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.