Emotional distress amongst paediatric oncology patients prior to reaching five-year survivorship statusSarah Elizabeth CanningDoctor of Clinical PsychologyThe University of ManchesterJune 2012The primary aim of this thesis was to increase healthcare professionals' understanding surrounding the emotional distress of paediatric oncology patients prior to reaching five-year survivorship status, to inform resource allocation and evidence-based clinical interventions. Paper 1 systematically reviewed the extant literature that has assessed the emotional distress severity of paediatric oncology patients who had not yet reached five-year survivorship status. Contradictory findings were evident from the 21 studies reviewed. These inconsistencies in findings were discussed in relation to methodological limitations present within the studies and the heterogeneous oncology and control groups studied. The review concluded that further multiple-centre studies, using appropriate self-report and parent-proxy standardised measures, and larger, representative samples comprising patients with CNS and non-CNS malignancies at differing points in their treatment journeys, are needed to identify demographic, illness and treatment variables that leave paediatric oncology patients vulnerable to emotional distress. The empirical paper presented in Paper 2 utilised a rigorous methodology to address this need, and additionally explored modifiable psychological risk factors for emotional distress in this population. 74 paediatric oncology patients (aged 12-18 years), who were within five years of treatment completion, completed self-report measures of emotional distress, self-concept and health related quality of life (HRQOL), whilst their parents provided background information regarding patients' demographics, diagnoses and treatment protocols. 72 parents also provided ratings surrounding patients' self-concepts and HRQOL. The mean emotional distress rating indicated that the sample was clinically distressed. Demographic, illness and treatment factors explained little variance in emotional distress, whilst global self-concept, global-generic and cancer-specific HRQOL were significant predictors. Provisional analyses indicated that experiencing pain, illness-related worries, communication difficulties and negative self-views in relation to maths abilities, parent relations and opposite-sex peer relations were specific risk factors in the sample studied. Patient- and parent-reports of patients' self-concepts and HRQOL were highly consistent. These findings suggest that paediatric oncology patients would benefit from frequent routine screening for emotional distress to allow early identification and intervention. Furthermore, prevention-oriented interventions surrounding emotional distress, and indirect interventions targeting global self-concept and HRQOL could be beneficial. Paper 3 critically appraises the systematic review and empirical paper in terms of their methodologies and clinical contexts. It is acknowledged that some of the results are preliminary in nature and need replicating in larger samples. Nevertheless, this research was successful in exploring demographic, illness, treatment and psychological risk factors for emotional distress for paediatric oncology patients prior to reaching five-year survivorship status, providing guidance for future clinical interventions, and making suggestions for future studies, in terms of their aims and methodologies.
|Date of Award
|31 Dec 2012
- The University of Manchester
|Penelope Trayner (Supervisor)
- oncology, cancer, paediatric, pediatric, emotional distress, depression, anxiety, predictors