Psychosocial functioning and friendship quality among school-aged pediatric brain tumor survivors

OBJECTIVE: Pediatric brain tumor survivors (PBTS) experience social difficulties, including fewer friendships. The presence or absence of a best friend may meaningfully reflect broader functioning. This study compared the psychosocial functioning of PBTS with and without best friends. METHODS: PBTS (N = 65; 55.4% female; 84.2% White; Mage= 10.12 ± 1.32; range 8-12) completed measures of psychosocial functioning. Parents completed measures of parenting practices. PBTS were asked to identify a best friend and describe their friendship. Survivor-reported best friends were contacted and reported on dyadic friendship quality. Analyses compared survivors' functioning based on the presence of a best friend and evaluated friendship quality ratings between survivors and their best friend. RESULTS: Twelve PBTS (18%) could not identify a best friend. PBTS without a best friend were more years off-treatment (p =.029), engaged in less prosocial behaviors (p =.007, d = 0.86), and indicated worse peer relations (p =.025, d = 1.00). Parents of PBTS without a best friend reported lower parental warmth behaviors (p =.035, d = 0.98). Of PBTS with a best friend, 43.4% reported their friendship developed after diagnosis and 61% identified meeting in school. Friendship quality only differed for PBTS and their best friend for companionship and recreation (p =.010, d = -0.63). CONCLUSIONS: PBTS with a best friend have high-quality friendships and differ in psychosocial functioning from those without a best friend. Targeting facilitative parenting behaviors, school engagement, and friendship could improve PBTS functioning. Emphasizing friendship in research and clinical care may ensure PBTS have the psychosocial support and skills needed to develop these relationships.