Originally published as JCO Early Release 10.1200/JCO.2007.12.8132 on November 24 2008

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Multinational Study of Cancer Patients and Their Children: Factors Associated With Family Functioning

Florence Schmitt, Jorma Piha, Hans Helenius, Christiane Baldus, Christian Kienbacher, Barbara Steck, Mikael Thastum, Maggie Watson, Georg Romer

From the Child Psychiatry Clinic and University Hospital of Turku; and Department of Biostatistics, Turku University, Turku, Finland; Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Germany; Department of Child and Adolescent Neuropsychiatry, University of Vienna, Austria; and Clinic of Child and Adolescent Psychiatry, Basel University Hospital, Basel, Switzerland; Department of Psychology, University of Aarhus, Denmark; Psychological Medicine Service, Royal Marsden Hospital, London and Sutton, United Kingdom

Corresponding author: Florence Schmitt, PhD, Child Psychiatry Clinic, University Hospital of Turku, PO Box 51-FI-20521, Turku, Finland; e-mail: Florence.schmitt{at}tyks.fi

Purpose This study examined factors associated with family functioning in cancer patients’ families with dependent children.

Patients and Methods A sample of 381 families (639 parents and 489 children) was recruited simultaneously in six European countries. Patients and family members completed a background questionnaire, the Family Assessment Device (FAD), the Beck Depression Inventory, and the short form version of the Medical Outcomes Health Survey. Descriptive statistics and a multilevel model that allowed a multi-informant design were used. Analyses were carried out with all participants, and separately with parent-rated and children-rated FAD scores.

Results In descriptive analyses, children reported more impairment in family functioning than parents, but the difference was not significant. Depression prevalence was 35% for ill mothers and 28% for ill fathers. In the multilevel analyses with all participants (ie, adults and children) the ill parent's depression was significantly associated with impaired family functioning on five of seven FAD subscales. In analyses with only children, the perception of impairment of family functioning was not associated with parental depression. Additionally, poorer physical status of the ill parent was significantly associated with impairment on roles and communication.

Conclusion The ill parent's depression was the most significant factor associated with impairment in family functioning. Screening for depression, active diagnostics, and appropriate treatment of cancer patient's and partner's depression may be important to protect their children from mental disorders. Therefore, support systems need to be more family-oriented and child-centered in their approaches to cancer psychosocial care.

published online ahead of print at www.jco.org on November 24, 2008

Supported in part by Grant No. QLGT-2001-02378 from the European Union in its fifth Framework Program, Quality of Life: Mental Health Prevention in a Target Group at Risk—Children of Somatically Ill Parents (COSIP).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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