BACKGROUND
Pediatric cancer is a potentially life-threatening disease that severely affects the functioning of the entire family system1. Invasive procedures and painful adverse effects of the treatment increase the risk of psychological distress in children with cancer. The parents providing care for the children also feel both physically and mentally stressed, which reduces their capability to cope with new stress and may persist in their later lives2. Children depend on their parents for both physical and emotional needs, and impaired mental health of their parents can have a negative impact on their psychological growth and physical recovery2. Currently studies remain scarce that examine the psychological distress in families of children with cancer in China.
A previous study showed that posttraumatic stress symptoms (PTSS) were common among the parents participating in the caring of children with ongoing treatment for cancer4. A theoretical model demonstrated that PTSS of parents could affect PTSS levels in their children with cancer5. During cancer treatment, some families experience lasting damages of daily function, strained relationships and demands on family resources, which result in frequently disrupted family functioning6. Positive family functioning can protect children with cancer from developing PTSS7. About half of the individuals with posttraumatic stress disorder (PTSD) have concurrent major depressive disorder8. So far consistent findings have not been available regarding the prevalence of PTSD and depression in children with cancer and their parents. While some studies suggested that PTSD and depression occurred in around 30% in children with cancer and their parents7,9,10, other studies reported no elevated PTSD rates or PTSS levels in either the pediatric cancer patients11-16 or their parents17,18compared to healthy controls.
Understanding the impact of disease experience on PTSS in children with cancer may help in high risk screening for psychological stress. In children and adolescents with chronic physical illness, the association of the level of PTSS with the disease severity, duration of treatment and disease course remains elusive19,20 and needs to be defined. In addition to the psychological distress, pain is also one of the common symptoms of childhood cancer21,22, but currently how the fear of cancer pain contributes to the development of psychological trauma has not been fully explored.
The purpose of this study was to analyze the correlations among PTSS, depression and family functioning in families of children with cancer in comparison with healthy families, and explore the impact of disease experience on PTSS and the association between pain and PTSS in children with cancer. We hypothesized that (ⅰ) both parents and children in families of children with cancer had higher levels of psychological trauma than those in healthy families; (ⅱ) the parents’ PTSS and depression and family functioning were closely related to PTSS in the children; and (ⅲ) disease experience could affect PTSS, and pain intensity was positively correlated with PTSS in children with cancer.