psychological adjustment. Data were collected through an online cross-sectional survey study of 66 parents of AYAs with cancer (aged 15–39) and analyzed using bootstrapping techniques for ordinary least squares regression. One-third of the parents reported moderate to severe depressive symptoms. Serial mediation analyses indicated that greater social constraints were related to poorer cognitive processing and higher FCR, and, ultimately, greater depressive symptoms. Alternative models were tested and were not significant. Future psychosocial interventions for parents of AYAs with cancer should include improving cancer-related communication between parents and their social network.

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References

  1. Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review,21, 683–703. https://doi.org/10.1016/s0272-7358(00)00057-x

    CAS  Article  PubMed  Google Scholar 

  2. Adams, R. N., Winger, J. G., & Mosher, C. E. (2015). A meta-analysis of the relationship between social constraints and distress in cancer patients. Journal of Behavioral Medicine,38, 294–305. https://doi.org/10.1007/s10865-014-9601-6

    Article  PubMed  Google Scholar 

  3. Alderfer, M. A., Cnaan, A., Annunziato, R. A., & Kazak, A. E. (2005). Patterns of posttraumatic stress symptoms in parents of childhood cancer survivors. Journal of Family Psychology,19, 430–440. https://doi.org/10.1037/0893-3200.19.3.430

    Article  PubMed  Google Scholar 

  4. Applebaum, A. J., Panjwani, A. A., Buda, K., O’Toole, M. S., Hoyt, M. A., Garcia, A., et al. (2018). Emotion regulation therapy for cancer caregivers—an open trial of a mechanism-targeted approach to addressing caregiver distress. Translational Behavioral Medicine. https://doi.org/10.1093/tbm/iby104

    Article  PubMed  PubMed Central  Google Scholar 

  5. Barnett, M., McDonnell, G., DeRosa, A., Schuler, T., Phillip, E., Peterson, L., et al. (2016). Psychosocial outcomes and interventions among cancer survivors diagnosed during adolescence and young adulthood (AYA): A systematic review. Journal of Cancer Survivorship,10, 814–831. https://doi.org/10.1007/s11764-016-0527-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bellizzi, K. M., Smith, A., Schmidt, S., Keegan, T. H. M., Zebrack, B., Lynch, C. F., et al. (2012). Positive and negative psychosocial impact of being diagnosed with cancer as an adolescent or young adult. Cancer,118, 5155–5162. https://doi.org/10.1002/cncr.27512

    Article  PubMed  Google Scholar 

  7. Bränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. T. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients—a randomized study. Annals of Behavioral Medicine,39, 151–161. https://doi.org/10.1007/s12160-010-9168-6

    Article  PubMed  Google Scholar 

  8. Caes, L., Vervoort, T., Devos, P., Verlooy, J., Benoit, Y., & Goubert, L. (2014). Parental distress and catastrophic thoughts about child pain. The Clinical Journal of Pain,30, 787–799. https://doi.org/10.1097/ajp.0000000000000028

    Article  PubMed  Google Scholar 

  9. Cohee, A. A., Adams, R. N., Fife, B. L., Von Ah, D. M., Monahan, P. O., Zoppi, K. A., et al. (2017a). The relationship between depressive symptoms and social cognitive processing in partners of long-term breast cancer survivors. Oncology Nursing Forum,44, 44–51. https://doi.org/10.1188/17.onf.44-51

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cohee, A. A., Adams, R. N., Johns, S. A., Ah, D. V., Zoppi, K., Fife, B., et al. (2017b). Long-term fear of recurrence in young breast cancer survivors and partners. Psycho-Oncology,26, 22–28. https://doi.org/10.1002/pon.4008

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cordova, M. J., Andrykowski, M. A., Kenady, D. E., McGrath, P. C., Sloan, D. A., & Redd, W. H. (1995). Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. Journal of Consulting and Clinical Psychology,63, 981. https://doi.org/10.1037/0022-006x.63.6.981

    CAS  Article  PubMed  Google Scholar 

  12. Creswell, P. D., Wisk, L. E., Litzelman, K., Allchin, A., & Witt, W. P. (2014). Parental depressive symptoms and childhood cancer: The importance of financial difficulties. Supportive Care in Cancer,22, 503–511. https://doi.org/10.1007/s00520-013-2003-4

    Article  PubMed  Google Scholar 

  13. Edwards, J. R., & Lambert, L. S. (2007). Methods for integrating moderation and mediation: A general analytical framework using moderated path analysis. Psychological Methods,12, 1–22. https://doi.org/10.1037/1082-989x.12.1.1

    Article  PubMed  Google Scholar 

  14. Grinyer, A. (2002). Cancer in young adults: Through parents’ eyes. Florence: Open University Press.

    Google Scholar 

  15. Grinyer, A. (2009). Contrasting parental perspectives with those of teenagers and young adults with cancer: Comparing the findings from two qualitative studies. European Journal of Oncology Nursing,13, 200–206. https://doi.org/10.1016/j.ejon.2009.04.002

    Article  PubMed  Google Scholar 

  16. Hamilton, A. S., Zhuang, X., Modjeski, D., Slaughter, R., Ritt-Olson, A., & Milam, J. (2018). Population-based survey methods for reaching adolescent and young adult survivors of pediatric cancer and their parents. Journal of Adolescent and Young Adult Oncology;. https://doi.org/10.1089/jayao.2018.0033

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis, second edition: A regression-based approach (2nd ed.). New York: Guilford Publications.

    Google Scholar 

  18. Hodges, L., Humphris, G., & Macfarlane, G. (2005). A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Social Science and Medicine,60, 1–12. https://doi.org/10.1016/j.socscimed.2004.04.018

    CAS  Article  PubMed  Google Scholar 

  19. Horrell, B., Stephens, C., & Breheny, M. (2015). Online research with informal caregivers: Opportunities and challenges. Qualitative Research in Psychology,12, 258–271. https://doi.org/10.1080/14780887.2015.1040318

    Article  Google Scholar 

  20. Juth, V., Silver, R. C., & Sender, L. (2015). The shared experience of adolescent and young adult cancer patients and their caregivers. Psycho-Oncology,24, 1746–1753. https://doi.org/10.1002/pon.3785

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kazak, A. E., Alderfer, M., Rourke, M. T., Simms, S., Streisand, R., & Grossman, J. R. (2004). Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors. Journal of Pediatric Psychology,29, 211–219. https://doi.org/10.1093/jpepsy/jsh022

    Article  PubMed  Google Scholar 

  22. Klassen, A., Raina, P., Reineking, S., Dix, D., Pritchard, S., & O’Donnell, M. (2007). Developing a literature base to understand the caregiving experience of parents of children with cancer: A systematic review of factors related to parental health and well-being. Supportive Care in Cancer,15, 807–818. https://doi.org/10.1007/s00520-007-0243-x

    Article  PubMed  Google Scholar 

  23. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine,16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. Lebel, S., Ozakinci, G., Humphris, G., Thewes, B., Prins, J., Dinkel, A., et al. (2017). Current state and future prospects of research on fear of cancer recurrence. Psycho-Oncology,26, 424–427. https://doi.org/10.1002/pon.4103

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lepore, S. J. (2001). A social–cognitive processing model of emotional adjustment to cancer. In A. Baum & B. L. Andersen (Eds.), Psychosocial interventions for cancer (pp. 99–116). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  26. Lepore, S. J., & Ituarte, P. H. (1999). Optimism about cancer enhances mood by reducing negative social interactions. Cancer Research, Therapy and Control,8, 165–174.

    Google Scholar 

  27. Lepore, S. J., & Revenson, T. A. (2007). Social constraints on disclosure and adjustment to cancer. Social and Personality Psychology Compass,1, 313–333. https://doi.org/10.1111/j.1751-9004.2007.00013.x

    Article  Google Scholar 

  28. Ljungman, L., Cernvall, M., Grönqvist, H., Ljótsson, B., Ljungman, G., & Essen, L. V. (2014). Long-term positive and negative psychological late effects for parents of childhood cancer survivors: A systematic review. PLoS ONE,9, e103340. https://doi.org/10.1371/journal.pone.0103340

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. Luberto, C. M., Hall, D. L., Chad-Friedman, E., & Park, E. R. (2019). Theoretical rationale and case illustration of mindfulness-based cognitive therapy for fear of cancer recurrence. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-019-09610-w

    Article  PubMed  Google Scholar 

  30. Mackinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research,39, 99–128. https://doi.org/10.1207/s15327906mbr3901_4

    Article  PubMed  PubMed Central  Google Scholar 

  31. McCarthy, M. C., McNeil, R., Drew, S., Dunt, D., Kosola, S., Orme, L., et al. (2016). Psychological distress and posttraumatic stress symptoms in adolescents and young adults with cancer and their parents. Journal of Adolescent and Young Adult Oncology,5, 322–329. https://doi.org/10.1089/jayao.2016.0015

    Article  PubMed  Google Scholar 

  32. Mehranfar, M., Younesi, J., & Banihashem, A. (2012). Effectiveness of mindfulness-based cognitive therapy on reduction of depression and anxiety symptoms in mothers of children with cancer. Iranian Journal of Cancer Prevention,5, 1–9. https://doi.org/10.2147/ndt.s160761

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Mellon, S., Kershaw, T. S., Northouse, L. L., & Freeman-Gibb, L. (2007). A family-based model to predict fear of recurrence for cancer survivors and their caregivers. Psycho-Oncology,16, 214–223. https://doi.org/10.1002/pon.1074

    Article  PubMed  PubMed Central  Google Scholar 

  34. National Cancer Institute. (2018). Adolescents and young adults with cancer. Accessed from https://www.cancer.gov/types/aya

  35. Nelson, L. P., & Gold, J. I. (2012). Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: A review. Pediatric Critical Care Medicine,13, 338–347. https://doi.org/10.1097/pcc.0b013e3182196a8f

    Article  PubMed  Google Scholar 

  36. Northouse, L. L., Katapodi, M. C., Schafenacker, A. M., & Weiss, D. (2012). The impact of caregiving on the psychological well-being of family caregivers and cancer patients. Seminars in Oncology Nursing,28, 236–245. https://doi.org/10.1016/j.soncn.2012.09.006

    Article  PubMed  Google Scholar 

  37. Pai, A. L., Greenley, R. N., Lewandowski, A., Drotar, D., Youngstrom, E., & Peterson, C. C. (2007). A meta-analytic review of the influence of pediatric cancer on parent and family functioning. Journal of Family Psychology,21, 407. https://doi.org/10.1037/0893-3200.21.3.407

    Article  PubMed  Google Scholar 

  38. Panjwani, A. A., Marin-Chollom, A. M., Pervil, I. Z., Erblich, J., Rubin, L. R., Schuster, M. W., et al. (2019a). Illness uncertainties tied to developmental tasks among young adult survivors of hematologic cancers. Journal of Adolescent and Young Adult Oncology,8, 149–156. https://doi.org/10.1089/jayao.2018.0024

    Article  PubMed  Google Scholar 

  39. Panjwani, A. A., O’Toole, M. S., Applebaum, A. J., Fresco, D. M., & Mennin, D. S. (2019b). Emotion regulation therapy for cancer caregivers: targeting mechanisms of distress. In A. J. Applebaum (Ed.), Cancer caregivers (pp. 219–236). New York: Oxford University Press. https://doi.org/10.1093/med/9780190868567.003.0013

    Chapter  Google Scholar 

  40. Panjwani, A. A., & Revenson, T. A. (2017). A tale of two studies: Young adults with cancer, parent caregivers, and uncertainty. In Poster presented at the international conference on stress and dyadic coping: Health, family and cultural contexts, Milan, Italy.

  41. Pasipanodya, E. C., Parrish, B. P., Laurenceau, J., Cohen, L. H., Siegel, S. D., Graber, E. C., et al. (2012). Social constraints on disclosure predict daily well-being in couples coping with early-stage breast cancer. Journal of Family Psychology,26, 661–667. https://doi.org/10.1037/a0028655

    Article  PubMed  Google Scholar 

  42. Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology,80, 1007–1020. https://doi.org/10.1037/a0028329

    Article  PubMed  Google Scholar 

  43. Revenson, T. A. (2016). Never the right time: Unique stressors facing young and middle-aged adults with hematologic cancer. Hannover, Germany: Keynote address presented at the Association for Psychooncology, German Cancer Society.

    Google Scholar 

  44. Salthouse, T. A. (2011). All data collection and analysis methods have limitations: Reply to Rabbitt (2011) and Raz and Lindenberger (2011). Psychological Bulletin,137, 796–799. https://doi.org/10.1037/a0024843

    Article  PubMed  PubMed Central  Google Scholar 

  45. Sheridan, M. A., Sherman, M. L., Pierce, T., & Compas, B. E. (2010). Social support, social constraint, and affect in spouses of women with breast cancer: The role of cognitive processing. Journal of Social and Personal Relationships,27, 5–22. https://doi.org/10.1177/0265407509347836

    Article  Google Scholar 

  46. Smyth, J., Pennebaker, J., & Arigo, D. (2012). What are the health effects of disclosure? In A. Baum, T. A. Revenson, & J. E. Singer (Eds.), Handbook of health psychology (2nd ed., pp. 175–192). New York, NY: Taylor & Francis.

    Google Scholar 

  47. Stanton, A. L., Luecken, L. J., MacKinnon, D. P., & Thompson, E. H. (2013). Mechanisms in psychosocial interventions for adults living with cancer: Opportunity for integration of theory, research, and practice. Journal of Consulting and Clinical Psychology,81, 318–335. https://doi.org/10.1037/a0028833

    Article  PubMed  Google Scholar 

  48. Szasz, P. L. (2009). Thought suppression, depressive rumination and depression: A mediation analysis. Journal of Cognitive and Behavioral Psychotherapies.,9, 199–209.

    Google Scholar 

  49. Vickberg, S. M. (2003). The concerns about recurrence scale (CARS): A systematic measure of women’s fears about the possibility of breast cancer recurrence. Annals of Behavioral Medicine,25, 16–24. https://doi.org/10.1207/s15324796abm2501_03

    Article  PubMed  Google Scholar 

  50. Wegner, D. M., Schneider, D. J., Knutson, B., & Mcmahon, S. R. (1991). Polluting the stream of consciousness: The effect of thought suppression on the mind’s environment. Cognitive Therapy and Research,15, 141–152. https://doi.org/10.1007/bf01173204

    Article  Google Scholar 

  51. Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale-revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399–411). New York: Guilford.

    Google Scholar 

  52. Yeung, N. C., Ramirez, J., & Lu, Q. (2017). Perceived stress as a mediator between social constraints and sleep quality among Chinese American breast cancer survivors. Supportive Care in Cancer,25, 2249–2257. https://doi.org/10.1007/s00520-017-3632-9

    Article  PubMed  Google Scholar 

  53. You, J., & Lu, Q. (2014). Social constraints and quality of life among Chinese-speaking breast cancer survivors: A mediation model. Quality of Life Research,23, 2577–2584. https://doi.org/10.1007/s11136-014-0698-4i

    Article  PubMed  Google Scholar 

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Funding

This study was funded by grants from the Professional Staff Congress-CUNY (TRADB-45-376) and the Hunter College Presidential Fund for Faculty Advancement to Dr. Revenson, as well as a Doctoral Student Research Grant awarded to Ms. Panjwani.

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Correspondence to Aliza A. Panjwani.

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Emilia E. Mikrut, Aliza A. Panjwani, Rebecca Cipollina and Tracey A. Revenson declare that they have no conflict of interest.

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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. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

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Mikrut, E.E., Panjwani, A.A., Cipollina, R. et al. Emotional adjustment among parents of adolescents and young adults with cancer: the influence of social constraints on cognitive processing and fear of recurrence. J Behav Med 43, 237–245 (2020). https://doi.org/10.1007/s10865-019-00072-x

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Keywords

  • Caregivers
  • Parents
  • Cancer
  • Social constraints
  • Fear of recurrence
  • Young adult