Psychological issues in childhood cancer survivors.

Anne E. Kazak, PhD. is a psychologist at the University of Pennsylvania and Children’s Hospital of Philadelphia in Philadelphia, Pennsylvania. Very little is known about the short and long-term psychological implications of surviving childhood cancer because the cure rates in pediatric oncology have only recently been so high. From research on adjustment to other types of chronic childhood disorders we know that there is considerable heterogenicity in affected children and their families. There is no one profile of reaction to chronic illness in these children and a similar diversity would be expected in childhood cancer survivors. Since the cancer is no longer present for these children, it is different in many ways from living with an ongoing chronic illness such as diabetes. However, for those childhood cancer survivors who have ongoing medical effects of treatment, some of the same psychological issues may be pertinent. For example, those survivors with learning impairments must, along with their families, establish long-term relationships with special education services. As with other types of disabilities, the child and family must cope with a chronic condition that requires perseverance and possible readjustment of goals and expectations. Therefore, the literature on the adaptation of the child and family’ to other chronic conditions may be useful in understanding their ongoing concerns and the ways in which they function in response to chronic stressors. One approach to understanding childhood cancer survivors is to consider children who have experienced other traumas or events, for example severe accidents or near drownings. In 1964, Solnit and Green identified the vuinerable child syndrome to describe children who survived accidents or diseases from which they were not expected to recover.’ The childrens’ reactions included a tendency to fantasize having died and returned, or of being a ghost or freak: Parents reported feeling that the children were both special and vulnerable. One of the challenges we face now is understanding both this vulnerability and specialness. In their well-known book, The Damocles Syndrome, Koocher and O’M alley report on the psychological adjustment of 117 childhood cancer survivors.’ The age range was 5 to 37 years, with the average age being 18 years. Using rating scales and measures of self-esteem, anxiety, and depression, these researchers found that slightly over half the