Courtesy of Dana-Farber Cancer Institute
When you learn your child has cancer, the natural response is to do anything possible to make them happy. However, it is important to balance this desire to comfort with an understanding of what is in your son or daughter’s best interest. This is especially true when your child with cancer exhibits difficult behaviors. “Even as your child and family are going through this incredibly stressful time, it is imperative that you maintain your parental role,” says Brian Delaney, PsyD, a senior psychologist in theDivision of Pediatric Psychosocial Oncology at Dana-Farber/Boston Children’s Blood and Cancer Disorders Center. “Give yourself time to accept the realities of your child’s’ medical situation, but feel confident in trusting your instincts about the behaviors you want to maintain, and those that you are more willing to let go.” Delaney, who has worked with pediatric patients and families at Dana-Farber/Boston Children’sfor 16 years, offers these tips on dealing with the behavioral problems sometimes brought on by a child’s cancer diagnosis: Focus on the positive. It’s easy to respond to bad behavior, but a healthier, more preventative approach is to emphasize and reinforce the positive things your kids are doing. If they are having trouble going to bed, remind them about the many nights they have been able to sleep independently – and tell them you know they can make it through the night. Recognize how brave they are being during treatment and point out all the ways in which they are being strong. Expect developmental regression. Children under the stress of cancer often regress to previous behaviors or coping methods. An adolescent in treatment may resent the fact she is suddenly more dependent on her parents, while a younger child may become more clingy and unwilling to socialize with peers. These reactions are normal; try to create a space to accommodate them and not be judgmental. Don’t worry about maintaining the rigid developmental milestones you may have had for your child before, and try to encourage coping skills to help them feel better. In returning to school, focus first on peer connections. Working with your care team and school administrators, make a back-to-school plan with modified educational goals. Maintain school attendance as much as possible, but if your child can’t go for the whole day, try one or two hours or some other modified schedule. Maintaining the appropriate developmental and social connection with school can often be more important initially than academic success. You can address schoolwork through tutoring, but the big issue early on should be on getting back on track socially with peers and the routine of school attendance. Let kids play a part in their own care. Hearing age-appropriate information about their cancer and treatment can help alleviate their worries, accept the limitations of their diagnosis, and increase their capacity to connect with the normal parts of their lives. Make time for siblings. Sometimes behavioral issues with siblings are rooted in the fact that the patient is getting more attention than they are. Setting up a fun activity for your other child (or children) helps some of these feelings, as does involving siblings in the patient’s care. The more siblings know, the less worried they are going to be – and the less behavioral disruption will result. Pick your battles. Discuss and prioritize the behaviors you want to emphasize. Know that when you don’t prioritize certain behaviors, you’re going to have to live with the results. Maybe you can accept a messy room, but you won’t tolerate rudeness and disrespectful backtalk. Adapt to treatment patterns. Pay attention to your child’s sleep pattern and medications, and discuss with team members the way these things may be contributing to behavioral changes. For instance, a kid on steroids may have mood swings and some sleep problems, and being able to anticipate that will help you understand when to have things ready to calm them down.. Take time for parental self-care. Kids react to parental stress, and so taking care of yourself and addressing your own stress has a direct effect on your child’s anxiety level and behavior. “The challenges may change over time,” says Delaney, “but keeping life as normal as possible for your children is always the best approach.”
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Courtesy of St. Jude's Children's Research Hospital
Research from the Childhood Cancer Survivors Study has identified distinct profiles of psychological symptoms in adolescent cancer survivors; a finding that is expected to advance mental health screening and treatment Most adolescent survivors of childhood cancer have no reported psychological symptoms, but an analysis led by St. Jude Children’s Research Hospital found that those who do often have multiple symptoms and distinct symptom profiles. The findings, which appear today in the Journal of Clinical Oncology, highlight strategies to improve mental health screening and interventions. “Historically, mental health symptoms in childhood cancer patients were studied in isolation,” said first and corresponding author Tara Brinkman, Ph.D., an assistant member of the St. Jude Department of Epidemiology and Cancer Control. “This research shows that psychological symptoms typically occur together in adolescent cancer survivors rather than in isolation. That raises hope that with more robust screening efforts and identification of appropriate treatments we can help to prevent behavioral, emotional and social symptoms in adolescence from becoming chronic problems that persist into adulthood.” The study included 3,893 adolescent survivors of childhood cancer who were enrolled in the federally funded Childhood Cancer Survivor Study (CCSS) and were treated between 1970 and 1999 at one of 31 medical centers. All had survived at least five years and were 12 to 17 years old when their parents or guardians completed the questionnaires used in this analysis. The study focused on behavioral, emotional and social symptoms. The CCSS is headquartered at St. Jude. Researchers found that like adolescents in the general population, most adolescent survivors of childhood cancer were well adjusted with no significant reported psychological symptoms. “One of the primary take-home points is that most survivors had no significant psychological symptoms,” Brinkman said. However, such symptoms, when they were reported, occurred together, never in isolation. Researchers also found survivors had distinct symptom profiles that often corresponded with their cancer treatments or the late effects of treatment. For example, 31 percent of survivors treated with brain irradiation had reported symptoms of depression, anxiety, social withdrawal, peer conflict and attention problems compared to 9 percent of survivors who received other treatments. In contrast, headstrong behavior and attention problems were reported in 16 percent of survivors treated without brain irradiation but that combination of symptoms was not reported in survivors who received brain irradiation. A small percentage of survivors from both treatment groups had more global symptoms that combined headstrong behavior and inattention with anxiety, depression and social withdrawal. The findings underscore the need for more robust screening. “Screening survivors for attention problems alone might miss symptoms of anxiety, depression or headstrong behavior, which means missed treatment opportunities,” Brinkman said. She noted that adolescents with untreated attention problems and headstrong behavior are at risk for substance abuse as adults, and survivors with those symptoms may benefit from substance abuse prevention efforts during adolescence. In addition, while stimulant medication is recommended for adolescents with attention problems, survivors who also have anxiety may benefit from alternative therapies. Certain late effects of cancer treatment, including obesity, cancer-related pain and scarring, were associated with a significantly increased risk for reported psychological symptoms regardless of whether survivors had received brain irradiation. For example, survivors with hearing loss or other sensory impairments were up to 2.5 times more likely than survivors without the impairment to have reported symptoms of anxiety, depression, inattention, social withdrawal and peer conflict or to have global symptoms that also included headstrong behavior. “This study highlights an opportunity to improve the quality of life for the growing population of childhood cancer survivors and underscores the need for robust screening that includes survivor- and parent-reported symptoms,” Brinkman said. “These symptoms tend to persist into adulthood if they are not successfully treated in adolescence.” The senior author is Kevin Krull, Ph.D., a member of the St. Jude Epidemiology and Cancer Control department. The other authors are Chenghong Li, Cara Kimberg, Stefanie Vuotto, Deokumar Srivastava, Leslie Robison and Gregory Armstrong, all of St. Jude; Kathryn Vannatta, Nationwide Children’s Hospital, Columbus, Ohio; Jordan Marchak, Emory University School of Medicine, Atlanta; Jin-Shei Lai, Northwestern University, Evanston, Ill.; Pinki Prasad, Louisiana State University, Baton Rouge; and Chongzhi Di, Fred Hutchinson Cancer Research Center, Seattle. The study was supported in part by grants (CA55727, CA21765) from the National Cancer Institute, part of the National Institutes of Health; and ALSAC. |
AuthorBerni & Murcer, Friends for LifeTM Archives
September 2019
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