Abstract
The experience of childhood cancer (CC) could be a traumatic event that produces long-term emotional responses such as posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) in survivors. The relationship between both PTSS and PTG is not clear in CC survivors. Assessing challenges to core beliefs and rumination could give information regarding the different paths that lead to traumatic responses. Thus, this study aims to identify childhood cancer survivors’ profiles from PTSS and PTG measures and to examine the pathways of relationships between PTSS and PTG, rumination, and challenge to core belief. Sixty-two CC survivors completed surveys on their childhood cancer experience, PTSS, PTG, challenge to core beliefs, and rumination. High PTG scores among childhood cancer survivors (Cluster 1), High PTSS scores among childhood cancer survivors (Cluster 2), and Childhood cancer survivors without changes (Cluster 3). Network analysis found that the challenge to core beliefs is the central point in the relationship between the variables, in a direct and positive relationship with PTG. We found an indirect path from challenge to core beliefs to PTSS, mediated by intrusive and deliberative ruminations. The combined findings suggested that there are different profiles related to trauma in CC survivors and the relationship between PTSS and PTG is mediated by the challenge to core beliefs and deliberative and intrusive rumination.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen, J., Willard, V. W., Klosky, J. L., Li, C., Srivastava, D. K., Robison, L. L., Hudson, M. M., & Phipps, S. (2018). Posttraumatic stress-related psychological functioning in adult survivors of childhood cancer. Journal of Cancer Survivorship, 12(2). https://doi.org/10.1007/s11764-017-0660-x
Berkman, A. M., Robert, R. S., Roth, M., & Askins, M. A. (2022). A review of psychological symptoms and post-traumatic growth among adolescent and young adult survivors of childhood cancer. Journal of Health Psychology, 27(4), 990–1005. https://doi.org/10.1177/1359105320971706
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. https://doi.org/10.1002/jts.22059
Brooks, M., Graham-Kevan, N., Lowe, M., & Robinson, S. (2017). Rumination, event centrality, and perceived control as predictors of post-traumatic growth and distress: The cognitive growth and stress model. British Journal of Clinical Psychology, 56(3), 286–302. https://doi.org/10.1111/bjc.12138
Bruce, M. (2006). A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents. Clinical Psychology Review, 26(3), 233–256. https://doi.org/10.1016/j.cpr.2005.10.002
Cann, A., Calhoun, L. G., Tedeschi, R. G., Kilmer, R. P., Gil-Rivas, V., Vishnevsky, T., & Danhauer, S. C. (2010). The core beliefs inventory: A brief measure of disruption in the assumptive world. Anxiety Stress and Coping, 23(1), 19–34. https://doi.org/10.1080/10615800802573013
Cann, A., Calhoun, L. G., Tedeschi, R. G., Triplett, K. N., Vishnevsky, T., & Lindstrom, C. M. (2011). Assessing posttraumatic cognitive processes: the event related rumination inventory. Anxiety, Stress, and Coping, 24(February 2013), 137–156. https://doi.org/10.1080/10615806.2010.529901
Cordova, M. J., Riba, M. B., & Spiegel, D. (2017). Post-traumatic stress disorder and cancer. The Lancet Psychiatry, 4(4), 330–338. https://doi.org/10.1016/S2215-0366(17)30014-7
Corrar, L. J., Paulo, E., & Dias Filho, J. M. (2007). Análise multivariada: Para os cursos de administração, ciências contábeis e economia. Atlas.
de Castro, E. K., Crespo, C., Barros, L., Armiliato, M. J., & Gregianin, L. (2020). Assessing the relationship between PTSS in childhood cancer survivors and their caregivers and their quality of life. Pediatric Hematology and Oncology. https://doi.org/10.1080/08880018.2020.1825574
de Moura, T. C., Donat, J. C., da SiLva, T. L. G., Arteche, A. X., de Lisboa, C. S. M., & Kristensen, C. H. (2019). Validation of the Core beliefs Inventory (CBI) in Brazilian Portuguese. Trends in Psychiatry and Psychotherapy Original, 41(4), 409–414. https://doi.org/10.1590/2237-6089-2018-0038
Epskamp, S., & Fried, E. I. (2016). A tutorial on regularized partial correlation networks. Psychological Methods, 23(4), 617–634. https://doi.org/10.1037/met0000167
Epskamp, S., Borsboom, D., & Fried, E. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195–121. https://doi.org/10.3758/s13428-017-0862-1
Goodman, G. S., Quas, J. A., Goldfarb, D., Gonzalves, L., & Gonzalez, A. (2019). Trauma and long-term memory for childhood events: Impact matters. Child Development Perspectives, 13(1), 3–9. https://doi.org/10.1111/cdep.12307
Groleau, J. M., Calhoun, L. G., Cann, A., & Tedeschi, R. G. (2013). The role of centrality of events in posttraumatic distress and posttraumatic growth. Psychological Trauma: Theory Research Practice and Policy, 5(5), 477–483. https://doi.org/10.1037/a0028809
Instituto Nacional de Câncer, I. N. C. A., M. da S., & Brasil (2020). Câncer Infantojuvenil. https://www.inca.gov.br/tipos-de-cancer/cancer-infantojuvenil
Janoff-Bulman, R. (2004). Posttraumatic growth: Three explanatory models. Psychological Inquiry, 30–34. https://doi.org/10.1080/15325029608412837
Janoff-Bulman, R., & Frantz, C. M. P. (1996). The loss of illusions: The potent legacy of trauma. Journal of Personal and Interpersonal Loss, 1(2), 133–150. https://doi.org/10.1080/15325029608412837
Johnston, W. T., Erdmann, F., Newton, R., Steliarova-Foucher, E., Schüz, J., & Roman, E. (2021). Childhood cancer: Estimating regional and global incidence. Cancer Epidemiology, 71(October 2019). https://doi.org/10.1016/j.canep.2019.101662
Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006). An integrative model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 31(4), 343–355. https://doi.org/10.1093/jpepsy/jsj054
Klosky, J. L., Krull, K. R., Kawashima, T., Leisenring, W., Randolph, M. E., Zebrack, B., Stuber, M. L., Robison, L. L., & Phipps, S. (2014). Relations between posttraumatic stress and posttraumatic growth in long- term survivors of childhood cancer: A report from the childhood cancer survivor study. Health Psychology, 33(8), 878–882. https://doi.org/10.1037/hea0000076
Kosir, U., Wiedemann, M., Wild, J., & Bowes, L. (2019). Psychiatric disorders in adolescent cancer survivors: A systematic review of prevalence and predictors. Cancer Reports, 2(3), 1–15. https://doi.org/10.1002/cnr2.1168
Koutná, V., Blatný, M., & Jelínek, M. (2021). Posttraumatic stress and growth in childhood cancer survivors: Considering the pathways for relationship. Journal of Psychosocial Oncology (Vol, 39(1), 105–117. https://doi.org/10.1080/07347332.2020.1789907
Levine, S. Z., Laufer, A., Hamama-Raz, Y., Stein, E., & Solomon, Z. (2008). Posttraumatic growth in adolescence: Examining its components and relationship with PTSD. Journal of Traumatic Stress, 21(5), 492–496. https://doi.org/10.1002/jts.20361
Li, G., Wang, L., Cao, C., Fang, R., Chen, C., Qiao, X., Yang, H., Forbes, D., & Elhai, J. D. (2020). Test of the dynamic interplay between DSM-5 PTSD symptom clusters in children and adolescents. Journal of Anxiety Disorders, 76, https://doi.org/10.1016/j.janxdis.2020.102319
Meyerson, D. A., Grant, K. E., Carter, J. S., & Kilmer, R. P. (2011). Posttraumatic growth among children and adolescents: A systematic review. Clinical Psychology Review, 31(6), 949–964. https://doi.org/10.1016/j.cpr.2011.06.003
Mingoti, S. A. (2005). Análise de dados através de métodos de estatística multivariada: uma abordagem aplicada. Editora UFMG.
Moulds, M. L., Bisby, M. A., Wild, J., & Bryant, R. A. (2020). Rumination in posttraumatic stress disorder: A systematic review. Clinical Psychology Review, 82(September), 101910. https://doi.org/10.1016/j.cpr.2020.101910
Osório, F. D. L., Silva, T. D. A., Santos, R. G., Chagas, M. H. N., Chagas, N. M. S., Sanches, R. F., & Souza Crippa, J. A. (2017). Posttraumatic stress disorder checklist for DSM-5 (PCL-5): Transcultural adaptation of the Brazilian version. Revista De Psiquiatria Clinica, 44(1), 10–19. https://doi.org/10.1590/0101-60830000000107
Phipps, S., Klosky, J. L., Long, A., Hudson, M. M., Huang, Q., Zhang, H., & Noll, R. B. (2014). Posttraumatic stress and psychological growth in children with cancer: Has the traumatic impact of cancer been overestimated? Journal of Clinical Oncology, 32(7), 641–646. https://doi.org/10.1200/JCO.2013.49.8212
Price, J., Kassam-adams, N., Alderfer, M. A., Christofferson, J., & Kazak, A. E. (2016). Systematic review: A reevaluation and update of the integrative (trajectory) model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 41(1), 86–97. https://doi.org/10.1093/jpepsy/jsv074
Schwartz, L. A., Kazak, A. E., DeRosa, B. W., Hocking, M. C., Hobbie, W. L., & Ginsberg, J. P. (2012). The role of beliefs in the relationship between health problems and posttraumatic stress in adolescent and young adult cancer survivors. Journal of Clinical Psychology in Medical Settings, 19(2), 138–146. https://doi.org/10.1007/s10880-011-9264-1
Shakespeare-Finch, J., & Lurie-Beck, J. (2014). A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder. Journal of Anxiety Disorders, 28(2), 223–229. https://doi.org/10.1016/j.janxdis.2013.10.005
Shand, L. K., Cowlishaw, S., Brooker, J. E., Burney, S., & Ricciardelli, L. A. (2015). Correlates of post-traumatic stress symptoms and growth in cancer patients: A systematic review and meta-analysis. Psycho-Oncology, 24(6), 624–634. https://doi.org/10.1002/pon.3719
Sharp, K. M. H., Willard, V. W., Barnes, S., Tillery, R., Long, A., & Phipps, S. (2017). Emotion socialization in the context of childhood cancer: Perceptions of parental support promotes posttraumatic growth. Journal of Pediatric Psychology, 42(1), 95–103. https://doi.org/10.1093/jpepsy/jsw062
Silva, T. L. G., da, Donat, J. C., Gauer, G., & Kristensen, C. H. (2016). Posttraumatic growth measures: Translation and adaptation of three self-report instruments to Brazilian Portuguese. Archives of Clinical Psychiatry, 43(3), 47–50. https://doi.org/10.1590/0101-60830000000083
Stuber, M. L., Meeske, K. A., Leisenring, W., Stratton, K., Zeltzer, L. K., Dawson, K., Kazak, A. E., Zebrack, B., Mertens, A. C., Robison, L. L., & Krull, K. R. (2011). Defining medical posttraumatic stress among young adult survivors in the childhood cancer survivor study. General Hospital Psychiatry, 33(4), 347–353. https://doi.org/10.1016/j.genhosppsych.2011.03.015
Taku, K., Tedeschi, R. G., Shakespeare-Finch, J., Krosch, D., David, G., Kehl, D., Grunwald, S., Romeo, A., Di Tella, M., Kamibeppu, K., Soejima, T., Hiraki, K., Volgin, R., Dhakal, S., Zięba, M., Ramos, C., Nunes, R., Leal, I., Gouveia, P., & Calhoun, L. G. (2021). Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) across ten countries: Global validation of the PTG-PTD theoretical model. Personality and Individual Differences, 169(June 2020). https://doi.org/10.1016/j.paid.2020.110222
Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9(3), 455–471.
Tedeschi, R. G., & Calhoun, L. G. (2004). Psychological inquiry posttraumatic growth: A developmental perspective. Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501
Tedeschi, R. G., & Calhoun, L. G. (2008). Beyond the concept of recovery: Growth and the experience of loss. Death Studies, 32(1), 27–39. https://doi.org/10.1080/07481180701741251
Tedeschi, R. G., Shakespeare-Finch, Taku, J., & Calhoun, L. G. (2018). Posttraumatic growth: Theory, research, and applications. Routledge.
Tillery, R., Sharp, H., Okado, K. M., Long, Y., A., & Phipps, S. (2016). Profiles of resilience and growth in youth with cancer and healthy comparisons. Journal of Pediatric Psychology, 41(3), 290–297. https://doi.org/10.1093/jpepsy/jsv091
Turner, J. K., Hutchinson, A., & Wilson, C. (2018). Correlates of post-traumatic growth following childhood and adolescent cancer: A systematic review and meta-analysis. In Psycho-Oncology (Vol. 27, Issue 4, pp. 1100–1109). https://doi.org/10.1002/pon.4577
Vloet, T. D., Vloet, A., Burger, A., & Romanos, M. (2017). Post-traumatic growth in children and adolescents. Journal of Traumatic Stress Disorders & Treatment, 06(04). https://doi.org/10.4172/2324-8947.1000178
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD.
Yi, J., & Kim, M. A. (2014). Postcancer experiences of childhood cancer survivors: How is posttraumatic stress related to posttraumatic growth? Journal of Traumatic Stress, 27(August), 461–467. https://doi.org/10.1002/jts
Zhou, X., Wu, X., Fu, F., & An, Y. (2015). Core belief challenge and rumination as predictors of PTSD and PTG among adolescent survivors of the Wenchuan earthquake. Psychological Trauma: Theory Research Practice and Policy, 7(4), 391–397. https://doi.org/10.1037/tra0000031
Acknowledgements
We would like to thank Instituto do Câncer Infantil for the recruitment of participants for the research, in special Doctor Lauro Gregianin. We also thank Danielle Kirsch, Luísa Vital, Luiza Pavalello, and Luana Thums for the support to collect data.
Funding
The research project was funded by CNPq/Brazil (Conselho Nacional de Desenvolvimento Científico e Tecnológico – no 306,925/2016-8) and Fapergs/Brazil (Fundaçao de Amparo a Pesquisa do Rio Grande do Sul – no 17/1110-4).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics Approval and Informed Consent
Ethics Committee approved the research project according to Brazil’s rules (CAAE no. 66321317.6.1001.5344). All participants signed the Informed Consent
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
de Castro, E.K., da Silva Oliveira, J.A., Armiliato, M.J. et al. Profiles of Posttraumatic Growth and Posttraumatic Stress Symptoms in Childhood Cancer Survivors. Journ Child Adol Trauma (2023). https://doi.org/10.1007/s40653-023-00605-2
Accepted:
Published:
DOI: https://doi.org/10.1007/s40653-023-00605-2