title: Parental Experiences with Chemotherapy-Induced Alopecia among Childhood Cancer Patients in Indonesia.
abstract: BACKGROUND
  This study assessed parental experiences with chemotherapy-induced alopecia among children with cancer treated at an Indonesian academic hospital.
  
  
  METHODS
  Fifty parents of childhood cancer patients were interviewed using semi-structured questionnaires.
  
  
  RESULTS
  The moment that hair fell out was the moment that parents (84%) had to admit their child had cancer. Alopecia was a traumatizing painful experience (46%). Active strategies to hide alopecia, mainly hats, were used by 66% of children, while 34% never covered their bald head. If money had not been an issue, 40% would use another strategy. Alopecia made children limit outdoor daily activities (78%) and engagement with others (60%). Significantly more children from high-educated (95%) than low-educated (60%) parents received sympathy from other people (P=0.012). Significantly more Christian (29%) than Muslim (0%) families confirmed that alopecia lowered the quality of life (P=0.046). Most parents (82%) had no prior plans about alopecia management, yet for significantly more girls (26%) than boys (0%) such plans existed (P=0.044). Parents received most information about alopecia from other parents (66%). Parents (92%) needed more alopecia education from doctors. Of all school-attending children, 53% were bullied and 47% did not want to attend school due to alopecia. Significantly more high-educated than low-educated families received pity from teachers and pupils (94% vs. 0%, P=0.004), and acceptance by pupils (81% vs. 0%, P=0.021).
  
  
  CONCLUSIONS
  Alopecia is a severe, far-stretching side-effect of chemotherapy with physical, psychological and social consequences for children and parents. Parents should be better informed about occurrence and impact of alopecia. Extra attention is required to facilitate children's return to school. Health- care providers should facilitate optimal supportive care through open dialogue and provision of educational materials for parents, children and their community.
authors.affiliation: Department of Pediatrics, Kandou Hospital, Manado, Indonesia, E-mail : s.mostert@vumc.nl.
authors.forename: Stefanus
authors.initials: S
authors.lastname: Gunawan
authors.forename: Chloe Ten
authors.initials: CT
authors.lastname: Broeke
authors.forename: Peter van de
authors.initials: Pv
authors.lastname: Ven
authors.forename: Marijn
authors.initials: M
authors.lastname: Arnoldussen
authors.forename: Gertjan
authors.initials: G
authors.lastname: Kaspers
authors.forename: Saskia
authors.initials: S
authors.lastname: Mostert
mesh_terms: D000293:Adolescent; D000505:Alopecia / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology; D010290:Parents / Q000523:psychology*; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires