Post-Traumatic Stress, depression and anxiety symptoms among childhood cancer survivors and their parents

Abstract

Background: Multiple studies demonstrated increased risk for psychological symptoms among childhood cancer survivors (CCS) and their parents. We aimed to assess the prevalence and severity of post-traumatic stress symptoms (PTSS), depression, and anxiety among CCS and their parents, examine associations between these measures, and identify potential risk factors. Methods: A cross-sectional study comprising 118 CCS aged 7–21 years and their parents, at least one year post-treatment. PTSS, depression and anxiety were assessed using validated questionnaires. Medical and sociodemographic data were collected from the medical charts. Results: PTSD criteria were met by 8.7% of CCS and 18.3% of parents, about a third reporting post-traumatic stress symptoms. Moderate-to-severe depression occurred in 22% of CCS and 7.6% of parents, and anxiety in 12.7% of CCS and 22% of parents. There were robust positive correlations between depression, anxiety, and PTSS within both CCS and parental self-reports. Parents’ proxy- reports correlated more strongly with their self-report than with CCS self-reports. Predictors of PTSS included time since diagnosis, parent’s education, parent’s sex, type of cancer, and depression and anxiety level. Conclusions: The study highlights the importance of screening both children and parents, prioritizing child self-report, and providing tailored, ongoing psychosocial support for CCS and their families. Impact: Our study revealed high rates of psychological symptoms among CCS and their parents during the survivorship phase. The dual-informant design using pediatric self-report, parent self-report, and parent-proxy report enabled exploration of interconnections between psychological symptoms of CCS and their parents. Parents’ perceptions of children’s distress correlated more with their own emotional state than with children’s self-reports, suggesting parental projection. Predictors of post-traumatic stress symptoms, including time since diagnosis, parental education and biological-sex, depression and anxiety. Our results emphasize the need for screening both children and parents, prioritizing child self-report, and providing tailored, ongoing psychosocial support for CCS and their families.