Psychosocial impact of pediatric BMT on siblings

Abstract

Summary:Although bone marrow transplantation (BMT) has become standard therapy for many life-threatening disorders of childhood, there is little research on the psychosocial impact of BMT on siblings of children undergoing BMT. Such siblings face issues common to any family with a chronic illness. However, the psychological impact on the family is intensified because two family members, usually children, are subjected to intrusive medical procedures. Investigators had earlier noted that sibling donors may be at risk for behavioral problems and anxiety, while nondonors may experience ambivalent feelings of disappointment and relief. It was suggested that psychosocial stages of BMT may parallel the medical transplant process, with high levels of stress experienced pre-BMT, during hospitalization, and postdischarge. Our own group has recently conducted more systematic investigations on the psychosocial effects of BMT on donor vs nondonor siblings of surviving pediatric BMT patients. We found that sibling donors showed significantly more anxiety, lower self-esteem, and more adaptive skills in school than nondonors. Nondonors, on the other hand, showed significantly more school problems. One third of the siblings in each group reported a moderate level of post-traumatic stress. Taken together, our research indicates that BMT affects the life of the child at home and at school and that posttraumatic stress symptomatology is a component of the psychological reaction in siblings. The psychosocial adjustment of siblings is a critical area of investigation in BMT populations. Parents need to know that the BMT process affects every member of the family system, and both parents and professionals need to direct more emotional support and attention to siblings. Studies are needed that focus on interventions designed to reduce levels of sibling psychosocial maladjustment. The psychosocial developmental model of posttraumatic stress disorder is a viable theoretical model that may be used to guide future research.

Psychological effects of hematopoietic SCT on pediatric patients, siblings and parents: a review

“…The literature has shown that siblings of HSCT patients are at risk of developing emotional reactions such as post-traumatic stress disorder, anxiety, and overall low self-esteem. [31][32][33][34] Pot-Mees and Zeitlin 8 found new behavior problems occurred far more frequently among siblings who were BM donors than among nondonors. See Table 4 for a list of psychosocial reactions specific to siblings.…”

“…As a result, a considerable portion of parental stress stems from concern involved with the health of not only the patient, but the sibling donor as well. 31 Parents have also expressed concerns regarding the nondonor sibling's psychosocial adjustment. 31 Some other sources of parental stress include relocating to the transplant center, living in two separate households, commuting between the home and the transplant center, concurrently caring for other family members, work-related changes, lengthy hospital stays, financial burdens, parental informed consent for the HSCT procedure, dealing with medication compliance and other medical complications.…”

“…31 Parents have also expressed concerns regarding the nondonor sibling's psychosocial adjustment. 31 Some other sources of parental stress include relocating to the transplant center, living in two separate households, commuting between the home and the transplant center, concurrently caring for other family members, work-related changes, lengthy hospital stays, financial burdens, parental informed consent for the HSCT procedure, dealing with medication compliance and other medical complications. [37][38][39] In addition to these difficulties, the emotional stress parents experience may stem from worry, concern and guilt regarding a child undergoing the HSCT procedure, apprehension regarding losing a child and fear of relapse once the HSCT procedure is completed.…”

The interface between assisted reproductive technologies and genetics: technical, social, ethical and legal issues

“…Consequently, the psychological impact of bone marrow donation among siblings should not be underestimated. 233 Children from DI may remain ignorant of their biological parents. Firstly, it has been traditionally considered as a family matter and left for parents to decide, whether they disclose the conception method to their children or not, even though the legislation would allow to detect donor identity.…”

The siblings of childhood cancer patients need early support: a follow up study over the first year

“…14 One important and fairly new aspect of sibling adaptation is the issue of the psychosocial impact of paediatric bone marrow transplantation. 15 Imprecise definitions and a lack of longitudinal studies are identified as deficiencies in current research on siblings' psychosocial well being. 16 In order to obtain more definitive information about the impact of childhood cancer on siblings, we conducted a prospective, controlled follow up study of the siblings of newly diagnosed cancer patients.…”