Academic journal article Exceptional Children

Children Surviving Cancer: Psychosocial Adjustment, Quality of Life, and School Experiences

Academic journal article Exceptional Children

Children Surviving Cancer: Psychosocial Adjustment, Quality of Life, and School Experiences

Article excerpt

Each year nearly 8,000 children are diagnosed with some form of cancer (American Cancer Society, 1997). Thirty years ago few of these children were cured and issues relating to their education and overall quality of life were overshadowed by the need for improved medical treatment. Today with more than 60% of children diagnosed with cancer effectively cured by surgery, chemotherapy, radiation, or a combination of these treatments, childhood cancer has evolved from an inevitably fatal illness to a life-threatening chronic disease (Varni, Katz, Colegrove, & Dolgin, 1994). Data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute suggest that 70% or more of children diagnosed with cancer in 1990 would be 5-year survivors compared with only 28% in 1960 (Boring, Squires, & Tong, 1993). Therefore, in addition to traditional physiological endpoints in medical management of pediatric illness, a newly emerging body of research is focusing on the psychosocial and cognitive development of children with specific chronic illnesses (Brown, 1993). As such, parents and educators must learn to facilitate healthy emotional, social, and intellectual development during and after a child's treatment (Koocher & O'Malley, 1981).

In order to promote such growth, it is necessary to understand the difficulties encountered by these children. This study examined the psychosocial adjustment, quality of life, and school experiences of posttreatment survivors of pediatric cancer. A multimethod, multisource approach, including both quantitative and qualitative methodologies, was utilized to investigate the life experiences of the participants. This investigation also gave voice to survivors' views related to educational and psychosocial sequelae of treatment.


Investigations of the psychosocial consequences of childhood cancer have resulted in mixed findings. A number of studies suggest that youth who are diagnosed with cancer are at increased risk for a variety of psychosocial adjustment problems including poor self-esteem, poor self-satisfaction, less ambitious ideals, death anxiety, depression, poor social skills, school reintegration problems, and school phobia (Deasy-Spinetta, 1981; Futterman & Hoffman, 1970; Greenberg, Kazak, & Meadows, 1989; Varni, Katz, Colegrove, & Dolgin, 1994). Other researchers, however, found healthy levels of psychosocial adjustment among long-term survivors (Gray et al., 1992; Kazak, 1994; Noll, Bukowski, Davies, Koontz, & Kulkarni, 1993). It has been suggested that one possible explanation for these contradictory findings is the extreme heterogeneity of the participants in terms of diagnosis, age at diagnosis, intensity of treatment, and time since diagnosis (Varni, Blout, & Quiggins, 1998).


The assessment of quality of life (e.g., self-competence) provides an important outcome measure that complements physiological measures typically obtained. Such information can help provide the basis for designing educational interventions to enhance the lives of survivors of childhood cancer. However, a review of pediatric cancer clinical trial reports revealed that overall only 3% of the published findings were identified as including data related to issues of quality of life (Bradlyn, Harris, & Spieth, 1995). Unavailable until recently, the Pediatric Cancer Quality of Life Inventory-32 (PCQL; Varni, Katz, Seid, Quiggins, & Friedman-Bender, 1998) and the Miami Pediatric Quality of Life Questionnaire (MPQOLQ; Armstrong, Toledano, et al., 1999) are the only quality of life instruments appropriate for use with children with cancer. These multidimensional assessments incorporate psychosocial adjustment and scholastic competence.


Successful school experiences are a strong factor in providing a child with a feeling of normalcy. After nearly 2 decades of research there is no consensus about the long-term neuropsychological effects of childhood cancer treatments. …

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