Summary: A study of the parents of children undergoing treatment for cancer finds that in most of the families, at least one of the parents has symptoms of post-traumatic stress. Although the symptoms may fade with time, they can interfere with the care of the child and the parent's well-being, researchers from the Children's Hospital of Philadelphia report in the Journal of Clinical Oncology.

Why it's important: In the past, parents who were having trouble dealing with their child's illness were thought to be either "anxious" or "depressed." But the parents may really be having symptoms of post-traumatic stress, which can be far more damaging. Parents who experience these symptoms may have trouble complying with their child's caregiving needs. They may respond inappropriately to health care providers. The family may not function well when cancer treatment is over. Recognizing the post-traumatic symptoms and helping parents overcome them may avoid these problems.

What's already known: Post-traumatic stress has been recognized for thousands of years. Many people who have had a traumatic experience such as a personal assault, or have been in combat, or experienced a catastrophe (9/11 is a perfect example) will develop psychological after-effects known as post-traumatic stress syndrome or disorder – sometimes called PTSD. Some of the main symptoms of this are nightmares and flashbacks, avoiding situations or even thoughts that might recall the event, and irritability, including outbursts of anger. People may also experience physical symptoms like sweating, dizziness, or rapid heart rate when reminded of the traumatic experience. Several studies have found some of these symptoms, but not the full-blown disorder, in parents of children who have been treated for cancer.

How this study was done: In a change from earlier studies where parents were examined after the child had been treated, this study looked at parents while their child was still in active treatment. The parents (119 mothers and 52 fathers) of 125 children undergoing cancer therapy were given questionnaires about their psychological state. The results of these were compared with a measure of the intensity of their child's therapy.

What was found: About 68% of mothers and 57% of fathers had moderate to severe symptoms of post-traumatic stress. These didn't seem to be related to the intensity of their child's treatment. Mothers were more severely affected than fathers, with more symptoms of intrusive thoughts, avoiding reminders of the treatment, and more irritability, perhaps even anger. These results were compared with those of previous studies that looked at other parents after their child’s treatment had been completed and found that parents' symptoms were worse during treatment.

The bottom line: The study authors say health care providers need to be aware of the effect cancer treatments and tests may have on the psychological health of the parents. Parents should be counseled on how to deal with the stress of their child's treatment and taught when to seek more extensive professional help.

"We hope these findings will help mothers and fathers understand it's normal to have stress symptoms in reaction to their children's cancer," said psychologist Melissa Alderfer, PhD, a co-author of the current study. "Parents need to take care of themselves to they can be more helpful to their children."

Citation: "Posttraumatic stress symptoms during treatment in parents of children with cancer." Published in the Oct. 20, 2005, Journal of Clinical Oncology (Vol. 23, No. 30: 7405-7410). First author: Anne E. Kazak, PhD, ABPP, the Children's Hospital of Philadelphia.