DISCUSSION
As consistent with previous studies11-13, we found
that the parents of children with cancer endorsed PTSS more than the
parents of healthy children. In the parents of children with cancer, the
prevalence of severe PTSS (21.98%) in this study is comparable with
that of PTSD (22%) at 4 months after the children’s
diagnosis28, but higher than that of PTSD (17%) at 12
months or later after the diagnoses using the same scales with the same
cutoff score of 5029. This discrepancy may arise from
the different lengths of time after cancer diagnosis, as the parents are
particularly at risk for PTSS in the first year of their children’s
cancer diagnosis29. We noted that the parents of
children with cancer reported more severe depression and poorer general
family functioning than those of healthy children, which is consistent
with previous findings31,32. A previous study found
that more than 90% of families of children with cancer reported
unhealthy functioning in all dimensions of FAD, with the general family
function rated as the unhealthiest33. Caring for a
child with cancer may trigger depression in the parents, which leads to
ill family functioning.
Our results suggested that children with cancer had no elevated levels
of PTSS relative to healthy children of a similar age, in contrast with
the result of a previous study that reported psychological trauma
resulting from childhood cancer7. But our results are
supported by other studies that have included healthy
controls11-16, suggesting that posttraumatic stress is
less applicable in the context of psychological responses of children
with ongoing cancer treatment, and being diagnosed with pediatric cancer
might be considered more as a difficult but manageable stressor than a
major traumatic event34. Children are too young to
feel the psychological stress of cancer, while their parents may
experience more psychological trauma and are at higher risks of
developing severe PTSS.
In pediatric cancer families, parents’ PTSS and depression were
correlated with children’s PTSS, which is supported by findings in
pediatric oncology population5,35. However, this
correlation does not exist in healthy families, possibly due to the fact
that cancer families share the same stressful experience following a
cancer diagnosis and during the treatment. The long and painful process
of cancer treatment binds the entire family emotionally. We also found
that PTSS in the parents of children with cancer was related to their
depression and general family functioning, which is consistent with
previous studies29,36. Poor family functioning often
produces an adverse impact on the parents’ psychology, and PTSS is
associated with an increased risk of depression in the parents. The
children’s PTSS is correlated with family functioning, which underlines
the importance of supporting the whole family system in the event of
pediatric cancer diagnosis.
We did not find significant correlation between PTSS and disease
experience in the children with cancer. Currently no relevant studies
that examine the variables of disease experience have been available,
and the impact of disease experience on PTSS in children with cancer
still awaits further investigation by studies with larger sample sizes.
In children with cancer, the severity of PTSS is reported to be
independent of the treatment responses or the length of time after
diagnosis19. PTSS is associated more with such
personality factors and traits as adaptive style, rather than the
history of health
conditions14. Presumably, the disease experience
increases the vulnerability of the children to life challenges instead
of directly leading to PTSS.
Pain reported by children with cancer is related to
PTSS37, but the nature of this relationship remains
unclear. Children normally do not fully understand the significance of a
cancer diagnosis, but the pain caused by cancer treatment has an
intuitive psychological impact. Children are more sensitive to the
feeling of pain than to the disease experience of cancer, suggesting the
importance of effective pain management in order to alleviate the
traumatic experiences. Patient-controlled analgesia or authorized
agent-controlled analgesia is safe, timely, and acceptable to children,
which can achieve the best balance between effective pain management and
adverse reactions38.