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.