The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Psychooncology. 2010 Aug;19(8):789-805. doi: 10.1002/pon.1638.
To promote a broader understanding of the psychosocial impact of childhood cancer on siblings, a systematic review was undertaken. Directions for future research are proposed and clinical strategies are suggested for addressing the needs of these children.
Searches of Medline, PsycINFO and CINAHL revealed 65 relevant qualitative, quantitative, or mixed methods' papers published between 1997 and 2008. These papers were rated for scientific merit and findings were extracted for summary.
Siblings of children with cancer do not experience elevated mean rates of psychiatric disorders, but a significant subset experiences post-traumatic stress symptoms, negative emotional reactions (e.g. shock, fear, worry, sadness, helplessness, anger, and guilt), and poor quality of life in emotional, family, and social domains. In general, distress is greater closer to time of diagnosis. School difficulties are also evident within 2 years of diagnosis. Qualitative studies reveal family-level themes such as loss of attention and status as well as positive outcomes including increased sibling maturity and empathy.
Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services.
为了更全面地了解儿童癌症对其兄弟姐妹的心理社会影响，我们进行了系统评价。提出了未来研究的方向，并为满足这些儿童的需求提出了临床策略。
在 Medline、PsycINFO 和 CINAHL 上进行了检索，共发现了 65 篇相关的定性、定量或混合方法的论文，这些论文发表于 1997 年至 2008 年期间。对这些论文进行了科学价值评估，并提取了研究结果进行总结。
儿童癌症患者的兄弟姐妹并未出现明显更高的精神障碍平均发病率，但相当一部分患者出现创伤后应激症状、负性情绪反应（如震惊、恐惧、担忧、悲伤、无助、愤怒和内疚），以及情感、家庭和社会领域的生活质量下降。一般来说，在接近诊断时，痛苦会更大。在诊断后 2 年内，也会出现学校困难。定性研究揭示了家庭层面的主题，如失去关注和地位，以及积极的结果，包括兄弟姐妹的成熟度和同理心的提高。
关于儿童癌症患者兄弟姐妹的研究在方法学上仍然存在局限性。定性和定量研究的结论有很大差异。我们提出了一个研究议程，以推动这一领域的发展，包括更加关注正常发展的变化（而不是精神状况），开发更合适的定量测量方法，检查适应的潜在调节因素，以及使用前瞻性纵向设计。儿童癌症患者的兄弟姐妹是一个心理社会风险群体，应提供适当的支持服务。
