https://doi.org/10.1177/1043454218810136 Journal of Pediatric Oncology Nursing 1–14 © 2018 by Association of Pediatric Hematology/Oncology Nurses Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1043454218810136 journals.sagepub.com/home/jpo Review Introduction Bullying occurs when one is repeatedly exposed to the negative actions of another person or group, and has dif- ficulty defending oneself (Olweus, 1993). Bullying may take various forms (Smith et al., 2008): physical bullying is behavior that causes physical harm or injury, including hitting, kicking, spitting, and damage to property; verbal bullying involves teasing, name-calling, or threats; social or relational bullying involves exclusion or the spreading of rumors intended to harm a person’s reputation; and when these behaviors are executed through electronic devices, it is known as cyber-bullying. The serious and enduring psychological sequelae of school bullying are well documented. Victims are more likely to experience mental health problems, including depression, anxiety, substance abuse, and suicidal ide- ation (Holt et al., 2015; Reijntjes et al., 2011). Bullying has also been linked to school phobia and absenteeism in adolescent victims, leading to poor academic outcomes 810136JPO XX X 10.1177/1043454218810136Journal of Pediatric Oncology NursingCollins et al. research-article 2018 1 Sydney Children’s Hospital, Sydney, New South Wales, Australia 2 University of New South Wales, Sydney, New South Wales, Australia 3 Macquarie University, Sydney, New South Wales, Australia 4 University of Sydney, Sydney, New South Wales, Australia 5 ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia Corresponding Author: Joanna E. Fardell, PhD, M.Clin.Neuropsych, BSc (Hons I), Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, High Street, Randwick, New South Wales 2031, Australia. Email: j.fardell@unsw.edu.au A Systematic Review Summarizing the State of Evidence on Bullying in Childhood Cancer Patients/Survivors Daisy E. Collins, BPsych (Hons I) 1,2 , Sarah J. Ellis, BAPsych (Hons)/BHlth 1,2 , Madeleine M. Janin 1,2 , Claire E. Wakefield, PhD, MPH, BPsych (Hons I) 1,2 , Kay Bussey, PhD, BEcon (Hons) 3 , Richard J. Cohn, MB, BCh 1,2 , Suncica Lah, PhD, MSc (Clin. Neuropsych), BA (Hons) 4,5 , and Joanna E. Fardell, PhD, M.Clin.Neuropsych, BSc (Hons I) 1,2 Abstract Background: One in four school-aged children is bullied. However, the risk may be greater for childhood cancer patients/survivors (diagnosed <18 years), because of symptoms of the disease and treatment that may prejudice peers. While the serious consequences of bullying are well documented in the general population, bullying may have even greater impact in children with cancer due to the myriad of challenges associated with treatment and prolonged school absence. Objective: To summarize the state of evidence on bullying in childhood cancer patients/ survivors; specifically, the rate and types of bullying experienced and the associated factors. Method: We searched five electronic databases from inception to February 2018 for original research articles reporting on bullying in childhood cancer patients/survivors. Results: We identified 29 eligible articles, representing 1,078 patients/survivors (M = 14.35 years). Self-reports from patients/survivors revealed a considerably higher rate of bullying (32.2%) compared with the general population (25%). Our review identified little information on the factors associated with bullying in patients/ survivors. However, the bullying described tended to be verbal and was often related to the physical side effects of treatment, indicating that differences in appearance may prejudice peers. It was further suggested that educating the child’s classmates about cancer may prevent bullying. Conclusions: Our findings confirm that bullying is a significant challenge for many childhood cancer patients/survivors. Additional studies are needed to identify factors that may influence the risk of bullying, which will inform the development of evidence-based interventions and guidelines to prevent bullying in childhood cancer patients/survivors. Keywords childhood cancer, bullying, teasing, social exclusion, peer victimization