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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
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
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
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/10.1037/0893-3184.108.40.2060
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
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
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
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
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
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
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
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
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
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
Grinyer, A. (2002). Cancer in young adults: Through parents’ eyes. Florence: Open University Press.
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
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
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis, second edition: A regression-based approach (2nd ed.). New York: Guilford Publications.
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
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
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
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
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
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
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
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.
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.
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
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
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
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
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
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
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
National Cancer Institute. (2018). Adolescents and young adults with cancer. Accessed from https://www.cancer.gov/types/aya
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
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
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/10.1037/0893-3220.127.116.117
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
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
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.
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
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
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.
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
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
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.
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
Szasz, P. L. (2009). Thought suppression, depressive rumination and depression: A mediation analysis. Journal of Cognitive and Behavioral Psychotherapies.,9, 199–209.
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
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
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.
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
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
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.
Conflict of interest
Emilia E. Mikrut, Aliza A. Panjwani, Rebecca Cipollina and Tracey A. Revenson declare that they have no conflict of interest.
Human and animal rights and Informed consent
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
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
- Social constraints
- Fear of recurrence
- Young adult