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.