Psychosocial Risks and Invulnerability

Abstract

Childhood cancer consitutes a series of chronic, uncontrollable, and stressful life events that may have lasting impact on survivors. The uncertainty and the threat of loss associated with childhood cancer is traumatic and disruptive not only for the ill child but also for the child's parent and siblings. As a consequence, surviving patients and their famliies are at risk for problems of adjustment in later life. This article discusses several risk factors that increase the child and family's vulnerability to maladjustment: namely, (1) the severity and spacing of medical and other life stresses, (2) iatrogenic physical impairment, (3) social stigma, and (4) an interrelated cluster of poverty, ethnicity, and a single-adult family structure. It also describes three sources of invulnerability to maladjustment - individual coping style, family functioning, and social support - that may increase resiliency in the face of stress and thus reduce the risk of long-term dysfunction. The risk of psychological maladjustment points to the need for preventive family-focused intervention that enhances the cancer survivor's ability to resist the disruptive effects of the illness.