POSTTRAUMATIC STRESS AFTER CHILDHOOD-CANCER .1. THE ROLE OF APPRAISAL

Life threat or physical injury have been shown to produce post-traumatic stress symptoms in children. Recent studies have demonstrated that a subset of survivors of pediatric cancer report post-traumatic stress symptoms years after completing successful treatment. However, it is not clear whether these symptoms represent a response to the perception of life-threat or to the repeated intrusive procedures that accompany cancer treatment. In this exploratory study, 30 childhood cancer survivors 8 to 19 years old, who were at least 22 months off treatment without recurrence of disease, were evaluated using self-report questionnaires. The survivor's appraisal of treatment intensity significantly correlated with the severity of post-traumatic stress symptoms. When age at the time of diagnosis was evaluated, appraisal of treatment intensity was significantly correlated with symptoms only in those six years old and younger. For children aged seven years or older at the time of diagnosis, duration of treatment was a significant contributor to symptoms. Diagnostic category (leukemia or solid tumor), length of time since completion of treatment and the child's appraisal of life-threat were not significantly correlated with severity of post-traumatic stress symptoms. Further study of the impact of intensive pediatric treatment on children and the importance of developmental factors in traumatic response to illness appears to be indicated.