The emotional toll of childhood cancer lasts long after treatment

When childhood cancer treatment ends, the emotional impact often does not. A new study published in the Nature journal Pediatric Research finds that symptoms of post-traumatic stress, anxiety, and depression remain common among childhood cancer survivors and their parents more than a year after treatment has been completed, highlighting the long-term psychological consequences of pediatric cancer.

The study was led by Bar-Ilan University PhD student Maya Yardeni, a senior psychologist in the Pediatric Hemato-Oncology Division at Sheba Medical Center, and conducted under the co-supervision of Prof. Ilanit Hasson-Ohayon from the Department of Psychology at Bar-Ilan University and Prof. Dalit Modan-Moses from Sheba Medical Center. The research brings new insight into how trauma can develop not only from violent events, but also within medical settings marked by prolonged fear, invasive procedures, repeated hospitalizations, and ongoing uncertainty.

“Even after treatment is over, children and their parents can continue to experience high levels of stress, anxiety, and depression,” said Prof. Hasson-Ohayon, who heads the Rehabilitation Psychology Lab at Bar-Ilan University. “Pediatric cancer is a shared journey of uncertainty and fear. Our study shows how critical it is to screen both children and parents and provide ongoing emotional support long into survivorship.”

In pediatric cancer, this experience is inherently shared. Parents accompany their children throughout the illness trajectory, exposing both to a continuous sense of threat and experience of loss of control. Over time, this shared exposure can result in lasting psychological distress for both survivors and caregivers, even after medical recovery.

To examine this, the researchers conducted a cross-sectional study involving 118 childhood cancer survivors aged 7 to 21 and their parents, all at least one year after treatment completion. Symptoms of post-traumatic stress, anxiety, and depression were assessed using validated questionnaires, alongside medical and sociodemographic information drawn from medical records. By collecting data from both children and parents, the study allowed for direct comparison between children’s self-reported experiences and parental perceptions.

The findings show that psychological distress remains highly prevalent during survivorship, the period after a patient has completed treatment, and that symptoms of trauma, anxiety, and depression are closely interconnected. Notably, parents’ perceptions of their children’s emotional distress were often more strongly associated with the parents’ own emotional state than with the children’s self-reports, suggesting that parental distress may shape how children’s well-being is interpreted by them.

Beyond its scientific contribution, the study carries an important clinical message. Long-term follow-up care in pediatric oncology should extend beyond physical health to include sensitive and ongoing assessment of psychological well-being in both children and parents. Prioritizing children’s self-reports and offering tailored psychosocial support throughout survivorship may significantly improve long-term outcomes for families.

Building on this work, the research team is currently conducting a follow-up study examining the effectiveness of trauma-focused psychotherapy for parents of childhood cancer survivors, with the goal of reducing long-term trauma symptoms and improving family well-being.

The study was funded by a grant from the Israel Cancer Association.