Our previous research on psychological sequelae of childhood cancer treatment indicates that symptoms of post traumatic stress are significant for many survivors and their mothers and fathers. Indeed, there are many aspects of cancer and its treatment which are potential traumatic stressors, including invasive medical procedures, life threat, and disruption of family relationships. These prior data support the importance of anxiety, beliefs about cancer and its treatment, social support and family functioning as both direct and indirect contributions to posttraumatic stress symptoms. This proposal expands research on child and family adjustment to long-term survival of childhood cancer by developing and examining an intervention for posttraumatic stress in childhood cancer survivors and their families. The intervention integrates cognitive behavioral and family intervention approaches for 11-18 year old adolescent survivors, at least one year from the completion of their cancer treatment, and their mothers and fathers, at The Children's Hospital of Philadelphia. Home-based pre (Time 1) and six-month post (Time 2) evaluations will be conducted. Families will be randomized to the intervention or wait list condition after Time 1. The wait list group will receive the intervention after Time 2. The intervention consists of two half-day weekend sessions, eight weeks apart, with the first half-day session focused individually on the recognition of the long-term psychological effects of cancer and its treatment and use of cognitive-behavioral strategies for reducing cancer-related distress, for survivors, mothers and fathers separately. The second half-day session is a family-oriented intervention directed towards helping families communicate more effectively about the impact of cancer and reframe the experiences for themselves as families. Eight families will participate in each intervention, for a total n of 128 families. Data analysis strategies address change in post traumatic stress symptoms with particular attention to anxiety, perceptions of life threat and perceived intensity of treatment, social support and family factors. To our knowledge, this project is unique in providing an empirical evaluation of an intervention combining cognitive behavioral and family intervention techniques to alleviate and prevent ongoing psychological distress in children who have survived cancer and their parents.
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