DISCUSSION
The diagnosis of cancer in the pediatric age group is widely described
as a traumatic event for the parents, and may result in experiences,
emotions, and even symptoms of psychopathological conditions such as
post-traumatic stress disorder27–29. There are
different approaches to investigate these phenomena and any discordant
results 30,31. Generally, parents’ high levels of
anxiety and distress following their child’s diagnosis24,26 decrease over time with a decline already
present three months after diagnosis 34,35.
The principal objective of the present study was to explore the
influence of the impact of a pediatric cancer diagnosis on parents,
particularly during the health emergency caused by the COVID-19
pandemic. We were interested in determining if, unlike a period without
a socio-sanitary emergency, the influence of past traumatic experiences
might exacerbate the challenges or symptoms, such as anxiety or stress,
or place parents at a new or additional risk of psychological suffering.
This supposition is supported by evidence showing that COVID-19 has
great emotional impact, even on the general population, with or without
specific medical conditions.36
Consistent with our hypothesis, our sample’s parents showed high levels
of post traumatic symptoms related to the oncological diagnosis of their
child. They also had an elevated perception of stress symptoms referable
to the pandemic, much higher than the general population’s during
COVID-19.37,38 The average level of state anxiety,
measured with STAI-Y1, indicated the presence of a considerable number
of anxiety symptoms.
The correlation matrix (2-tailed) showed that parents recording a higher
traumatic impact level on the IES-R also perceived higher stress levels
measured with the PSS. This suggests the presence of an increased risk
condition and a probable need for support from the family. It also
suggests the possibility of identifying populations at risk for
experiencing sequelae and consequences on child well-being. Studies have
shown that parents experiencing greater stress find it more difficult to
understand their child’s needs and respond in a sensitive
manner39,40.
The results of this study show that parents who exhibit symptoms of
post-traumatic stress related to their child’s diagnosis appear to be
more vulnerable to stress symptoms perceived during the pandemic
lockdown. The parents’ symptom states do not appear to be related to the
individual characteristics of anxiety traits. In fact, comparing the
scores of ”anxious” and ”non-anxious” parents, there were no significant
differences on all questionnaires except for the form of state STAY-Y 1.
Data from the few parents who received the oncological diagnosis of
their child during the pandemic show a high level of PSS. Parents who
received the diagnosis close to the onset of the COVID-19 pandemic were
subjected to this potential acute stress event 40 and
showed an increase in the already high risk 27,31 of
developing post-traumatic symptoms.
Therefore, it seemed worthwhile to investigate the correlation with
temporal distance from the time of diagnosis to understand the role of
time as a protective factor41,42. Among this study’s
participants, the variable ”months” from the time of diagnosis did not
have a significant impact on the IES-R score. Moreover, this factor had
even less of an impact on the development of stress symptoms during
COVID-19. To understand this phenomenon, it is important to consider
that the scores of most parents documented a significant presence of
post-traumatic symptoms. In accord with the literature, traumatic
psychological conditions can have long term consequences43,44. The inclusion in the protocol of parents’
perception of their child’s quality of life (PedsQL - parent
proxy-report version) made it possible to collect important information
on the children’s activities and behaviours during COVID-19 (physical,
scholastic and social activity) as well as the degree of emotional needs
or difficulties of children. This last variable showed a significant
positive correlation (P < 0.001) with the tool on
parental stress (PSS), highlighting a strong relationship between the
psychological state of child and parent 45,46,47,48Previous reports have found a significant difference between mothers’
and fathers’ scores on PSS (P < 0.001)31,49–51. Additionally, there is a significant
difference between the parents of patients “off therapy” and those
still “on therapy” in the IES-R (P < 0.001) and PSS
scores (P < 0.001).
Studies suggest that it is important to observe the stress of the
parents of children with cancer, even long after the
diagnosis52,30, but in this particular emergency it
seems to be very important to do so during treatment, when children are
exposed to the risk of infection53–57.