Clinical experience with psychological aspects in pediatric patients amputated for malignancies.
OBJECTIVE
Amputation surgery in pediatric patients suffering from malignant tumors is less common than in the past, but has a great emotional impact on patients and their families as well as on the medical team. Studies addressing the psychological aspects of limb amputation in childhood cancer are still relatively limited, and the results have sometimes been contradictory.


METHODS
At the Pediatric Oncology Unit of the Istituto Nazionale Tumori of Milan psychological support was provided to candidates for amputation and their families, involving medical oncologists, a clinical psychologist, and social assistants. Twenty-two patients were analyzed and 16 underwent mutilating surgery.


RESULTS
Different emotional reactions were observed. Surgery proved to be easier to accept when the tumor caused pain and functional loss. Specialist medical psychological support was needed in case of defense mechanisms (eg, splitting and projection) and depressive reactions evolving into isolation or intolerance.


CONCLUSIONS
The reported experience could be helpful in providing adequate support to children with tumors requiring mutilating surgery.
Clerici
Carlo Alfredo
CA
Pediatric Oncology Unit, Istituto Nazionale dei Tumori, Milan, Italy. carlo.clerici@fastwebnet.it
Ferrari
Andrea
A
Luksch
Roberto
R
Casanova
Michela
M
Massimino
Maura
M
Cefalo
Graziella
G
Terenziani
Monica
M
Spreafico
Filippo
F
Polastri
Daniela
D
Mapelli
Sergio
S
Daolio
Primo
P
Bellani
Franca Fossati
FF
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology*; D000842:Ankle / Q000601:surgery; D001859:Bone Neoplasms / Q000523:psychology / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D012516:Osteosarcoma / Q000523:psychology / Q000601:surgery; D012208:Rhabdomyosarcoma / Q000523:psychology / Q000601:surgery; D012509:Sarcoma / Q000523:psychology* / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000523:psychology / Q000601:surgery; D013584:Sarcoma, Synovial / Q000523:psychology / Q000601:surgery; D013315:Stress, Psychological / Q000209:etiology*; D013977:Tibia / Q000601:surgery