Behavioral distress in pediatric patients with cancer receiving chemotherapy

The purpose of this study was to assess prospectively the behavioral effects of chemotherapy in children and adolescents with cancer. A total of 94 patients, with a range of malignancies and chemotherapy protocols, were evaluated 1, 4, and 7 months after treatment initiation. Assessments focused on behavioral distress symptoms and nausea/vomiting experienced in anticipation of chemotherapy and following its administration. Significant disturbances were described in a variety of domains, with adolescents exhibiting consistently higher levels of behavioral symptoms and nausea/vomiting than younger children. Behavioral distress tended to decrease and stabilize throughout time for children and to increase throughout time for adolescents. Age differences in behavioral distress were independent of the emetogenicity of therapy given to younger and older patients. The interaction of biologic and psychosocial factors in determining treatment-related distress is discussed, along with implications for future predictive and intervention studies.