Psychological Problems in Children with Cancer in the Initial Period of Treatment

Maria Gerali, PhD; Marina Servitzoglou, MD, PhD; Dimitra Paikopoulou, PhD; Helen Theodosopoulou, PhD; Michael Madianos, MD, PhD; Helen Vasilatou-Kosmidis, MD, PhD


Cancer Nurs. 2011;34(4):269-276. 

In This Article

Abstract and Introduction


Background: The increasing survival rate of children with cancer because of more refined treatments makes necessary the investigation of psychological burden for the young patients.
Objective: The aim of the study was to evaluate the development of psychological problems in children with cancer during the initial 6-month period of intensive treatment.
Methods: This prospective, comparative study was conducted at one of the largest Greek pediatric oncology units in Athens. The sample comprised 132 children with cancer treated during a 30-month period and 100 children with no cancer as control group. Data were collected using the Rutter instruments for parents and teachers. For patients, it was completed by their parents at 1 (T1), 3 (T2), and 6 months (T3) from diagnosis and by teachers at T3. In the control group, the questionnaire was completed by teachers and parents once.
Results: The comparison of total Rutter scores for patients at T1, T2, and T3, according to parents' responses, showed statistically significant difference (P < .001). The difference in scores for patients (at T3) and control subjects was also significant according to both parents' (P < .00001) and teachers' (P < .001) responses. Children with leukemia had higher score reduction during treatment (P = .009) compared with the rest. Only age had a marginal impact on score of patients at T1 (R 2 = 0.04).
Conclusions: Based on parental reports, children treated for cancer develop psychological problems during the period of intensive treatment. The development and evolution of these problems depend on their age and type of cancer.
Implications for Practice: This information can be used for relevant interventions in specific groups.


Childhood cancer is a chronic, life-threatening disease, which is considered a crisis not only for the young patient, but also for his/her entire family and social environment. It is a traumatic experience for the child who must face numerous stressors, such as painful, invasive procedures; treatment-related physical adverse effects; and significant body changes.[1] The constantly improving survival rate of children with cancer in recent years, particularly those with a diagnosis of the most frequent type, leukemia, is reasonably attributable to the more refined but also more aggressive treatment.[2]

The period of disease and treatment is physically and emotionally stressful for the children and the families, who must adapt to a hospital environment with not only physical but also psychosocial challenges. Therapy often leads to disruption in normal family, social, and school life, separating the child from siblings, friends, and peers.

The child with cancer is coping concurrently with the emotional impact of diagnosis and the physical, social, and psychological effects of the disease and its treatment. The somatic pain, the lack of energy, and the fear of the unknown could compromise the quality of life of the child with a diagnosis of cancer.

Many studies, even from 1970, have focused on the psychological impact of cancer on the child and his/her family, and the field of pediatric psycho-oncology has significantly evolved.[3–5] Some reports describe an increased occurrence of psychological problems in children with cancer who present with social competence deficits and behavioral disturbances.[6,7] On the contrary, other research suggests a rather normal psychosocial adjustment of young patients, with only minor differences compared with children with no cancer.[8,9] Personality factors such as adaptive style seem to be much stronger predictors of their psychosocial adaptation than is health history.[10,11]

However, most studies have focused on the psychological functioning of survivors and the long-term effects of the disease, in specific subgroups of children with cancer, such as those undergoing allogeneic bone marrow transplantation.[8,9,12–14] Surprisingly, few studies have been conducted on the immediate impact of the disease in the psychological functioning of the child during ongoing cancer treatment. Research has provided evidence of emotional and social problems in children with cancer, who develop increased distress during the treatment period and seem to be influenced more by the psychosocial than the physical aspects of the disease.[15,16] Some other reports underline the impact of age at diagnosis on the behavioral adjustment of children with cancer during ongoing oncological treatment.[17]

It is important to evaluate the psychological adaptation of children during the acute phase of cancer and assess if their levels of distress are comparable with those of their healthy peers. The recognition of possible problems in their attitude, behavior, and relationships during treatment could guide the medical and nursing team to the appropriate intervention strategies and a more comprehensive care.

The primary aim of our study was to evaluate the development of psychological problems in children with newly diagnosed cancer during the initial 6-month period of their intensive treatment. Based on previous research findings in other countries, we hypothesized that children with cancer develop some psychological problems after the initiation of therapy. Our secondary aim was to examine the possible effect of age, sex, and subtype of cancer in the development and evolution of these psychological problems in children during treatment.


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