INTRODUCTION
The COVID-19 pandemic has affected several aspects of lives all around
the globe, and the unprecedented health crisis has put a strain on
health services. Patients with cancer have been particularly affected,
with a consequent high psychological impact1 due to
their vulnerability, immunosuppression, or need for cancer
treatment2. Among oncology patients, infants and
children are at higher risk for medical or psychological complications.
Their patients fear the consequences of infection on their child’s
already fragile state of health as well as potential treatment
interruptions or delays. The type and intensity of antineoplastic
treatments are known to have important psycho-evolutionary implications3,4,5 . These have been frequently noted in the
literature 6,7,8,9 framing pediatric cancer as a
stressful and traumatic life cycle event 10,11,12.
Numerous studies have identified different interpretations of the
concept of trauma 13,14,15,16; however, complex
trauma, linked to the exposure to multiple traumatic events in
childhood, shows more pervasive symptoms 17,18.
Exposure to further traumatic experiences, such as pandemics, torture,
war, imprisonment, or migration possibly leads to additional risks for
chronic traumatization. The sum of these events could result in an
elevated sense of threat levels for the patient’s own life and that of
their family members.
The risk of COVID-19 infection, and the unpredictability of relative
potential emergencies, could exacerbate the emotional burden on patients
and family members during oncological disease and treatment. The changes
and general alarm of the current pandemic have amplified the sense of
precariousness and vulnerability for family members who, in addition to
the emotional trauma of the cancer diagnosis, add the distress and fear
of the risks associated with infection. In addition to the standard
complex oncological clinical pathway, they require additional measures
of self-protection, social distancing 19, prolonged
isolation, and new daily habits 20. Also, hospital
rules have become more restrictive, requiring the suspension of some
services and limitations to family visitation.22 These
factors significantly affect the patients’ and their family’s quality of
life both during hospitalization and afterwards upon discharge.
Families have a central role in preserving patients’ psychological
integrity. They represent a safe-harbour where children and adolescents
can find psychic and psychological supplementary resources22. Families with a child with cancer are already
under a great deal of stress and vulnerable to trauma induced by the
diagnosis itself. It is reasonable to suppose that the added stress of
the pandemic could undermine the psychological state and balance of the
family.
The primary objectives of the present study was to investigate the
psychological impact of the COVID-19 pandemic on the parents of
pediatric cancer patients, and to investigate the level of stress,
anxiety, and the child’s quality of life perceived by the parents during
the Covid-19 epidemic. Subsidiary objective of the study was to explore
correlations between the results obtained and the variables
investigated.