Fact Sheet: Cancer in Children and Adolescents

Childhood cancers include various malignancies resulting from uncontrolled proliferation of cells in blood, bone, muscle, skin and the central nervous system (CNS). The causes of childhood cancers are largely unknown. These cancers are always life-threatening, and are a leading cause of death among children.

Prevalence and Course

Approximately 14,000 children are diagnosed in the US each year. Survival exceeds 80 percent overall but varies by diagnosis, stage and demographics. Treatments are intensive and multimodal (chemotherapy, radiation, surgery) and include experimental therapies. Cancer is a chronic condition; survivors often experience lifelong health issues related to cancer and its treatment despite being cured of cancer.

Health and Psychosocial Consequences

Although most children and families demonstrate competence and resilience, and some experience posttraumatic growth, concerns for physical and psychosocial quality of life remain. At diagnosis, parents, patients and siblings often experience acute stress. Patients on treatment may experience fatigue and sleep problems, pain, nausea, and anxiety. Normative developmental tasks/goals (e.g., school, peer relationships) are disrupted due to intensive and immunosuppressive treatment. Survivors are at risk for second cancers; almost 70 percent develop physical, potentially life-threatening, treatment-related late effects (e.g., cardiac and pulmonary problems), and/or cognitive late effects (e.g., attention and processing speed problems). Most survivors do not experience psychopathology but may have problems in psychosocial functioning (e.g., depression, anxiety, posttraumatic stress, social deficits) and delays in meeting developmental milestones; siblings and parents are also at risk for psychosocial problems. Parents whose children relapse are especially at risk for post-traumatic stress. Bereavement issues are prominent for surviving family members of the children who die. 

Evidence-based Assessment

Reflecting a social ecological context, relevant domains of assessment for the patient and family include family structure and resources, parental distress, acute stress/posttraumatic stress, and family functioning. Health behaviors, child behavior, adherence, health beliefs, pain, fatigue/sleep, nausea, and neurocognitive status are also important. The Psychosocial Assessment Tool (PAT) is a brief parent-report screener of psychosocial risk.

Culture, Diversity, Demographic, and Developmental Factors

Infants are at higher risk for long-term neurocognitive effects. Adolescents experience worse psychosocial outcomes and are less likely to receive support services, enroll in clinical trials, and be diagnosed early compared to younger patients. Minority patients have higher rates of relapse and mortality than White patients. 

Evidence-based Psychological Interventions

Cancer-specific evidence-based interventions and those used in other pediatric illnesses include cognitive-behavioral interventions for adherence, pain, and sleep; social skills interventions; and parental problem solving. The Surviving Cancer Competently Intervention Program targets traumatic stress and family adaptation. The Medical Traumatic Stress Toolkit provides healthcare providers with tools for preventive interventions. Systems-oriented consultation models focus on the child, family and medical team, and target interventions based on family risks and resources (e.g., the Pediatric Psychosocial Preventative Health model). 

References

Hocking, M.C., & Alderfer, M.A. (In press). Neuropsychological sequelae of childhood cancer. In S. Kreitler, M.W. Ben Arush, & A. Martin (Eds.), Pediatric psycho-oncology: Psychosocial aspects and clinical interventions, 2nd edition. Chichester, West Sussex: John Wiley & Sons, Inc.

Kazak, A. Rourke, M. et al. (2007). Evidence-based assessment, intervention and psychosocial care in pediatric oncology: A blueprint for comprehensive services across treatment. Journal of Pediatric Psychology, 32(9), 1099-1110.

Noll, R.B., & Kupst, M.J. (2007). Commentary: The psychological impact of pediatric cancer hardiness, the exception or the rule? Journal of Pediatric Psychology, 32(9), 1089-1098.

Vannatta, K., Salley, C.G., & Gerhardt, C.A. (2009). Pediatric oncology: Progress and future challenges. In M. Roberts & R. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 319-333). New York: Guilford.

Wiener, L., Pao, M., Kazak, A., Kupst, M.J. & Patenaude, A. (2009). Quick reference for pediatric oncology clinicians: The psychiatric and psychological dimensions of pediatric cancer symptom management. Charlottesville, VA: IPOS Press.