Children with cancer are at risk for developing behavioral problems after diagnosis, and therefore, should be screened for baseline adaptation, parental stress, and coping, according to a report in Supportive Care in Cancer.1

As many as 60% of children with ALL experience impaired neurocognitive domains that are often ongoing and have a significant impact on survivors’ quality of life. Although their risk for psychological problems is known, the link between adaptation during treatment and long-term difficulties is not clear.

In this multicenter longitudinal study, researchers sought to identify the distinct subgroups of patients with ALL and their adaptation during active treatment, and to identify the sociodemographic, medical, and psychosocial predictors of adaptation trajectories.

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Participants were parents of a child age 1.5 to 18 years with newly diagnosed ALL undergoing treatment at 6 of 7 Dutch pediatric oncology centers, and families were asked to select one parent to serve as parent-proxy to complete all assessments. The children were treated according to Dutch Childhood Oncology Group (DCOG) ALL 10 protocol. Parent-proxy measurements were taken during induction treatment, after induction/consolidation treatment, and during maintenance using the Child Behavior Checklist (CBCL). Of the 159 families who agreed to participate, only those families with complete data for 2 of the 3 assessments were included in the analysis (N = 108).

Three-trajectory models were found for internalizing and externalizing behavioral problems. The internalizing trajectories were resilience (60%), children who did not experience any problems after diagnosis; recovery (30%), children who experienced problems initially but recovered during treatment; and chronic (10%), children whose behavioral problems started at high levels and remained at heightened levels.

The externalizing trajectories were resilience (83%), children who did not experience problems after diagnosis; chronic (12%), children who initially had externalizing behavioral problems that remained stable; and increasing (5%), children with clinical levels of externalizing behavioral problems who showed increasing problems during treatment. Parenting stress and baseline quality of life were the only factors found to contribute uniquely to adjustment trajectories.

Although parent reports reflected no or transient behavioral problems in most children (77%), 23% of children exhibited maladaptive trajectories of internalizing and/or externalizing behavioral problems. In addition, the researchers found that the psychological reaction of the parents after diagnosis had a significant influence on the child’s risk for psychosocial difficulties.

On the basis of these results, the researchers suggest screening for a broad range of risk factors, such as child baseline adaptation, parental stress, and coping, would help identify those patients at increased risk for behavioral problems.


1. Sint Nicolaas SM, Hoogerbrugge PM, van den Bergh EM, et al. Predicting trajectories of behavioral adjustment in children diagnosed with acute lymphoblastic leukemia. Support Care Cancer. 2016;24:4503-4513.