Introduction 40 14 17 21 23 25 27 17 5 6 13 25 29 11 37 39 26 28 20 36 20 36 30 Materials and methods Procedure Both hospitalized cancer patients and those being treated or seen for follow-up visits at the outpatient clinic of the University Medical Center Groningen between January 2001 and February 2003 were approached by surgical, medical, and radiation oncologists and oncology nurses. Patients were eligible for the study if they were diagnosed with cancer 1–5 years before study entry and had children between the ages of 4 and 18 years at the time of parent’s diagnosis who resided or had frequent contact with the diagnosed parent. Furthermore, both parents and children needed to be fluent in Dutch. A family could participate in the study if the patient and at least one child agreed to participate. Physicians and oncology nurses offered all eligible patients and spouses written information plus an information brochure adapted for the children. Informed consent was obtained from each family member separately, as regulated by the Medical Ethical Committee of the University Medical Center Groningen. After obtaining informed consent, researchers mailed packages with questionnaires and prepaid return envelopes to each family member. Cancer patients, spouses, and children were instructed to fill in questionnaires independently of each other and to not discuss their answers. Instruments Demographic data was gathered on: age, gender, level of education, length of relationship, number of children living at home, and who the primary caregiver in the family is. Patients provided information about when they were diagnosed, their type of cancer, treatment intensity, and recurrence. Education was measured on a seven-point scale from (1) elementary school only to (7) university degree. 8 31 38 31 M 8 32 33 1 34 2 35 Analysis t p 10 10 24 p p p p 10 Results Participants 1 3 N N Table 1 Demographics   Patient Spouse Children Mean age in years (SD) 44.7 (4.9) 45.8 (6.4) 14.5 (4.2) Range 32.8–57.8 31.2–65.7 4–23 N 129 (78) 37 (22) 167 (55) N 37 (22) 129 (78) 137 (45) Mean length of relationship in years (SD), range 4–41 21.3 (6.6)   Mean education level (SD), range 1–7 3.8 (1.6) 3.9 (1.8)  Mean number of children per couple, range = 1–6 2.3   N     Mother 105 (63)    Father 5 (3)    Both parents 54 (33)    Other 2 (1)   Mean time since diagnosis in years (SD) 2.76 (1.2)   N 23 (14)   N 143 (86)   Recurrence of cancer N (%) 36 (22)   N N N N Patients’ and spouses’ QoL in comparison with the norm 2 Table 2 Descriptives of the RAND-36 scores by parents’ gender and health status and comparison between groups and with the norm group   Gender Patient Partner Health status and gender Norm Mean SD t Effect size Mean SD t Effect size F Mean SD Physical functioning female 76.1 22.2 −2.12 0.20 91.9 14.9 4.29 0.75 12.99 80.7 23.6 male 77.3 22.0 −1.96 0.33 89.1 16.9 2.44 0.27  84.5 22.3 Social functioning female 78.5 24.4 −3.16 0.31 74.7 15.9 −4.17 0.71 4.28 86.1 20.9 male 72.6 28.4 −3.31 0.56 85.6 21.7 1.29 0.13  88.4 19.6 Role limitations—physical female 64.9 41.2 −3.44 0.33 84.2 29.1 1.19 0.20 7.20 78.3 36.5 male 57.4 45.6 −3.13 0.53 81.6 35.0 0.03 0.00  81.5 33.6 Role limitations—emotional female 79.3 35.6 0.98 0.09 81.9 33.9 −0.09 0.02 1.45 82.5 33.5 male 83.8 32.9 −0.62 0.11 87.8 28.9 0.16 0.02  87.3 29.3 Mental health female 72.5 16.8 −1.82 0.18 74.6 14.8 −0.36 0.06 2.96 75.5 18.9 male 78.5 14.5 −0.37 0.06 77.9 16.0 −0.89 0.09  79.4 17.3 Vitality female 58.8 21.8 −3.63 0.34 63.8 17.6 −0.84 0.14 6.54 66.3 19.6 male 56.9 21.4 −3.07 0.59 69.1 18.7 −0.23 0.02  69.5 20.5 Pain female 81.6 21.5 −0.78 0.07 85.3 18.3 −1.69 0.29 2.34 80.0 25.4 male 80.4 24.6 0.66 0.11 87.7 19.2 2.14 0.23  83.2 23.8 General health female 66.3 21.9 −2.25 0.24 74.8 15.3 −1.27 0.22 8.71 71.5 21.8 male 58.5 25.9 −2.92 0.49 75.3 18.7 −1.92 0.21  71.4 23.3 Physical summary female 47.2 9.8 – – 49.7 10.2 – – 11.38 Not available  male 44.9 11.4 – – 50.3 9.8 –   Not available  Psychosocial summary female 49.7 10.2 – – 53.6 8.6 – – 2.31 Not available  male 44.9 11.4 – – 52.2 8.5 – –  Not available  p p p Clinically relevant ESs were found for female spouses’ physical functioning and social functioning. Female spouses reported statistically significantly higher scores than the norm on physical functioning. They also scored statistically significantly lower on social functioning than the norm. Effects of health status and gender, time since diagnosis, recurrence, treatment intensity, and type of cancer on QoL 2 p p p p p p p p p r p t p t p t p t p t p t p t p t p t p t p t p t p t p t p t p 3 Table 3 Descriptives of the patients’ RAND 36 scores by type of cancer and comparisons between groups   Gynecological tumors Breast cancer Urological tumor Soft tissue/bone Hematological Dermatological ANOVA N N = 86 N N N N F M SD M SD M SD M SD M SD M SD Physical functioning 78.1 17.1 78.5 20.4 81.0 14.7 59.5 15.7 57.8 32.1 88.3 15.8 5.21 Social functioning 77.3 17.2 79.2 23.3 72.5 22.7 70.0 25.8 54.7 35.9 96.7 9.9 5.34 Role limitations—physical 64.0 43.8 68.3 39.9 62.5 11.5 32.5 33.4 31.2 43.3 86.7 28.1 4.61 Role limitations—emotional 91.7 25.8 79.5 34.7 96.7 10.5 76.7 41.7 60.4 42.5 100.0 00.0 3.16 Mental health 73.0 15.0 73.6 16.5 77.6 16.4 69.5 25.9 74.5 17.7 76.0 13.8 0.29 Vitality 60.6 17.6 58.9 20.7 58.5 24.3 52.0 16.9 43.4 28.7 77.3 18.8 4.18 Pain 86.9 17.6 81.7 21.9 75.9 19.1 60.6 20.9 73.6 29.2 92.8 13.9 3.44 Gen. health perception 72.8 16.0 64.9 23.1 61.0 21.6 54.5 17.9 47.2 28.2 85.7 9.8 5.79 Physical summary 78.1 17.11 78.5 20.4 81.0 14.7 59.5 15.7 57.8 32.1 88.3 15.8 6.48 Psychosocial summary 77.3 17.2 79.2 23.3 72.5 22.7 70.0 25.8 54.7 35.9 96.7 9.9 2.95 p p Functionality of patient in relation to functionality of spouse r p r p r r Relationship between patient and spouse’s functioning and emotional and behavioral functioning of the children 4 Table 4 Correlations between parents QoL, as measured by RAND-36 composite scores, and children’s functioning by age group as reported by parents (CBCL) and adolescents themselves (YSR)   N N  Physical functioning Psychosocial functioning Physical functioning Psychosocial functioning Elementary school-aged children (CBCL) Total −0.05 −0.33** −0.19 −0.11 Internalization −0.03 −0.36** −0.19 −0.17 Externalization −0.03 −0.26** −0.16 −0.05 Adolescents (CBCL) Total −0.18** −0.24** −0.11 −0.22** Internalization −0.19** −0.23** −0.15 −0.27** Externalization −0.10 −0.21** −0.09 −0.09 Adolescents (YSR) Total −0.32** −0.29** −0.11 −0.15 Internalization −0.31** −0.32** −0.11 −0.19* Externalization −0.20* −0.13 −0.09 −0.02 p p 4 Discussion 7 9 3 4 16 27 33 30 12 40 9 18 18 22 15 Research considerations In our investigation, being the first to evaluate family functioning in families in the child-rearing age, we purposely did not choose a homogenous cancer group (i.e., only breast cancer). Our results are statements for the general group of child-rearing families with cancer. Comparisons between patients in our research group with varying diagnoses showed differences between groups; however, the small subgroups make it difficult to generalize our findings. Future research will be required to investigate the effect of varying forms of cancer, the stage of cancer, its prognosis, and treatment on the functioning of individual family members. 19 26 In conclusion, cancer patients’ QoL 1–5 years after diagnosis seems to be returning to normal, except in three domains. Their spouses seem to be doing well. The patients’ QoL varied according to the type of cancer, how intense their treatment had been, and whether they had experienced a recurrence. Spouses’ QoL seemed to be unaffected by the type of cancer and treatment intensity but did vary depending on whether the patient experienced a recurrence. A moderate positive relationship was found between the patient’s functioning and his/her spouse’s. Parents’ physical and psychosocial functioning was weakly to moderately strongly related to their children’s functioning. The patients’ functioning related more strongly to the children’s functioning than the spouses’ did. How cancer patients’ families function may have an impact on the patient’s functioning, up to 5 years after diagnosis. This is something that should be taken into account by clinicians.