CBT Framework Shows Feasibility in Pediatric Oncology Caregivers

Results from a poster shared at the 2026 American Psychosocial Oncology Society (APOS) Annual Meeting demonstrated that the Antecedent (Adversities), Beliefs, Consequences (ABC) model was a usable and appropriate tool to integrate a cognitive behavioral therapy framework into the psychosocial care of parents and caregivers of children with cancer.

Participants in the study gave responses to the ABC model in their own lives after reviewing core 1 of the Electronic Surviving Cancer Competently Intervention Program (eSCCIP). Responses were analyzed qualitatively using thematic analyses.

The model was broken into 3 categories:

1. Adversities – something tough, sad, or scary
2. Beliefs – a thought or self-talk about an adversity
3. Consequences – how something turns out.

Adversities

Caregivers of children with cancer reported adversities that were related to general uncertainty; medical and treatment-related stressors; external stressors, such as work and financial strain; and family, relationship, and communication-related stressors.

Three example responses were shared:

1. A mother of a child with a solid tumor: “Not knowing the prognosis of our son's cancer.”
2. A mother of a child with a brain tumor: “My adversities are […] I know I have to keep working, but at times, it is very difficult to juggle work, [my child's] treatment and understanding how to make all the things in our household work smoothly.”
3. A mother of a child with leukemia: “Being a single parent and going through it all alone.”

Beliefs

Caregivers of children with cancer reported beliefs that there would be negative medical outcomes for their child, they had an internal locus of control, they had an external locus of control, and cancer would disrupt family relationships and responsibilities. Furthermore, the caregivers reported worrying about their own well-being, intentionally directing their attention, and religious beliefs.

Two example responses were shared:

1. Mother of a child with leukemia: “Thinking all [patients with] AML relapse. The stress and worry will never go away.”
2. Father of a child with leukemia: “I believe I can only control certain things such as my daughter's home environment so I just try to make her as happy as I can.”

Consequences

Caregivers of children with cancer reported 3 different categories of consequences.

The first was relationships, including those: with their child; with siblings of child with cancer; with their partner; and with negative impacts on childhood/family because of cancer experience. The second was feelings/cognitive, including: frustration with medical team; sadness, guilt, stress/feeling overwhelmed; distracted/not present, rumination; self-doubt; self-efficacy; acceptance related to religious belief; and being alone/having to do everything by oneself. The third was actions, including: seeking information; prioritizing others’ needs over their own; receiving support; and being short-tempered.

Two example responses were shared:

1. Mother of a child with a solid tumor: “I am hiding my feelings from others to try to maintain a positive atmosphere. I am finding it more difficult to communicate with my husband.”
2. Mother of a child with lymphoma: “I spend a lot of energy questioning why and how it happened in the first place and overthinking the what ifs of the future.”

Study Information and Conclusions

In this analysis, a total of 73 parents or caregivers of a child with cancer were enrolled in an eSCCIP pilot or community-based trial in the mid-Atlantic US. Of them, 68.4% (n = 50; from 42 unique families) provided written responses for the ABC model.

Among responders, 78% were the mother or primary female caregiver and 20% were the father or primary male caregiver; the mean caregiver age was 38.36 years (SD, 8.93); and 90% were non-Hispanic/Latino. The child’s diagnosis was leukemia/lymphoma in 55%, a solid tumor in 31%, a brain tumor in 10%, and other in 5%.

Lead study author Julia B. Tager, PhD, of Nemours Children’s Health, and coinvestigators, highlighted that emotional and cognitive consequences of beliefs were primarily negative. They stated, “Additional study of eSCCIP is needed, particularly with diverse populations, including those not well represented in the current sample (e.g., males, minoritized racial/ethnic communities).”

References

Tager JB, Ramirez AP, Lewis AM, Canter K. Adversities, Beliefs, and Consequences reported by caregivers of children with cancer: qualitative reports from eSCCIP. Presented at the 2026 APOS Annual Meeting; March 18-20, 2026; New Orleans, LA. Poster W173.