It might surprise you to learn that many, even most, children undergoing cancer treatment are fairly well-adjusted. Still, there are kids who struggle with anxiety and depression, which can affect them getting better. Jordan Gilleland Marchak, a psychologist at Emory University School of Medicine and Children’s Healthcare of Atlanta, is developing a web-based screening tool to assess how each patient is doing. “The tool will take the information and share it with the medical team in real time so they can put needed supports in place,” said Marchak, who has a PhD and works at Children’s Aflac Cancer and Blood Disorders Center. The tool’s development is being funded by a grant from the St. Baldrick’s Foundation, which supports pediatric cancer research. The parents of children with cancer also will be screened. It probably won’t surprise you that many of them are dealing with stress and anxiety.
Q: What kind of issues do you deal with on a day-to-day basis?
A: There could be issues with medication adherence, pain, anxiety or depression. Say a family is having problems with chemotherapy at home — maybe the child doesn't want to swallow pills or the family is having trouble staying on a schedule. Pain is a problem for many cancer patients. Psychologists can have a real impact with these kinds of issues, not only with health outcomes for patients but also improving their quality of life.
Q: Do you treat just the kids or entire families?
A: We provide care for kids and families at our center. Parents aren't seen for their own psychotherapy but I will work one-on-one with them if there is a parenting issue related to the care of their child. We work as a team to find good mental health resources for our parents should they need individual counseling.
Q: How long has psychological care been part of the treatment for kids with cancer?
A: It has been around for a long time but has recently been gaining momentum. Within the past five years, the major professional health organizations have been making strong recommendations, recognizing that psychological factors and distress play a real role in the care and the health outcomes of kids and families. The research I am doing focuses on figuring out a way to help kids and their parents get the psychological care they need.
Q: Talk about the tool you are building.
A: With the St. Baldrick's grant, we are building a technological tool that will allow us to screen every patient and family in our care. What is their level of psychosocial distress? What are their stressors? If a family is dealing with some severe anxiety or depression, they might see a psychologist for help. If a parent is reporting a lot of stress around financial issues, the team might link them to their social worker. This tool leverages technology to gather information so we can provide comprehensive supports in a standardized way across our center.
Q: Is this tool something that other cancer centers could use?
A: My hope is that we learn a lot in terms of coming up with a process that works for our center and our families. We should be able to share the technology and the process with other centers.
Q: What insight can you offer about how kids deal with cancer?
A: About 70 percent of patients do just great, which is amazing to me. However, that leaves about 30 percent of kids who end up struggling with anxiety or depression or some post-traumatic stress after their treatment ends. Really, it's parents who usually have a more difficult time in terms of distress and trauma.
Q: Why do so many kids who are sick do better than their parents?
A: As parents, we are more focused on what is coming next, what things are going to be like tonight, tomorrow, two years from now. I think kids are busy being kids. They focus on the here and now. Part of our job is to make their here and now the best it can be.
Information on St. Baldrick’s Foundation: www.stbaldricks.org.
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