Week 11: Psychosocial Pediatric Oncology

Question 1

Pediatric oncology

Answer 1

• Over a 1000 youth diagnosed with cancer each
year in Canada
• 5 year survival rates: ~85%; 74% brain tumor
• Rising incidence + increased survival rates
• Growing population of survivors
• Quality of life in survivorship may be impacted by disease and treatment sequelae

Question 2

Depression and anxiety

Answer 2

It is hard to research on this topic because the kids are so rare
Getting easier as more survive

Family are involved in care and are stressed

Neurocognitive functions - issues with working memory and processing speed

All can interact to cause depression and anxiety

Question 3

Social competence in pediatric oncology

Answer 3

• Socially isolated
• Lower Social Competence & 
higher Social Problems
• More likely to have no friends
• Problems worsen over time
• Less likely to get married
• Perceived as most devastating consequence by 
parents
• Pediatric brain tumor survivors at greater risk

Question 4

Social competence in pediatric oncology: How should we intervene?

Answer 4

• Recent review of social interventions found 19 different social
skills targeted across interventions
• Limited impact of interventions on social competence
WE DO NOT KNOW WHAT TO TARGET
• Limited knowledge of specific social behaviors impacting overall
social competence.
• Lack of available measures of social behavior as a barrier to developing targeted social skills intervention.

If we teach kids social skills without removing the barriers to using them like anxiety and depression, they wont/cant use them

Question 5

Q. Can we use the ADOS-2 to assess social behaviors in pediatric
brain tumor survivors?

Answer 5

 Semi-structured measure
 Standardized
 Clinician-administered
 Objective
 Can be used across a wide age and functioning 
range
 Yields coding of 20+ discrete social 
behaviors

We already use this to assess social functioning in autistic kids

Question 6

Participants

Answer 6

n = 27 pediatric brain tumor survivors
 Exclusion criteria: diagnosis of autism or first degree relative
with autism diagnosis
 Ages 9-17
 Males make up 52% of the sample.
 Time since diagnosis 2-14 years.
 Treatment: surgery only (33%), radiation and chemotherapy
(26%), chemotherapy (19%), radiation (15%).

What are their deficits?

Question 7

Results

Answer 7

Lowest impairment in:
 Echolalia, stereotyped/idiosyncratic words, compulsions or rituals (0%)
 Eye contact (4%)
 Facial expressions (8%)

THESE ARE THE ITEMS TYPICALLY ASSOCIATED WITH AUTISM SO YOU CAN SEE FROM THEIR LOW LEVELS THAT THE TEST IS NOT PICKING UP AUTISM!

Highest Impairment in:
 Asking for information (50%) - you do not just ask questions, you prompt and see if they can respond to it
 Insight (42%) - they do not even know they have an issue
 Quality of social response (42%) - immature answers, can work with older people but cannot handle their age range (perhaps lack of experience)
 Reporting of events (42%_ - can you tell me what happened 2-3 weeks ago?

Looked at qualitative data too.
Kids say they have friends
And do at school
Parents say they have no friends cos they never see a playdate

Question 8

Blended Social-Emotional Group Intervention Development

Set up

Answer 8

Building off of evidence-based social skills intervention1
 8 week group intervention
 2 hours/week
 Ages 8-16

Question 9

Blended Social-Emotional Group Intervention Development

Enhancement aims

Answer 9

Enhance via:
 Focus social skills identified via ADOS-2 as
impaired2
 Incorporate control-based model of coping3
 Incorporate parenting component

Social Skills
a) Cooperation
b) Initiation
c) Conversation 
d) Awareness of 
self and others
e) Conflict 
resolution
f) Listening

Coping
a) Controllable vs 
uncontrollable 
stress
b) Primary & 
Secondary 
control coping

Parenting

a) Coping
b) Communication

Question 10

Why is qualitative information good

Answer 10

Things have changed since adults were kids and we are out of touch with what is socially useful for children

Question 11

Key take home messages

Answer 11

• Need to attend to quality of life of survivors
• Identification as a primary point of intervention
• Blended interventions essential (coping and social skills as important targets)

Question 12

Kids and missing social interaction

Answer 12

Not as much as you think cos put straight back into school

Missing school has not come out as a predictor

Lots of digital connection tot their peers now :)

Nurses go into class and answer children’s questions about peers

Might be that kids gain maturity fast and other children cannot relate
-Very good with grown ups
But could still struggle with children as this is a different skill