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Pediatric cancer patients encounter painful medical procedures on a routine basis. Extreme anticipatory anxiety and behavioral distress are exhibited by these children prior to and during the procedures. This study investigated the relationship between children's distress and a number of psychosocial, medical, and demographic variables. Results indicated that the observation scale used to measure distress was a reliable, valid instrument. The three variables most highly predictive of children's distress included the age of the child, the number of previous medical procedures experienced by the child, and parental anxiety in relation to the medical procedures. A number of other significant variables are discussed and implications for intervention are reviewed.Painful medial procedures must be administered during the course of diagnosis and treatment of the pediatric cancer patient, which exacerbate the emotional and physical distress inherent in the disease itself. Of these procedures, bone marrow aspirations are reported by both parents and their parents to be the most painful and traumatic events in the entire therapeutic regimen. Bone marrow aspirations are diagnostic procedures in which a needle is inserted into the bone and marrow is extracted to determine the presence or absence of cancer cells.The anxiety produced by anticipation of these procedures can be so severe that patients (and sometimes parents) may report symptoms such as nausea, vomiting, skin rashes, and insomnia days before procedures are scheduled.

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This study evaluated the efficacy of a cognitive-behavioral intervention package and a low-risk pharmacologic intervention (oral Valium), as compared with a minimal treatment-attention control condition, in reducing children's distress during bone marrow aspirations. The subjects were 56 leukemia patients who ranged in age from 3 years to 13 years. The three intervention conditions were delivered in a randomized sequence within a repeated-measures counterbalanced design. Dependent outcome measures included observed behavioral distress scores, self-reported pain scores, pulse rate, and blood pressure scores. Repeated-measures analyses of variance indicated that children in the cognitive-behavior therapy condition had significantly lower behavioral distress, lower pain ratings, and lower pulse rates than when they were in the attention-control condition. When children were in the Valium condition, they exhibited no significant differences from the attention control condition except that they had lower diastolic blood pressure scores.

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