Discussion
In recent years, the requirements for the quality of life of child patients have increased and the development of modern tumor theories has led to great changes in the principles and concepts of treatment of pediatric cancers15. The purpose of treatment can not only be satisfied with the improvement of survival rate but also requires improvement of the quality of life.
However, in clinical practice, there are still many problems and challenges in the actual situation of children’s psychological status, which seriously affects their life quality. A study from the United States surveyed online pediatric oncologists (n=99), psychosocial leaders (n=132), and pediatric oncology managers (n=58) from 144 training programs in 44 states and the Columbia region. The results showed that most of the participants indicated that the psychosocial care provided by their centers met the relevant standards based on evidence-based medicine. However, only half of the pediatric oncologists (55.6%) and psychosocial leaders (45.6%) believed that their psychosocial and social care is comprehensive and advanced, but it is usually provided when children have mental problems16. A study in South Korea in 2018 showed that 20% to 25% of pediatric cancer survivors had no friends after returning to school, 41% had learning difficulties, and 53% had lower academic performance than before, suggesting that education support should be provided for children with pediatric cancers to return to school17.
Through questionnaire surveys and interviews, we learned that the WSP has an overall good effect on the child patients. In the perspective of children, the WSP has a positive effect on their life quality and social mental functions, especially on the aspects of self-conception and learning skills. In terms of quality of life, the IDP group believed they are more energetic, happier in life, and better in memory than the OP group. At the same time, the children of the IDP group are more satisfied with their health and sleep quality. In terms of learning skills, the specific performance is that learning ability can be more persistent, easier to remember knowledge points, and willing to do other things besides homework for the children of IDP group. However, this project did not improve the relationship between children and their friends, teachers, and parents. They still feel nervous and scared from time to time, worry about doing something wrong, which indicated the child patients may need further psychological assistance and psychosocial care during the clinical treatment.
Besides, This WSP has greatly improved the children’s character problems and relieved their anxiety from the perspective of their parents. In terms of character, the children of the IDP group became more polite to the elders, their tempers became better, more honest, and more disciplined compared to the children of the OP group. Furthermore, the parents found that this project alleviated children’s anxiety. The children of the IDP group became less shy, no longer afraid of strangers and new environments, and no longer worried about bad things such as loneliness, illness, and death. In addition, the parents found that the WSP alleviated children’s anxiety. But they also found that children are still more sensitive and impulsive, and often feel headaches, stomachache, and other discomforts. In addition, contrary to the opinions of the children, the parents still found that the children have difficulty in learning, lack concentration during the learning process, and are easily distracted and discouraged. These results suggested that the parents have high expectations for their children’s learning, and it also demonstrated the child patients and their parents need more communication to promote mutual understanding and deepen the parent-child relationship.
Of note, this pilot project could guide us to respond promptly to the quality of life and psychological changes of children with pediatric cancers during the clinical treatment, and it also allows us to provide psychological intervention and psychosocial support for them as early as possible. Although our sample size was limited, all of the participants endorsed the WSP as a meaningful and valuable project of psychological intervention support during the treatment.
The WSP developed by our team uses cultural subjects and psychological counseling courses to improve the scientific knowledge of children with pediatric cancers so that the children will be easier to return and adopt the school life after treatment. Campus life also improves the quality of life of children and reduces their feelings of social isolation. This program has clinical value in improving the quality of life and psychosocial issues of child patients. Therefore, based on the preliminary work of this study, we will develop a prospective study to further explore the impact of the WSP on the quality of life and psychosocial behavior of children with pediatric cancers.