Anxiety, depression, and quality of life in children with solid tumors: a single-center exploratory study of sociodemographic, clinical, school, and social functioning correlates

A recent exploratory study conducted at a leading pediatric hematology-oncology center in Turkey has shed critical light on the significant psychological burden experienced by children battling solid tumors. The findings, published in Frontiers in Psychology, reveal that a substantial proportion of these young patients exhibit high levels of anxiety and depressive symptoms, underscoring the urgent need for comprehensive psychosocial support integrated into their cancer care.

The research, a single-center cross-sectional evaluation, involved 50 children aged 8 to 18 years diagnosed with solid tumors. These children, navigating the complexities of prolonged treatment, frequent hospitalizations, and the inherent uncertainties of their diagnosis, were assessed for anxiety symptoms, depressive symptoms, and health-related quality of life. The study’s primary objective was to quantify this psychological distress and explore its associations with various factors, including sociodemographic characteristics, clinical status, school functioning, and social interactions.

Key Findings Illuminate a Significant Psychological Burden

The results paint a concerning picture: 16% of the children met the threshold for clinically significant depressive symptoms, as indicated by scores on the Children’s Depression Inventory (CDI). Even more striking, a staggering 56% of participants displayed a high risk for anxiety, identified through scores on the Screen for Child Anxiety Related Emotional Disorders (SCARED) scale. Further detailed assessments using the Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) revealed median total anxiety and depression scores of 42.0 and 44.5, respectively, indicating a widespread emotional symptom burden across the cohort.

Beyond symptom prevalence, the study delved into quality of life. Girls in the study reported significantly higher emotional functioning scores on the Pediatric Quality of Life Inventory (PedsQL) compared to boys (p < 0.001). This finding, while potentially suggesting a gender-specific coping mechanism or emotional expression, warrants further investigation. Interestingly, school functioning did not show significant differences between younger (8-12 years) and older (13-18 years) age groups (p = 0.124), a result that may reflect the diverse impact of illness and treatment on educational engagement across different developmental stages.

Exploring Correlates: Maternal Education and Psychological Well-being

In a significant exploratory finding, lower maternal education levels were associated with a higher likelihood of children experiencing clinically significant depressive symptoms. This correlation, quantified by a Spearman’s rho of -0.383 (p = 0.006), suggests that socioeconomic and educational background may play a crucial role in a child’s psychological resilience during cancer treatment. The study posits that maternal education could serve as a proxy for various factors, including health literacy, access to support resources, and the family’s capacity to navigate the complexities of pediatric cancer care.

Contextualizing the Challenge: The Landscape of Pediatric Cancer Care

Children diagnosed with solid tumors face a uniquely challenging journey. Unlike some hematological cancers that may have more standardized treatment protocols, solid tumors encompass a vast array of diagnoses, each with its own biological behavior, treatment intensity, and prognosis. This heterogeneity adds layers of complexity to their care, often necessitating prolonged hospital stays, extensive diagnostic procedures, and multimodal therapies such as surgery, chemotherapy, and radiotherapy.

The emotional and psychological toll on these children and their families is often immense. The disruption of normal developmental trajectories, the separation from peers and school environments, and the constant threat to their well-being can lead to significant emotional distress. Previous research has consistently highlighted the elevated risk of anxiety and depression in pediatric cancer patients, with studies pointing to factors such as treatment intensity, disease recurrence, and the availability of social support as significant moderators.

This study’s findings align with a growing body of literature emphasizing the interconnectedness of physical health and mental well-being in pediatric oncology. The integration of psychosocial support into routine care is no longer considered a secondary concern but a critical component of holistic treatment. International guidelines and systematic reviews increasingly advocate for routine psychosocial screening, early intervention, and family-centered approaches to address the unique needs of these vulnerable children.

Methodological Rigor and Limitations

The study, conducted between August 2024 and August 2025, employed validated Turkish versions of well-established psychometric instruments: the Children’s Depression Inventory (CDI), the Screen for Child Anxiety Related Emotional Disorders (SCARED), the Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV), and the Pediatric Quality of Life Inventory (PedsQL). Assessments were administered by a child and adolescent psychiatry specialist to ensure clinical accuracy.

While the study provides valuable insights, its exploratory nature and single-center design necessitate cautious interpretation. The sample size of 50, while sufficient for exploratory analysis, limits the generalizability of the findings. The clinical heterogeneity of the solid tumor diagnoses also precluded diagnosis-specific or stage-based analyses. Furthermore, the cross-sectional design means that causal relationships cannot be definitively established. Future research employing larger, longitudinal, and multicenter designs is crucial to validate these findings and explore the long-term impact of psychosocial factors on the trajectory of these children’s lives.

The reliance on self-report measures, while standard in this field, can be influenced by factors such as age, literacy, and individual response biases. The researchers acknowledge this limitation and note that clinician assistance was provided to children with reading difficulties. The absence of item-level data in the final dataset prevented a recalculation of Cronbach’s alpha coefficients for the psychometric instruments, though a domain-level reliability estimate for PedsQL was obtained.

Implications for Clinical Practice and Future Research

The study’s conclusions strongly advocate for the implementation of standardized psychosocial assessments in pediatric oncology settings. Early identification of children experiencing anxiety or depressive symptoms is paramount to facilitating timely and appropriate interventions. This could include psychoeducation for the child and family, individual or group therapy, pharmacological interventions when indicated, and support services tailored to their specific needs.

The finding regarding maternal education highlights the importance of considering the broader family context and socioeconomic factors. Interventions may need to be culturally sensitive and address potential barriers related to health literacy, access to resources, and family support systems. This underscores the value of a family-centered approach, recognizing that the well-being of the child is intricately linked to the well-being of the entire family unit.

The study’s authors emphasize the need for future research to explore a wider range of variables, including parental health literacy, caregiving burden, family communication dynamics, and treatment adherence. Understanding how these factors interact with clinical and sociodemographic variables can lead to more targeted and effective interventions. Moreover, the development and evaluation of culturally adapted psychosocial interventions, such as stress management programs, resilience-building activities, and digital support platforms, hold significant promise for improving the lives of children with solid tumors.

A Call for Integrated Care

In conclusion, this exploratory study from Turkey serves as a vital reminder that the fight against childhood cancer extends beyond physical healing. The significant prevalence of anxiety and depressive symptoms among children with solid tumors necessitates a paradigm shift towards more integrated care models. By prioritizing psychosocial assessment and intervention, healthcare providers can offer a more holistic and supportive environment, empowering these young patients and their families to navigate the challenges of cancer with greater resilience and an improved quality of life. The call for larger, longitudinal studies is clear, aiming to build upon these initial findings and pave the way for evidence-based psychosocial care that truly addresses the multifaceted needs of children facing this formidable disease.