Kanser tanılı çocuk ve ergenlerde travma sonrası büyüme ile travmatik ve ruhsal etkilenmenin incelenmesi

Year 2023, , 89 - 100, 31.01.2023

Merve Aktaş Terzioğlu , Tugce Soyleyici Mert , Selin Yakarışık , Hande Şenol

https://doi.org/10.31362/patd.1210932

Abstract

Amaç: Hematoloji-onkoloji kanser remisyonunda olan hasta grubu ve sağlıklı kontrol grubunun karşılaştırarak
travmatik ve ruhsal etkilenmelerini ve post travmatik büyümelerini değerlendirmek ve karşılaştırmak
amaçlanmıştır.
Gereç ve yöntem: 01 Eylül 2021-30 Nisan 2022 tarihleri arasında Pamukkale Üniversitesi Çocuk Hematolojisi
Anabilim Dalı’na başvuran ve çalışmaya katılmayı kabul eden çocukluk çağı kanser tanısı remisyonda olan 8-18
yaş arası çocuk ve ergenler ile daha önce çocukluk çağı kanser tanısı almamış sağlıklı kontrol grubu çocuk ve
ergenler ile çalışma tamamlanmıştır. Çocuk ve ergenlere Travma Sonrası Büyüme Envanteri (PTGI), Revize
Edilmiş Çocuk Olayın Etkisi Ölçeği -13 (CRIES-13), Çocuklarda Anksiyete ve Depresyon Ölçeği-YenilenmişÇocuk
Formu (ÇADÖ-Y-ÇF) ölçekleri uygulanmıştır. Ebeveynlere de Sosyodemografik form ve Çocuklarda
Anksiyete ve Depresyon Ölçeği-Yenilenmiş-Ebeveyn Formu (ÇADÖ-Y-EF) uygulanmıştır.
Bulgular: Çalışmaya 8-18 yaş arası, 27 çocukluk çağı kanser tanısı remisyonda olan hasta ve 25 sağlıklı kontrol
katılmıştır. İki grup arasında anne baba yaşı, aile yapısı, anne ve babanın öğrenim durumu ve ortalama aylık gelir dağılımında istatistiksel olarak anlamlı düzeyde bir farklılık saptanmamıştır (p>0,05). ÇADÖ-Y-EF Panik
Bozukluk, Obsesif Kompulsif Bozukluk, Depresyon alt ölçek skorları kontrol grubunda remisyon grubuna göre
istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır (p=0,048; p=0,045; p=0,047). İki grubun CRIES-13
puanları karşılaştırıldığında istatistiksel olarak anlamlı farklılık bulunmamıştır (p=0,659). İki grubun PTGI ölçek
ve alt ölçekleri karşılaştırıldığında; total PTGI puanında istatistiksel olarak anlamlı farklılık saptanmazken
(p=0,066), PTGI ölçeğinin Yaşam Felsefesinde Değişim ve Başkalarıyla İlişkilerde Değişim alt ölçek ortalaması
hasta grubunda kontrol grubuna göre istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır (p=0,038;
p=0,05). CRIES-13 ve PTGI ölçek puanları arasındaki ilişkiye bakıldığında, remisyon grubunda istatistiksel
olarak anlamlı ilişki bulunmamıştır.
Sonuç: Kanseri yenenler bu olumsuz deneyimden büyüyerek, güçlenerek ve olumlu kazanımlarla sağ çıkarak;
kendilerinden, dünyadan ve geleceklerinden beklentilerini ayarlayabilmektedir. Günümüzdeki kanser prevalansı
ve tedavilerle artan sağkalım oranları göz önüne alındığında bu konuda yapılacak çok merkezli ve daha büyük
örneklemli yeni çalışmalara ihtiyaç vardır.

Keywords

Travma sonrası büyüme, travma, kanser, çocuk, ergen

Supporting Institution

YOK

Project Number

YOK

Thanks

YOK

Investigation of post-traumatic growth with traumatic and psychological effects in children and adolescents diagnosed with cancer

Abstract

Purpose: The aim of this study was to evaluate and compare traumatic and mental effects and PTG by
comparing a patient group in hematological-oncological cancer remission with a healthy control group.
Materials and methods: Children and adolescents aged 8-18 years, who were in remission with a diagnosis of
childhood cancer, and presented at the Paediatric Hematology Department of Pamukkale Unıversity between 1
September 2021 and 30 April 2022 were included as the study group and a control group was formed of healthy
children and adolescents with no history of cancer diagnosis. The Post-Traumatic Growth Inventory (PTGI), the
Child Revised Impact of Events Scale (CRIES-13) and the Revised Child Anxiety and Depression Scale-Child
Version (RCADS-CV) were applied to all the children in both groups. A sociodemographic information form
prepared by the researchers, and the Revised Child Anxiety and Depression Scale- Parent Version (RCADSPV)
were applied to parents.
Results: Evaluation was made of 27 patients aged 8-18 years with a diagnosis of childhood cancer who were
in remission, and a control group of 25 healthy children. No statistically significant difference was determined
between the groups in respect of parental ages, family structure, parental educational levels, and mean monthly
family income (p>0.05). In the comparisons of the raw scores of the RCADS-PV between the two groups,
RCADS-PV Panic Disorder, Obsessive Compulsive Disorder, and Depression subscale scores were found to
be statistically significantly higher in the control group than in the remission group (p=0.048; p=0.045; p=0.047).
When the CRIES-13 scores of the two groups were compared, no statistically significant difference was found
(p=0.659).When the PTGI scales and subscales of the two groups were compared; while no statistically
significant difference was found in the total PTGI score (p=0.066), the change in life philosophy subscale and
the change in relationships with others subscale was found to be statistically significantly higher in the remission
group than in the control group (p=0.038; p=0.05).Considering the relationship between CRIES-13 and PTGI
scale scores, no statistically significant relationship was found in the remission group.
Conclusion: Cancer survivors grow from this negative experience, become stronger and survive with positive
gains; they can adjust their expectations from themselves, the world and their future. Considering the current
prevalence of cancer and increasing survival rates with treatments, new multicenter studies with larger samples
are needed on this subject.

Keywords

post-traumatic growth, trauma, cancer, child, adolescent

Project Number

YOK

References

• 1. Marziliano A, Tuman M, Moyer A. The relationship between post-traumatic stress and post-traumatic growth in cancer patients and survivors: a systematic review and meta-analysis. Psycho‐Oncology 2020;29:604-616. https://doi.org/10.1002/pon.5314
• 2. Özbaran B, Erermiş S. Kanser tedavisi gören çocuk ve gençlerde uzun süreli izlem sürecinde psikososyal özelliklerin tanımlanması ve genel yaklaşım ilkeleri. Klinik Psikiyatri 2006;9:185-190.
• 3. Smith MY, Redd WH, Peyser C, Vogl D. Post‐traumatic stress disorder in cancer: a review. Psychooncology 1999;8:521-537. https://doi.org/10.1002/(sici)1099-1611(199911/12)8:6<521::aid-pon423>3.0.co;2-x
• 4. Kazak AE, Rourke MT, Alderfer MA, Pai A, Reilly AF, Meadows AT. Evidence-based assessment, intervention and psychosocial care in pediatric oncology: a blueprint for comprehensive services across treatment. J Pediatr Psychol 2007;32:1099-1110. https://doi.org/10.1093/jpepsy/jsm031
• 5. Turner Sack AM, Menna R, Setchell SR, Maan C, Cataudella D. Posttraumatic growth, coping strategies, and psychological distress in adolescent survivors of cancer. J Pediatr Oncol Nurs 2012;29:70-79. http://dx.doi.org/10.1177/1043454212439472
• 6. Phipps S. Adaptive style in children with cancer: implications for a positive psychology approach. J Pediatr Psychol 2007;32:1055-1066. https://doi.org/10.1093/jpepsy/jsm060
• 7. Tedeschi RG, Calhoun LG. The posttraumatic growth ınventory: measuring the positive legacy of trauma. J Traumatic Stress 1996;9;455-471. https://doi.org/10.1007/BF02103658
• 8. Joseph S, Linley PA. Trauma, recovery, and growth: positive psychological perspectives on posttraumatic stress. John Wiley and Sons 2008. https://doi.org/10.1002/9781118269718
• 9. Barakat LP, Alderfer MA, Kazak AE. Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers. J Pediatr Psychol 2006;31:413-419. https://doi.org/10.1093/jpepsy/jsj058
• 10. Berntsen D, Rubin DC. The centrality of event scale: a measure of integrating a trauma into one’s identity and its relation to post-traumatic stress disorder symptoms. Behav Res Ther 2006;44:219-231. https://doi.org/10.1016/j.brat.2005.01.009
• 11. Boals A, Steward JM, Schuettler D. Advancing our understanding of posttraumatic growth by considering event centrality. J Loss Trauma 2010;15:518-533. https://doi.org/10.1080/15325024.2010.519271
• 12. Linley PA, Joseph S. Positive change following trauma and adversity: a review. J Trauma Stress 2004;17:11-21. https://doi.org/10.1023/B:JOTS.0000014671.27856.7e
• 13. Phipps S, Klosky JL, Long A, et al. Posttraumatic stress and psychological growth in children with cancer: has the traumatic ımpact of cancer been overestimated? J Clin Oncol 2014;32:641-646. https://doi.org/10.1200/JCO.2013.49.8212
• 14. Kamibeppu K, Sato I, Honda M, et al. Mental health among young adult survivors of childhood cancer and their siblings including posttraumatic growth. J Cancer Surviv 2010;4:303-312. https://doi.org/10.1007/s11764-010-0124-z
• 15. Kağan M, Güleç M, Boysan M, Çavuş H. Travma sonrası büyüme envanteri’nin türkçe versiyonunun normal toplumda hiyerarşik faktör yapısı. TAF Prev Med Bull 2012;11:617-624. https://doi.org/10.5455/pmb.1323620200
• 16. Altınışık E. Suriyeli ergenlerde travma sonrası büyüme ve psikolojik problemler ile ilişkili faktörler. Yüksek Lisans Tezi. İbn Haldun Üniversitesi, Lisansüstü Eğitim Enstitüsü, Psikoloji Anabilim Dalı, İstanbul, 2020.
• 17. Zebrack B, Kwak M, Salsman J,et al. The relationship between posttraumatic stress and posttraumatic growth among adolescent and young adult (AYA) cancer patients. Psychooncology 2015;24:162-168. https://doi.org/10.1002/pon.3585
• 18. Ying L, Wang Y, Lin C, Chen C. Trait resilience moderated the relationships between PTG and adolescent academic burnout in a post-disaster context. Pers Individ Dif 2016;90:108-112. https://doi.org/10.1016/j.paid.2015.10.048
• 19. Laufer A, Raz Hamama Y, Levine SZ, Solomon Z. Posttraumatic growth in adolescence: the role of religiosity, distress, and forgiveness. J Soc Clin Psychol 2009;28:862-880. https://doi.org/10.1521/jscp.2009.28.7.862
• 20. Levine SZ, Laufer A, Hamama Raz Y, Stein E, Solomon Z. Posttraumatic growth in adolescence: examining its components and relationship with PTSD. J Trauma Stress 2008;21:492-496. https://doi.org/10.1002/jts.20361
• 21. Milam JE, Ritt Olson A, Unger JB. Posttraumatic growth among adolescents. J Adolesc Res 2016;19:192-204. https://doi.org/10.1177/0743558403258273
• 22. Cryder CH, Kilmer RP, Tedeschi RG, Calhoun LG. An exploratory study of posttraumatic growth in children following a natural disaster. Am J Orthopsychiatry 2006;76:65-69. https://doi.org/10.1037/0002-9432.76.1.65
• 23. Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE. Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Therapy 2000;38;835-855 https://doi.org/10.1016/S0005-7967(99)00130-8
• 24. Gormez V, Kılınçaslan A, Cahid Orengul A, et al. Psychometric properties of the Turkish version of the revised child anxiety and depression scale-child version in a clinical sample. Psychiatry Clin Psychopharmacol 2017;27:84-92. https://doi.org/10.1080/24750573.2017.1297494
• 25. Perrin S, Meiser Stedman R, Smith P. The children’s revised ımpact of event scale (CRIES): validity as a screening instrument for PTSD. Behav Cogn Psychother 2005;33:487-498. https://doi.org/10.1017/S1352465805002419
• 26. Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med 1979;41:209-218. https://doi.org/10.1097/00006842-197905000-00004
• 27. Çeri V, Hamidi F, Çakır B, et al. Child Revised Impact of Event Scale (CRIES): validity and reliability study of Turkish version. Neuropsychiatr Invest 2021;59:21-26. https://doi.org/10.5455/NYS.20201101115427
• 28. Dejong M, Fombonne E. Depression in paediatric cancer: an overview. Psychooncology 2006;15:553-566. https://doi.org/10.1002/pon.1002
• 29. Elkin TD, Phipps S, Mulhern RK, Fairclough D. Psychological functioning of adolescent and young adult survivors of pediatric malignancy. Med Pediatr Oncol 1997;29:582-588. https://doi.org/10.1002/(sici)1096-911x(199712)29:6<582::aid-mpo13>3.0.co;2-8
• 30. Phipps S, Srivastava DK. Repressive adaptation in children with cancer. Health Psychol 1997;16:521-528. https://doi.org/10.1037/0278-6133.16.6.521
• 31. Frank NC, Blount RL, Brown RT. Attributions, coping, and adjustment in children with cancer. J Pediatr Psychol 1997;22:563-576. https://doi.org/10.1093/jpepsy/22.4.563
• 32. Kazak AE, Stuber ML, Barakat LP, Meeske K. Assessing posttraumatic stress related to medical illness and treatment: the impact of traumatic stressors interview schedule (ITSIS). Fam Syst Heal 1996;14:365-380. https://doi.org/10.1037/h0089795
• 33. Erickson SJ, Steiner H. Trauma and personality correlates in long-term pediatric cancer survivors. Child Psychiatry Hum Dev 2001;31:195-213 https://doi.org/10.1023/A:1026477321319
• 34. Erickson SJ, Steiner H. Trauma spectrum adaptation: somatic symptoms in long-term pediatric cancer survivors. Psychosomatics 2000;41:339-346. https://doi.org/10.1176/appi.psy.41.4.339
• 35. Langeveld NE, Grootenhuis MA, Voûte PA, de Haan RJ. Posttraumatic stress symptoms in adult survivors of childhood cancer. Pediatr Blood Cancer 2004;42:604-610. https://doi.org/10.1002/pbc.20024
• 36. Kazak AE, Barakat LP, Alderfer M, et al. Posttraumatic stress in survivors of childhood cancer and mothers: development and validation of the ımpact of traumatic stressors ınterview schedule (ITSIS). J Clin Psychol Med Settings 2001;8:307-323. https://doi.org/10.1023/A:1011977031826
• 37. Meeske KA, Ruccione K, Globe DR, Stuber ML. Posttraumatic stress, quality of life, and psychological distress in young adult survivors of childhood cancer. Oncol Nurs Forum 2001;28:481-489.
• 38. Schwartz L, Drotar D. Posttraumatic stress and related ımpairment in survivors of childhood cancer in early adulthood compared to healthy peers. J Pediatr Psychol 2006;31:356-366. https://doi.org/10.1093/jpepsy/jsj018
• 39. Rourke MT, Hobbie WL, Schwartz L, Kazak AE. Posttraumatic stress disorder (PTSD) in young adult survivors of childhood cancer. Pediatr Blood Cancer 2007;49:177-182. https://doi.org/10.1002/pbc.20942
• 40. Yavuz MS, Akın U, Karabağ G, Ozan E, Aykir OF. Travma sonrası gelişen ruhsal bozuklukların adli-tıbbi açıdan değerlendirilmesi. Van Tıp Derg 2020;27:100-102. https://doi.org/10.5505/vtd.2020.47154
• 41. Özgen F, Aydın H. Travma sonrası stres bozukluğu. Klinik Psikiyatri 1999;1:34-41.
• 42. Cordova MJ, Cunningham LL, Carlson CR, Andrykowski MA. Posttraumatic growth following breast cancer: a controlled comparison study. Heal Psychol 2001;20:176-185. https://doi.org/10.1037/0278-6133.20.3.176