title: Clinical experience with psychological aspects in pediatric patients amputated for malignancies.
abstract: 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.
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale dei Tumori, Milan, Italy. carlo.clerici@fastwebnet.it
authors.forename: Carlo Alfredo
authors.initials: CA
authors.lastname: Clerici
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: Luksch
authors.forename: Michela
authors.initials: M
authors.lastname: Casanova
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.forename: Graziella
authors.initials: G
authors.lastname: Cefalo
authors.forename: Monica
authors.initials: M
authors.lastname: Terenziani
authors.forename: Filippo
authors.initials: F
authors.lastname: Spreafico
authors.forename: Daniela
authors.initials: D
authors.lastname: Polastri
authors.forename: Sergio
authors.initials: S
authors.lastname: Mapelli
authors.forename: Primo
authors.initials: P
authors.lastname: Daolio
authors.forename: Franca Fossati
authors.initials: FF
authors.lastname: Bellani
mesh_terms: 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