It is now generally accepted that the diagnosis of many pediatric cancers and their treatments result in significant and long-lasting neurocognitive, psychological, and psychosocial impairments and difficulties. The current status of research in this field has been addressed by other chapters in this text. We would, however, like to emphasize at the onset of our chapter that we firmly believe pediatric cancer is truly a family affair. The effects of the diagnosis of a life-threatening illness and its often-chronic treatment not only result in significant impact on the child’s or adolescent’s neuropsychological and psychological state, but also cause psychological ramifications for the parents, siblings, and extended family members. In healthy, well-functioning families, this major life obstacle can serve as an impetus to rally family members in support of the child. When this happens, interventions for late effects are beginning to be identified as effective and of potential benefit. This field, however, is clearly in its infancy. If the family is chaotic and struggling with relationship issues, the prognosis is less positive. Our clinical observations of these relationships are supported both by preliminary data from studies conducted by our research group and others, and by published manuscripts in the field of pediatric traumatic brain injury (Yeates et al., 1997, 2001). In one of the only studies investigating the impact of familial variables on psychosocial and neuropsychological outcome in pediatric brain tumor patients, the results are extremely consistent with the traumatic brain injury population (Carlson-Green, Morris, & Krawjecki, 1995). Reduced maternal dependence on external coping resources, higher parental socioeconomic status, dual-parent families, and familial cohesion were all identified as improving long-term outcome in this population, as documented by intellectual and behavioral integrity. The late effects of pediatric cancer and its treatment are physical, cognitive, psychological, and social. When multiple effects are present, they can be expected to result in a synergistic impact not only on the child, but also on other family members. The important point is that late effects should not be viewed in isolation or summated but should be appreciated for their interrelatedness.
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