Psychologic functioning in 8- to 6-year-old cancer survivors and their parents Helaine S. Greenberg, MSW, Anne E. Kazak, PhD, and Anna T. Meadows, MD From the University of Pennsylvania Schools of Social Work and Medicine, Philadelphia, and the Children's Hospital of Philadelphia Cancer Research Center This study presents data on psychologic adjustment (self-concept, depression, locus of control, family environment, and parental distress) for a sample of 8- to 16-year-old long-term cancer survivors (n = 138) and their mothers, and for a sample consisting of a matched group of healthy children (n = 92) and their mothers. The null hypothesis Of no group differences between survivors and control subjects was tested with respect to these variables. It was hypothesized that survivors with severe late effects would have poOrer self-concepts, a more external locus of control, and more depressive symptoms than children with no or mild-to-moderate !ate effects. The children completed the Piers-Harris Self-Concept Scale, the NowiCki-Strickland Locus of Control Scale, and the Children's Depression Inventory. Mothers completed the Family Environment Scale and the Derogatis Stress Profile. The majority of former patients are functioning within normative limits on these standardized measures, although their scores were lower than those in the corn parison group. One-way analyses of variance on the dependent measures indicate that the children with severe medical late effects have a poorer total self-concept, more depressive symptoms, and a more external locus of control than those with no or mild-to-moderate late effects. Therapies for childhood Cancer are now well standardized and many long-term deleterious effects are known, so children at risk can be identified readily and steps taken early in treatment to prevent or mitigate future psychologic problems. (J PEDIATR 1989;114:488-93) Improved treatments for childhood cancer have led to increasing survival rates; the expectation is that more than 60% will be cured. It is estimated that by the year 2000, one in every 1000 young adults (20 to 29 years of age) will have survived cancer in childhood.! As cure of cancer becomes increasingly common, it seems important to investigate psychologic adjustment and the impact of Cancer cure on children and families. Deleterious late Supported in part by a contract (SPC 789311) from the Common- wealth of Pennsylvania and by the Joan B. Kroc Foundation. Submitted for publication May 12, 1988; accepted Aug. 5, 1988. Reprint requests: Anna T. Meadows, MD, Children's Hospital of Philadelphia, Cancer Research Center, Room 9028, 34th Street arid Civic Center Blvd., Philadelphia, PA 19104. effects of treatment include potentially handicapping con- ditions such as cosmetic deformities, organ dysfunction, learning disabilities, delayed menarche or sterility, and oncogenesis) Although Van Eys 3 noted that the goal of cure with respect to psychologic adjustment is "the accep- tance ~ of having had cancer as a past event without interference with normal development," relatively little research has assessed the extent to which this occurs in young cancer survivors. Most literature in this area has focused on late adoles- cents an d young adults. There is evidence that survivors in this age range function relatively well,4-8 although psycho- logic difficulties for some have been documented. 9-13 The literature on family adjustment to childhood cancer is inconclusive. Some studies suggest that family disorgani- 488