**6. PTSD and pediatric cancer**

The present search revealed few reports of cancer-related PTSD in pediatric patients.

#### **6.1 Results**

The search revealed only two studies assessed within the five-year mark with data regarding cancer-related PTSD (Landolt et al.,1998; Pelcovitz et al., 1998). However, due to the lack of studies, a third study that assessed PTSD at 5.3 years, was included (Kazak et al., 2004). The participants were less than 18 years of age at the time of these investigations, which all consisted of mixed cancer diagnoses. The sample sizes were 150, 7, and 23; the mean sample size was 60 with a median of 23 participants. The prevalence rates in these

survivors to be 13.7% for mothers and 9.6% for fathers. Lastly, an interesting finding in the literature demonstrating the parent-child relationship is that the ill child's psychological adjustment to his/her cancer diagnosis and treatment is highly correlated with the parents'

It has been estimated that for every person that dies five close friends or family members are affected (Zisook et al., 1998), therefore, the bereaved family and friends of cancer patients are at risk of developing psychological traumatic disorders as well as complicated grief. Indeed, the existing PTSD literature for the most part ignores bereaved individuals despite the fact that such individuals meet the A1 stressor criterion of the *DSM* (American Psychiatric Association, 1994). One of the few studies in this area investigated pre- and postloss bereavement levels of posttraumatic stress symptoms (intrusion and avoidance) in 50 partners of women with metastatic/recurrent breast cancer as well as the relationship of these symptoms to past, current, and anticipatory stressors (Butler et al., 2005). The data

significant PTS symptom levels prior to the patients' deaths; specifically, prior to loss, partners' symptoms were positively associated with their current level of perceived stress and anticipated impact of the loss. However, following the death of the loved one, partners' posttraumatic stress symptoms were predicted by higher pre-loss levels of symptoms, past

A more recent study investigated PTSD and PTSD predictors in bereaved individuals who had experienced the loss of a close relative to cancer and were attending counseling (Elklit et al., 2010). A total of 251 bereaved relatives, with ages ranging from 14 to 76 (M = 41.3), were recruited at a counseling service that assisted cancer patients and their relatives. The findings indicated that the prevalence of current PTSD was 40% in this sample. Furthermore, hierarchical logistic regression analysis showed that the following variables moderated the risk for PTSD: full-time employment, perceived control, and a secure attachment style. An extended period of caretaking as well as high levels of somatization and dissociation also were associated with an increased risk of PTSD (Elklit et al., 2010).

As parents become distressed over the condition of their child diagnosed with cancer, they likely will spend extended periods of time at home or in the hospital attending to the needs of that child. As the stress of the malignant disease process takes its biopsychosocial toll on the child and the parents, the time will come, undoubtedly, when the adults will not be able to physically and emotionally meet the needs of their other children in the family (Alderfer & Kazak, 2006). It is not surprising, then, that the siblings of children with cancer become increasingly at risk for affective, behavioral, and school problems (Aldelfer & Hodges, 2010; Alderfer et al., 2010). Siblings of children with cancer experience feelings of anger, fear, grief, guilt, helplessness, insecurity, jealousy, loneliness, loss, resentment, and shock, (e.g., McGrath, 2001; Nolbris et al., 2007; Woodgate, 2006). Furthermore, investigations examining sibling distress increasingly indicate that a marked subset of siblings with a brother or a

One study investigated whether 78 adolescent siblings of childhood cancer survivors experience posttraumatic stress; the participants completed self-report measures of anxiety,

adjustment to their child's diagnosis and treatment (Ljungman et al., 2003).

indicated that 17 (34%) of the bereaved partners experienced clinically

sister with cancer display post-traumatic stress (PTS) symptoms.

family deaths, and anticipated impact of the loss.

**7.3 The forgotten children: Siblings** 

**7.2 The bereaved** 

studies for current cancer-related PTSD were documented as ranging from 4.7% to 71%; the mean prevalence rate was 31% with a median of 17%. It must be pointed out that the prevalence rate finding of 71% comes from a study with a small sample size of only seven participants who were identified as "newly diagnosed." Therefore, the possibility that this assessment may have occurred within the first month of diagnosis calls into question the appropriateness and validity of these data. Unfortunately, the small number of studies in this area of current PTSD prevalence as well as the questionable data provided limit the scope of this review; therefore, conclusions about prevalence rates in this population are prohibitive at this time.
