COMMENTARY

Stress in Parents of Kids With Cancer

John M. Maris, MD

Disclosures

September 12, 2011

Editorial Collaboration

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Hi. My name is John Maris. I am the chief of the Division of Oncology at Children's Hospital in Philadelphia, and today I would like to talk to you about the psychological impact of childhood cancer, with a focus on the family, in particular the parents.

It is probably obvious that the diagnosis of cancer in a child is a psychologically stressful event for the family unit and that is not a surprise. However, maybe a little bit of a surprise is how well studied this issue is and what we have learned over the years about the impact, not only on the patient and the siblings, but [also on] the parents.

It is very interesting to know that, because cure rates have improved dramatically in childhood cancer in some almost difficult to understand ways, parents who have been studied over the years have demonstrated actually a positive experience. While there is obviously stress with this kind of diagnosis, this life-changing event also causes posttraumatic growth, the term used in the field, and many of these patients have a much more positive outlook on family and spiritual connections and other issues. Many parents turn out okay after going through the issue of childhood cancer even if it ends in the death of the child. They more commonly end up okay, of course, when the child does well and is a long-term survivor.

There is certainly a subset of patients who have significant temporary problems with the stress and need intensive psychosocial support through the diagnosis, treatment, and the whole journey through the cancer experience. However, it is not a debilitating stress and it is one that they can deal with.

There is a subset of parents, and the exact percentage is not well quantified, where true posttraumatic stress disorder (PTSD) occurs and needs to be identified and diagnosed. There are preexisting conditions that one can screen for to help identify parents at risk for PTSD, and these can be preexisting financial issues, preexisting family interaction issues such as divorce, and other stressors. Psychologists here at the Children's Hospital in Philadelphia have put together an assessment tool to help healthcare professionals identify parents at significant risk for PTSD.

Indeed PTSD, with all of the symptoms of hypervigilance and flashbacks to the diagnosis events, can plague some parents, regardless of the outcome for the child, for many, many years. This has to be recognized, by either the pediatric oncologist or the community family clinician as a possibility in parents that may occur with any childhood treatment for cancer. Those parents can benefit greatly from referral to a community mental healthcare provider.

PTSD is thankfully relatively rare in childhood cancer, but it is a definite known entity, and one that has to be recognized and screened [for]. Thank you for your attention.

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