La experiencia psicológica de un paciente pediátrico con cáncer en momentos de amenaza vital: estudio de caso / The psychological experience of a pediatric patient with cancer facing life-threatening situations: a case study

Introducción: El cáncer se considera una enfermedad amenazante para la vida que implica la posibilidad de que el niño fallezca prematuramente. Existe poca información desde la visión del paciente pediátrico sobre su experiencia psicológica en momentos de amenaza vital. El presente trabajo pretende ampliar este conocimiento a través de la experiencia vivida en momentos de amenaza vital de un niño superviviente de cáncer. Paciente y métodos: Paciente de 9 años al que le diagnosticaron un osteosarcoma en el fémur. Se trata de un estudio de caso en el que se realizó un análisis fenomenológico interpretativo con los datos obtenidos a través de una entrevista semiestructurada. Resultados: Se evidencia que los principales sentimientos en el momento de amenaza vital fueron miedo, tristeza e impotencia. Uno de los factores desencadenantes fue pensar en la posibilidad de tener que separarse de sus padres. Esta experiencia tuvo impacto en su vida e influyó en su identidad. Para hacer frente a esta situación difícil utilizó estrategias de afrontamiento de aproximación, como la conexión emocional, y de evasión como la distracción, el humor y el olvido. Discusión: Las reacciones emocionales frente a la posibilidad de amenaza vital y el impacto que esta tuvo en la vida del menor se pueden interpretar dentro del modelo del Estrés Traumático Médico Pediátrico. Conocer la experiencia desde el punto de vista del paciente pediátrico y la forma de afrontarla puede ayudar a reforzar o adaptar las intervenciones de la práctica clínica. (AU)

Introduction: Cancer is considered a life-threatening disease as it implies the probability that the child will die prematurely. There is little information from the pediatric patient's perspective about their psychological experience in life-threatening situations. This study aims to expand knowledge in this area by presenting the experience of a child cancer survivor in lifethreatening situations. Patient and methods: a 9-year-old patient who was diagnosed with osteosarcoma in the femur. A case study design followed, in which the information was collected through a semi-structured interview, and an interpretative phenomenological analysis was carried out with the resulting data. Results: The main feelings experienced in life-threatening situations were fear, sadness and impotence. One of the trigger factors was to think about the possibility of being separated from his parents. This experience had an impact on his life and shaped his identity. To deal with this difficult situation, he used approach coping strategies, such as emotional connection, and avoidance strategies such as distraction, humor, and forgetting. Discussion: The emotional reactions to the experience and the impact that this had on the child's life can be interpreted within the Pediatric Medical Traumatic Stress model. Knowing the experience from the point of view of the pediatric patient, together with his or her way of coping with it, can help to reinforce or adapt the interventions in clinical practice. (AU)

Aspectos psicosociales de la calidad de vida en supervivientes pediátricos de tumores en el sistema nervioso central / Psychosocial aspects of the quality of life in pediatric survivors of tumors in the central nervous system

Introducción: Los supervivientes de tumores del sistema nervioso central (TSNC) presentan peor calidad de vida en relación a la salud (CVRS) que los supervivientes de otras neoplasias y la población normativa. El tipo y gravedad de las secuelas no parecen tener un impacto claro en la CVRS, pero la afectación del cociente intelectual (CI) sí podría modular la CVRS. Además, las estrategias de afrontamiento del paciente y de los progenitores y el malestar emocional parental podrían también actuar sobre la CVRS. Objetivo: Determinar si las estrategias de afrontamiento del adolescente y su CI, y las estrategias de afrontamiento, el estrés general y el malestar emocional parental, modulan las dimensiones psicosociales de la CVRS del superviviente. Método: Estudio transversal descriptivo-correlacional. Se reclutaron 37 adolescentes (12-19 años) que llevaban ≥1 año fuera de tratamiento oncológico y 44 progenitores. Resultados: En la CVRS valorada por los adolescentes, las dimensiones Relación con los Padres y Vida Familiar, Amigos y Apoyo Social, y Entorno Escolar dependen de la estrategia de afrontamiento de resolución del problema usada por el adolescente. La dimensión Aceptación Social depende del estilo de afrontamiento improductivo del adolescente y del estilo de búsqueda de ayuda social de los padres. La CVRS valorada por los padres depende de las secuelas, el CI del adolescente y, el tipo de tratamiento oncológico recibido. Discusión y conclusiones: Las estrategias de afrontamiento centradas en la resolución del problema, deben ser consideradas para valorar e intervenir en la mejora de la CVRS de los supervivientes TSNC

Introduction: Central Nervous System Tumor (CNST) survivors tend to show worse HRQoL than survivors of other types of cancer and general population. There are still many doubts about what variables and to what extend these are related to their HRQoL. Type and severity of late effects have not a clear impact on HRQoL. However, Intelligence Quotient (IQ) changes as a specific late effect of this sample population, could modulate their HRQL. Furthermore, coping from both patients and parents, as well as parental distress could play a significant role modulating HRQoL in these survivors. Aim: To study whether survivors' coping strategies and IQ, as well as coping, general stress and cancer-related distress of parents could modulate some psychosocial dimensions of their children HRQoL. Methodology: Correlational descriptive cross-sectional study. Thirty-seven teenagers (12-19 years old, both included) ≥1 year free of disease and 44 parents were recruited for the study. Results: When HRQoL is assessed by adolescents, the dimensions Parent Relations and Home Life, Social Support and Peer, and School Environment are related with the use of coping with problem style by adolescents. Social Acceptance/Bullying dimension is related with nonproductive coping by the adolescent and helpseeking coping style by parents. HRQoL assessed by parents is related with late effects, adolescents' IQ, and type of oncological treatment received. Discussion/Conclusion: Coping strategies, and specifically problem-solving strategies must be taken into account to assess and to intervene in the improvement of HRQoL of this sample population

The Hidden Sufferers: Parental Reactions to Childhood Cancer during Treatment and at Survival.

This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents' reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 - 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child's sequelae at survival. These findings support the hypothesis that "the end of treatment is not the end". Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival.

The hidden sufferers: parental reactions to childhood cancer during treatment and at survival

This study was twofold: 1) to assess parental reactions to childhood cancer throughout the oncological experience and 2) to explore associations between parents’ reactions during treatment and cancer-related distress at survival. A cross-sectional descriptive study collecting data (at survival) from retrospective (perceived social support, optimism, distress, coping in the worst situation) and current variables (general stress, distress regarding cancer, benefit finding) was carried out. Forty-one parents of childhood cancer survivors were assessed. High levels of distress (M = 9.5, SD = 1.32, range 4-10) and self-reported efforts to overcome difficulties occurring during the hospitalization (M = 7.48, SD = 3.01, range 0-10) were found. However, parents received high social support from very different sources. This could explain the satisfactory levels of optimism found (43.9% of the sample, M ≥ 16, range 9 - 24). Most parents reported to use engagement (M = 2.57, SD = 0.41, range 1-4) and help-seeking (M = 2.52, SD = 0.53, range 1-4) coping strategies to overcome difficulties. Some parents recognized to use psychological defenses when coping with the distress of cancer. However, this disengagement style was less preferred (M = 1.62, SD = 0.37, range 1-4). Finally, 22% of parents reported positive consequences and 60% reported positive and negative consequences too. When exploring how treatment experiences can influence cancer-related distress in survivorship, we observed that those who received less social support used more disengagement coping and referred higher efforts to overcome difficulties during treatment, displayed persistent distress at survival. These same parents showed higher scores on general stress. Besides, these results were not influenced by child’s sequelae at survival. These findings support the hypothesis that 'the end of treatment is not the end'. Consequently, special attention should be placed in screening parents experiences throughout different milestones of cancer to design tailored interventions aimed at reducing persistent distress at survival (AU)

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Surviving cancer: The psychosocial outcomes of childhood cancer survivors and its correlates.

This study assessed the psychosocial outcomes of adolescent cancer survivors and their relationship with personal and socio-familiar factors. Using a cross-sectional design, 41 survivors answered the four psychosocial dimensions of the KIDSCREEN-52 questionnaire and measures for social support and coping. Similarly, 41 parents answered coping and cancer-related distress measures. All psychosocial scores were within normative values (50 ± 10). Multiple linear regression analyses revealed four models with a range of explained variance between 9.4 percent and 31.9 percent that include the informative and emotional support, parental distress, and coping. This study contributes to the understanding of psychosocial outcomes of childhood cancer survivors and its correlates.

Social support during childhood cancer treatment enhances quality of life at survival / El apoyo social durante el cáncer infantil favorece la calidad de vida en periodo de supervivencia

Introducción: La calidad de vida en relación a la salud (CVRS) en cáncer se ha relacionado con distintos factores de riesgo y protección tales como el apoyo social percibido (ASP) y el afrontamiento. Sin embargo, la investigación acerca de los efectos de dichos factores sobre la CVRS de supervivientes pediátricos sigue siendo no concluyente. Objetivo: Describir y explorar la relación entre CVRS en periodo de supervivencia y factores presentes durante el periodo de hospitalización (ASP y afrontamiento). Métodos: Diseño transversal. 41 supervivientes de cáncer infanto-juvenil respondieron medidas de CVRS en referencia al periodo actual de supervivencia, así como medidas de ASP y afrontamiento en relación al periodo de hospitalización. Resultados: La función discriminante obtenida logró clasificar correctamente al 78% de la muestra. Los supervivientes con mayores puntuaciones en CVRS, fueron aquellos que, en los peores momentos durante su hospitalización, percibieron un apoyo emocional satisfactorio (por parte del personal de enfermería) y no desplegaron un gran número de recursos de afrontamiento para hacer frente al evento estresante (sólo la estrategia de afrontamiento de acción social mostró relación estadísticamente significativa con CVRS). Conclusiones e implicaciones: Considerando estos resultados, parece adecuado el llevar a cabo intervenciones de tipo psicoeducativo destinadas a fortalecer la red de apoyo social, sobre todo por parte del personal sanitario (enfermería). Estos resultados ponen de manifiesto la importancia de considerar todas las oportunidades para abordar las necesidades emocionales de los pacientes durante su hospitalización, ya que se ha observado que esto puede tener un efecto positivo perdurable en periodo de supervivencia

Background: Health-related quality of life (HRQoL) in cancer has been related to several protective and risk factors such as perceived social support (PSS) and coping. However, their effects on HRQoL once patients are in survivorship have not been fully described in pediatric samples. Objective: To describe and explore the relationship between HRQoL in survivorship and some factors (PSS, coping) present while active treatment. Methods: Cross-sectional study. Forty-one pediatric cancer survivors answered HRQoL measures referred to survivorship, as well as PSS and coping measures referred to treatment period. Results: The discriminant function obtained succeeds to correctly classify 78% of the sample. Survivors who showed high HRQoL were those who, in the hardest moment while hospitalization, perceived satisfactory emotional support (from nurses) and did not deploy a wide range of active coping resources to cope with stressful events (only social action coping strategy showed a significant relationship with HRQoL). Conclusions and implications: Considering these outcomes, educational and counseling interventions to strengthen patients’ social networks and supportive relationships are recommended, specially, among health providers (nurses). These results highlight the importance of not overlooking opportunities to address the emotional needs of patients while hospitalization, since a positive and endurable effect has been observed at survivorship

Perceived positive and negative consequences after surviving cancer and their relation to quality of life.

Surviving childhood cancer has multiple implications on both physical and psychological domains of the individual. However, its study and possible effects on health-related quality of life (HRQoL) outcomes of adolescent survivors has been understudied. The objective of this study was twofold; to assess positive and negative cancer-related consequences (psychosocial and physical) in a sample of adolescent cancer survivors and to explore their relationship with HRQoL outcomes. Forty-one participants answered two questions about positive and negative consequences in the aftermath of cancer and filled in the KIDSCREEN-52 self-reported version. Data were analysed using mixed methods approach. Overall, 87.8% of the studied sample identified positive consequences and 63.4% negative consequences in survivorship. Four positive categories and five negative categories with regard to cancer-related consequences were found. Changed perspectives in life narratives seem to be the positive consequence more related to HRQoL (physical well-being, mood & emotions, autonomy, social support & peers), followed by useful life experience (physical well-being, autonomy, social support & peers). Psychological impact was the most referred negative consequence with a significant detrimental effect on social support and peers HRQoL dimension. Even if the majority of survivors reported benefit finding in the aftermath of cancer, concomitant positive and negative consequences have been found. However, findings only reveal a significant relationship between positive narratives and HRQoL, and negative consequences do not seem to have a significant influence on overall HRQoL in survivorship.

Ejercicio físico y calidad de vida en adolescentes supervivientes a un cáncer / Physical exercise and health-related quality of life in adolescent cancer survivors

Objetivo y métodos: La práctica regular de ejercicio físico (EF), es una de las principales conductas relacionadas con un estilo de vida saludable que ha demostrado reportar beneficios tanto físicos como psicológicos sobre la calidad de vida en relación a la salud (CVRS) de las personas. Sin embargo, en España son escasos los trabajos que exploren dicha asociación en población infanto-juvenil superviviente a un cáncer. Por ello, el presente estudio descriptivo mediante encuesta analiza la relación entre el patrón de realización de EF y la CVRS en una muestra de adolescentes oncológicos en remisión (GS), en comparación con un grupo normativo de referencia (GN). Todos los participantes cumplimentaron el cuestionario de salud SF-12v2 y el Autoinforme del Estadio de Cambio para el Ejercicio Físico (AECEF). Resultados: En ambos grupos había un porcentaje significativamente mayor de varones activos para EF que, además, presentaban puntuaciones significativamente superiores en MCS. No obstante, la CVRS entre ambos grupos era similar e incluso significativamente superior para el GS en MCS. El EF sólo explicó un 12% de la varianza de MCS en el GN, en conjunción con el género y la edad del superviviente. Conclusiones: A partir de los resultados, creemos necesario seguir explorando otros factores no contemplados en el presente trabajo, tales como la intensidad o el tipo de actividad física llevada a cabo, que puedan mediar la asociación entre EF y CVRS en supervivientes. También se discute la necesidad de utilizar instrumentos específicos de CVRS para población adolescente superviviente a un cáncer

Purpose and methods: The regular practice of physical exercise (PE) is one of the main behaviours related with a healthy lifestyle that has demonstrated to yield benefits both on physical and psychological health-related quality of life’ domains (HRQoL). However, in Spain, studies exploring such association in pediatric survivors of childhood cancer are scarce. For that reason, this descriptive study examines the relationship between the pattern of PE performance and self-rated HRQoL in a sample of adolescent survivors of childhood cancer (ASCC), compared to a normative group from the general population (NG). All participants filled in the SF-12v2 questionnaire and the AECEF. Results: In both groups, a significantly higher percentage of male active survivors was found and they also showed significantly higher mean scores in MCS. However, HRQoL between groups was equivalent and even higher in the case of MCS for the GS. Only 12% of explained variance for MCS was accounted in the NG, considering PE, gender and age at the assessment. Conclusions: Considering these results, we believe it’s needed to explore other factors not addressed in the present work, such as PE intensity or type of physical activity performed that might be mediating the association between PE and HRQoL in adolescent cancer survivors. It is also discussed the suitability of using specific tools to assess HRQoL in adolescent survivors of childhood cancer populations

Making sense of resilience: A review from the field of paediatric psycho-oncology and a proposal of a model for its study / Explicando la resiliencia: una revisión desde la psico-oncología pediátrica y una propuesta de modelo para su estudio

The present article is intended to review the concept of resilience from the scope of pediatric psycho-oncology. The origin of resilience, its different definitions and its adequacy applied to serious physical illness such as cancer will be analyzed. Likewise, differences between resilience and other concepts commonly associated or confused with it such as posttraumatic growth or benefit finding will be discussed

En el presente artículo se pretende hacer una revisión del concepto de resiliencia desde el ámbito de la psico-oncología pediátrica. Se analizará su origen, sus distintas definiciones y adecuación de la misma aplicada al ámbito de las enfermedades físicas graves como el cáncer. También se tratará de diferenciar la resiliencia de otros conceptos como el crecimiento postraumático o el benefit finding, comúnmente asociados o confundidos con ésta. Por último, se plantea una propuesta de modelo integrador de resiliencia en cáncer infanto-juvenil

Surviving childhood cancer: relationship between exercise and coping on quality of life.

This research assesses Health-Related Quality of Life (HRQoL) in a Spanish sample of adolescent cancer survivors, and analyzes the relationship between HRQoL, coping styles and physical exercise. Forty-two survivors (12-19 years), who were ≥ 1 year of remission, completed standardized measures of HRQoL (CHIP-AE), coping strategies (ACS) and physical exercise (AECEF). Mean scores in all HRQoL domains were within normative values. Multiple regression analysis revealed that physical exercise and productive coping were related to higher HRQoL, whereas non-productive coping was related to lower HRQoL. This sample of survivors reported good levels of HRQoL, which are mediated by coping styles and physical exercise.

Afrontamiento y malestar emocional parental en relación a la calidad de vida del adolescente oncológico en remisión / Parental coping and distress with regard to health-related quality of life in adolescent survivors of childhood cancer

Objetivo: Explorar si la calidad de vida (CV) de los adolescentes oncológicos en remisión, está relacionada con el afrontamiento y/o el malestar emocional parental. Método: A partir de un diseño transversal, se recogió información de un total de 62 participantes (31 adolescentes oncológicos en remisión y 31 padres de los anteriores). La CV de los adolescentes fue evaluada a través del Cuestionario de Salud SF-12v2. Para evaluar el estilo de afrontamiento parental se administró el COPE en versión disposicional; y para medir su nivel de malestar emocional actual en relación al cáncer, se administraron dos escalas numéricas de 5 puntos. Los datos médicos y socio-demográficos se obtuvieron a partir de las historias clínicas. Resultados: El estilo de afrontamiento parental de vinculación con el problema (engagement) explicaba un 25% de la varianza del componente mental de CV de los adolescentes oncológicos en remisión (ß = -,500; p = ,004). Conclusiones: La CV del adolescente superviviente a un cáncer, no depende única y exclusivamente de sí mismo. El ámbito familiar en el que éste está inmerso va a tener un papel muy destacado en su adaptación. Por ello es necesario atender las necesidades tanto del paciente, como de sus padres; favoreciendo un mayor ajuste a la situación de remisión, ayudando a disminuir el malestar emocional una vez ha finalizado el tratamiento, y de algún modo, fomentando una mejor y más rápida adaptación a la normalidad de todo el núcleo familiar (AU)

Purpose: To explore whether Health-Related Quality of Life (HRQoL) in a sample of adolescent survivors of childhood cancer is related to parental coping and/ or parental emotional distress. Methods: Sixty-two participants (31 adolescent survivors of childhood cancer and 31 parents) completed several questionnaires in a cross-sectional study. HRQoL was assessed using the SF-12v2 questionnaire. Parental coping styles were assessed using the COPE (dispositional version); and their emotional distress with regard to the oncological experience was assessed by means of two 5-point numeric scales. Medical and demographical data were obtained from medical records. Results: The parental coping style of engagement explained 25% of the variance in mental component dimension of HRQoL of adolescent survivors of childhood cancer (ß = -,500; p = ,004). Conclusions: HRQoL of adolescent survivors of childhood cancer does not depend only of their own determinants. The family context will play a major role in their adaptation. Therefore it is necessary to take care of the needs of both patients and their parents, encouraging a greater adjustment to the remission phase, helping them to reduce the emotional distress after the end of treatment, and somehow, fostering a better and faster adjustment to the situation of the whole family (AU)

Calidad de vida en adolescentes supervivientes de cáncer infantojuvenil / Quality of life in adolescent survivors of childhood cancer

Fundamento y objetivo: Evaluar la calidad de vida en relación con la salud de un grupo de adolescentes oncológicos en remisión en comparación con adolescentes de la población general sin historia previa de cáncer. Pacientes y método: Se evaluó a un total de 372 adolescentes con edades comprendidas entre los 14 y los 19 años, de los cuales 34 formaban parte del grupo de supervivientes oncológicos y 338 del grupo normativo. A todos ellos se les administró el cuestionario de salud SF-12v2 en una única sesión de evaluación. Resultados: Los adolescentes oncológicos en remisión presentaron puntuaciones medias estadísticamente superiores en comparación con el grupo control en el componente mental (MCS) de calidad de vida del SF-12v2 (52,60 frente a 47,85; p=0,004; intervalo de confianza del 95%: −7,9 a −1,6). No se encontraron diferencias estadísticamente significativas entre ambas muestras en el componente físico (PCS), pese a que los supervivientes presentaron puntuaciones medias superiores (54,03 frente a 52,72). Conclusiones: Los adolescentes supervivientes de cáncer manifiestan una calidad de vida satisfactoria (valores en torno a la media poblacional) y, en concreto, presentan mayor percepción de bienestar psicológico que el grupo control sin historia previa de cáncer (AU)

Background and objective: To assess health-related quality of life of adolescent survivors of childhood cancer, compared to adolescent's health-related quality of life who had no history of cancer. Patients and method: A total of 372 adolescents aged between 14 and 19 years, 34 cancer survivors and a comparison group of 338 peers without a history of cancer, were assessed. All of them filled in the SF-12v2 in a cross-sectional study. Results: Survivors revealed significantly higher mean values compared to the normative group for the Mental Component Scale (MCS) from the SF-12v2 (52,60 vs. 47,85; p=0,004; IC 95%, −7,9–−1,6). No significant differences between groups were found for the Physical Component Scale (PCS), even though adolescent survivors of childhood cancer showed higher mean scores (54,03 vs. 52,72). Conclusions: Adolescent cancer survivors showed a satisfactory quality of life (mean scores around the normative values), and, specifically, they reported greater perception of psychological wellbeing compared to peers (AU)

[Quality of life in adolescent survivors of childhood cancer]. / Calidad de vida en adolescentes supervivientes de cáncer infantojuvenil.

BACKGROUND AND OBJECTIVE: To assess health-related quality of life of adolescent survivors of childhood cancer, compared to adolescent's health-related quality of life who had no history of cancer. PATIENTS AND METHOD: A total of 372 adolescents aged between 14 and 19 years, 34 cancer survivors and a comparison group of 338 peers without a history of cancer, were assessed. All of them filled in the SF-12v(2) in a cross-sectional study. RESULTS: Survivors revealed significantly higher mean values compared to the normative group for the Mental Component Scale (MCS) from the SF-12v(2) (52,60 vs. 47,85; p=0,004; IC 95%, -7,9--1,6). No significant differences between groups were found for the Physical Component Scale (PCS), even though adolescent survivors of childhood cancer showed higher mean scores (54,03 vs. 52,72). CONCLUSIONS: Adolescent cancer survivors showed a satisfactory quality of life (mean scores around the normative values), and, specifically, they reported greater perception of psychological wellbeing compared to peers.

Módelo de intervención en oncología pediátrica / Modality of Intervention in paediatric oncology

ste artículo describe un modelo de intervención psicológca basado en la ayuda emocional y la contención, en una unidad de onco-hematología pediátrica. Se analizan cada una de las etapas por las que pasan elniño y su familia, con el objetivo de ofrecer una atención pediátrica. Se analizan cada una de las etapas por las que pasan el niño y su familia, con el objetivo de ofrecer una atención integral durante y después de la enfermedad, a fin de aliar el sufriminto mental, facilitar la adaptación al tratamiento, prevenir problemas, minimizar las secuelas psicológicas y nuerológica inmediatas y a largo plazo, propiciar conductas que favorezcan la normalización de la vida, la integración social y una buena calidad de vida posterior (AU)

This paper describes a model for psychologicla interention, based on emtional support and containment, in a paediatric onco-hematology unit. The different phases children and families go through are analyed inorder to provide and integral care during and after the illness. Other goals are to relieve mental stress, facilitate adjustent to treatment, minimise immediate psychological and neurologial sequelae and foster long-tem behaviours that will favour the subsequent return to normal life, social integration and quality of life (AU)