**5. Supportive care**

Supportive care describes the multidisciplinary care required to fulfill the needs of the patient and family in order to meet the physical, informational, psychosocial, emotional, practical, and spiritual needs during all phases of their cancer care [53]. The treatment of pediatric brain and spinal cord tumors is complex and every family is different, with variable needs throughout treatment. This requires a collaborative and multidisciplinary health-care team to effectively assess and address the required supportive care early during the stage of diagnosis or initial therapy [53, 54].

The supportive care needs of pediatric patients and their families include the physical (physiotherapy, occupational therapy, speech pathology, dietician, medical, pharmacy), education/informational (often met by nursing and medical team members), as well as psychosocial (social work, psychology, child life, psychiatry). It is important to reassure the family that the intense emotional reactions (including fear, powerlessness, denial, guilt, sadness, anger, confusion, anxiety, and depression) are normal responses to the child's illness and that the team is there to support and not judge them. Complete family assessment including psychosocial and practical resources, employment, socioeconomic status, as well as an assessment of marital-parental and sibling relationships should be studied and managed [54]. Misunderstanding may influence care [54].

#### **5.1. Informational needs**

Good communication by the health-care team, repetition of information, opportunities to ask questions, and written materials are important for assisting families. Gaining information about their child's condition allows parents to feel some control over the situation and regain some peace of mind. Psychosocial providers can assist families to manage feelings of infor‐ mation overload and problem solving according to the demands.

Parents may require guidance from the team regarding how and when to talk to their children, to do it so honestly and at an age-appropriate level, yet in a way that decreases anxiety and increases trust in the treatment process and team.

Normalizing activities as much as possible can be of great help in restoring a sense of safety and normalcy for children. Child life specialists can help to normalize daily activities. Once the child is discharged from the hospital, encourage parents to allow the child to live life as

normal as possible. Social and medical staff have to help the parents to overcome their own fears, and to allow patients to return to pre-illness activities within the restrictions of the illness with no overindulging or overprotecting [54].
