SIBLINGS OF PEDIATRIC CANCER PATIENTS: STRESS AND PSYCHOLOGICAL OUTCOMES

Each year, 12,500 pediatric cancer cases are diagnosed in the U.S. Although a majority survives these illnesses, challenges associated with prolonged, intensive treatment periods disrupt the entire family system, and effects on siblings are poorly understood. We have employed a developmentally-sensitive, transactional stress framework to study adjustment in 20 adolescent siblings (ages 10-17) of children undergoing cancer treatment. We aimed to (1) determine if contextual threat and treatment intensity are associated with sibling distress, as measured by perceived and posttraumatic stress and symptoms of anxiety and depression; (2) identify factors that may moderate these relationships; (3) understand the nature of sibling stress using qualitative data; and (4) compare adjustment between younger and older adolescent siblings. Qualitative data were collected using a semi-structured interview consisting of open-ended questions and probes about contextual details of the cancer experience. Qualitative findings fell into three broad categories consistent with the transactional theory of stress: (1) uncertainty regarding diagnosis, prognosis, and family changes; (2) loss of normalcy; and (3) cancer as a serious, adult illness. Quantitative analyses revealed positive associations between contextual threat and depression, anxiety, and perceived stress scores; and between treatment intensity and anxiety scores. In terms of potential moderators, older siblings endorsed more symptoms of depression and posttraumatic stress than younger siblings, and siblings younger than the child with cancer endorsed more symptoms of depression and higher levels of perceived and posttraumatic stress than siblings older than the child with cancer. Overall, results suggest that contextual threat is a promising approach to predicting sibling distress and that sibling adjustment can be conceptualized using a transactional stress framework