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National Institutes of Health: National Cancer Institute: Division of Cancer Control and Population Sciences
Grant Details

Grant Number: 5R01CA136782-03 Interpret this number
Primary Investigator: Phipps, Sean
Organization: St. Jude Children'S Research Hospital
Project Title: Trauma and Growth in Pediatric Cancer
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Childhood cancer is widely viewed as a traumatic event, and application of traumatic stress models has become the dominant approach in pediatric psychooncology research. This approach to understanding the experiences of children with cancer presupposes 'cancer as trauma', and focuses on psychopathology rather than adjustment. These biases have influenced research design, and contribute to proliferation of deficit- oriented models, despite the fact that the majority of studies have not shown an increased incidence of post- traumatic stress disorder (PTSD) or of subclinical levels of post-traumatic stress symptoms (PTSS) in children with cancer. This proposal is based on the assumption that the diagnosis of cancer represents a significant life event that is not only a potential trauma, but also a potential catalyst for growth and positive change, calling for examination of positive outcomes such as post-traumatic growth (which we now refer to as challenge-related growth) and benefit-finding (CRG), constructs that have been studied primarily in adults with cancer but not in children. The proposed study will address several gaps in our understanding of PTSD outcomes in pediatric cancer, while broadening the focus to include simultaneous assessment of positive outcomes. Guided by positive psychology theory, we will examine determinants of PTSD and CRG outcomes, focusing on several resilience-related personality variables, including adaptive style, optimism, and dispositional positive affect. The aims of this proposal will be addressed with a two-group (cancer and healthy control), cross-sectional design, using patient self-report, parent-report, and structured diagnostic interviews as the primary sources of data. A frequency matching approach will be used to ensure demographic comparability of the cancer and healthy comparison groups. Measures of child PTSS and CRG along with dichotomous PTSD diagnosis will be obtained as primary outcomes. Measures of parental PTSS/PTSD and CRG will be obtained as secondary outcomes. Determinants of child PTS and CRG outcomes will be identified from child personality factors, life events history, medical factors (within the cancer group), parental PTSS/CRG, and parenting behavior. Separate predictive models will be developed for PTSS/PTSD and CRG outcomes. These analyses will advance our understanding of risk factors for the development of PTSD, which will improve targeting of intervention efforts to those most in need, while identification of factors associated with resilient, or growth outcomes will inform the development of intervention strategies and approaches. PUBLIC HEALTH RELEVANCE: This study will address gaps in our understanding of the traumatic effects of childhood cancer, while simultaneously examining positive outcomes such as growth and benefit-finding. Determinants of posttraumatic stress and posttraumatic, or 'challenge-related' growth outcomes will be examined, focusing on resilience-promoting factors. Separate predictive models will be developed for posttraumatic stress and growth outcomes. These analyses will advance our understanding of risk factors for the development of posttraumatic stress disorder, which will improve targeting of intervention efforts to those most in need, while identification of factors associated with resilient, or growth outcomes will inform the development of novel intervention strategies and approaches.

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Publications

Profiles Of Resilience And Growth In Youth With Cancer And Healthy Comparisons
Authors: Tillery R. , Howard Sharp K.M. , Okado Y. , Long A. , Phipps S. .
Source: Journal Of Pediatric Psychology, 2016 Apr; 41(3), p. 290-7.
PMID: 26423321
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Profiles Of Dispositional Expectancies And Affectivity Predict Later Psychosocial Functioning In Children And Adolescents With Cancer
Authors: Okado Y. , Howard Sharp K.M. , Tillery R. , Long A.M. , Phipps S. .
Source: Journal Of Pediatric Psychology, 2016 Apr; 41(3), p. 298-308.
PMID: 26476282
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Life Stress Versus Traumatic Stress: The Impact Of Life Events On Psychological Functioning In Children With And Without Serious Illness
Authors: Willard V.W. , Long A. , Phipps S. .
Source: Psychological Trauma : Theory, Research, Practice And Policy, 2016 Jan; 8(1), p. 63-71.
PMID: 26766295
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Effects Of Time Since Diagnosis On The Association Between Parent And Child Distress In Families With Pediatric Cancer
Authors: Okado Y. , Tillery R. , Sharp K.H. , Long A.M. , Phipps S. .
Source: Children's Health Care : Journal Of The Association For The Care Of Children's Health, 2016; 45(3), p. 303-322.
PMID: 27630380
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Profiles Of Connectedness: Processes Of Resilience And Growth In Children With Cancer
Authors: Howard Sharp K.M. , Willard V.W. , Okado Y. , Tillery R. , Barnes S. , Long A. , Phipps S. .
Source: Journal Of Pediatric Psychology, 2015 Oct; 40(9), p. 904-13.
PMID: 25968051
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Parents Of Children With Cancer: At-risk Or Resilient?
Authors: Phipps S. , Long A. , Willard V.W. , Okado Y. , Hudson M. , Huang Q. , Zhang H. , Noll R. .
Source: Journal Of Pediatric Psychology, 2015 Oct; 40(9), p. 914-25.
PMID: 25997639
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Predictors Of Psychological Functioning In Children With Cancer: Disposition And Cumulative Life Stressors
Authors: Howard Sharp K.M. , Rowe A.E. , Russell K. , Long A. , Phipps S. .
Source: Psycho-oncology, 2015 Jul; 24(7), p. 779-86.
PMID: 25132111
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Association Between Parent And Child Distress And The Moderating Effects Of Life Events In Families With And Without A History Of Pediatric Cancer
Authors: Okado Y. , Long A.M. , Phipps S. .
Source: Journal Of Pediatric Psychology, 2014 Oct; 39(9), p. 1049-60.
PMID: 25064801
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Child Perceptions Of Parental Care And Overprotection In Children With Cancer And Healthy Children
Authors: Tillery R. , Long A. , Phipps S. .
Source: Journal Of Clinical Psychology In Medical Settings, 2014 Jun; 21(2), p. 165-72.
PMID: 24682801
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Posttraumatic Stress And Psychological Growth In Children With Cancer: Has The Traumatic Impact Of Cancer Been Overestimated?
Authors: Phipps S. , Klosky J.L. , Long A. , Hudson M.M. , Huang Q. , Zhang H. , Noll R.B. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2014-03-01 00:00:00.0; 32(7), p. 641-6.
PMID: 24449230
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