The years after:: a concept of the psychological integration of childhood cancer

Goals of work. To define and measure the psychological integration of childhood cancer experiences into a personal biography and to explore the association between integration with illness-related factors and psychosocial conditions. Patients and methods. Analysis of cancer survivors' narratives on the course of their illness was used to measure integration. Psychosocial condition, body concepts, health locus of control, and illness-related distress were evaluated by questionnaires. Illness factors were assessed by reviewing hospital case notes and sociodemographic factors by a structured interview. Of 72 eligible subjects contacted, 60 agreed to participate. Main results. High inter-rater correlations established the reliability of the concept of testing integration by narrative analysis. Subjects with good psychological integration of the experience of cancer saw chance as having less to do with illness and health, and perceived illness and therapy retrospectively as more distressing than survivors with poor integration. In contrast, integration did not correlate with distress evoked by present feelings toward illness and therapy or by thoughts of a relapse. Conclusions. Successful integration of the experience of cancer may be associated with the ability to accept painful feelings and to allow them to emerge, and with a readiness to accept responsibility in relation to health and medical care. Assisting young cancer patients and their families to create and maintain their personal narratives of the experience of illness is an important clinical task for all professionals working in paediatric oncology.