Coping with childhood cancer: Interaction and development of self-esteem and defense mechanisms

A severe disease in childhood has a deep impact on intrafamilial relationships, and is the major component of an evolving process. From diagnosis onwards, any element interfering with physical, cognitive, emotional, or behavioral development should be avoided. The family acts as a disease-related stress container, bearing the major burden of the child's psychological adjustment. Living with disease requires the activation of psychological defense mechanisms, cognitive functions, perception, memory, communication, judgment, acceptance, and emotions, which, taken together, mean coping. The successful evolution of the coping process enables good quality of life and adaptation. Evaluating the mother-child relationship in case of severe disease, such as leukemia or tumor, can help us understand how to cope with the situation. Our experience confirms that good communication and treatment as of onset will lead to good adjustment while a bad initial experience may result in long-term psychological impairment and maladjustment, even though the child-mother relationship may be excellent, and is often complementary. Psychological late effects are often due to the difficulties that have been suffered in adaptation and coping and especially when the patient is an adolescent. According to Folkman, risk and resistance factors contribute to adaptation, a mechanism which includes several factors, such as personality, motivation, social assertion, self-esteem, and a positive outlook. Other factors, such as family environment, social support, cognitive appraisal, and coping strategies must also be taken into consideration.