Assessing the Efficacy of a Psychosocial Intervention Program for Siblings of Children With Cancer

The psychosocial effects of childhood cancer and its demanding medical treatment can affect not only the ill child but the whole family, particularly siblings who are often overlooked given the terrible circumstances these families face. Current evidence suggests that negative long-term psychosocial effects of childhood cancer may be more severe in siblings than in the child with cancer. Addressing these effects on siblings may benefit the child with cancer and the entire family. Thus, early psychosocial preventive interventions are needed to foster psychosocial adjustment in siblings and promote better quality of life for the entire family. The immediate objective of this study is to address siblings' psychological distress by assessing feasibility and efficacy of a manualized group intervention for siblings of children with cancer (Siblings Coping Together, SibCT). A longer term objective is that the evidence-based intervention could then be exported to other centres across Canada and internationally. Additionally, the study results will identify biomedical, personal, familial and social determinants of intervention outcomes that can guide clinical effort for those at greatest risk. Finally, the overall aim of the project is to reduce psychological distress and improve quality of life for siblings and families impacted by a cancer diagnosis and its demanding treatment.

Study Overview

• Status: Completed
• Conditions: Cancer
• Intervention / Treatment: Behavioral: Control Group; Behavioral: Experimental Group

Detailed Description

Siblings of children with cancer can endure great psychological distress as a result of their brother's or sister's diagnosis and treatment. Understandably, when a child has cancer, their parents' attention is focused mainly on that child and therefore the siblings' needs may not be fully addressed. Thus, siblings often develop feelings of anger, abandonment, jealousy, and fear, which may lead to an increased risk for academic difficulties, symptoms of depression and anxiety and post traumatic stress disorder, although the results are not consistent across studies. Of most concern is that psychological problems may persist through adulthood, as suggested by a recent study in which alcoholism was more prevalent among siblings of children with cancer when compared to peers and cancer survivors. Therefore, it is imperative to develop evidence based psychological intervention programs to prevent these detrimental psychological effects in siblings of children with cancer. This project aims to address siblings' psychological distress by assessing the efficacy of a manualized group intervention for siblings of children with cancer (SibCT) across three Canadian sites (SickKids, Alberta Children's Hospital, BC Women and Children's Hospital) using a randomized control trial (RCT) experimental design. A manualized intervention is considered the gold standard for psychological intervention as it ensures replicability of the study and intervention fidelity. The primary aim is to demonstrate that survivors in the SibCT group (EG) demonstrate decreased symptoms of depression and anxiety improve their overall quality of life compared to an attention control group (CG). A secondary aim is to show that compared to CG, EG will show improvements in secondary measures of quality of life as well as knowledge about cancer. We will also explore other factors such as disease and treatment variables, social contextual variables, individual (sibling) variables and family variables. Randomized Control Trial design with repeated measures will be used. Siblings of children on active cancer treatment and at least 3 months from diagnosis to reduce parental burden; between 8-16 years of age will be included in the study. Siblings will be randomized to either the EG or CG. Approximately 184 siblings will be recruited across the three pediatric centres. After baseline assessment, both groups will have 8 two-hour weekly group sessions consisting of arts and crafts and games, and two post-intervention assessments; at the end of session 8 and three months later. In the EG the critical ingredient has education and social and therapeutic problem solving components based on the manual. Examples of weekly session topics include: age-appropriate medical information about cancer; siblings' fears and feelings; relationships at school, etc. The CG will not have any education or therapeutic-based components. Rigorous testing of the efficacy of an intervention program is a critical step for developing evidence-based treatments.

• Study Type: Interventional
• Enrollment (Actual): 184
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada
      • Alberta Children's Hospital
  • British Columbia
    • Vancouver, British Columbia, Canada
      • BC Women and Children's Hospital
  • Ontario
    • Toronto, Ontario, Canada, M5V1X8
      • The Hospital for Sick Children

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 16 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Siblings of children on active cancer treatment at one or the three sites; at least three months from diagnosis to reduce parental burden
2. Siblings and one caregiver are fluent in English, ensuring full participation
3. Siblings are age 8-16 years

Exclusion Criteria:

1. Siblings who are diagnosed with a developmental or psychiatric disorder which will prevent full group participation
2. Are receiving active psychological treatment at the time of recruitment
3. Has a brother/sister who is receiving palliative care, and is not expected to live longer than 6 months or who had died.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control Group; Behavioural: Participants in this arm will experience an 8-week manualized intervention program with activities and games. Sessions will NOT be designed around a specific theme related to childhood cancer and sibling relationships. Activities and games will NOT have a specific focus. Sessions will be conducted by facilitators who will receive the standard training for volunteers and will work under the supervision of one of the investigators at each site.	Behavioral: Control Group; Sessions will not be designed around a specific theme related to childhood cancer and sibling relationships. Activities and games will not have a specific focus. CG sessions will be conducted by facilitators who will receive the standard training for volunteers and will work under the supervision of one of the investigators at each site.
Experimental: Experimental Group; Behavioural: Participants in this arm will experience an 8-week manualized intervention program which focuses on education, therapeutic problem solving, and social support. Each intervention session is structured by theme relevant to the cancer experience and themes are addressed through fun activities, games, arts, and crafts.To maximize the therapeutic effect of the intervention fun work (homework) will be assigned after each session. Training for the EG facilitators requires reading and studying the manual to become fully familiarized with the intervention approaches, observing group sessions through a one-way mirror prior to participation as a group facilitator, and participating as a group facilitator assistant for the intervention program.	Behavioral: Experimental Group; The experimental group will be detailed, session by session, in the manual written for this purpose. It addresses on topic per session (respecting each other, medical information about cancer, family relationships, sibling's fears and feelings, relationship between siblings, relationships at school, generating hope.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline depression scores at end of intervention and 3 months	Measured by Childhood Depression Inventory (CDI) [Kovacs, 1992]. ). This self-rated, 27-item scale was designed for children between the ages of 7-17.	day 1, 8 weeks later, and 3 months after day 1
Change from baseline anxiety scores at end of intervention and 3 months	Measured by State Trait Anxiety Inventory for Children (STAIC)( Spielberger, 1983). This is a 20-item self-report measure	day 1, 8 weeks later, and 3 months after day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
knowledge about cancer	Siblings Perception Questionnaire (SPQ) (Barbarin, 1995) is a 17-item questionnaire specifically designed for siblings of children with cancer	day 1, 8 weeks later, and 3 months after day 1
quality of life	Pediatric Quality of Life Inventory (PedsQL 4.0 Varni, 1999) is a 23-item, standardized generic measure of health related QOL. The PedsQL, self-report and parent proxy, is composed of four subscales: Physical, Social, Emotional and School Functioning and a Total score.	day 1, 8 weeks later, and 3 months after day 1

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
exploratory outcome, maternal distress	Multidimensional Anxiety Questionnaire, (MAQ) (Reynolds, 1999). MAQ consists of 40 items.	day 1, 8 weeks later, and 3 months after day 1
perceived social support	Perceived social support will be assessed as a potential social determinant of siblings' outcomes, using the Social Support Scale for Children (SSSC) (Harter, 1985). This scale has 24 items assessing 8 to 17-year-old children's perceptions of social support from others, including parents, teachers, classmates, and close friends.	day 1, 8 weeks later, and 3 months after day 1

Collaborators and Investigators

• Sponsor: The Hospital for Sick Children
• Investigators: Principal Investigator: Maru Barrera, PhD, The Hospital for Sick Children

Publications and helpful links

General Publications

• Barrera, M, Chung, JJ, Greenberg, M & Fleming, CF. Preliminary investigation of a group intervention for siblings of pediatric cancer patients. Children's Health Care, 31(2), 131-142, 2002.
• Alderfer MA, Labay LE, Kazak AE. Brief report: does posttraumatic stress apply to siblings of childhood cancer survivors? J Pediatr Psychol. 2003 Jun;28(4):281-6. doi: 10.1093/jpepsy/jsg016.
• Alderfer MA, Hodges JA. Supporting Siblings of Children with Cancer: A Need for Family-School Partnerships. School Ment Health. 2010 Jun 1;2(2):72-81. doi: 10.1007/s12310-010-9027-4.
• Barrera, M., Chung, J. J., & Fleming, C. F. (2004). A group intervention for siblings of pediatric cancer patients. Journal of Psychological Oncology, 22(2), 21-39.
• Sidhu R, Passmore A, Baker D. The effectiveness of a peer support camp for siblings of children with cancer. Pediatr Blood Cancer. 2006 Oct 15;47(5):580-8. doi: 10.1002/pbc.20653.
• Kamibeppu K, Sato I, Honda M, Ozono S, Sakamoto N, Iwai T, Okamura J, Asami K, Maeda N, Inada H, Kakee N, Horibe K, Ishida Y. Mental health among young adult survivors of childhood cancer and their siblings including posttraumatic growth. J Cancer Surviv. 2010 Dec;4(4):303-12. doi: 10.1007/s11764-010-0124-z. Epub 2010 Apr 16.
• Packman W, Weber S, Wallace J, Bugescu N. Psychological effects of hematopoietic SCT on pediatric patients, siblings and parents: a review. Bone Marrow Transplant. 2010 Jul;45(7):1134-46. doi: 10.1038/bmt.2010.74. Epub 2010 Apr 12.
• Lown EA, Goldsby R, Mertens AC, Greenfield T, Bond J, Whitton J, Korcha R, Robison LL, Zeltzer LK. Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction. 2008 Jul;103(7):1139-48. doi: 10.1111/j.1360-0443.2008.02242.x.

Study record dates

Study Major Dates

• Study Start: January 1, 2011
• Primary Completion (Actual): December 1, 2015
• Study Completion (Actual): December 1, 2016

Study Registration Dates

• First Submitted: May 9, 2016
• First Submitted That Met QC Criteria: May 25, 2016
• First Posted (Estimate): June 1, 2016

Study Record Updates

• Last Update Posted (Actual): October 27, 2017
• Last Update Submitted That Met QC Criteria: October 26, 2017
• Last Verified: October 1, 2017

More Information

Terms related to this study

• Keywords: psychosocial; siblings; pediatric cancer
• Other Study ID Numbers: 1000028990

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO