Mental Health and Childhood Cancer

The diagnosis and treatment of childhood cancer is a significant source of stress for the parents. They must shoulder the emotional and financial burdens of caring for a severely ill child. Even with increasing survival rates, cancer treatment requires prolonged, complicated, and intensive treatment protocols that can significantly affect the quality of life for the child as well as the whole family. It has been shown that mothers experienced a 40% increased rate of mental health-related outpatient visits compared with their peers. The prevalence of specific psychiatric conditions tends to differ among parents of children with cancer, ranging from 5% to 65% for anxiety and 7% to 91% for depression. Through significant correlation of mental health outcomes within families suggests that mental health needs in one member may justify the evaluation of the rest of the family.

Siblings need to be considered during the course of treatment of a child with cancer. Siblings often feel as though their needs are less important than those of their sick brother or sister, but they experience the same emotions in reaction to the diagnosis of cancer (shock, helplessness, sadness) plus jealousy because they do not have all of the doctors and staff worrying about their needs. The healthy sibling may feel isolated if parents spend a lot of time in the hospital, or the sibling has to spend time with friends or extended family throughout treatment. Disruptions in the sibling’s normal life and routines can lead to problems in school, behaviour issues, anger, or withdrawal. Hospital programs that include siblings in their programs and those that have specific programs for siblings are increasingly being developed 

Infants and toddlers mostly respond to how safe and comfortable they feel. Allowing the child the ability to maintain a secure attachment to their primary caregiver while in the hospital going through treatment is a priority; hence, caregiver “rooming in” has been a vast improvement in hospital care allowing them to continue to develop as normally as possible4.

Preschool children may believe that their cancer is a punishment for being bad and that the treatments and procedures are additional punishments. Family is still the core social interaction for children this age, so prolonged separations from family members can cause anxiety and be very difficult for the patient and the treatment team4. 

School age children can understand simple explanations of their cancer and learn the names of their medications and procedures. At this age, rules become very important, so having a diagnosis of cancer is disruptive and frustrating. Many children question why and can become confused or distressed because there are no identifiable causes of most childhood cancers. Missing school and disrupted friendships are common and upsetting since school and friends play such an important role in social development in this age group4.

The developmental issues facing teens include finding their identity, establishing independence, and seeking intimacy with peers which can be extremely difficult while having to endure cancer treatment. Another important concern for teens is physical attractiveness; losing hair, losing/gaining weight, and having scars can negatively impact a teenager’s self-esteem. They may be reluctant to have friends visit or may isolate themselves at a time when friends and peer groups are extremely important for social development4.