Cancer stressors and protective factors : predictors of stress experienced during treatment for childhood cancer

Abstract

The purpose of this study was to evaluate cancer stressors · and protective factors as predictors of stress experienced during treatment for childhood cancer. The conceptual framework evolved from the stress and coping literature and childhood cancer research. A conveni~nce sample of 44 children between 6 1/2 and 13 .1/2 years of age receiving treatment for cancer were evaluated during two clinic visits. Protective factors included the child's self-perception, coping strategies, -perceived social support, and family environment. Cancer stressors included acute stressors represented by the type of treatment received during two clinic visits. Chronic stressors were evaluated by the child's perception of stressors related to the cancer experience. Responses to stressors were assessed by physiologic and psychologic indicators of stress. Physiologic measures included epinephrine, norepinephrine, and cortisol measures of urine and psychologic measures of state and t~ait anxiety. No significant differences were found in the physiologic or psychologic response to stressors in relation to the type of treatment received during either clinic visit. Epinephrine and norepinephrine were elevated for children during both clinic visits. Stepwise multiple regression analyses revealed that family expressiveness and the child's perceived global self-worth were the best predictors of epinephrine leve~s. Perceived social support from friends had the greatest effect on norepinephrine levels. Family activities and recreation and family intellectual cultural orientation were the best predictors of state anxiety The intensity of chronic cancer stressors, family activities and recreation, family intellectual cultural brientation, the child's perception of physical appearance, and the presence of family conflict had the greatest effect on trait anxiety. This study is the first to examine the child's perception of chronic cancer stressors and protective factors associated with treatment for cancer. The findings provide insight into the importance of the interactions among the nature of the stressor, perceptual meaning of the stressor, and physiologic and psychologic responses to stressors that may affect long-term adjustment to childhood cancer.