Psychological Adjustment

Most children who have cancer adjust well.

Cancer treatment is stressful on the child and the family. However, studies have shown that most children treated for cancer, and children who are long-term survivors of cancer, have few serious psychological problems.

The early days of treatment, when the child is often in the hospital, are usually the most stressful for the child and the family. The child may be anxious about being away from home and receiving new treatment. This anxiety usually decreases over time. Studies have reported that, in general, children treated for cancer have no differences from other children in self-esteem, hopefulness, depression, anxiety, or loneliness.

Children who have a lot of support from their family are less likely to have problems adjusting.

The type of cancer and the treatments used can affect adjustment.

Some of the factors that may increase the risk of social, emotional, or behavioral problems include:

• Having leukemia, lymphoma, or a cancer or treatment that affects the central nervous system (brain and spinal cord).
• Having a stem cell transplant.
• Having family problems.
• Being younger than school age during treatment.

Depression and Suicide

A small number of children may have problems that lead to depression or suicide.

Some studies have shown that physical and emotional distress related to cancer and its treatment can cause mental health problems in certain childhood cancer survivors. These problems include depression that needs treatment and can lead to suicide. Signs of depression include the following:

• Feeling empty, worthless, unloved, or that life isn’t worth living.
• Feeling nervous, restless, or irritable.
• Changes in appetite.
• Low energy.
• Sleep problems.
• Decreased interest in activities.
• Increased crying.

See the PDQ Supportive Care summary for more information about Depression in children.

Certain antidepressant medicines may cause suicidal thoughts or actions in children, teenagers, and young adults.

Drugs called SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease depression in young people. SSRIs usually have few side effects but they may cause suicidal thoughts or actions in young people (children, teenagers, and young adults). The Food and Drug Administration (FDA) has warned that young people up to age 25 who are taking SSRIs should be watched closely for signs that the depression is getting worse, especially suicidal thinking or behavior. Close monitoring is especially important during the first four to eight weeks of treatment. The patient, family, and health care provider should discuss the risks and benefits of using SSRIs to treat depression.

The side effects of SSRIs have not been studied in children, adolescents, or young adults with cancer.

It is important that survivors of childhood cancer have regular mental health check-ups as part of follow-up care.

Follow-up cancer care may be given by the cancer treatment doctor or the main provider, such as the family doctor. It is important that regular mental health check-ups be part of this follow-up care. A patient who shows signs of depression or other mental health problems during follow-up care may be referred to a therapist or other mental health specialist. Many survivors get help from therapists who are experts in helping people who are recovering from cancer.

Post-traumatic Stress Disorder and Symptoms

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs after serious physical injury or severe mental or emotional distress.

Being diagnosed with a life-threatening disease and receiving treatment for it is often traumatic. This trauma may cause a group of symptoms called post-traumatic stress disorder (PTSD). PTSD is defined as having certain symptoms following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others.

People who have survived very stressful situations, such as military combat or natural disasters, may also have PTSD. PTSD can affect cancer survivors in the following ways:

• Reliving the time they were diagnosed and treated for cancer, in nightmares or flashbacks, and thinking about it all the time.
• Avoiding places, events, and people that remind them of the cancer experience.
• Being constantly overexcited, fearful, irritable, or unable to sleep, or having trouble concentrating.

Family problems, little or no social support from family or friends, and stress not related to the cancer may increase the chances of having PTSD.

Because avoiding places and persons connected to the cancer is part of PTSD, survivors with PTSD may not get the medical treatment they need.

Childhood cancer survivors who are diagnosed with PTSD are more likely to have depression and to have difficulty with common aspects of young adulthood, such as doing well in school, taking part in social activities, and reaching career goals.

Children and teens with cancer, as well as parents and siblings, may be at risk for post-traumatic stress disorder.

In children and teens with cancer, symptoms of PTSD may occur during treatment or after treatment has ended. Those who feel very uncertain about their disease and future may be more likely to have PTSD symptoms. Parents and siblings (brothers and sisters) of childhood cancer survivors are also at high risk for PTSD.

It is important that cancer survivors and their families receive information about the possible psychological effects of their cancer experience and about early treatment of symptoms of PTSD.

Follow-up cancer care may be given by the cancer treatment doctor or the main provider, such as the family doctor. It is important that regular mental health check-ups be part of this follow-up care. A patient who shows signs of PTSD or other mental health problems during follow-up care may be referred to a therapist or other mental health specialist. Many survivors get help from therapists who are experts in helping people who are recovering from cancer.

The Web site of the National Cancer Institute (http://www.cancer.gov)