Findings highlight the need to consider the ecological context of pediatric cancer, particularly the impact of sociodemographic disadvantage on stress and distress in this population.

Objective The diagnosis and treatment of cancer present children and adolescents with significant stress. However, research on the ways that children and adolescents cope with cancer-related stress has not yielded clear findings on the efficacy of different coping strategies, and has been limited by reliance primarily on self-reports of both coping and distress. To address this gap, the current study used a control-based model of coping to examine self- and parent reports of child/adolescent coping and symptoms of anxiety and depression in a sample of children with cancer. Method Children and adolescents (5 to 17 years old) and their parents were recruited near the time of a child’s diagnosis or relapse of cancer (M = 1.30 months postdiagnosis). Child self-reports (n = 153), mother reports (n = 297), and father reports (n = 161) of children’s coping and symptoms of anxiety/depression were obtained. Results Bivariate correlations revealed significant associations for secondary control coping (efforts to adapt to source of stress; e.g., acceptance, cognitive reappraisal) and disengagement coping (e.g., avoidance, denial) with anxiety/depression within and across informants. Linear multiple regression analyses indicated that secondary control coping accounted for unique variance in symptoms of anxiety/ depression both within and across informants. Conclusions Secondary control coping appears important for children and adolescents during early phases of treatment for cancer, and it may serve as an important target for future interventions to enhance adjustment in these children.

Objective To examine individual and interpersonal processes of coping and emotional distress in a sample of mothers and fathers of children with recently diagnosed cancer. Method A sample of 317 mothers and 166 fathers of 334 children were recruited near the time of the child’s cancer diagnosis or relapse (M = 1.4 months, SD = 1.2). Mothers and fathers completed standardized measures of coping and depressive symptoms. Results Analyses of individual coping responses revealed that, for both mothers and fathers, primary control coping (e.g., problem solving, emotional modulation) and secondary control coping (e.g., acceptance, cognitive reappraisal) were associated with lower depressive symptoms. Interpersonal analyses of coping and distress indicated that mothers’ and fathers’ coping as well as depressive symptoms were significantly correlated. Actor–partner interdependence model analyses indicated that mothers’ coping was associated with fathers’ depressive symptoms. Significant interactions also suggested that mothers’ secondary control coping may have a compensatory effect against fathers’ use of disengagement coping, both for themselves and their husbands. Conclusion Mothers’ and fathers’ adaptation to a child’s cancer diagnosis and treatment are characterized by both individual and interpersonal processes, with secondary control coping playing a central role in both of these processes. Implications for interventions to enhance effective coping for parents of children with cancer are highlighted.

After completing this course, the reader will be able to:1. Explain the current state of evidence-based treatment for anxiety in patients with cancer and the need for tailored intervention, especially for those with terminal cancer.2. Discuss and utilize methods for increasing access to psychosocial intervention for patients with cancer who suffer significant physical and psychological morbidity.3. Describe the effect of a brief cognitive-behavioral therapy intervention tailored to the needs of patients with terminal cancer and comorbid anxiety symptoms.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTIntroduction. Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidencebased treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials. gov identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.

The results provide new evidence for the associations between cognitive function and coping, and the association of both of these processes with depressive symptoms in children with SCD. Findings provide potential implications for clinical practice, including interventions to improve children's cognitive functioning to attenuate depressive symptoms.

Objective The purpose of this study was to prospectively examine adolescent and maternal posttraumatic stress symptoms (PTSS) and maternal communication from time near cancer diagnosis to 12-month follow-up to identify potential risk factors for adolescent PTSS. Methods Forty-one adolescents with cancer (10–17 years, 54% female) and their mothers self-reported PTSS at T1 (two months after cancer diagnosis) and T3 (one year follow-up). At T2 (three months after T1), mother-adolescent dyads were videotaped discussing cancer and maternal communication was coded with macro (harsh and withdrawn) and micro (solicits and validations) systems. Results Adolescent PTSS at T1 was associated with adolescent PTSS at T3. Greater maternal PTSS at T1 predicted greater harsh maternal communication at T2. There was an indirect effect of maternal PTSS at T1 on adolescent PTSS at T3 through maternal validations at T2. Conclusions Findings underscore the importance of maternal PTSS, maternal communication, and subsequent adolescent PTSS over the course of treatment of childhood cancer.

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Maternal primary control coping and depressive symptoms predict mothers' subsequent harsh and withdrawn communication about cancer.