Parental perspective on the psychological adjustment of children in cancer relapse or remission

Wechsler, Amanda Muglia; Bragado-Álvarez, Carmen; Hernández-Lloreda, María José; Lopes, Luiz Fernando; Perina, Elisa Maria

doi:10.1590/1982-0275202441e210164

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Estudos de Psicologia (Campinas)

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Sumário

RESEARCH REPORT | Health Psychology • Estud. psicol. 41 • 2024 • https://doi.org/10.1590/1982-0275202441e210164 copy

Parental perspective on the psychological adjustment of children in cancer relapse or remission

Perspectiva de pais sobre o ajustamento psicológico de crianças em recidiva e remissão de câncer

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This article aimed to evaluate the psychological adjustment of Brazilian children experiencing cancer relapse by comparing their adjustment with cancer survivors and “healthy” children, based on the reports of their parents or caregivers.

Method

Participants were 140 caregivers of children in relapse (n = 24), remission (n = 59), and of children considered “healthy” (control group) (n = 57). The Behavior Assessment System for Children and the Family Environment Scale were applied. Data analyses were performed through Student’s t-test, Chi-square, analysis of variance, and Pearson correlations.

Results

The results showed that children with cancer did not present more psychopathologies than the control group; however, they had more social and leadership skills. Protective (family cohesion) and risk factors (child´s age, number of relapses, treatment duration, caregiver’s income and education level) were also observed.

Conclusion

This study proposes the screening of psychological symptoms for risk subgroups and the design of intervention strategies for this population.

Keywords
Adaptation; Cancer in children; Emotional adjustment; Psycho-Oncology; Relapse

Variables		Relapse		Remission		Control
Variables		n	%	n	%	n	%
Child’s gender - valid n		24		59		57
	Female	12	50	31	52.5	34	59.6
	Male	12	50	28	47.5	23	40.4
Caregiver’s Marital Status - valid n		24		59		55
	With partner	17	71	45	76	32	58
	Without partner	7	29	14	24	23	42
Caregiver’s Education Level - valid n		23		59		55
	Elementary	8	35	23	39	25	45
	High school/higher education	15	65	36	61	30	55
Variables		Relapse		Remission		Control
Variables		M	SD	M	SD	M	SD
Child’s age - valid n		24		59		57
Child’s age - valid n		9.1	1.1	9.5	01.4	10.1	01.5
Family income - valid n		22		59		55
Family income - valid n		2.1	1.5	5.3	05.6	02.3	01.7
Time in current situation (months) - valid n		24		59		–
Time in current situation (months) - valid n		06.57	7.41	61.75	25.31	–	–
Time in treatment (months) - valid n		24		59		–
Time in treatment (months) - valid n		39.59	31.03	12.20	010.85	–	–

Subscale		Relapse		Remission		Control		F	p	Cohen’s d	ɳ²
Subscale		M	SD	M	SD	M	SD	F	p	Cohen’s d	ɳ²
Clinical Scales
	Aggression	10.54	07.52	9.36	5.38	8.72	06.00	0.78^* * p < 0.05.			0.01
	Hyperactivity	11.55	05.99	10.61	5.41	9.33	04.46	1.60^* * p < 0.05.			0.02
	Conduct Problems	3.13	02.94	03.64	3.15	4.42	03.94	1.40^* * p < 0.05.			0.02
	Attention Problems	011.04	3.41	10.74	2.70	9.74	02.70	2.60^* * p < 0.05.			0.04
	Atypicality	06.88	04.28	7.12	4.50	8.68	04.45	3.60^* * p < 0.05.	0.03^a a Significant differences between RG (group in cancer relapse) and CG (control group); 0.03^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.41^a a Significant differences between RG (group in cancer relapse) and CG (control group); 0.35^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.05
	Depression	11.00	06.53	8.76	5.74	8.72	05.05	1.61^* * p < 0.05.			0.02
	Anxiety	8.45	03.50	7.11	3.44	8.62	3.51	1.11^* * p < 0.05.			0.02
	Withdrawal	8.21	3.31	6.52	2.98	6.42	3.71	2.68^* * p < 0.05.			0.03
	Somatization	08.79	04.26	07.41	5.35	8.14	05.00	0.70^* * p < 0.05.			0.01
	Adaptive Scales
Adaptability		15.25	04.48	14.67	2.83	13.44	03.85	2.79^* * p < 0.05.			0.03
	Social Skills	28.46	07.13	26.26	5.90	23.74	06.56	5.12^* * p < 0.05.	0.00^a a Significant differences between RG (group in cancer relapse) and CG (control group); 0.03^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.69^a a Significant differences between RG (group in cancer relapse) and CG (control group); 0.40^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.07
	Leadership	15.88	04.40	16.28	3.67	14.09	4.11	4.62^* * p < 0.05.	0.00^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.56^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.06
General Scales
	Externalizing Problems	25.73	14.92	23.46	11.82	22.44	12.77	0.80^* * p < 0.05.			0.01
	Internalizing Problems	29.14	11.69	22.93	11.03	25.02	10.06	1.45^* * p < 0.05.			0.02
	Adaptive Skills	59.58	13.55	57.21	10.65	51.26	12.81	5.40^* * p < 0.05.	0.00^a a Significant differences between RG (group in cancer relapse) and CG (control group); 0.00^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.63^a a Significant differences between RG (group in cancer relapse) and CG (control group); 0.50^b b Significant differences between RMG (group in cancer remission) and CG (control group).	0.07
	Behavioral Symptoms Index	59.29	23.85	53.67	19.59	53.79	19.85	0.73^* * p < 0.05.			0.01

Variables		Group	1	2	3	4	5
1.	Externalizing	RG	–
	Problems	RMG	–
		CG	–
2.	Internalizing	RG	0.70^ p < 0.001. CG:	–
	Problems	RMG	0.69^ p < 0.001. CG:	–
		CG	0.60^ p < 0.001. CG:	–
3.	Adaptive	RG	-0.01	0.04	–
	Skills	RMG	0.06	-0.11	–
		CG	0.10	0.39^ p < 0.001. CG:	–
4.	Behavioral symptoms Index	RG	0.92^ p < 0.001. CG:	0.89^ p < 0.001. CG:	-0.01	–
		RMG	0.89^ p < 0.001. CG:	0.87^ p < 0.001. CG:	-0.06	–
		CG	0.87^ p < 0.001. CG:	0.86^ p < 0.001. CG:	0.27^* * p < 0.05;	–
5.	Family Cohesion	RG	0.01	0.12	0.38	0.04	–
		RMG	-0.34^* * p < 0.05;	-0.46^* * p < 0.05;	0.22	-0.37^* * p < 0.05;	–
		CG	-0.180	-0.07	0.09	-0.15	–

Variable		Group	1	2	3	4	5	6	7	8	9
1.	Externalizing	RG	–
	Problems	RMG	–
		CG	–
2.	Internalizing	RG	0.70^ p < 0.001.	–
	Problems	RMG	0.69^ p < 0.001.	–
		CG	0.60^ p < 0.001.	–
3.	Adaptive	RG	-0.01	0.04	–
	Skills	RMG	0.00	-0.11	–
		CG	0.10	0.39^ p < 0.001.	–
4.	Behavior symptoms index	RG	0.92^ p < 0.001.	0.89^ p < 0.001.	-0.01	–
		RMG	0.89^ p < 0.001.	0.87^ p < 0.001.	-0.06	–
		CG	0.88^ p < 0.001.	0.86^ p < 0.001.	0.27^* * p < 0.05;	–
5.	Child’s gender	RG	0.33	0.03	-0.33	0.17	–
		RMG	0.14	0.07	-0.19	0.19	–
		CG	0.13	-0.18	-0.23	-0.01	–
6.	Child’s age	RG	-0.35	-0.15	0.15	-0.31	-0.30	–
6.	Child’s age	RMG	-0.09	-0.05	0.28^* * p < 0.05;	-0.10	0.18	–
		CG	-0.13	-0.07	-0.08	-0.17	-0.17	–
7.	Caregiver’s Marital Status	RG	0.32	0.31	-0.18	0.39	0.08	-0.21	–
		RMG	-0.13	-0.06	-0.14	-0.09	0.07	0.16	–
		CG	-0.27^* * p < 0.05;	-0.25	0.04	-0.27^* * p < 0.05;	0.15	-0.03	–
8.	Caregiver’s Educ. Lvl.	RG	0.02	-0.26	0.25	-0.20	-0.03	0.14	-0.48^* * p < 0.05;	–
		RMG	-0.17	-0.29^* * p < 0.05;	0.07	-0.23	0.07	0.10	-0.10	–
		CG	-0.31^* * p < 0.05;	-0.15	-0.02	-0.19	-0.11	-0.04	-0.08	–
9.	Family income	RG	0.07	0.12	-0.06	0.12	-0.16	0.51*	-0.24	0.46^* * p < 0.05;	–
		RMG	-0.26^* * p < 0.05;	-0.27^* * p < 0.05;	0.14	-0.26^* * p < 0.05;	-0.02	0.07	-0.23	0.47^ p < 0.001.	–
		CG	-0.20	-0.11	-0.06	-0.17	-0.11	0.01	-0.16	0.37^ p < 0.001.	–

Variables		Group	1	2	3	4	5	6	7
1.	Externalizing	RG	–
	Problems	RMG	–
2.	Internalizing	RG	0.70^ p < 0.001.	–
	Problems	RMG	0.69^ p < 0.001.	–
3.	Adaptive	RG	-0.01	0.04	–
	Skills	RMG	0.00	-0.11	–
4.	Behavioral symptoms index	RG	0.92^ p < 0.001.	0.89^ p < 0.001.	-0.01	–
4.	Behavioral symptoms index	RMG	0.89^ p < 0.001.	0.87^ p < 0.001.	-0.06	–
5.	Time in current situation	RG	0.20	0.02	-0.20	0.09	–
5.	Time in current situation	RMG	0.08	-0.8	0.15	0.01	–
6.	Time in treatment	RG	0.26	0.45^* * p < 0.05;	-0.18	0.38	0.26	–
6.	Time in treatment	RMG	-0.07	0.04	0.05	-0.01	-0.46^ p < 0.001.	–
7.	Number of relapses	RG	0.44^* * p < 0.05;	0.50^* * p < 0.05;	-0.09	0.46^* * p < 0.05;	0.02	0.36	–

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E-mail: psychologicalstudies@puc-campinas.edu.br

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