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Journal of Clinical Oncology, Vol 24, No 14 (May 10), 2006: pp. 2216 © 2006 American Society of Clinical Oncology. DOI: 10.1200/JCO.2006.05.5822
Post-Traumatic Stress Symptoms During Treatment in Mothers of Children With LeukemiaDepartment of Developmental and Social Psychology, University of Padova, Padova, Italy
Pediatric Oncoematology Clinic, Department of Pediatrics, University of Padova, Padova, Italy To the Editor: The Journal of Clinical Oncology recently published an important study by Kazak et al1that shows that 99% of parents of children under treatment for different types of cancer suffer from post-traumatic stress disorder (PTSD). The same study reports that the intensity of the child's therapy does not affect parental PTSD, that time from the diagnosis is only marginally related to PTSD, and that 83.8% of mothers and 75.5% of fathers of long-term childhood cancer survivors have PTSD.2 We wish to present here preliminary findings from an ongoing Italian study that do not support these catastrophic findings. Participants were 58 Italian mothers (mean age, 37.1 years) of children receiving treatment for acute lymphoblastic (n = 45; 77.6%) or myeloid (n = 13; 22.4%) leukemia. Most had high-school (n = 31; 53.4%) or compulsory education (n = 19; 32.8%) and 32 (55.2%) were working mothers. There were 12 low socioeconomic status (SES) families (20.7%), 28 medium-SES families (48.3%), and 18 high-SES families (31.0%). Of the patients, 30 (51.7%) were boys. Children's ages ranged from 9 months to 17 years (mean, 5.48 years; standard deviation, 4.05 years).
PTSD symptoms were measured by a 17-item checklist. Scales assessing anxiety, depression, cognitive functioning, and life evaluation were also used. The instruments are drawn from the Childhood Cancer Survivor Study (CCSS)3 and are available on the CCSS Web site, http://www.cancer.umn.edu/ltfu. Instruments showed good psychometric properties for the Italian sample (
Preliminary analyses showed that child age and sex, parental education and employment, and family SES did not affect mothers' PTSD symptoms. The main result is that in the Italian sample, only 20 mothers (34.5%) of 58 have full PTSD. The The rationale for presenting these findings from an ongoing study is that they invite for optimism. In our sample of 58 Italian mothers of children under treatment for leukemia, only 20 mothers (35.4%) had stress symptoms suggestive of a full PTSD diagnosis, and symptoms were stable after 6 months in a subsample. Because the results of Kazak et al1were not replicated, the outcomes of the present study draw our attention on the larger context of the medical care for pediatric cancer, including family, social, and cultural factors. Our results may be related to the typically close-knit structure of the Italian families, which, in times of crisis, can provide notable emotional as well as practical support to their members. It may be hypothesized that such support empowers the parents' positive cognitive functioning, which seems to be the best early protective factor against later PTSD symptoms. We suggest that cross-cultural research on the psychosocial aspects of childhood cancer should be encouraged. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. ACKNOWLEDGMENTS Supported by the foundation La Città della Speranza. REFERENCES
1. Kazak AE, Boeving CA, Alderfer MA, et al: Posttraumatic stress symptoms during treatment in parents of children with cancer. J Clin Oncol 23:7405-7410, 2005 2. Kazak AE, Barakat L, Alderfer M, et al: Posttraumatic stress in survivors of childhood cancer and mothers: Development and validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS). J Clin Psychol Med Settings 8:307-323, 2001 3. Zebrack BJ, Gurney JG, Oeffinger K, et al: Psychological outcomes of long term survivors of childhood brain cancer: A report from the Childhood Cancer Survivors Study. J Clin Onc 22:999-1006, 2004
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Copyright © 2006 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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, 0.82 to 0.89). The study is currently running at the Onco-ematology Clinic of the Children's Hospital, University of Padova (Padova, Italy). It was approved by the local human investigation committee. After written parental informed consent, the battery of questionnaires and an in-depth interview are administered in the second week after the diagnosis. The PTSD symptoms checklist is assessed in the second month after the diagnosis, and assessed again 6 months after the diagnosis. 
2 test (
