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.