A Study of Determinants of Coping in Childhood Cancer Survivors

A Study of Determinants of Coping in Childhood Cancer Survivors Lea Helene Mallett OBJECTIVES: The purposes of this research were to (1) determine the association between time since the completion of cancer treatment and the type of stressor (cancerrelated versus non-cancer-related) identified; (2) determine whether the stressor identified (cancer-related or non-cancer-related) and strategies utilized to cope with that stressor change over time; (3) determine whether type of cancer and treatment are associated with specific coping strategies, and (4) determine if family characteristics (household structure, median household income, and presence of siblings) impact the endorsement and efficacy of coping strategies utilized to cope with a stressor. BACKGROUND: Cancer alters children’s lives in many ways, beginning at diagnosis and continuing well after therapy ends. As a result, survivors of childhood cancer may face psychological problems, adjustment problems, or depression. Certain combinations of demographic variables, disease and treatment factors, and family structure factors have been suggested as predictors of more difficult psychological adjustment in childhood cancer survivors. These risk factors influence the child’s coping strategies, which, in turn, affect their overall adjustment. METHODS: Data from 270 surveys from 139 participants from the Medical University of South Carolina Follow-up After Cancer Treatment clinic were analyzed. Hierarchical regression modeling was used to examine treatment length, time since completion of treatment to assessment, and demographic variables as a predictor of stressor reporting. Change in stressor reporting and coping strategy use over time also was evaluated. Logistic regression and linear regression analyses were performed to examine demographic, family, diagnosis and treatment variables, alone and in combination, as predictors of coping strategy endorsement and efficacy. RESULTS: Hierarchical regression analyses revealed age at assessment and time since completion of treatment to assessment significantly predicted type of stressor reported (Wald (5) =13.07, p<. 05). Stressor reporting and coping strategy use changed over time, while controlling for age, race, and gender (p<.05). Female participants had a significant increased odds of using approach coping (OR=2.27; 95% CI: 1.04, 4.93) and participants with a diagnosis of leukemia had a greater likelihood using withdrawal coping (OR=2.91; 95% CI: 1.07, 7.87), controlling for treatment and treatment length. Furthermore, participants from a two parent household (OR=2.13; 95% CI: 1.06, 7.19), and those participants who had a median household income of $50,000 (OR=1.88; 95% CI: 1.06, 2.65) had a greater likelihood of using approach coping. Results of the linear regression revealed that median household income, age at assessment, household structure, and siblings significantly (p<.05) predicated mean coping efficacy. CONCLUSIONS: Overall, this research demonstrated that stressors and coping strategy use in childhood cancer survivors changes over time to give way to non-cancer-related stressors and adaptive coping strategies. The interrelationships detected among demographic, diagnosis, treatment, household variables and coping identified characteristics of childhood cancer survivors at increased risk of psychological adjustment issues and in need of psychosocial interventions.