Northeast Florida Medicine
Vol. 66, No. 2 2015
27
Pediatric Oncology
Introduction
Pediatric cancer is, without a doubt, one of the most
challenging stressors a family can experience. It is estimat-
ed that approximately 15,000 new cases of cancer were
diagnosed in 2014 in children and adolescents between the
ages of birth-19 years in the United States.
1
In addition, as
of 2010, it is projected that there are more than 375,000
survivors of pediatric malignancies living in the U.S.
2
While
great advances have been made in the treatment of pediatric
malignancies, much work still remains on addressing its
initial and lingering impact.
Researchon theways anddegrees towhich a pediatric cancer
diagnosis affects families show the results to be highly variable.
For somepatients and families, the impact is relativelyminimal,
while for others it is a tremendously disruptive event. Factors
that play a role include extent of the illness and likelihood for
a good outcome, presence of other family stressors, parental
dynamic, level and structure of family support, and overall
experiencewith the healthcare system, eitherwithprior family
illnesses or the current cancer diagnosis.
1
In addition, a pediatric malignancy can have different
impacts within the family on the patient, the parents, and
siblings. Thus, ongoing research has sought to understand
this impact both on each family member individually and
as a whole.
Impact on the Pediatric Patient
While a cancer diagnosis is stressful in nature, research
has shown it can elicit a highly variable response in the
pediatric patient: from social and emotional distress and
maladjustment, to personal growth and ultimate resilience.
3
Sources of distress include painful procedures, side effects
during treatment, time away from friends and social
activities, hospitalizations, and the uncertainty of cure.
4
The variability in the response for children diagnosed
with cancer has led to research on factors associated with
each outcome.
Several studies have highlighted the family environment
on patient distress. Pediatric cancer patients who are raised
in high conflict families have been shown to exhibit more
difficulties with adjustment and internalizing their vulnera-
bilities.
5,6
In contrast, children of families with less frequent
conflict, open expression and dialogue, and a nurturing
atmosphere, more often exhibit resilience.
5,7
Unfortunately,
even in the best of families, a cancer diagnosis has been
shown to be disruptive to the traditional dynamic, making
it important to screen families for signs of distress not
only at the time of diagnosis, but throughout the process.
In an important study on child adjustment to pediatric
cancer, Robinson et al examined several factors including
patient age, gender, health status, and severity of treat-
ment.
2
Families with a child diagnosed with cancer were
compared with matched pair families of otherwise healthy
children. Their results showed that children below the age
of ten were more vulnerable to distress than older children,
particularly if the father was also struggling with distress.
2
Older children were less affected by parental distress as
they relied more on their peer networks for support.
Males were also more affected by perception of a father’s
stress and more likely to internalize their feelings in this
situation. Children of both genders and all age levels were
not as affected by maternal stress levels. Most importantly,
for every category analyzed, results consistently showed
the impact of any stressor was mitigated in families with
a cohesive structure and positive family environment.
2
Impact on Parents
At the time of diagnosis, parents of children with cancer
are reported to experience higher levels of anxiety, depression,
and loneliness compared to children diagnosed with other
acute and chronic illnesses.
8
Other common symptoms
include shock, rumination, difficulty coping, and sense of
loss of control.
9
Symptoms often appear more pronounced
in mothers, who are reported to have more difficulty inter-
nalizing their emotions compared to fathers.
10
Fathers, in
contrast, appearmore affectedby perceptions of their children
internalizing their symptoms and feelings.
2
In additions,
higher stress reactions are seen in parents with less formal
education and in a lower socioeconomic status.
10
The Impact of Pediatric Cancer on Families
By Cynthia Anderson, MD
Address correspondence to:
Cynthia Anderson, MD
Department of Radiation Oncology
Baptist Health System
1235 San Marco Boulevard
Jacksonville, FL 32207
Telephone: 904-202-7020
Fax: 904-202-7029
