Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Cancer Med. 2018 May;7(5):1680-1688. doi: 10.1002/cam4.1393. Epub 2018 Mar 25.
Little is known about the impact of cancer on family relationships from the perspective of the pediatric cancer patient and their sibling(s). This study assessed and compared children's experiences of family relationships in patients receiving active cancer therapy, those who have completed therapy, and siblings. A cross-sectional study of children with cancer and their siblings aged 8-17 years old was conducted. Children completed the PROMIS Pediatric Family Relationships short form and the Depressive Symptoms, Anxiety, and Peer Relationships short forms. The Mann-Whitney test assessed differences in Family Relationships scores between therapy groups, while the Wilcoxon signed-rank test assessed differences between patients and siblings. An actor-partner interdependence model (APIM) was used to assess how patient and sibling variables were associated with their own and each others' family relationships. Two hundred and sixty-five children completed the assessments. Siblings of patients on-therapy had worse family relationships than patients on-therapy (P = 0.015). Family relationships of patients off-therapy did not differ from their siblings or the patients on-therapy. Family relationships scores did not differ between the sibling cohorts. The APIM found patient family relationships were impaired when their own peer relationships decreased and when either their own or their siblings had increased depressive symptoms. Sibling family relationships were impaired when their own depression increased, and when the patient counterpart was female, younger age, had less depressive symptoms, more anxiety or a diagnosis of leukemia/lymphoma (compared to solid tumor). Based on these findings, increased psychosocial resources for patients and siblings of children undergoing cancer therapy may be warranted.
目前鲜少从儿科癌症患者及其兄弟姐妹的角度来了解癌症对家庭关系的影响。本研究评估和比较了正在接受积极癌症治疗、已完成治疗的患者和兄弟姐妹的儿童的家庭关系体验。本研究采用了横断面研究设计，纳入了年龄在 8-17 岁的癌症患儿及其兄弟姐妹。儿童完成了 PROMIS 儿科家庭关系简短量表和抑郁症状、焦虑和同伴关系简短量表的评估。采用曼-惠特尼检验评估了治疗组之间家庭关系评分的差异，而采用 Wilcoxon 符号秩检验评估了患者与兄弟姐妹之间的差异。采用演员-伙伴相互依赖模型（APIM）评估了患者和兄弟姐妹自身及其彼此的变量如何与家庭关系相关。共有 265 名儿童完成了评估。正在接受治疗的患者的兄弟姐妹的家庭关系比正在接受治疗的患者更差（P=0.015）。已完成治疗的患者的家庭关系与他们的兄弟姐妹或正在接受治疗的患者没有差异。兄弟姐妹队列之间的家庭关系评分没有差异。APIM 发现，当患者自身的同伴关系下降，或自身或兄弟姐妹的抑郁症状增加时，患者的家庭关系会受损。当兄弟姐妹自身的抑郁情绪增加，或者患者自身是女性、年龄较小、抑郁症状较少、焦虑程度较高或被诊断为白血病/淋巴瘤（与实体瘤相比）时，兄弟姐妹的家庭关系会受损。基于这些发现，为正在接受癌症治疗的患儿及其兄弟姐妹提供更多的社会心理资源可能是必要的。
