OBJECTIVE: First, we sought to determine if parents of children with cancer or a 
brain tumor had greater stress compared to parents of healthy children and to 
evaluate the correlates of stress among parents of children with cancer or brain 
tumors. Second, we sought to examine the relationship between perceived stress 
and symptoms of stress and how that relationship may differ for parents of 
children with cancer.
METHODS: In-person, interviewer-assisted surveys were administered to 73 case 
dyads (children with cancer or a brain tumor and their parents) and 133 
comparison dyads (children without health problems and their parents from a 
community sample). Descriptive analyses and multivariable logistic regressions 
were performed for case-comparison and case-only analyses to distinguish 
correlates of parental stress.
RESULTS: Parents of children with cancer exhibited higher levels of 
physiological symptoms of stress than parents of healthy children. Poor sleep 
quality and greater social stress (negative social interactions) were 
significant correlates of increased levels of stress in parents of children with 
cancer (odds ratio 4.23, 95% confidence interval 1.15-15.60; and odds ratio 
1.07, 95% confidence interval 1.00-1.14, respectively). A subset of parents 
reported symptoms of stress but not perceived stress, and this discordance was 
more pronounced among cancer caregivers.
CONCLUSIONS: Implementation of screening tools that include symptoms of stress 
may help clinicians to comprehensively identify parents of children with cancer 
who are in need of additional services. Targeted stress-reduction interventions 
that address sleep quality and negative social interactions may mitigate the 
deleterious effects of caregiving, improving the psychosocial well-being of both 
parents and children with cancer.