Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia.
Disparities in parental distress in a multicenter clinical trial for pediatric acute lymphoblastic leukemia.
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儿童急性淋巴细胞白血病多中心临床试验中父母痛苦的差异。
DOI：
10.1093/jnci/djad099
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Silverman,Lewi
中科院分区：
文献类型：
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作者：
Umaretiya,PujaJ;Koch,VictoriaB;Flamand,Yael;Aziz-Bose,Rahela;Ilcisin,Lenka;Valenzuela,Ariana;Cole,PeterD;Gennarini,LisaM;Kahn,JustineM;Kelly,KaraM;Tran,ThaiHoa;Michon,Bruno;Welch,JenniferJG;Wolfe,Joanne;Silverman,Lewi
背景：儿童癌症治疗期间父母的心理困扰对父母、孩子和家庭的健康有短期和长期的影响。确定父母痛苦的可预测因素对于告知干预措施至关重要。我们调查了1-17岁急性淋巴细胞白血病（ALL）患儿父母的家庭物质困难（HMH）、可改变的贫困暴露（定义为住房、食物或公用事业不安全）与严重心理困扰之间的关系，这些患儿参加了多中心Dana-Farber ALL联合试验16-001。方法对家长报告的资料进行二次分析。家长在临床试验入组32天（T0）内完成了HMH调查，并在治疗6个月（T1）时再次完成了调查。T0时的主要暴露是HMH， T0和T1时的主要结局是严重的父母困扰，定义为凯斯勒-6心理困扰量表得分大于或等于13分。多变量模型对ALL风险组和单亲状态进行了调整。结果在375名可评估家长中，三分之一（32%,n = 120/375）在0时报告了HMH。在多变量分析中，T0 HMH与T0时严重心理困扰的几率相关，而T1时HMH与T1时严重心理困扰的几率相关超过5倍。结论：尽管在资源丰富的儿科中心对他们的孩子进行了统一的临床试验治疗，但与未接触过hmh的父母相比，接触过hmh的父母在孩子被诊断为白血病时出现严重心理困扰的几率显著增加，这种情况在治疗6个月后恶化。这些数据确定了一个高风险的父母群体，他们可能受益于早期的社会心理和hmh目标干预，以减轻福祉的差异。
BackgroundParent psychological distress during childhood cancer treatment has short- and long-term implications for parent, child, and family well-being. Identifying targetable predictors of parental distress is essential to inform interventions. We investigated the association between household material hardship (HMH), a modifiable poverty-exposure defined as housing, food, or utility insecurity, and severe psychological distress among parents of children aged 1-17 years with acute lymphoblastic leukemia (ALL) enrolled on the multicenter Dana-Farber ALL Consortium Trial 16-001.MethodsThis was a secondary analysis of parent-reported data. Parents completed an HMH survey within 32 days of clinical trial enrollment (T0) and again at 6 months into therapy (T1). The primary exposure was HMH at T0 and primary outcome was severe parental distress at T0 and T1, defined as a score greater than or equal to 13 on the Kessler-6 Psychological Distress Scale. Multivariable models were adjusted for ALL risk group and single parent status.ResultsAmong 375 evaluable parents, one-third (32%; n = 120/375) reported HMH at T0. In multivariable analyses, T0 HMH was associated with over twice the odds of severe psychological distress at T0 and T1 HMH was associated with over 5 times the odds of severe distress at T1.ConclusionsDespite uniform clinical trial treatment of their children at well-resourced pediatric centers, HMH-exposed parents—compared with unexposed parents—experienced statistically significantly increased odds of severe psychological distress at the time of their child’s leukemia diagnosis, which worsened 6 months into therapy. These data identify a high-risk parental population who may benefit from early psychosocial and HMH-targeted interventions to mitigate disparities in well-being.