Psychosocial issues in childhood cancer. An ecological framework for research

A number of psychosocial issues are evolving as childhood cancer becomes a chronic rather than a fatal condition. These include issues associated with extended hospitalization and social isolation, as well as long-term adjustment to survival that may involve recurrence of disease. Primary emphasis in current research and intervention is placed on how children and their families adapt to long-term survival. This article reviews the scope and limitations of previous research in this area, which focuses on the individual with little reference to the family, school, or social networks or to the interactions occurring among these arenas. An ecological model is suggested as the most useful perspective for enhancing our understanding of the impact of childhood cancer on the child, family, and community. Much of what is already known about how cancer and its treatment affect children and families is consistent with the propositions of an ecological model. The transactional, reciprocal, and interdependent nature of coping behaviors within a family system is perhaps the most obvious indicant of the need for multiple perspectives for understanding how families respond to the pressures of a chronic, but possibly life-threatening, illness. An ecological approach is timely, therefore, in that there is a need for psychological research and intervention directed beyond the immediate context of treatment to extended levels of social interaction and social systems.