Discussion
Limited research has examined early sociodemographic and family factors
near diagnosis that predict long-term QOL among childhood cancer
survivors. The goal of this study was to examine the relative impact of
sociodemographic factors using a cumulative risk score, mother’s stress,
survivor’s cancer-specific stress, and mother-adolescent communication
on later QOL of survivors. We expected that a higher cumulative
sociodemographic score (i.e., higher risk) would lead to lower levels of
QOL in survivors. Survivor QOL was, on average, in the normative range
at 5-year follow-up. Contrary to our hypothesis, the sociodemographic
score was not a significant predictor of QOL when other factors like
cancer-related stress and communication, were considered. While these
results did not align with our expectations for the sociodemographic
score, they demonstrate the lasting importance of more proximal family
factors in relation to later QOL in long-term survivors.
In both the mother-reported model and the survivor-reported model,
earlier exposure to stress consistently predicted long-term QOL, whether
it was survivor’s cancer-specific stress or mother’s general stress. The
mother-reported model explained almost 60% of the variance in survivor
QOL, with survivor’s cancer-specific stress and mother’s general stress
contributing 38% of explained variance in the model. These results
support our hypothesis about stress and are consistent with literature
finding that stress and negative emotions in response to a chronic
illness, such as cancer, can affect QOL [26]. For survivor-report of
QOL, the addition of survivor’s cancer-specific stress and mother’s
general stress contributed 13% of explained variance in QOL, with the
overall model explaining 24% of the variance in long-term QOL. However,
only cancer-specific stress was a significant predictor. Thus,
survivors’ QOL may be affected more by their own stress specifically
related to their diagnosis, than their mother’s general stress. To our
knowledge, this is the first study that has examined the longitudinal
impact of general and cancer-related stress on survivor-reported QOL in
a pediatric cancer sample.
In both models, higher quality of mother-adolescent communication was a
significant predictor of better QOL, particularly with respect to
child-report of QOL. These results support our hypothesis that
communication has a significant impact on survivors’ QOL. Previous
research in pediatric populations has found that a high quality of
family communication enhanced adolescents’ life satisfaction [27].
Other studies have also identified family communication as a correlate
of important developmental, psychosocial and health outcomes
[14,28,29].
While research has largely focused on medical predictors of QOL in
pediatric cancer, few studies have examined the longitudinal impact of
family factors near diagnosis, such as stress and communication, on
later QOL. The present research shows that these factors should not be
overlooked. Each of these factors were both associated with QOL and were
significant predictors over time. Although cumulative sociodemographic
factors did not predict long-term QOL in our final models, they were
significantly correlated with mother-reported QOL. They were also
associated with early outcomes, which is similar to previous findings
[2], and were significantly correlated with mother’s general stress,
adolescent’s cancer-specific stress, and mother-adolescent communication
near diagnosis. Therefore, future research should continue to examine
the role of sociodemographic factors and key outcomes over time.
Our study was limited by several factors. First, our sample was
primarily White and non-Hispanic. Similar research should be conducted
with a more diverse sample to examine if associations may vary as a
function of race or ethnicity in regard to sociodemographic factors and
QOL. We also examined only survivor-report and mother-report of family
factors. Future research should solicit perspectives from fathers in
addition to mothers and survivors to examine data from both parents.
Importantly, the mother-proxy model may have been affected by common
method variance, and multiple informants are necessary to test more
robust models. Lastly our sample was comprised of mothers who were
largely partnered, had few children per household, and had an education
of at least a high school diploma, resulting in a relatively low-risk
sample. This could have explained why the cumulative sociodemographic
score was no longer a factor when stress and communication were examined
concurrently. Future research should continue to identify other social
and family factors early in the cancer trajectory that may influence the
long-term QOL of pediatric cancer survivors.
Our study also had several key strengths. First, the sample was
recruited soon after a child was diagnosed with cancer or had relapsed
and was followed longitudinally over five years. This allowed us to
identify early predictors of later outcomes in long-term survivorship.
Second, the sample was inclusive in terms of different diagnoses,
allowing us to examine QOL in children affected by pediatric cancer more
broadly, rather than focusing on one type of diagnosis. This research is
unique in its family-centered approach assessing both general stress and
cancer-specific stress, as well as multiple viewpoints (parent
self-report, parent proxy-report of survivor, survivor self-report).
Limited research has examined the contributions of sociodemographic and
family factors that predict QOL in youth affected by pediatric cancer.
This information can help inform family-centered care to improve
long-term QOL in pediatric cancer survivors. Despite the effects of
cumulative sociodemographic risk, family stress and communication may
offer potential points of intervention to improve QOL of pediatric
cancer survivors over time. Clinicians should assess family and
cancer-related stress, as well as facilitate open and honest
communication early in treatment to reduce risks. Previous psychosocial
interventions have shown promise in the areas of physical,
psychological, and social-relational aspects of quality of life [30,
31]. While additional research is needed, healthcare professionals
should encourage stress management and strong mother–child
communication to enhance survivors’ long-term QOL. Such interventions
may be helpful, irrespective of known sociodemographic risk factors that
often affect health.