COPING WITH PAIN IN CHILDREN WITH LEUKEMIA

Background: Children’s reactions to painful events vary widely but there is a fairly wide consensus on the fact that children with leukemia may have special difficulties in dealing with the stressful medical procedures needed for the treatment of their disease. In problem/emotion focused coping three factors categories must be examined: Illness parameters (type, severity, treatment), personal factors (cognitive resources, age and past experiences, gender, temperament) and social factors (protective or risk factors related to family, peers support, environment support). This chapter has two aims: the first is to show and to discuss models on how a child with cancer cope with the illness; the second is to understand how children’s and parents’ factors impact on their coping with the illness and which can be the best strategy adopted by them. Method: Eighty-three leukemic children and their families, recruited at the Haematology-Oncologic Clinic of the Department of Child and Woman Health, University of Padua, participated in this study. Children’s mean age was 6.69 years (SD = 3.85, range = 1 year-17 years), 46 males and 37 females. Mostly children had Acute Lymphoblastic Leukemia (ALL) (N =70), while 13 had Acute Myeloid Leukemia (AML). All the parents were Caucasian, with a mean age of 37.95 years (SD = 5.93) and a mean of 11.83 years of schooling (SD=3.75). The parents who participated were mostly mothers (N = 73) and only a few were fathers (N = 10) because the mothers were more proximal to the child during hospitalization while fathers stayed with other siblings or continued to work to maintain the family. The families were contacted by a clinical psychologist during the first hospitalization of their children. The project aims were explained and informed consent was asked for. Parental perceptions on child’s coping during hospitalization (EFI-C, Tremolada et al., 2013) and child’s coping with pain (PPCI questionnaire, Varni et al., 1996; Italian version by Bonichini & Axia, 2000) were assessed in the first month after the diagnosis. Results: Problem solving and Cognitive self-instructions were more used with age increasing; Seek for social support was the preferred strategy; Catastrophizing was negatively correlated with child’s coping and adaptability measured at the second week from the diagnosis. Family routine and time reorganization was associated with a major use of Problem solving and Cognitive self-instructions during the first month of therapy. Discussion: These data give relevant information on coping with pain used by children with leukemia at their first hospitalization. Specific interventions can be applied to children taking into consideration their age and their preferred coping strategy. Other supportive interventions can be studied for parents at more risk for their family routine and time reorganization at the diagnosis so to increase the use of cognitive strategies by all the family during the first hospitalization.