Psychotherapy with Hospitalized Children with Leukaemia: Is it Possible?

The prognosis for Childhood Leukaemia has changed considerably in recent years. In the past, this constellation of diseases was inevitably fatal whereas with the progress made in medical research particularly with new forms of chemotherapy and bone marrow transplantation, the cure rate (meaning the complete eradication of the physical symptoms of the disease for over 5 years) for leukaemia can now be as high as 60 to 70%. Children are required to have usually 3 or 4 courses of intravenous chemotherapy. After each course, they are required to spend approximately a month in protective isolation being barrier nursed in sterile conditions until their immune systems recover enough to allow them to have safe exposure to everyday life. If the chemotherapy is successful in bringing about a remission of the disease, it has been found that a bone marrow transplant can be highly effective in some forms of leukaemia in curing the disease. Preferably a matched donor is found (usually a sibling) and healthy bone marrow is transfused into the leukaemic child. This process in itself is not too traumatic, however prior to this the child has to undergo several extensive tests including bone marrow aspirations and lumbar punctures. They also require other prophylactic treatments including total body radiation. These treatments invariably render the children infertile as well as making them feel very ill. Temporary hair loss always occurs. A further period of time in isolation is required after transplant before the child can be cared for in out-patients. A close check is kept on the children for many years necessitating frequent hospital visits and tests. So although the child's life may be saved, the treatment of leukaemia is highly invasive and is potentially psychologically scarring. We will be discussing children who have been treated with both conventional chemotherapy as well as those who have undergone bone marrow transplantation.

There is a large body of literature