Skip to main content

Posttraumatic growth in children aged 8–18 years with malignancies in China

Abstract

Objective

To establish a nomogram prediction model for posttraumatic growth (PTG) in children aged 8–18 years with malignancies in China and to convenient intuitively judge psychological tendencies.

Methods

We recruited 358 children aged 8–18 years with malignancies in China as the study participants. Data from 250 cases collected from June 2019 to November 2019 were used as the model group, data from 108 cases collected from December 2019 to January 2020 were used as the validation group. Logistic regression was used to analyze the influencing factors of PTG in the model group. A prediction model was then established using a nomogram. The centrality measurement index(C-index) and receiver operating characteristic curves (ROC) were used to verify the model.

Results

Among the 250 children in the model group, 65 children with malignancies had PTG, with an occurrence of 26%. The model showed that the child’s age, diagnosis, coping style and self-efficacy level and the educational level of the caregiver were core predictors of PTG (P < 0.05). The ROC of the model was 0.837, the best cutoff value was 0.566. The C-indexes of the internal and external validation were 0.837 (95% CI: 0786 ~ 0.886) and 0.813 (95% CI: 0732 ~ 0.894), respectively.

Conclusions

The prediction model of PTG in children aged 8–18 years with malignancies in China has good discrimination and consistency and can accurately predict PTG. It can be used to clinically assess the psychological status of children in the future.

Peer Review reports

Introduction

In recent years, the number of new cases of children with malignancies worldwide has been approximately 168,000 per year, and the annual incidence rate is increasing at a rate of 0.7% [1] Yet, the 5-year survival rate for children with malignancies is as high as 85% [2]. The growing number of survivors represents children and their families facing a range of problems, such as secondary tumors, late complications [3], the development of poor behavior [4] and even death. Moreover, according to the relevant literature, children possess a definite cultural knowledge base after the age of 8 years to have an initial understanding of society and personal thoughts [5]. There is also the ability to self-report the occurrence of events [6]. However, during this time, children are at a specific stage of transition to adulthood and more likely to feel stress when faced with events or experiences in their growing environment. Cancer issues can have a serious impact on their future health-related quality of life [7, 8]. Research has shown that children with cancer show both negative and positive psychological responses in their fight against cancer. Negative psychological changes include anxiety [9], depression [10] and suicidal ideation [11], and one positive psychological change is posttraumatic growth (PTG). PTG a collection of positive psychological and spiritual changes experienced by individuals during the follow-up process after a traumatic event or situation [12]. However, previous studies have focused on negative psychological changes in children, ignoring the positive reflections during their cancer experience that are beneficial to their development [13, 14]. Therefore, it is of great practical importance to clarify the factors affecting PTG in children aged 8–18 years with malignancies in China in order to inform guide clinical caregivers in implementing interventions.

At present, several studies [15, 16] have shown that PTG is a common phenomenon for children with malignancies and their families. The positive reflections and beliefs brought about by PTG could help survivors successfully resume their daily lives in the follow-up survival process [17]. One study [18] also demonstrated that PTG can be an important predictor of quality of life in children with malignancies, but further exploration is needed [19]. Furthermore, due to the different cultural backgrounds in different countries, there is disagreement as to whether factors such as religion and gender affect PTG [20]. Many studies of PTG in children with malignancies have focused on caregiver and disease factors [21, 22]. Our pre-exploration study also identified age, region, self-efficacy, social support, and coping styles as influential factors in PTG [23], but the sample size was too small (64 cases) to provide high-quality evidence. It is evident that the independent influences on PTG are not well defined in domestic and international studies. Moreover, longitudinal studies are still relatively lacking, and there is wide variation in the choice of longitudinal time points and methods of data analysis, leaving the pattern of PTG development in cancer patients poorly understood. In addition, the existing psychological interventions are mainly aimed at children whose problems have already occurred, making it difficult to provide high-quality evidence for the development of an early intervention program for PTG. This research aims to clarify the independent predictors of PTG in children with malignancies in China and construct a measurable predictive tool to address the above issues.

In summary, it is important to be able to predict the occurrence of PTG for the quality of life and mental health of children with malignancies in China. We screened the core influences of PTG to develop a nomogram prediction model to predict PTG. This study will allow clinical caregivers to more clearly assess the probability of PTG, which can be helpful for children to establish good PTG and quickly return to ordinary life.

Materials and methods

Study participants

Starting from June 2019 to January 2020, children with malignancies from the inpatient unit of the Department of Hematology and Oncology Surgery at a tertiary care children’s hospital were recruited for an online survey. The inclusion criteria were as follows: (1) patients aged 8–18 years (this age group has self-reporting capabilities) [6]; (2) patients diagnosed with cancer by the standard guidelines for the diagnosis and treatment of childhood malignancies [24]; and (3) children who provided informed consent. The exclusion criteria were (1) children suffering from severe organic or cognitive impairment and (2) children who were unable to understand the questionnaire. The final recruited children will be divided into two groups: the modeling group and the validation group. The model group was used to construct the prediction model; the verification group was used to evaluate the applicability of the model. This study was approved by the Institutional Review Board of Children’s Hospital of Chongqing Medical University, China [2019 (year) No. 8]. All the study subjects and caregivers had the right to withdraw at any time during the study.

Data collection

Prior to the investigation, the researchers introduced themselves to the children and their caregivers and informed them of the purpose and content of the study. In addition, data adhered to the principle of confidentiality, private information such as the child’s name was not disclosed, the primary caregiver and children signed informed consent form, and the survey was completed anonymously. Each study participant could only submit one questionnaire, which prevented the possibility of double registration. To ensure the quality of the participants’ responses, we required that each question be answered. Variables that were not understood were explained in detail to guide the participants to choose the options that fit their situation.

To better screen the core predictors of PTG, we selected the following basic information potentially relevant to PTG as independent variables based on previous studies and ecosystem theory, including the child’s age, gender, diagnosis, time of hospitalization, stage of disease, area of residence, temperament, whether or not the religious, primary caregiver, education level of the caregiver, family economic status, family parenting style, and type of family. Among them, family parenting style, family type and temperament of the child were judged mainly in relation to the actual situation of the child and family for subjective selection. Some of the above variables are not core predictor variables of PTG, therefore, only preliminary determination of the variables was made in this study. The typology of specific variables can be seen in Table 1.

Table 1 Univariate analysis of the PTG of children with malignancies (N = 250)

Measurement tools

PTG was measured by the Posttraumatic Growth Assessment Scale (PTGI), which is a 21-item questionnaire with five factors [25]. The participants responded on a 6-point Likert scale, with 0 for no change and 5 for complete change. The total score ranges from 0 to 105, with higher scores indicating higher levels of PTG. In this study, the total score ≥ 54.23 indicates PTG [26]. The Cronbach’s alpha value of PTG was 0.91 in our sample.

The level of negative emotions was measured by the 21-item Depression Anxiety Stress Scale (DASS-21) [27] with three dimensions: depression, anxiety and stress. Each item is scored from 0 (never) to 3 (almost). A higher score indicates more serious negative emotional symptoms. In this study, the total Cronbach’s alpha value of this scale was 0.88.

The children’s coping styles were calculated by the Simplified Coping Style Questionnaire [28]. The 4-point scale from 0 (never) to 3 (quite a lot) has 20 items. Coping tendency = positive coping standard score (z score) - negative coping standard score (z score). Z score = (dimension individual total score - dimension mean) / dimension standard deviation. If the coping tendency value is greater than 0, it means that the subjects mainly adopt positive coping style in the state of stress. In this study, the Cronbach’s alpha values of positive, negative dimension and total score were 0.81, 0.68 and 0.79 respectively.

The children’s self-efficacy was measured by the General Self-Efficacy Scale (GSES) [29], which includes one dimension and 10 items. Each item is scored from 1 (quite wrong) to 4 (quite right), and the total score ranges from 10 to 40. The standard score is the total score divided by the total number of items. The higher the standard score is, the higher the self-efficacy is. According to the score index, the self-efficacy level was divided into three grades: high (≥80%), medium (60% ~ 80%) and low (< 60%). The score index was calculated as follows: actual standard score/theoretical maximum standard score* 100%. The total Cronbach’s alpha value of the scale in this study was 0.81.

Statistical analysis

All statistical analysis was performed using R (version 4.2.1) and SPSS 24.0. In single factor analysis, the count data are described as the frequency and percentage (%). The K-S test was used to test the normality of the data. The measurement data are described as the mean (\(\overline{\chi}\) ± standard deviation (SD). the Mann–Whitney U rank sum test was used to compare the difference between two samples of nonnormally distributed measurement data. Then, we assigned values to variables with P < 0.1 in the univariate analysis and those after clinical consideration. Among them, dummy variables were set for polytomous variables and referenced to the first category. For identifying the final prediction model, a forward-stepwise method was used to select predictors of PTG in multivariable logistic regression. The nomogram and calibration curves were constructed and evaluated using the package with the “Rms” and “Hmisc”. The C-index and ROC curves were used to evaluate the model with a test level of α = 0.05. Internal verification was evaluated using the bootstrapping validation method.

Results

Study population

A total of 358 children were eventually completed the survey. Data from 250 cases collected from June 2019 to November 2019 were used as the model group, data from 108 cases collected from December 2019 to January 2020 were used as the validation group. The PTG scale score was 43.42 ± 17.43 for the model group consisting of 250 children, 143 of whom were boys. The mean age of the group without No PTG was (10.97 ± 2.18) and the mean age of the group with PTG was (11.98 ± 2.19), comparing the two groups (t = − 3.200, p = 0.001). The mean time of hospitalization in the group without No PTG was (8.00 ± 16.00) and in the group with PTG was (10.00 ± 17.50), comparing the two groups (t = − 0.204, p = 0.839). Among them, 41 (16.4%) had lymphoma, 153 (61.2%) had leukemia, 20 (8.0%) had sarcoma, and 36 (14.4%) had other tumors (including teratomas, nasopharyngeal carcinomas, ovarian yolk sac tumors, neuroblastomas, etc.) For statistical convenience, the children were divided into those with solid and nonsolid tumors (Table 1).

Factors associated with PTG in Chinese children aged 8–18 years with malignancies

Gender was not shown to be statistically associated with PTG in the univariate analysis. However, based on clinical professional judgment, it was considered for inclusion. The final results showed that the most meaningful predictors of PTG were level of self-efficacy, educational level of the caregiver, age, diagnosis and coping style of the child (Table 2).

Table 2 Logistic regression analysis of PTG in Chinese children with malignancies

Prediction model for PTG in Chinese children aged 8-18 years with malignancies

The nomogram that could predict the occurrence of PTG was created using the factors of age, diagnosis, educational level of the caregiver, level of self-efficacy and coping style of the child (Fig. 1). The area under the ROC curve was 0.837 (Fig. 2). The model with the highest Youden index defined PTG as 0.566, with a sensitivity of 83.1% and a specificity of 73.5%. The 108 children with malignancies were used as a verification group to validate the model. The C-indexes of internal and external validation were 0.837 (95%CI:0786~0.886) and 0.813 (95%CI:0732~0.894), respectively, indicating a high discrimination of the nomogram. The calibration plots also showed high coherence between the predicted occurrence of PTG and the actual observations (Fig. 3), which indicated good calibration of the model. And, according to Fig. 1, we can see that the specific scale on the line segment corresponding to each of the five variables represents the range of values available for that variable, while the length of the line segment reflects the size of the variable’s contribution to the ending event.

Fig. 1
figure 1

Establishment of a nomogram model for predicting PTG in Chinese children aged 8-18 years with malignancies

Fig. 2
figure 2

Nomogram model predicted the ROC curve of PTG in children aged 8-18 years with malignancies. AUC, area under the curve

Fig. 3
figure 3

Calibration curves of the nomogram model for predicting PTG in children with malignancies. B ¼ 1000 repetitions, boot mean absolute error ¼ 0.039, n ¼ 108. The x-axis shows the predicted occurrence of PTG, and the y-axis shows the observed occurrence of PTG. The dotted and solid lines indicate the observed (apparent) nomogram performance before and after bootstrapping

Discussions

PTG in Chinese children aged 8–18 years with malignancies was low

The results of this study showed that the percentage of children with malignancies who had PTG was 26.0% (65/250), and the total score on the PTG scale was (43.42 ± 17.43), which was significantly lower than those in previous studies (41.13% [30] and 53.30 ± 20.22 [23]). The reason for this difference may be that children aged 8–18 years are in a period of psychological defiance, they are sensitive, and emotionally unstable, and experiencing a traumatic event such as a tumor can intensify their negative emotions, which be detrimental to PTG production [31]. Repeated hospitalization, invasive operations and complications can cause traumatic stress, as can overprotective caregivers and a closed social environment [9]. Additionally, influenced by traditional Chinese culture, caregivers are not sufficiently aware of the rehabilitation care of children with malignancies and can overemphasize children’s illness [32] and use approaches such as control and restrict activities to overprotect them [33]. This hinders the development of their early independent consciousness and socially adaptive behavior, which is not conducive to PTG. Therefore, it is important to clarify the core factors of PTG in Chinese children aged 8–18 years with malignancies and construct a prediction model to enhance their coping and adaptation abilities.

PTG in Chinese children aged 8–18 years with malignancies was influenced by multiple factors

Age

The study found that older age was a protective predictor of PTG in children aged 8–18 years with malignancies. This finding fits with the report by Turner JK et al. [34]. This might be because older children have greater access to information and a deeper understanding of illness and tend to develop mature cognitive resources and self-awareness, which leads to more positive reflections on trauma [35]. Moreover, the effect of age on PTG in Chinese children with malignancies was found to be no different from that in other countries by comparison [10, 34]. We suggest that nursing staff can provide younger children with more simple methods of psychological suggestion such as sand tray games, music therapy, and drawing to promote PTG.

Diagnosis

This study shows that solid tumors can promote PTG production in children with malignant tumors. This is contrary to the findings of Wang Jingjing et al. [30]. It may be related to the children with osteosarcoma in this study had an onset at age 12 or older. There is a strong capacity for posttraumatic cognitive reconstruction for older children to engage in positive psychological adjustment, which are conducive to PTG [34]. But, a Korean study [36] showed that children with solid tumors were less prone to PTG because they were treated for a shorter period of time than children with hematological tumors. Therefore, follow-up studies should further explore the specific mechanism.

Educational level of the caregiver

As in previous studies, the educational level of the caregiver was also closely related to PTG in children with malignancies [22]. The reasons why children with highly-educated caregivers have better PTG might be as follows: They have a better understanding of disease and treatment, are more psychologically resilient, which can provide more informational resources and support to the children, facilitating the children’s psychological and behavioral adjustments [37]. Additionally, China is a developing country, and the education level of the caregivers in this study was predominantly junior or senior high school, generally inferior to that in developed countries. Therefore, we recommend that nursing staff take measures such as positive parenting courses [38] and parent management training to raise caregiver’s awareness to provide more social support.

Coping style of the child

We found that children with negative coping styles had a lower probability of PTG. Morris et al. [39] also showed that more adaptive coping styles were associated with higher PTG. This may be the positive coping style can help children view traumatic experiences such as tumors optimistically and reduce the impact of negative emotions that can cause PTG. Unlike developed countries, such as Europe, where more educated parents place a high value on independent thinking and self-direction of their children40, this study found that Chinese children with malignancies cope mostly with refusal and resistance [40]. Caregivers are overly constrained and caring, which is not conducive to the positive development of the child’s self-response. We recommend that nursing staff instruct caregivers to help the children with appropriate exercise and socialization and allow them to handle tasks within their abilities.

Level of self-efficacy

Based on Fig. 1, we found that self-efficacy had the greatest effect on PTG. This finding is also consistent with previously reported findings that increased self-efficacy can improve PTG in cancer patients [41]. It is possible that self-efficacy allows affected children to increase their sense of control, helps them view traumatic experiences as opportunities for growth. In this study, 93.2% (233/250) of the children had low or medium levels of self-efficacy, significantly lower than Japanese [42] and Korean [43]. It is obvious that the self-efficacy level of Chinese children aged 8–18 years with malignancies needs to be improved. We recommend that nursing staff invite recovered children to share their experiences, help children in treatment learn self-confidence and communication skills through regular sharing sessions or health seminars, and provide appropriate psychological support to improve PTG.

The nomogram model constructed could well predict the probability of PTG in Chinese children aged 8–18 years with malignancies

We included five predictor variables related to PTG in our logistic regression analysis. The high C-index and consistent calibration curve indicate that the model has good discrimination and calibration. Distinguishing between high and low PTG levels based on the optimal threshold of 0.566 will not only allow early screening for adverse psychological problems but also help health care professionals promote PTG with intervention strategies. Additionally, we found that the level of self-efficacy had a greater impact on PTG in Chinese children with malignancies aged 8–18 years than other factors in this study. This indicates that the follow-up intervention should focus on the regulation of the children’s intrinsic self-mechanisms.

This study had some limitations. First, only a single tertiary children’s hospital was included, with a single source of data. Second, PTG is a psychological change process, but due to sample size and model limitations, some influencing factors, such as network information found in clinical observations, peer support, and support received from health care providers during treatment, may be missed. And dynamic longitudinal observations were not conducted in this study, providing a weaker explanation of causality. Future studies can use a longitudinal design to further explore the relationship between different treatment phases and PTG in children with malignancies.

Conclusions

Our study suggests that age, diagnosis, coping style of the child, educational level of the caregiver and level of self-efficacy are independent predictors of PTG in children aged 8–18 years with malignancies, and provide a reference basis for clinical nursing to conduct psychological interventions for children with malignancies and, to a certain extent, help them recover after trauma.

Availability of data and materials

Research data are not shared. (The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request).

References

  1. SEER website. Annual Report to the Nation 2021: Overall Cancer Statistics. Available at: https://seer.cancer.gov/report_to_nation/statistics.html. Accessed July 21, 2022.

  2. Rivera LR, Shalkow KJ, Velasco HL, Cárdenas CR, Zapata TM, Olaya VA, et al. Descriptive epidemiology in Mexican children with cancer under an open national public health insurance program. BMC Cancer. 2014;14:790.

    Article  Google Scholar 

  3. Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in “chronic” cancer survivors: a meta-analysis. J Cancer Surviv. 2020;14(4):504–17.

    Article  Google Scholar 

  4. Tao Shuhua W, Suyun ZJ, Ke L. Healthy-related quality of life among long-term survivors of childhood cancer. J Nurs Sci. 2021;36(2):77–80 in Chinese.

    Google Scholar 

  5. Xiaobai C. The general principles of the civil law to amend the minimum age limit of civil capacity of minors to explore the reasonableness. Legality Vision. 2019;7:235. In Chinese.

  6. Mack JW, McFatrich M, Withycombe JS, Maurer SH, Jacobs SS, Lin L, et al. Agreement between child self-report and caregiver-proxy report for symptoms and functioning of children undergoing cancer treatment. JAMA Pediatr. 2020;174:e202861.

    Article  Google Scholar 

  7. Halvorsen JF, Sund AM, Zeltzer L, Ådnanes M, Jensberg H, Eikemo TA, et al. Health-related quality of life and psychological distress in young adult survivors of childhood cancer and their association with treatment, education, and demographic factors. Qual Life Res. 2018;27:529–37.

    Article  Google Scholar 

  8. McLoone J, Wakefield CE, Sansom-Daly UM, Thornton-Benko E, Govender D, Gabriel M, et al. The lived experience of children and adolescents with cancer. Aust J Gen Pract. 2021;50(8):545–9.

    Article  Google Scholar 

  9. Cook JL, Russell K, Long A, Phipps S. Centrality of the childhood cancer experience and its relation to post-traumatic stress and growth. Psychooncology. 2021;30(4):564–70.

    Article  Google Scholar 

  10. Kunas SL, Lautenbacher LM, Lueken PU, Hilbert K. Psychological predictors of cognitive-behavioral therapy outcomes for anxiety and depressive disorders in children and adolescents: a systematic review and Meta-analysis. J Affect Disord. 2021;278:614–26.

    Article  Google Scholar 

  11. Wang J, MacQueen G, Patten S, Manuel D, Lashewicz B, Schmitz N. A randomized controlled trial to examine the impacts of disclosing personalized depression risk information on the outcomes of individuals who are at high risk of developing major depression: a research protocol. BMC Psychiatry. 2019;19(1):285.

    Article  Google Scholar 

  12. Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455–71.

    Article  Google Scholar 

  13. Kim Y. Factors associated with post-traumatic growth in Korean survivors of childhood Cancer. Oncol Nurs Forum. 2022;49(1):71–80.

    Google Scholar 

  14. Weinstein AG, Henrich CC, Armstrong GT, Stratton KL, King TZ, Leisenring WM, et al. Roles of positive psychological outcomes in future health perception and mental health problems: a report from the childhood Cancer survivor study. Psychooncology. 2018;27(12):2754–60.

    Article  Google Scholar 

  15. López J, Ortiz G, Noriega C. Posttraumatic growth in parents of children and adolescents with cancer. An Sist Sanit Navar. 2019;42(3):325–37.

    Article  Google Scholar 

  16. Rodríguez-Rey R, Alonso-Tapia J. Predicting posttraumatic growth in mothers and fathers of critically ill children: a longitudinal study. J Clin Psychol Med Settings. 2019;26(3):372–81.

    Article  Google Scholar 

  17. Kim Y. Exploration of life experiences of positive growth in long-term childhood cancer survivors. Eur J Oncol Nurs. 2017;30:60–6.

    Article  Google Scholar 

  18. Sedmak M, Bogdanić A, Grubić M. Correlates of quality of life in pediatric Cancer survivors. Psychiatr Danub. 2020;32(Supple 4):533–9.

    Google Scholar 

  19. Gunst DC, Kaatsch P, Goldbeck L. Seeing the good in the bad: which factors are associated with posttraumatic growth in long-term survivors of adolescent cancer? Support Care Cancer. 2016;24(11):4607–15.

    Article  Google Scholar 

  20. Wang Jingjing G. Can. Research progress on post-traumatic growth among adolescent patients with mailgnant tumor. Chin Evid Based Nurs. 2020;6(7):642–8 in Chinese.

    Google Scholar 

  21. Yan A, Howden K, Mahar AL, Scott I, Glidden C, Deleemans J, et al. Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic. J Cancer Surviv. 2022;31:1–14.

    Google Scholar 

  22. Behzadi M, Rassouli M, Khanali ML, Pourhoseingholi MA, Alaie KF. Posttraumatic growth and its dimensions in the mothers of children with Cancer. Int J Community Based Nurs Midwifery. 2018;6(3):209–17.

    Google Scholar 

  23. Qian LIU, Lin MO, Xinyue TANG, Lu YU, Yang LIU. Status of post-traumatic growth and its influencing factors of pediatric cancer survivors. Chin Nurs Manag. 2021;21(5):674–9 in Chinese.

    Google Scholar 

  24. Children's National Medical Center. Treatment specifications for 12 diseases related to hematological diseases and malignant tumors in children (2021version). http://www.nhc.gov.cn/yzygj/s7659/202105/3c18fec8a37d452b82fe93e2bcf3ec1e.shtml. Accessed May 13, 2021.

  25. Luan BB, Wang WL, Zhu Y. Relation among post-traumatic growth, coping styles and self-efficacy of the primary caregivers of Cancer patients. Chin Gen Pract. 2016;19(19):2339–43 in Chinese.

    Google Scholar 

  26. Zhang Y, Huang Q, An YY. Dispositional mindfulness and PTSD and posttraumatic growth among adolescents. Chin J Clin Psychol. 2019;27(1):172–6 in Chinese.

    Google Scholar 

  27. Zhang L, Zhang L. Reliability and validity of the Chinese version of the low head behavior scale for measuring college student groups. Chinese. J Clin Psychol. 2020;28(1):29–32+36 in Chinese.

    Google Scholar 

  28. Jing F, Ya-ting W, Shui-yuan X, Mei Z, Hui J, Mi H. Reliability and validity of simplified coping style questionnaire among adolescents. Chinese. J Clin Psychol. 2018;26(5):905–9 in Chinese.

    Google Scholar 

  29. Ma DH, Cheng KW, Ding P, Wang P, Li HY. Relation of coping style to self-efficacy and health belief in patients with head and neck radiotherapy. Chin Ment Health J. 2019;33(5):363–5 in Chinese.

    Google Scholar 

  30. Jingjing W, Yao Z, Weizi W, Can G. Post-traumatic growth and influencing factors of adolescent malignant tumor patients. Chinese. Nurs Manag. 2020;20(9):1324–8 in Chinese.

    Google Scholar 

  31. Wang Fanfan X, Yanling WQ, et al. Research progress on instruments assessing symptom distress for adolescent cancer patients. J Nurs Sci. 2017;32(13):99–101 in Chinese.

    Google Scholar 

  32. Adi Pamungkas R, Chamroonsawasdi K, Usman AM. Unmet basic needs and family functions gaps in diabetes management practice among Indonesian communities with uncontrolled type 2 diabetes: a qualitative study. Malays Fam Phys. 2021;16(3):23–35.

    Article  Google Scholar 

  33. Baran G, Arda Sürücü H, Hülya ÜV. Resilience, life satisfaction, care burden and social support of mothers with a child with acute lymphoblastic leukaemia: a comparative study. Scand J Caring Sci. 2020;34(2):340–7.

    Article  Google Scholar 

  34. Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: a systematic review and meta-analysis. Psychooncology. 2018;27(4):1100–9.

    Article  Google Scholar 

  35. Şimşek AB, Özer Z, Buldukoğlu K. Posttraumatic growth in parentally bereaved children and adolescents: a systematic review. Death Stud. 2022;46(1):111–23.

    Article  Google Scholar 

  36. Shin YJ, Oh EG. Factors influencing resilience among Korean adolescents and young adult survivors of childhood cancer. Eur J Oncol Nurs. 2021;53:101977.

    Article  Google Scholar 

  37. Xiao Y. Posttraumatic growth and its influencing factors in children with malignant bone tumor. Jiangxi: Nanchang University; 2019.

    Google Scholar 

  38. Salisbury MR, Roos LE, Horn SR, Peake SJ, Fisher PA. The effectiveness of KEEP for families of children with developmental delays: integrating FIND video coaching into parent management training-oregon model: a randomized trial. Prev Sci. 2022;23(6):1029–40.

    Article  Google Scholar 

  39. Morris JN, Turnbull D, Martini A, Preen D, Zajac I. Coping and its relationship to post-traumatic growth, emotion, and resilience among adolescents and young adults impacted by parental cancer. J Psychosoc Oncol. 2020;38(1):73–88.

    Article  Google Scholar 

  40. Chen BB. Socialization values of Chinese parents: does parents’ educational level matter? Curr Psychol. 2020;39:511–7.

    Article  Google Scholar 

  41. Ye XX, Shu MC, Pan QQ, Qiong L. The effect of intensive self-efficacy nursing on self-efficacy and post-traumatic growth of postoperative patients with breast cancer. J Wenzhou Med Univ. 2020;50(9):765–8 in Chinese.

    Google Scholar 

  42. Saito M, Hiramoto I, Yano M, Watanabe A, Kodama H. Influence of self-efficacy on cancer-related fatigue and health-related quality of life in young survivors of childhood Cancer. Int J Environ Res Public Health. 2022;19(3):1467.

    Article  Google Scholar 

  43. Kwak Y, Kim Y, Choi ES, Im HJ. Self-efficacy, post-traumatic growth, and quality of life of pediatric cancer survivors: a cross-sectional study. Eur J Oncol Nurs. 2021;54:102019.

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This work was supported in the part by grants from Chongqing Science and Technology Bureau, China. (Great number: CSTB2022NSCQ-MSX0082).

Author information

Authors and Affiliations

Authors

Contributions

Yixuan Liu: data analysis and manuscript writing/editing. Qian Liu: data collection and manuscript writing. Lin Mo: conceived and designed the study, manuscript editing. Lu Yu: conceived and designed the study. The manuscript was critically reviewed by all of the authors. All of the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Lu Yu or Lin Mo.

Ethics declarations

Consent for publication statement

Not applicable.

Ethics approval and consent to participate

The study was approved by Ethics Committee (full name: Institutional Review Board of Children’s Hospital of Chongqing Medical University) (reference number [2019 (year) No. 8]) to the Department of Scientific Research, Children’s Hospital of Chongqing Medical University, China. All methods were carried out according to the relevant guideline and regulations. This study was carried out in compliance with the STROBE Statement. All included patients gave their oral and written informed consent. The study was entirely voluntary, and patients will give their consent for this material to appear in academic journals and associated publications. In addition, data adhered to the principle of confidentiality, private information such as the child’s name was not disclosed, the primary caregiver signed an informed consent form, and the survey was completed anonymously.

Competing interests

The authors declare no potential conflict of interest. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, YX., Liu, Q., Yu, L. et al. Posttraumatic growth in children aged 8–18 years with malignancies in China. BMC Pediatr 22, 742 (2022). https://doi.org/10.1186/s12887-022-03799-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12887-022-03799-w

Keywords