Psychological care during the treatment phase

During treatment, children may experience various side effects, such as nausea, vomiting, hair loss, and skin irritation. When a child receives a corticosteroid, such as dexamethasone, psychological side effects may also occur, including:

• Changes in behavior and mood, such as sadness or irritability

• Sleep problems, such as difficulty falling asleep or waking up more easily

• Increased appetite

Physical changes, such as hair loss, a feeding tube, or a swollen face, can be particularly difficult for adolescents. They often experience feelings of shame and sadness.

It is important for children to experience a sense of control during treatment. This can be strengthened by providing predictability and giving children a say in medical procedures. Child life specialists play an important role in this and support children using techniques such as focus language, which is distracting and reinforcing language, medical hypnosis, or virtual reality for preparation and distraction during procedures.

Especially teenagers may think more about the meaning of their illness during this phase, which can evoke feelings of grief and loss and affect their self-image.

Adjustment and psychological care

Children often adapt well to hospital routines. Research shows that children with cancer generally adjust just as well as their healthy peers. Children with brain injury or amputations do have a higher risk of long-term adjustment problems. Regular monitoring of quality of life is therefore important.

Psychological treatment during this phase may include play therapy for younger children or cognitive behavioral therapy. Online courses such as Op Koers, based on the Thinking-Feeling-Doing model, and iSleep for sleep problems, also offer support.

Children may become angry or disappointed by the limitations caused by their illness and treatment, such as long hospital stays or a weakened immune system. When their medical condition allows it, children are advised to return to school as soon as possible, even though this can feel stressful for both children and parents. School plays a crucial role in children’s social and cognitive development. The school at the Princess Máxima Center supports this by continuing education and maintaining involvement with the child’s own school.

Children who are able to attend school between treatments may sometimes feel different from other children because of what they have been through, changes in their appearance, or because they become tired more quickly than classmates. Children with a brain tumor may also notice that it is more difficult to keep up cognitively at school. Children who feel supported by teachers, parents, and friends experience fewer psychosocial problems and have higher self-esteem.

During treatment, children who have an increased risk of neuropsychological problems are assessed and monitored at fixed moments through neuropsychological follow-up.

Literature

Grootenhuis, M.A., Aarsen, F., & Van den Bergh, E. (2001). Pscyhologische behandeling bij kinderen met kanker. In S. Duijts, R. Sanderman, M. Schroevers, & T. Vos (Eds.), Psychologische patiëntenzorg in de oncologie (pp. 323-334). Uitgeverij Van Gorcum.

Michel, G., Brinkman, T. M., Wakefield, C. E., & Grootenhuis, M.A. (2020). Psychological outcomes, health-related quality of life, and neurocognitive functioning in survivors of childhood cancer and their parents. Pediatric Clinics of North America, 67(6), 1103-1134. https://doi.org/10.1016/j.pcl.2020.07.005

Scholten, L., Willemen, A. M., Last, B. F., Maurice-Stam, H., Van Dijk, E. M., Ensink, E., Zandbelt, N., Van der Hoop-Mooij, A., Schuengel, C., & Grootenhuis, M. A. (2013). Efficacy of psychosocial group intervention for children with chronic illness and their parents. Pediatrics, 131(4), e1196-e1203. https://doi.org/10.1542/peds.2012-2222

Van Schoors, M., Caes, L., Verhofstadt, L. L., Goubert, L., & Alderfer, M. A. (2015). Systematic review: Family resilience after pediatric cancer diagnosis. Journal of Pediatric Psychology, 40(9), 856-868. https://doi.org/10.1093/jpepsy/jsv055