Childhood Cancer Physical Symptom Burden and Parent Distress: The Role of Parent Rumination

Abstract

Objective: Symptom burden of children with cancer appears to contribute to parent distress, but the mechanisms of this relationship are relatively unexplored. The current cross-sectional study examined rumination (i.e., repeated focus on negative events and experiences) as a mediator of the associations between parent-report of child (a) pain or (b) nausea, and parent posttraumatic stress symptoms (PTSS); parent-report of child symptoms → parent rumination → parent PTSS. Methods: Caregivers (N = 40, M_Age = 38.7 years, female = 87.5%, White = 67.5%) of children with cancer (M_Age = 9.4 years) were recruited at a Midwest pediatric cancer center following their child’s diagnosis (M _Months = 2.97 ± 1.98). Parents completed the PedsQL-Cancer Module, the Ruminative Response Scale, and the Impact of Events Scale—Revised. To test the hypothesized indirect effects, 2 separate regression models specifying 5,000 bias-corrected bootstrapping resamples were conducted via Hayes’ PROCESS macro. Family income served as a covariate. Results: Bootstrap regression analysis revealed that parent-report of child pain had an indirect effect on parent PTSS via parent rumination, controlling for family income, R2 = .37, ß = −.24, 95% CI [−.494, −.033]. Child nausea demonstrated an indirect effect on parent PTSS via parent rumination, controlling for family income, R2 = .36, ß = −.22, 95% CI [−.428, −.008]. Conclusions: Findings indicate that worse parent perception of child symptoms may lead to elevated parent distress through increased rumination. These results support the role of pediatric psychologists and the interdisciplinary team in alleviating parent distress through clinical management of both child physical symptoms and parent rumination.

Implications for Impact Statement

Parents of children with cancer may feel greater psychological distress when they see their child feeling physically ill (e.g., experiencing pain, experiencing nausea). This study indicates that 1 particular parent coping strategy, rumination (i.e., intensive negative thinking about their child’s illness), may explain how parental perceptions of pain or nausea lead to greater parental distress. Addressing child symptoms as part of palliative care is essential for the well-being of the whole family, and parents may benefit from increased involvement in the clinical symptom management process and from learning adaptive strategies for coping with cancer-related distress.