METHODS
The study included 50 children and adolescents, aged 8-17 years, whose parents had cancer, and 50
age- and sex-matched healthy controls. Anxiety and depression levels were assessed using the State-Trait
Anxiety Inventory (STAI-1 and STAI-2) and the Children's Depression Inventory (CDI), respectively.
The Pediatric Quality of Life Inventory (PedsQL) was used to measure the quality of life.
RESULTS
Compared to the control group, the children and adolescents of parents with cancer had significantly
higher STAI-1, STAI-2, and CDI scores and significantly lower scores on the PedsQL physical health and
psychosocial health subscales, as well as the total scale score (p<0.05). The majority of these children
and adolescents were found to experience one or more problems related to their parent"s illness, such as
increased responsibilities and changes in lifestyle.
CONCLUSION
Our study found that anxiety and depression levels were higher and quality of life was poorer in children
and adolescents of parents with cancer. These results highlight the importance of providing psychological
support to these children and adolescents.
Keywords: Adolescents; anxiety; cancer; children; depression; parents; quality of life
Children and adolescents with parental cancer
may experience intense distress when faced with the
symptoms of the disease, the side effects of treatments,
and the threat of the parent's death. In addition, the
temporary inaccessibility of the parent in case of hospitalization
can also have negative effects on children.
[
It has been reported that psychological and psychosocial
problems, such as anxiety and depressive
symptoms, emotional/behavioral problems, and low
self-esteem, are observed in children of cancer patients,
usually due to the perception of weakness in
the sick parent, the threat of losing the parent, and
the change in daily activities.[
Although many studies have been conducted on
the emotional impact of cancer on families in relation
to spouses and adult children, especially in our country,
there has been little focus on psychiatric problems
in children under 18 years of cancer patients. In this
study, we aimed to evaluate anxiety and depression
levels, quality of life, and factors affecting the quality
of life of children and adolescents aged 8-17 years of
patients with any diagnosis of cancer.
As a control group, 50 age- and gender-matched healthy children and adolescents with healthy parents who did not have any known psychiatric, neurological, genetic, metabolic, or endocrine disease, substance addiction, or drug abuse were included in the study. The study group was asked questions prepared by the researchers, including the effect of the parent's illness on the child's life, such as their knowledge of their parent's illness, their reactions when they learned about the illness, role changes in the family, changes in their responsibilities, difficulties they experienced, and fear of developing a similar illness.
Furthermore, both the study group and the control group completed the sociodemographic data form prepared by the investigators, the State-Trait Anxiety Inventory (STAI-1 and STAI-2), which was used to assess the children's anxiety levels, the Child Depression Inventory (CDI), which was employed to assess the children's depression levels, and the Quality of Life Scale for Children and Adolescents (PedsQL), which was utilized to assess the children"s quality of life. The sociodemographic scale form of the control group did not include questions pertaining to parental illness and related matters.
Data Collection Tools
Sociodemographic Data Form
The questionnaire prepared by the researchers consists
of sociodemographic data such as age, gender, age of
parents, gender of the sick parent, and type of cancer,
as well as questions that determine situations that may
be problematic for children and adolescents, such as
role changes within the family during the course of the
disease, increased responsibilities, difficulties they experience,
fear of getting the disease, knowledge of the
parent"s disease, reaction to the disease, and thoughts
about the severity of the disease.
The State and Trait Anxiety Inventory
Children's Depression Inventory
The Quality of Life Scale for Children
Statistical Analysis
The "State and Trait Anxiety Inventory" (STAI) was
employed in this study, as developed by Spielberger,
Gorsuch, and Lushene in 1970.[
The Children's Depression Inventory (CDI) is a self-assessment
scale comprising 27 items designed for children
and adolescents between the ages of 6 and 17. It
is used to investigate child and adolescent depression.
The scale was initially developed by Kovacs and subsequently
adapted into Turkish by Oy.[
The scale is a general quality-of-life assessment tool
utilized in children and adolescents between the ages
of two and eighteen.[
The data from the study were evaluated using the
SPSS (Statistical Package for Social Sciences) 22.0
program for Windows. Numerical variables were expressed
as mean±standard deviation, and categorical
variables were expressed as number and percentage.
The Kolmogorov-Smirnov test was employed to assess
the conformity of the numerical data to the normal
distribution. Those that conformed to the normal
distribution were evaluated by Student's t-test,
and those that did not conform to the normal distribution
were evaluated by the Mann-Whitney U test.
Significance was accepted as p<0.05.
Family role changes, increased responsibilities, and
difficulties experienced by children and adolescents after
parental cancer are shown in Table
The STAI-1, STAI-2, and CDI scores were found
to be significantly higher (p<0.05) in the study group
compared to the control group, while the PEDsQL
physical, psychosocial, and total scores were observed
to be significantly lower (Table
A significant difference was observed in the STAI- 2 scores between genders, with girls exhibiting higher scores than boys (p=0.017). No significant differences were observed between girls and boys in terms of depression and quality of life scale scores and related factors (p>0.05).
With regard to the age groups within the study group (8-12 and 13-17 years), no significant differences were observed between the two age groups in terms of family role changes, increased responsibilities, difficulties experienced, gender, and other scale scores utilized in the study, with the exception of depression (p>0.05 for all). The adolescent group (13-17 years) exhibited a higher level of depression (p=0.027) and demonstrated a more pronounced reaction to the disease (p=0.035).
The STAI-1 score was found to be lower in individuals who were aware of their parents" disease diagnosis compared to those who were not (mean±sd = 42.94±6.98; 48.32±7.36, p=0.022). No significant differences were observed in the other scale scores (p>0.05 for all).
The results indicated that all subscale scores for quality of life were significantly lower in children whose mothers had cancer compared to those whose fathers had cancer (p=0.016, p=0.004, p=0.001). Conversely, the change in family roles (p=0.007), the rate of knowledge regarding the illness of the parent (p=0.006), and the fear of developing the disease (p=0.014) were observed to be higher.
Many studies have shown that a parental diagnosis
of cancer has negative psychosocial effects on their
children. The offspring were typically found to exhibit
elevated levels of internalizing and externalizing problems,
distress, anxiety, depression, stress, and cancerrelated
worry. Additionally, they demonstrated diminished
health-related quality of life and self-esteem.
[
The quality of life of young children of cancer patients
has been relatively under-researched in comparison
to the psychological effects of cancer on children,
such as internalizing and externalizing problems.
[
In our study, quality of life was found to be lower
when the patient"s parent was a mother. Given the functional
roles of mothers in the home, it was hypothesized
that the diagnosis of cancer in the mother may have resulted
in adverse psychosocial outcomes for children
and adolescents, thereby affecting quality of life.
In our study, it was found that there were significant
changes in the lives of children with a parent diagnosed
with cancer. Approximately 46% of children and adolescents reported that their role in the family had changed.
The most common roles were caregiver (69.6%) and
mother (30.4%). They reported that they had increased
and new responsibilities, such as taking responsibility
for housework (36%), taking responsibility for siblings
(34%), and caring for a sick parent (20%). At the same
time, not being able to spare time for themselves (44%), not being able to study (36%), and not being able to spend
time with friends (18%) were reported as the most common
difficulties. Sixty percent of children and adolescents
stated that they were fearful of contracting the disease.
In previous studies, similar to our own, it has been
reported that family members, children, and adolescents
who are caregivers of a person with cancer develop
new responsibilities. These include assuming the
role of the parent, limiting daily chores, assuming the
responsibilities of siblings, and having to do housework
during the illness. These new responsibilities impose
an additional emotional and physical burden on
children and cause psychological distress.[
The results of our study indicated that the trait anxiety
score was higher in girls, while the depression and
quality of life scale scores were similar in both genders.
The observed changes in family roles, increase in responsibilities,
difficulties experienced, and fear of getting the
disease were found to be similar in girls and boys.
With regard to the children most affected by parental
cancer, the extant literature indicates that girls experience
greater challenges than boys.[
The study group exhibited elevated depressive
symptoms in the adolescent age group (13-17 years)
relative to the younger age group. However, no significant
differences were observed in anxiety and quality
of life scale scores. Furthermore, it was established that
the 13-17 age group exhibited a heightened response to the disease, manifesting as feelings of profound sadness
and increased levels of crying. No significant differences
were observed between the two age groups in the
study with regard to the scale scores, changes in family
roles, increases in responsibilities, difficulties experienced,
fear of contracting the disease, and gender.
The findings of previous research indicate that adolescents
and young adults exhibit elevated levels of
anxiety and depression and are more prone to developing
emotional and behavioral symptoms in comparison
to preadolescent children.[
The findings of our study indicate that children and
adolescents who were aware of their parent's diagnosis exhibited
lower levels of state anxiety. Furthermore, the levels
of trait anxiety, depression, and quality of life observed
in these individuals were comparable to those of individuals
who were not aware of their parent's diagnosis. It is well
established that uncertainty in a given situation or with
regard to a disease state is a significant contributor to the
development of anxiety. The reduced level of state anxiety
observed in this study indicates that it may be beneficial to
provide information about the disease and the treatment
process in a manner that is accessible to the child. Nevertheless,
further research on this topic is required.
In our study, it was determined that all subscale
scores of quality of life were lower in those with a
mother who had been diagnosed with cancer than in
those with a father who had been diagnosed with cancer.
Additionally, the rate of change of roles within the
family, the rate of knowing the disease of the parent,
and the fear of getting the disease were higher in this
group. These results are to be expected when the role of
the mother at home and family functionality are taken
into consideration. Furthermore, the fact that the majority
of the mothers in our study had breast cancer
may have caused the fear of developing the disease to
be higher in terms of genetic predisposition. The effect
of the gender of the ill parent on the child"s functioning
is unclear, and studies do not provide definitive results.
Our study results support the findings of previous studies
in the literature which indicate that maternal cancer
has more negative results than paternal cancer.[
The major limitation of this study was its crosssectional
design. As the study was applied to a small
sample group, it cannot be generalized to all children
of cancer patients. Other limitations were that the
cases were not psychiatrically evaluated and assessed
with a semi-structured psychiatric interview, such as
the Schedule for Affective Disorders and Schizophrenia
for School-Aged Children-Present and Lifetime
Version (K-SADS-PL), and that the groups were assessed
with measurement tools based on self-reports
of children and adolescents. Nevertheless, it was considered
an important study that can serve as a basis
for prospective, large-scale studies in our country and
as a resource for assessing anxiety/depression levels,
quality of life, and difficulties experienced by children
and adolescents with parental cancer.
Acknowledgment: The authors wish to thank the patients and families who participated in this study.
Ethics Committee Approval: The study was approved by the Kahramanmaraş Sütçü İmam University Faculty of Medicine Clinical Research Ethics Committee (no: 06, date: 18/04/2018).
Authorship contributions: Concept - N.K., H.A.; Design - N.K.; Supervision - N.K., H.A.; Materials - N.K., H.A.; Data collection and/or processing - N.K., H.A.; Data analysis and/or interpretation - H.A., N.K.; Literature search ? H.A., N.K.; Writing - N.K., H.A.; Critical review - N.K., H.A.
Conflict of Interest: All authors declared no conflict of interest.
Use of AI for Writing Assistance: Only language editing support was received.
Financial Support: None declared.
Peer-review: Externally peer-reviewed.
