DECREASING CHILDREN'S DISTRESS DURING CANCER TREATMENT

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The treatment of childhood cancer involves a number of invasive diagnostic and therapeutic medical procedures which can be extremely stressful. Although some progress has been made in the psychological treatment of children's distress during these stressful medical procedures, existing approaches have only been demonstrated to reduce distress during a single medical procedure. Long-term maintenance of treatment benefits has been obtained. In addition, current intervention strategies require the presence of a therapist to coach the child during the procedure, and therefore, are costly to implement. Finally, the current literature only begins to address the full range of stressful experiences of children with cancer. The proposed study addresses these issues by evaluating a cognitive- behavioral intervention program designed to achieve long-term reductions in children's distress during a variety of stressful cancer treatment procedures, and by exploring cost-effective treatment options. Sixty pediatric cancer patients between the ages of 5 and 12 will be stratified by age and randomly assigned to one of the following conditions: a) multiple session cognitive-behavioral therapy with in vivo therapist coaching, b) multiple session cognitive-behavioral therapy with in vivo therapist and parent coaching, or c) wait list control. By means of a randomized three-group, multi-wave factorial design, the proposed study will: 1) Test whether a multiple session cognitive- behavioral treatment program which includes in vivo therapist coaching will result in decreases in physiological, behavioral, and self-reported distress in children undergoing chemotherapy venopunctures or injections as well as bone marrow aspirations and lumbar punctures; 2) Test whether reductions in distress will maintain after the coach is withdrawn; 3) Test whether parents can be taught to be effective coaches for their children, and evaluate the impact of parent training on both the child's and the parent's distress associated with the child's medical treatment; and 4) Compare the relative effectiveness of therapist coaching versus parent coaching in achieving long-term reductions in children's distress.