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Amp A0035695 PDF
Childhood cancers are life-threatening diseases that are ments on children and their families in the short and long
universally distressing and potentially traumatic for chil- term are among the most prominent accomplishments in
dren and their families at diagnosis, during treatment, and pediatric psychology. Subsequent to an introduction to
beyond. Dramatic improvements in survival have occurred pediatric cancer, we present key accomplishments of psy-
as a result of increasingly aggressive multimodal therapies chologists in pediatric cancer. We conclude with a discus-
delivered in the context of clinical research trials. None- sion of the translation of research into practice, including
theless, cancers remain a leading cause of death in chil- current challenges for assuring a sustained collaboration
dren, and their treatments have short- and long-term im- and integration of psychological science and practice in
pacts on health and well-being. For over 35 years, pediatric oncology.
pediatric psychologists have partnered with pediatric on-
cology teams to make many contributions to our under- Prevalence, Incidence, and Etiology
standing of the impact of cancer and its treatment on of Pediatric Cancer
children and families and have played prominent roles in
providing an understanding of treatment-related late ef- Cancer is the leading cause of death by disease in children.
fects and in improving quality of life. After discussing the Nearly 12,500 children under the age of 20 (11,000 under
incidence of cancer in children, its causes, and the treat- age 15) are diagnosed in the United States annually (Na-
ment approaches to it in pediatric oncology, we present tional Cancer Institute, 2013b), with the most common
seven key contributions of psychologists to collaborative types of cancer in children being leukemias (blood cell
and integrated care in pediatric cancer: managing proce- cancers, 37%), brain and other central nervous system
dural pain, nausea, and other symptoms; understanding (CNS) tumors (25%), and lymphomas (24%; Ries et al.,
and reducing neuropsychological effects; treating children 1999). These cancers are very different from those typi-
in the context of their families and other systems (social cally seen in adults, in whom carcinomas are the most
ecology); applying a developmental perspective; identify- common. For many adult cancers, the incidence is much
ing competence and vulnerability; integrating psychologi- higher in Blacks than in Whites; for childhood cancers, the
cal knowledge into decision making and other clinical care incidence rates are higher for Whites than for Blacks,
issues; and facilitating the transition to palliative care and Hispanics, or American Indians (Ries et al., 1999).
bereavement. We conclude with a discussion of the current Cancer in children, unlike many adult cancers, does
status of integrating knowledge from psychological re- not typically result from behavior or the milieu of the
search into practice in pediatric cancer. children or their parents. Pediatric cancers are rare diseases,
Keywords: pediatric oncology, childhood cancer, adjust-
ment, psychosocial, intervention Editor’s note. This article is one of 13 in the “Cancer and Psychology”
special issue of the American Psychologist (February–March 2015). Paige
P sychologists have conducted research in pediatric Green McDonald, Jerry Suls, and Russell Glasgow provided the scholarly
cancer settings since the 1970s, investigating, for lead for the special issue.
example, the psychological impact of isolation
rooms (Kellerman et al., 1976) and describing communi- Authors’ note. Anne E. Kazak, Center for Healthcare Delivery Science,
Nemours Children’s Health System, Wilmington, Delaware, and Depart-
cation among patients, families, and staff and early models ment of Pediatrics, Thomas Jefferson University; Robert B. Noll, Depart-
of consultation, with insight into issues in evidence-based ments of Pediatrics, Psychiatry, and Psychology, University of Pittsburgh,
care that persist today (Kupst et al., 1982; O’Malley & Chair, Behavioral Science Committee, Children’s Oncology Group.
Koocher, 1977). Cancer is one of the very first areas in The authors contributed equally to the preparation of this article.
which pediatric psychologists established themselves. Correspondence concerning this article should be addressed to Anne
E. Kazak, Center for Healthcare Delivery Science, Nemours Children’s
Their accomplishments in understanding the demands of Health System, Administration and Research Building, Room 291, A. I.
treatment and developing treatment approaches to prevent duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE
or reduce the impact of these serious illnesses and treat- 19803. E-mail: anne.kazak@nemours.org
Note. Adapted from “Pediatric Psychosocial Preventative Health Model (PPPHM): Research, Practice, and Collaboration in Pediatric Family Systems Medicine” by
A. E. Kazak, 2006, Families, Systems, & Health, 24, p. 385. Copyright 2005 and 2011 by the Center for Pediatric Traumatic Stress, The Children’s Hospital of
Philadelphia.
ent distress) and promote more adaptive adjustment across That is, given the life threat associated with a diagnosis of
the family system. At the top of the pyramid are families childhood cancer, traumatic stress responses are normative,
with more severe problems, many pre-existing risk factors not pathological. Traumatic stress responses include psy-
(e.g., child or parent psychopathology, child behavior prob- chological and physiological reactions of children and their
lems), and few resources (the Clinical level, ⬍ 10%) who families to pain, injury, medical procedures, and invasive
generally warrant multipronged intensive evidence-based or frightening treatment experiences. Traumatic stress re-
treatments. Factors contributing to classification at a level sponses are more common for parents than for patients.
of risk can change over time, resulting in potential changes Although posttraumatic stress symptoms are common in
in PPPHM risk levels and interventions. mothers and fathers of children with cancer across the
The Psychosocial Assessment Tool (PAT) is a brief spectrum from diagnosis through survivorship (Kazak,
parent-report screener based on social ecological theory Schneider, & Kassam-Adams, 2009), diagnoses of post-
which maps on to the PPPHM and generates a trilevel traumatic stress disorder are more rare. Significant trau-
classification of families into Universal, Targeted, or Clin- matic stress responses have also been found in siblings,
ical risk. The PAT has strong psychometric properties and across two independent studies (Alderfer, Labay & Kazak,
excellent sensitivity and specificity for child behavior and 2003; Kaplan, Kaal, Bradley, & Alderfer, 2013), and there
parent stress (Pai et al., 2008), and risk classification is is also evidence of posttraumatic growth for survivors
consistent with that of the PPPHM (McCarthy et al., 2009) (Zebrack et al., 2012) and parents (Barakat, Alderfer, &
and generally stable across treatment (Alderfer et al., Kazak, 2006).
2009). It is feasible to screen with the PAT within 48 hours Despite the obvious challenges and trauma, the prev-
of a child’s diagnosis (Kazak, Barakat, Ditaranto, et al., alence of psychosocial dysfunction in youth with cancer
2011), and there is evidence that families screened with the (i.e., psychopathology or social dysfunction) is similar to
PAT were provided psychosocial care consistent with their that found in the general population when appropriate
psychosocial risk (Kazak, Barakat, Hwang, et al., 2011). comparison groups are used (Noll & Kupst, 2007). Cancer
Also consistent with a competency-based approach to survivorship research has increasingly suggested that can-
cancer-related stress is a medical traumatic stress model. cer survivors exhibit remarkable psychological resilience