Surviving Cancer in Childhood : psychological and long-term adjustment

Abstract: Psychological long-term coping, mental health, social adjustment, and memories of illness and experiences of medical care were investigated in 30 young adult childhood cancer survivors. Coping with illness and treatment was studied with reference to a theoretical model based on psychodynamic theory of the integration of a psychological trauma. Mental health factors were assessed by the Rorschach test in comparison with healthy controls. Social adjustment was studied applying a case-control design. Memories of illness and medical care were highlighted through a descriptive survey approach. By cluster analysis, three clusters were produced that could be interpreted as exhibiting "good" (40%), "intermediate" (33%), and "poor" (27%) coping. Coping was significantly related to diagnosis, and poorer coping was related to a shorter period of continuous complete remission, more severe impairments through illness and treatment, and lower intellectual ability test scores. Also, an association, although weaker, was found between lengthy treatment and poor coping. Except for a tendency towards lower hostility levels among survivors, mental health factors did not differentiate patients from controls. Survivors displayed similar social adjustment as healthy controls, although future educational plans tended to be less frequent among survivors. Also, compared to general population data, survivors had less frequently pursued higher education. Most patients felt they had received the support and information they needed; that they were satisfied, or mostly satisfied, with the care. Yet only 60% judged the post-treatment medical check-ups as being supportive and important. Longer treatment periods were associated with lower satisfaction with care and follow-ups. The empirical results are discussed in terms of developmental issues of childhood and adolescence, and the psychological impact of disease and treatment. It was concluded that the traumatic components of the process of disease may, in a portion of survivors, lead to difficulties in long-term coping with the illness experience. However, in the majority of cases, these difficulties need not significantly endanger long-term mental health or social adjustment.