Anna Lorraine Olsavsky

Purpose: Though child and caregiver anxiety are known to contribute to child overall health, this has not been examined dyadically. This cross-sectional study dyadically examined anxiety (child-self, caregiver-self) and child overall health (child-self, caregiver-proxy) in pediatric cancer. Methods: Children and caregivers ( n = 76 dyads; n = 152) from two Midwestern children’s hospitals self- or proxy-reported child overall health, and their own anxiety. Descriptive statistics and bivariate analyses (e.g., correlations, t-tests) examined associations among demographics, medical characteristics, and focal variables. An Actor–Partner Interdependence Model (APIM) evaluated dyadic associations between child and caregiver self-reports of anxiety (independent variables) and child self- and caregiver proxy-reports of child overall health (dependent variables). Associations between independent and dependent variables for one reporter are actor effects, whereas across reporters are partner effects. Results: Among 76 child (88.2% White; 34.2% Female; M = 13.35-years-old, SD = 3.20) and caregiver (92.1% White, 69.7% Female) dyads, children ( M = 46.64, SD = 9.09) and caregivers ( M = 39.33, SD = 8.97) reported below-average child overall health. Children reported below-average anxiety levels ( M = 46.31, SD = 10.05), and caregivers reported above-average anxiety levels ( M = 55.18, SD = 8.37). APIM analyses revealed significant actor effects: higher levels of self-reported anxiety were associated with lower levels of child overall health ( b = − 0.29, p < .001). Marginally non-significant partner effects revealed greater anxiety was linked to lower partner reports of child overall health ( b = − 0.14, p = 0.051). Conclusion: Our findings underscore supporting the family system within pediatric cancer and suggest mitigating caregiver anxiety may have downstream benefits. Interventions are needed for caregivers and children to support their mental and overall health during cancer treatment.

Purpose: Effective parent–child communication is central to coping with psychosocial challenges of pediatric cancer, yet few studies have examined how caregivers and children perceive their communication. This study investigated differences between caregiver and child reports of communication and associations with family relationship quality. We hypothesized children would report more open and positive communication than caregivers report, reflecting directional discrepancies in communication quality. Methods: Seventy-six caregiver–child dyads (N = 152) were recruited from two Midwestern pediatric hospitals. Children aged 8–17 with cancer and their caregivers independently completed measures of parent–child communication (PCCS) and family relationships (PROMIS). Descriptive statistics, correlations, and paired- and independent-samples t-tests examined differences and associations across dyads. Exploratory Actor–Partner Interdependence Models (APIM) investigated dyadic associations between child and caregiver communication and child family relationships. Results: Caregivers (10-item: M = 3.90, SD = 0.55; 20-item: M = 3.94, SD = 0.58) and children (M = 4.15, SD = 0.61) reported generally high-quality communication. However, significant differences emerged: children rated caregivers as more attentive listeners (t(74) = 2.53, p = .01, Cohen’s d = 0.29), emotionally open (t(74) = 2.30, p = .02, Cohen’s d = 0.27), and willing to discuss problems (t(74) = 2.86, p = .005, Cohen’s d = 0.33) than caregivers reported children. Across correlation and APIM analyses, child-reported communication was strongly associated with child-reported family relationships and caregiver-reported communication was strongly associated with caregiver-reported child family relationships (actor effects). Older caregiver and child age was linked to lower communication scores. Conclusions: Interdependent caregiver and child perceptions of communication represent an underrecognized factor influencing family functioning in pediatric cancer. Findings underscore the importance of routine communication assessment and highlight the need for developmentally tailored interventions.

Health disparities refer to preventable differences in the burden of disease, injury, and opportunities to achieve optimal health experienced by marginaliz

Introduction: Little is known about psychosocial outcomes in pediatric cancer based on the area of residency. Therefore, we longitudinally examined differences in the adjustment of children with cancer living in rural and Appalachian areas relative to urban and non‐Appalachian children. Methods: Data were from a larger study of coping and communication in families of children with cancer ( n = 336; M _age = 10.69). Rural ( n = 118) and Appalachian ( n = 58) residency were based on federal codes. Mothers, fathers, and children reported on child internalizing problems, externalizing problems, and total competence near diagnosis and 1 year later. Results: Children with cancer exhibited significant increases in behavioral and emotional difficulties by 1 year post‐diagnosis, as reported by all three sources. There were no group differences in behavioral and emotional problems at diagnosis nor in change from diagnosis to 1 year based on rural or Appalachian residency. At 1 year post‐diagnosis, children from rural areas had significantly lower social competence based on mother ( b = −0.77, p = 0.02) and child reports ( b = −1.27, p = 0.02). Additionally, at 1 year post‐diagnosis, fathers reported children in Appalachian counties had significantly lower total competence ( b = −2.35, p = 0.04) and social competence ( b = −1.32, p = 0.03) than non‐Appalachian peers. Conclusions: Survivors in rural and Appalachian areas may experience greater social difficulties 1 year post‐diagnosis than those in more urban areas. Clinicians should routinely assess survivors’ access to mental health and follow‐up care. Future research should examine cultural barriers and beliefs that may contribute to these disparities.

Purpose: Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden.Methods: Caregiver‐child dyads were recruited within 1 year of cancer treatment. Addresses were coded for social determinants of health (SDOH) measures: Area Deprivation Index (ADI), rurality, medically underserved areas (MUA), and Appalachian residency. Total child symptom scores (0–31) were calculated for dyad reports using the Memorial Symptom Assessment Scale. Provider matching symptom reports were extracted from electronic medical records. Descriptive statistics and correlations examined associations between child, caregiver, and provider symptom reports and SDOH. Significant correlations informed three multiple linear regression models examining SDOH predictors of child symptoms by reporter.Findings: Fifty‐five caregiver‐child dyads were recruited. Caregivers were 65.5% female and 87.3% White. Children were 50.9% male, 85% White, an average of 12 years old, 30.9% rural, and 20.0% Appalachian. ADI scores (M = 4.22) indicated moderate disadvantage, and 14.5% were medically underserved. On average, children reported 8.61 symptoms, while caregivers reported 7.15, and providers recorded 1.87 child symptoms. For children, a bivariate association and significant regression model revealed Appalachian children experienced a higher number of symptoms. For caregivers, bivariate associations indicated a higher ADI was associated with more symptoms. For providers, bivariate associations revealed higher symptoms were associated with rurality, MUA, and Appalachian residency, though only Appalachian residency remained significant in the regression model.Conclusions: Results suggest Appalachian residency is associated with higher symptom burden for children with cancer. Findings support culturally sensitive care to minimize symptom burden.

Objective: The Center for Biobehavioral Health (CBH) at Nationwide Children’s Hospital (NCH) is a research center with approximately 75 trainees, permanent staff, and faculty. Since 2020, CBH has integrated diversity, equity, inclusion, and accessibility (DEIA) programming with participation of employees across all training and career levels. The aim of this paper was to analyze DEIA survey data over three timepoints (2020, 2022, and 2023) to examine areas of growth, consistency, and decline. Methods: All CBH employees were emailed a survey in 2020, 2022, and 2023. Participation was anonymous and voluntary. Participation rates varied, with 46, 26, and 36 employees completing the survey in 2020, 2022, and 2023, respectively. The surveys included items examining views about CBH’s DEIA programming, personal DEIA workplace experiences, and CBH’s inclusion of different groups. Results: Over time, respondents increasingly: viewed CBH as a model for diversity and inclusion in the workplace (programming); were satisfied with their access to diversity and inclusion training opportunities at work (programming); felt more comfortable discussing race, discrimination, and social justice at work (experiences); and reported increases in the inclusion of people of different gender identities and sexual orientations (inclusion). Respondents viewed declines in CBH’s inclusion of people with disabilities (inclusion). All other survey responses remained consistent from 2020 to 2023. Conclusions: DEIA efforts by CBH employees may promote a more inclusive and welcoming work environment. Ensuring the longevity of DEIA initiatives, adapting efforts based on employee feedback, and addressing unmet needs should continue to be areas of focus for CBH and other training institutions.

Though children with cancer experience better outcomes with supportive caregivers and family environments, these findings are predominantly informed by maternal perspectives. Given fathers’ increasing involvement, this scoping review examined paternal contributions to the biopsychosocial outcomes of their children with cancer. English, full‐text publications from any time before October 4, 2022 including at least one search term from these three groups were included: pediatric oncology diagnosis ≤18 years old, fathers/parents, child biopsychosocial outcomes. Title and abstract screening, full‐text reviews, data extraction, and quality assessments were completed by at least two reviewers. Results are presented using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Review guidelines. Of 10,116 studies screened, 29 were included. Most studies were poor (38%) or fair (45%) quality. Seventy‐six percent presented significant associations between father contributions and child biopsychosocial outcomes, including child mental state, coping, behavioral adjustment, relationship quality in adulthood, and adherence. Fathers’ contributions were ambiguously related to children's quality of life and physical wellbeing. Limited findings suggest fathers contribute in significant, positive ways to their child with cancer's biopsychosocial outcomes. Findings underscore research gaps and suggest greater efforts should be made to include fathers in pediatric oncology research, interventions, and clinical practice.

Objectives: Although pediatric cancer often causes significant stress for families, most childhood cancer survivors are resilient and do not exhibit severe or lasting psychopathology. Research demonstrates some survivors may report benefit-finding or positive outcomes following this stressful life event. However, considerably less research has included families of children who are unlikely to survive their illness. Thus, this study investigated benefit-finding among parents and their children with advanced cancer, as well as associated demographic and medical factors. Methods: Families (N = 72) of children with advanced cancer (ages 5–25) were recruited from a large pediatric hospital. Advanced cancer was defined as relapsed or refractory disease, an estimated prognosis of <60%, or referral to end-of-life care. Participants completed a demographic survey and the Benefit Finding Scale at enrollment. Results: Children, mothers, and fathers reported moderate to high benefit-finding scores. Correlations between family members were weak and non-significant. Children reported significantly higher benefit-finding than fathers. Demographic and medical factors were not associated with benefit-finding in children, mothers, or fathers. Significance of results: Families of children with advanced cancer reported moderate to high benefit-finding regardless of background or medical factors. Children identified benefits of their cancer experience independent of the experiences of their mothers and fathers. Larger studies should continue to examine factors associated with positive and negative outcomes in the context of childhood cancer to inform interventions.