Parent-Child Interactions in Children with Advanced and Non-Advanced Cancer: Children’s Perspectives during the First Year Post-Diagnosis 1 The Research Institute at Nationwide Children’s Hospital and The Ohio State University, and 2 Vanderbilt University Departments of Pediatrics & Psychology Method Results Procedures Following IRB approval and parental consent, target children were recruited from cancer registries at two children’s hospitals one month after a new cancer diagnosis or relapse. Healthy controls were recruited from surrounding area schools. Eligible participants were: (a) ages 10-17; (b) without developmental disorders; (c) English speaking; and (d) ≤ 100 miles of the hospital. AdvCa was coded on the basis of whether the child 1) relapsed, 2) died during the course of the study, or 3) had a physician-predicted chance of treatment success lower than 65%. Conclusions We would like to thank the families who participated in this work, as well as our funding source, the National Cancer Institute. Madelaine Keim, 1 Vicky Lehmann, 1 Emily Shultz, 1 Kathryn Vannatta, 1 Bruce E. Compas, 2 & Cynthia A. Gerhardt 1 In the year following diagnosis, children with AdvCa reported better parent-child interactions, particularly with fathers, and lower psychological control in parenting than children with Non-AdvCa or healthy controls. Considering the association between parent-child communication and future adjustment for children with AdvCa, clinical providers should focus on facilitating high-quality communication for these families. While cancer may impair parent-child interactions for some, the threat of limited time with one’s child may alternatively encourage parents to be more supportive and communicative. Consequently, this may buffer problems in child adjustment. Limitations include the attrition of participants with AdvCa. Future research should endeavor to replicate analyses in larger samples. Aims Background Parent-child interactions play a crucial role in child adjustment and may be particularly important in the context of an acute stressor, such as pediatric cancer. Dependent on cancer type and progression, diagnoses can have vastly different implications prognosis and family burden. Advanced cancer designates poor prognosis cases wherein cure is unlikely. We investigated potential distinctions between how advanced cancer (AdvCa) and non-advanced cancer (Non-AdvCa) impact parent-child interactions and adjustment relative to healthy comparison peers. Analyses Aims 1 & 2: ANOVAs with post-hoc Tukey comparisons were used to identify group differences. Cohen’s d was calculated between the two most discrepant groups. Aim 3: Models using multiple regression analyses were tested in Modprobe 2.0, an SPSS macro developed by Hayes (2015), to assess interaction effects with a multicategorical moderator. Results (ctd.) Parent-child interactions play a crucial role in child adjustment and may be particularly important in the context of an acute stressor, such as pediatric cancer. Dependent on cancer type and progression, diagnoses can have vastly different implications for prognosis and family burden. Advanced cancer designates poor prognosis cases wherein cure is unlikely. We investigated potential differences between how advanced cancer (AdvCa) and non- advanced cancer (Non-AdvCa) impact parent-child interactions and adjustment relative to healthy comparison peers. Aim 1: Compare parent-child interactions and child adjustment for children with AdvCa, children with Non-AdvCa, and healthy controls at one month after diagnosis (T1). Aim 2: Compare parent-child interactions and child adjustment for children with AdvCa, children with Non-AdvCa, and healthy controls at one year after diagnosis (T2). Aim 3: Determine whether the strength of association between parent- child interactions (T1) and child adjustment problems (T2) varies as a function of group status. Measures Parent Adolescent Communication Scale (PACS): Assesses child perceptions of parent-child communication quality. Scale Range: Subscales: Total Communication Quality Parenting Behavior Inventory (CRPBI-R): Assesses child perceptions of maternal and paternal parenting practices. Scale Range: Subscales: Warmth, Behavioral Control, Psychological Control Child Behavior Checklist (CBCL): Assesses mother report of adaptive and maladaptive functioning. Raw scores analyzed, T-scores reported. Subscales: Affective Problems, Anxiety Problems Procedures Target children were recruited from cancer registries at two children’s hospitals one month after cancer diagnosis. Controls were recruited from surrounding schools. Eligible participants were: (a) ages 10-17; (b) without developmental disorders; (c) English speaking; and (d) ≤ 100 miles from the hospital. Children with AdvCa 1) relapsed, 2) died during the course of the study, or 3) had a 5-year chance of disease-free survival lower than 65% (as rated by physician). ParticipantsT1T2 Advanced Cancern=56, M age =13.4, 45% male, 91% White n=30, M age =14.4, 56% male, 93% White Non-Advanced Cancern=70, M age =13.6, 51% male, 87% White n=53, M age =14.4, 51% male, 88% White Healthy Controln=63, M age =13.0, 46% male, 89% White n=47, M age =14.1, 43% male, 85% White Table 1: Time 1 Advanced Cancer Non-Advanced Cancer Healthy Control d Mother-Child Interactions Communication80.5 (14.0)78.1 (13.2)75.5 (12.0).39 Warmth27.7 (3.3)27.3 (2.8)26.8 (3.3).28 Psych Control15.3 (4.1)15.2 (3.5)16.3 (3.4).30 Beh Control 21.1 (3.3) † 19.6 (3.1) † 20.9 (3.4).49 † Father-Child Interactions Communication75.4 (16.0)72.4 (14.9)72.7 (13.8).18 Warmth26.0 (4.8)24.5 (4.9)24.9 (4.7).30 Psych Control13.9 (3.5) † 14.9 (4.1)15.7 (3.6) †.51 † Beh Control19.9 (3.7) † 21.8 (3.6)21.2 (3.9) †.51 † Child Adjustment Problems Affective Probs.55.0 (6.5)56.7 (7.0)55.1 (8.2).21 Anxiety Probs.53.4 (5.3)*55.4 (6.5)56.2 (7.2)*.52* Table 2: Time 2 Advanced Cancer Non-Advanced Cancer Healthy Control d Mother-Child Interactions Communication78.2 (13.7)73.9 (13.3)76.3 (12.8).32 Warmth27.6 (3.0)25.7 (4.0)26.2 (4.3).51 Psych Control13.7 (2.9)*15.0 (3.7)16.4 (4.0)*.71* Beh Control 20.1 (3.5) 19.9 (3.2)21.4 (3.9).37 Father-Child Interactions Communication75.9 (15.0)*66.3 (16.5)*71.4 (14.8).61* Warmth26.8 (3.3)*23.0 (5.4)*24.4 (4.5).77* Psych Control13.8 (3.7)14.4 (4.1)16.0 (4.4).51 Beh Control19.0 (4.0)20.9 (3.8)21.2 (4.9).46 Child Adjustment Problems Affective Probs.56.5 (7.8)57.3 (8.0)54.5 (6.0).36 Anxiety Probs.54.2 (5.5)55.4 (6.9)55.2 (6.6).26 Note: Means and SDs reported. Shaded cells indicate groups compared for Cohen’s d. † p <.10, *p <.05. Correspondence to Aim 1: No significant group differences in parent-child interactions at T1, though small to medium effect sizes were observed for differences. Children with AdvCa reported fewer anxiety problems than controls at T1 (Table 1). Aim 2: Children with AdvCa reported lower psychological control from mothers than controls and better communication/warmer interactions with fathers than children with Non-AdvCa at T2 (Table 2). Aim 3: Group moderated the association between T1 mother/father communication and T2 child affective problems (Fig. 1/2) such that poor communication was related to future affective problems in children with AdvCa but not children with Non- AdvCa or healthy controls.

Madelaine Keim Research Assistant The Research Institute at Nationwide Children’s Hospital Center for Biobehavioral Health 700 Children’s Drive J West Building Columbus, Ohio (614) (office) (513) (mobile)