Olagunju Andrew Toyin, Sarimiye Foluke Oladele, Olagunju Tinuke Oluwasefunmi, Habeebu Muhammad Yaqub Murtazha, Aina Olatunji Francis
Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria.
Department of Oncology and Radiotherapy, University College Hospital, Ibadan, Nigeria.
Ann Palliat Med. 2016 Jul;5(3):157-65. doi: 10.21037/apm.2016.04.03. Epub 2016 May 9.
Childhood cancers evoke various emotional reactions in caregivers which can impair their well-being and roles. Little is known about caregiving and which cancer-associated factors are related to caregiver's depression in resource-restricted settings. We sought to investigate if child's symptom burden is related to depressive symptoms in caregivers.
Seventy-two caregivers and children with cancers were administered questionnaires to elicit socio-demographic and disease-related data. Subsequently, the child's symptoms were profiled with Memorial Symptom Assessment Scale (MSAS 7-12); while screening for depressive symptoms in caregivers was done using the Center for Epidemiologic Studies Depression Scale-Revised (CES-DR).
All the caregivers were parents, and largely mothers (83.7%). The mean ages of caregivers and children were 39±2 and 10±2 years respectively. Majority of caregivers (90.3%) were either ignorant or attributed spiritual causation to the cancers. The common symptoms with prevalence >50% in the children included pain, nausea, worry, and lack of energy (LE); symptoms' prevalence ranged from LE (68%) to itching (32%). Approximately, one-third each of the children reported hair and weight loss which were considered 'unusual' in the design of MSAS 7-12. The symptoms showed variability in distress, frequency and intensity. In particular, pain, lack of appetite (LA) and feeling sad (FS) were reported as most burdensome in >50% of the children. More than one-third of caregivers (38.2%) screened positive for significant depressive symptoms. The global symptom burden (r=0.58) and individual symptom correlated positively with depressive symptoms in caregivers (P<0.05).
Our findings suggest the need for improved awareness creation on childhood cancers to obviate late presentations and poor access to care. Again, early integration of pediatric palliative care in childhood cancer care to ensure symptom management as well as its extended benefits on caregivers' wellbeing is desirable. The pattern of certain "unusual" symptoms in children with cancer in our work suggests the need to put into consideration 'novel' symptoms which were not captured in existing instruments. Future research on supportive care in pediatric cancers is indicated.
儿童癌症会在照料者身上引发各种情绪反应，这可能会损害他们的幸福和角色功能。在资源有限的环境中，关于照料情况以及哪些癌症相关因素与照料者的抑郁有关，人们知之甚少。我们试图调查儿童的症状负担是否与照料者的抑郁症状有关。
对72名癌症患儿的照料者和患儿进行问卷调查，以获取社会人口学和疾病相关数据。随后，使用纪念症状评估量表（MSAS 7 - 12）对儿童的症状进行分析；同时使用修订后的流行病学研究中心抑郁量表（CES - DR）对照料者的抑郁症状进行筛查。
所有照料者均为父母，且大多为母亲（83.7%）。照料者和儿童的平均年龄分别为39±2岁和10±2岁。大多数照料者（90.3%）对癌症要么一无所知，要么将其归因于精神因素。儿童中患病率>50%的常见症状包括疼痛、恶心、担忧和精力不足（LE）；症状患病率从精力不足（68%）到瘙痒（32%）不等。大约三分之一的儿童报告有头发脱落和体重减轻，这在MSAS 7 - 12的设计中被视为“异常”。这些症状在痛苦程度、频率和强度上存在差异。特别是，超过50%的儿童报告疼痛、食欲不振（LA）和悲伤情绪（FS）最为困扰。超过三分之一的照料者（38.2%）筛查出有显著抑郁症状。总体症状负担（r = 0.58）和个体症状与照料者的抑郁症状呈正相关（P<0.05）。
我们的研究结果表明，需要提高对儿童癌症的认识，以避免延迟就诊和获得医疗服务的机会不佳。此外，在儿童癌症护理中尽早纳入儿科姑息治疗，以确保症状管理以及对照料者幸福感的额外益处是可取的。我们研究中癌症患儿某些“异常”症状的模式表明，需要考虑现有工具未涵盖的“新”症状。未来需要开展关于儿科癌症支持性护理的研究。
