中枢神经系统定向癌症治疗与儿童适应：母亲教养的调节作用。
CNS-Directed Cancer Treatment and Child Adjustment: Moderating Effects of Maternal Parenting.
机构信息
The Abigail Wexner Research Institute at Nationwide Children's Hospital, USA.
The Ohio State University, USA.
出版信息
J Pediatr Psychol. 2022 Aug 12;47(8):916-928. doi: 10.1093/jpepsy/jsac021.
OBJECTIVE
The aim of this study was to examine whether maternal parenting behaviors (i.e., warmth, behavioral/psychological control) moderate the association between central nervous system (CNS)-directed treatment and adjustment among pediatric cancer survivors at 3 years post-diagnosis or relapse.
METHODS
Three years after their child's cancer diagnosis or relapse, mothers (N = 84) reported on their child's academic and social competence, as well as their internalizing and externalizing problems. Children (N = 84; Mage = 13.21 years, 52.4% male) reported on maternal parenting behaviors. Using medical chart data, children were separated into CNS (i.e., received cranial radiation, intrathecal chemotherapy, and/or neurosurgery; N = 45) or non-CNS-directed treatment (N = 39) groups. Twelve moderation models were tested when examining two-way interactions between CNS treatment group and maternal parenting behaviors.
RESULTS
Children in the CNS-directed treatment group demonstrated significantly worse academic and social competence. Moderation analyses revealed four significant two-way interactions between CNS treatment group and maternal parenting behaviors when predicting children's adjustment. High levels of maternal behavioral control buffered the negative impact of CNS-directed treatment on children's social competence. In addition, maternal warmth had a contrasting effect, as CNS-directed treatment was associated with worse academic competence at high levels of warmth. Analyses with psychological control revealed that low levels of this parenting style were not protective against internalizing or externalizing problems among those with CNS-directed treatment.
CONCLUSIONS
Children who receive CNS-directed treatment may benefit from a different pattern of parenting during early cancer survivorship. Findings highlight the importance of considering the broader family context when conceptualizing the impact of illness-related factors on adjustment among pediatric cancer survivors.
目的
本研究旨在探讨母亲养育行为（即温暖、行为/心理控制）是否调节了中枢神经系统（CNS）定向治疗与儿科癌症幸存者诊断或复发后 3 年时的适应之间的关系。
方法
在孩子癌症诊断或复发 3 年后，母亲（N=84）报告了孩子的学业和社交能力，以及他们的内化和外化问题。儿童（N=84；平均年龄=13.21 岁，52.4%为男性）报告了母亲的养育行为。使用医疗记录数据，将儿童分为中枢神经系统（即接受颅辐射、鞘内化疗和/或神经外科治疗；N=45）或非中枢神经系统定向治疗（N=39）组。在检查 CNS 治疗组和母亲养育行为之间的双向相互作用时，测试了 12 个调节模型。
结果
接受 CNS 定向治疗的儿童表现出明显较差的学业和社交能力。当预测儿童的适应情况时，调节分析显示 CNS 治疗组和母亲养育行为之间有四个显著的双向相互作用。母亲行为控制水平较高可缓冲 CNS 定向治疗对儿童社交能力的负面影响。此外，母亲温暖也产生了相反的影响，因为 CNS 定向治疗与高水平温暖时的学业能力下降有关。对心理控制的分析表明，在 CNS 定向治疗者中，这种养育方式的低水平并不能预防内化或外化问题。
结论
接受 CNS 定向治疗的儿童可能受益于在癌症早期幸存者期间采用不同的养育模式。研究结果强调了在概念化与疾病相关因素对儿科癌症幸存者适应影响时，考虑更广泛的家庭背景的重要性。
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