الفهرس 
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Abstract
The diagnosis and treatment of cancer are a stressful and threatening experience, which has tremendous impact on children and their families. As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained .
The aim of this study was to evaluate the psychosocial aspects of children with different types of pediatric cancer (newly diagnosed as well as survivors), their parents, and sibs in comparison with those with normal children.
This study comprised 60 children , their sibs and caregivers.They were classified into three groups. Group I (caregivers and sibs of newly diagnosed cancerous children) which comprised 20 children; 7 of them were females (35%) and 13 were males (65%); their ages ranged from 6 to 12 years with mean value of 9.43±2.05 years, group II (caregivers and sibs of cancer survivors) which comprised 20 children; 12 of them were females (60%) and 8 were males (40%); their ages ranged from 6 to 12 years with mean value of 10.33±1.62 years, group III (caregivers and sibs of controls) clinically healthy children which comprised 20 children; 9 of them were females (45%) and 11 were males (55%); their ages ranged from 6 to 12 years with mean value of years 9.12±2.11.
All children and their sibs in this study were subjected to full history taking, thorough clinical examination, assessment socioeconomic standard, assessment of pediatric quality of life , a battery of psychometric tests included pediatric checklist, anxiety, depression, and self- esteem scores.
All caregivers were subjected to record of demographic variable , assessment of socio-economic level , assessment of anxiety, depression, and isolation score, assessment of stress and burden related to the disease itself, if any, using standardized questionnaire and assessment of quality of life.
The mean value of age of cancer survivors was significantly higher than those of newly diagnosed cancer as well as controls (p <0.05 for both).
The statistical comparison between different studied children groups as regards sex distribution, consanguinity rate, and frequency of +ve family history shows that in newly diagnosed cancer children, 65% were males and 35% were females compared to 40% and 60% respectively in cancer survivors (p <0.01) and to 55% & 45% in controls (p < 0.05) i.e. males were more among newly diagnosed patients while females were more among survivors. On the other hand, consanguinity rate was comparable among studied children groups (p > 0.05 for all comparisons) while +ve family history of cancer was significantly more encountered among survivors compared to newly diagnosed patients as well as controls (p <0.05, <0.01 respectively). Sex distribution of sibs showed statistically insignificant differences between their different studied groups (p > 0.05 for all).
Because the study was conducted at Tanta Cancer Center, it was expected that El-Gharbia governorate to be the more frequently encountered residence of studied children groups and their parents; 50% in newly diagnosed, 60% in survivors, and 75% in controls.
The frequency distribution of no of yrs of follow up in studied cancer survivors shows that 50% of studied children belonged to this group were on follow up for one yr after cure.
The Bone marrow distribution shows that 70% of cancer survivors had free bone marrow aspirate at time of study compared to 65% of newly diagnosed; p > 0.05.
The study shows frequency distribution of different types of cancer encountered among studied children whether newly diagnosed or survivors.
Clinically manifest depression as well as psychosocial dysfunction was more prevalent in both newly diagnosed children and cancer survivors compared to controls (p < 0.05 for both). Meanwhile, below average IQ was more encountered among survivors compared to newly diagnosed children. On the other hand, clinically manifest depression and psychosocial dysfunction were significantly more prevalent in sibs of newly diagnosed compared to survivors and controls (p < 0.05 for both).
Parental clinically manifest depression and anxiety were significantly more encountered among newly diagnosed children and survivors compared to controls and the former was more in newly diagnosed compared to survivors. On the other hand, clinically manifest parental isolation was more prevalent among newly diagnosed compared to survivors and controls while clinically significant stress was significantly more prevalent among both newly diagnosed and survivors compared to controls.
Studied parental groups were comparable as regards levels of Socioeconomic Scores and Parental Health Related Quality of Life; p > 0.05 in all.
Mean value of DS was significantly higher in newly diagnosed and survivors compared to controls while AS and PCLS was only significantly higher in newly diagnosed compared to controls. On the other hand, mean value of IQ of newly diagnosed and survivors was significantly than controls. Mean values of Child as well as the Parental Total HRQL were significantly lower in newly diagnosed and survivors compared to controls with the former significantly lower than the later. In studied sib groups, AS was significantly higher in newly diagnosed compared to survivors and controls while PCLS was only significantly higher when newly diagnosed compared to survivors.
In studied parental groups, mean values of DS, AS, and SS were significantly higher in newly diagnosed compared to survivors and controls. Meanwhile, IS was significantly higher in newly diagnosed compared to controls.
Newly diagnosed cancerous children had significantly lower mean values of all Child HRQL subcategories; namely, physical, emotional, social, and scholastic compared to controls and survivors except for the emotional subcategory that was comparable in both patient groups. On the other hand, survivors showed only significantly lower physical and social subcategories compared to controls.
In studied sib groups only sibs of newly diagnosed patients and those of survivors, had significantly lower mean value of social subcategory compared to controls
On the other hand, studied parental group of newly diagnosed cancer children showed significantly lower mean values of all subcategories compared to survivors and controls while parents of survivors had similar results except for scholastic subcategory that was comparable with control.
In conclusion, the current study showed that newly diagnosed cancerous children had severe impact on their psychosocial aspects as well as their HRQL compared to controls while survivors showed a much lesser effects. On the other hand, sibs were mainly affected socially while parents were extremely affected by such an illness in one of their offspring.