SAN FRANCISCO – Children and adolescents with cancer showed greater adaptive skills and social skills than expected in healthy children, and certain adaptive styles help them thrive psychologically, separate speakers said at the annual meeting of the American Psychological Association.
A study of 172 children and teenagers with cancer looked at positive adjustment by measuring adaptability, social skills, and leadership. Results were compared with the same measures on a healthy sibling for 90 of the patients and with expected levels of these traits in healthy children.
Skills were assessed using the Revised Children's Manifest Anxiety Scale and the Behavioral Assessment System for Children-2.
Both the children with cancer and their siblings showed similar or lower levels of externalizing problems than would be expected in healthy controls. Children with cancer had higher composite scores for internalizing problems (anxiety, depression, and somatization), but their siblings had significantly lower composite scores, compared with expected rates, reported Melissa A. Alderfer, Ph.D., of Children's Hospital of Philadelphia.
Both the children with cancer and their siblings had greater adaptability and social skills than would be expected in conventional children. The siblings also showed more elevated levels of leadership than might be expected, but this trait was lower in children with cancer because of depressed leadership scores among children with brain tumors.
The children with cancer were 7–19 years of age and had been diagnosed between 44 days and 17 years prior to the study. Their siblings were 8–17 years old. Most (59%) of the children with cancer had leukemia, lymphoma, or blood disorders. A modest decline in positive adjustment was seen the further the cancer patient was from the time of diagnosis, Dr. Alderfer said.
Many previous studies have reported lower rates of depression in children with cancer, compared with healthy controls, Sean Phipps, Ph.D., said in a separate presentation. “The preponderance of evidence suggests that children with cancer are doing quite well” psychologically, said Dr. Phipps of St. Jude's Children's Research Hospital, Memphis, Tenn.
He and associates explored one of the possible reasons for this–each individual's style of coping or defense, termed adaptive style. In one study of 162 pediatric cancer patients and their parents, the parents and patients reported on their adaptive styles and levels of posttraumatic stress.
Children and parents who were identified as low anxious or repressors had less posttraumatic stress reported, compared with those who were identified as high anxious or defensive/high anxious (J. Pediatr. Psychol. 2006;31:298–309).
“These findings, in combination with the generally low levels of posttraumatic stress in the pediatric oncology population, raise questions about the utility of the posttraumatic stress model for understanding the experiences of children with cancer,” the investigators concluded.
A separate study in which Dr. Phipps was a coinvestigator assessed quality of life for 199 children with cancer and 108 healthy control children. The children with cancer and their parents reported better quality of life, compared with control children (Cancer 2006;106:2267–74).
Dr. Phipps wondered whether there is a downside to repressive adaptation. “I always thought so,” he said, which led him and his associates to conduct a separate study on the effects of adaptive style on somatic symptoms in children aged 7–18 years, including 120 children who had completed treatment for cancer at least 6 months earlier and 120 matched healthy controls.
Contrary to expectations, there were no significant differences between the cancer and control groups in self-reported somatic symptoms. Children who were identified as repressors were least likely to report somatic symptoms (Pediatr. Blood Cancer 2007;49:84–9).
“These results do not support the prevailing hypothesis that a repressive style may be a risk factor for psychosomatic illness,” the investigators reported.
Another study that hooked up physiologic monitoring devices to children with cancer found no relationship between measures of adaptive style and physiologic reactivity or short-term medical outcome, he added.
“Children with cancer are not only doing well, they're flourishing” psychologically, Dr. Phipps said.