Background

The diagnosis of pediatric cancer is one of the most stressful situations a child or an adolescent and family will face. It presents an overwhelming series of stressors, not the least of which is the possibility of the patient’s death. Although the survival rate for childhood cancer has improved significantly, the treatments remain lengthy and intensive, involving fundamental changes in the patient and family’s lives. Today, it is well known that a multidisciplinary approach to management should include psychosocial support services from the time of diagnosis to ensure maximum quality of life.

The provision of adequate information and the development of ongoing support will enable patients to grow and develop in preparation for entry into adult life, and to achieve their full potential. Psychosocial support should be an integral part of the total management of all patients. 

Management of children and adolescents with cancer requires the participation of a multidisciplinary team – the physician working with other specialists: nursing staff, psychologist/psychiatrist, social worker, teachers, recreation specialists and members of different health care disciplines as the need arises. Physicians should incorporate such consultations in the plan of treatment and, ideally, the multidisciplinary approach should be introduced in the routine of the patient immediately after the diagnosis is confirmed. Into practice, however, the multidisciplinary approach will become effective only through a carefully shared process in which all professionals perform their roles in a way that patient and family benefit from the interaction of all professional interventions.

The multidisciplinary approach

• Facilitates all necessary assistance to the patient and family, guarantees better adherence to the treatment and promotes the development of research;
• Determines the assistance needed to deal with the subjective dimension that the practice of modern medicine requires;
• Anticipates a perspective whose concept of health focuses not only on the absence of the disease, but also on quality of life.

Lack of a sophisticated psychosocial support structure in a hospital setting is not a reason to avoid or eliminate this crucial component of cancer care. In the absence of a dedicated professional, the physician in charge of the patient’s care should be the leader. Health organizations and authorities should be sensitive to psychosocial issues in order to provide adequate resources to oncology centers in order to enable them to offer integral assistance to patients and families through multidisciplinary treatment. We have the responsibility to increase this discussion through the involvement of others in the multidisciplinary approach with the intent of integrating it into public health policy.

Initiatives

1. Prepare a survey to be mailed to all INCTR members to investigate the organization of the psychosocial intervention in collaborating Pediatric Oncology Centers in order to exchange information regarding the various types of psychosocial support programs that currently exist (or not) in various centers. One of the goals is to identify programs that could become models for emulation or imitation, which centers could promote training opportunities, etc.
2. Develop documents (guidelines, recommendations) for psychological and social management and support in Pediatric Oncology.
3. Propose collaborative studies.
4. Invite the participation of interested professionals.
5. Extend the program to adults.

Claudia Lancman Epelman
and Doug Ennals
INCTR Psychosocial Program