Psychosocial adjustment of siblings of children with cancer: a systematic review.
OBJECTIVE
To promote a broader understanding of the psychosocial impact of childhood cancer on siblings, a systematic review was undertaken. Directions for future research are proposed and clinical strategies are suggested for addressing the needs of these children.


METHODS
Searches of Medline, PsycINFO and CINAHL revealed 65 relevant qualitative, quantitative, or mixed methods' papers published between 1997 and 2008. These papers were rated for scientific merit and findings were extracted for summary.


RESULTS
Siblings of children with cancer do not experience elevated mean rates of psychiatric disorders, but a significant subset experiences post-traumatic stress symptoms, negative emotional reactions (e.g. shock, fear, worry, sadness, helplessness, anger, and guilt), and poor quality of life in emotional, family, and social domains. In general, distress is greater closer to time of diagnosis. School difficulties are also evident within 2 years of diagnosis. Qualitative studies reveal family-level themes such as loss of attention and status as well as positive outcomes including increased sibling maturity and empathy.


CONCLUSIONS
Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services.
The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. alderfer@email.chop.edu
Melissa A
MA
Alderfer
Kristin A
KA
Long
E Anne
EA
Lown
Anna L
AL
Marsland
Nancy L
NL
Ostrowski
Janet M
JM
Hock
Linda J
LJ
Ewing
D000223:Adaptation, Psychological; D000293:Adolescent; D000342:Affective Symptoms / Q000175:diagnosis / Q000523:psychology; D002648:Child; D002667:Child Reactive Disorders / Q000175:diagnosis / Q000523:psychology*; D002675:Child, Preschool; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000523:psychology; D009369:Neoplasms / Q000523:psychology*; D010553:Personality Development; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D035781:Siblings / Q000523:psychology*; D012917:Social Adjustment; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology