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    When cancer strikes a family: Psychosocial issues in pediatric oncology

    A child’s cancer diagnosis affects his or her entire family, and presents psychosocial issues that the community pediatrician needs to assess and treat for the total well-being of the child, siblings, and parents.

     

    4. Develop proactive parenting skills. There are a number of things that the pediatrician can suggest to parents to reduce the negative impact of their illness and reduce stress:22

    ·      "Fear of the unknown" can create significant anxiety in children. To the best of their ability parents should be encouraged to explain what is going to happen at a visit or hospitalization.

    ·      "Rehearsal" can help decrease fear and anxiety. Just seeing the hospital ward may help decrease fear over an upcoming hospitalization.

    ·      Spending time with other children with cancer can make their child seem more normal.

    ·      Talking with their child about their cancer so that the child will comfortable bringing issues up.

    ·      Encouraging parents to identify their child's strengths so that they can support and encourage things their child does well despite their chronic illness.

    ·      Promote autonomy when possible. Small things, such as choosing the arm from which to have blood drawn, determining when a procedure will occur, or identifying a reward for cooperating, can help children feel in control.

    5. Think developmentally. When trying to help patients, parents, and families of children with cancer, a developmental approach is appropriate. See Table 2.

    6. Be an education resource for the families’ support network. Parents often report ineffective support, and the pediatrician can help these groups improve their knowledge of how to be supportive. Parents report help with housecleaning, childcare, providing ready-to-make meals, and running errands, such as shopping for groceries and picking up prescriptions, as some of the most helpful things their support network could do.

    Next: Puppy brigade reports for duty

    7. Address the needs of siblings. The pediatrician has an opportunity to talk with siblings about the impact a sibling’s illness is having on them and address any issues with parents.

    In conclusion

    Although standards of care for psychosocial assessment and treatment exist for children with cancer and their families, implementation remains suboptimal. The community pediatrician will likely need to address a broad range of psychosocial needs in their patients.

    References

    1. Kazak AE, Abrams AN, Banks J, et al. Psychosocial assessment as a standard of care in pediatric cancer. Pediatr Blood Cancer. 2015;62 suppl 5:S426-S459.

    2. Wiener L, Kazak AE, Noll RB, Patenaude AF, Kupst MJ. Standards for the psychosocial care of children with cancer and their families: an introduction to the special issue. Pediatr Blood Cancer. 2015;62 suppl 5:S419-S424.

    3. Marcus J. Psychosocial issues in pediatric oncology. Ochsner J. 2012;12(3):211-215.

    4. Brand S, Wolfe J, Samsel C. The impact of cancer and its treatment on the growth and development of the pediatric patient. Curr Pediatr Rev. 2017;13(1):24-33.

    5. Hosoda T. The impact of childhood cancer on family functioning: a review. Graduate Student J Psychol. 2014;15:1-28.

    6. Long KA, Marsland AL. Family adjustment to childhood cancer: a systematic review. Clin Child Fam Psychol Rev. 2011;14(1):57-88.

    7. Massimo LM, Wiley TJ. Young siblings of children with cancer deserve care and a personalized approach. Pediatr Blood Cancer. 2008;50(3):708-710.

    8. Nolbris M, Enskär K, Hellström AL. Experience of siblings of children treated for cancer. Eur J Oncol Nurs. 2007;11(2):106-112.

    9. Scialla MA, Canter KS, Chen FF, et al. Implementing the psychosocial standards in pediatric cancer: current staffing and services available. Pediatr Blood Cancer. 2017;64(11):e26634.

    10. Mooney-Doyle K, Dos Santos MR, Szylit R, Deatrick JA. Parental expectations of support from healthcare providers during pediatric life-threatening illness: a secondary, qualitative analysis. J Pediatr Nurs. 2017;36:163-172.

    11. Kosco M, Warren NA. Critical care nurses' perceptions of family needs as met. Crit Care Nurs Q. 2000;23(2):60-72.

    12. Nilsson J, Jervaeus A, Lampic C, et al. “Will I be able to have a baby?” Results from online focus group discussions with childhood cancer survivors in Sweden. Hum Reprod. 2014;29(12):2704-2711.

    13. Pai AL, Patiño-Fernández AM, McSherry M, et al. The Psychosocial Assessment Tool (PAT2.0): psychometric properties of a screener for psychosocial distress in families of children newly diagnosed with cancer. J Pediatr Psychol. 2008;33(1):50-62.

    14. Kazak AE, Schneider S, Didonato S, Pai AL. Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT). Acta Oncol. 2015;54(5):574-580.

    15. Patel SK, Mullins W, Turk A, Dekel N, Kinjo C, Sato JK. Distress screening, rater agreement, and services in pediatric oncology. Psychooncology. 2011;20(12):1324-1333.

    16. Haverman L, van Oers HA, Limperg PF, et al. Development and validation of the distress thermometer for parents of a chronically ill child. J Pediatr. 2013;163(4):1140.e2-1146.e2.

    17. Koschwanez HE, Kerse N, Darragh M, Jarrett P, Booth RJ, Broadbent E. Expressive writing and wound healing in older adults: a randomized controlled trial. Psychosom Med. 2013;75(6):581-590.

    18. Pennebaker JW, Colder M, Sharp LK. Accelerating the coping process. J Pers Soc Psychol. 1990;58(3):528-537.

    19. Stanton AL, Danoff-Burg S, Sworowski LA, et al. Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. J Clin Oncol. 2002;20(20):4160-4168.

    20. Elgar FJ, McGrath PJ. Self-administered psychosocial treatments for children and families. J Clin Psychol. 2003;59(3):321-339.

    21. Theofanidis D. Chronic illness in childhood: psychosocial adaptation and nursing support for the child and family. Health Sci J. 2007;1(2):1-9.

    22. American Academy of Pediatrics. Living with a chronic illness or disability. Available at: https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Coping-With-Chronic-Illness.aspx. Updated November 21, 2015. Accessed January 19, 2018.


    Pat F Bass III, MD, MS, MPH
    Dr Bass is Chief Medical Information officer and professor of Medicine and of Pediatrics, Louisiana State University Health Sciences ...

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