The diagnosis of cancer in children is an event of undue stress not only for children themselves, but also for their parents or primary caregivers. Even though this entity is well recognised, this is often not well-explored and has not been systematically studied. The recent article published in IJP by Reshetnikov et al. focused on this often-neglected topic and is an important addition to the existing literature [1].

The study reports the result of a large-scale survey of 237 parents of children diagnosed with cancer from Russia, nearly all of whom (99.1%) reported feeling emotions of fear or stress. Interestingly, the financial difficulties also accounted for a major cause of worry for significant proportion of respondents (55.3%) and parents often resorted to financial assistance. Additionally, difficulty in geographic access to specialized treatment centres was also reported by a considerable number of respondents (50.5%). In an analysis of 22893 children with cancer from 3 centres in India by Bhatia et al. it was observed that sex disparity at diagnosis for pediatric malignancies was more apparent for situations requiring financial hardship and where access to treatment centres is difficult [2]. Similarly, a qualitative study among children with acute lymphoblastic leukemia (ALL) and their caregivers from India also reported similar themes regarding caregiver burden, especially financial distress and stress of relocation for accessing treatment [3]. These observations underscore the importance of equitable distribution of pediatric oncology care across the country, rather than restricting them to specialized centres in major cities. A shared care approach by involvement of local primary care physicians in routine non-intensive oncological care under supervision may be an effective model to allay financial hardship and improve healthcare access.

The results of the survey also highlighted the fact that the diagnosis of cancer in a child affects family dynamics often leading to worsening of interpersonal relations between parents themselves and even with other siblings. A previous study, which assessed health-related quality of life of children with ALL from parents’ perspective, revealed parents often overrated the quality of life of children [4]. This suggests the existence of a possible disconnect between the experience of children and parents during the cancer treatment journey. Hence, psychological support during the course of treatment is imperative not only for children but also for parents during the whole course of treatment. Indeed, 63.3% of parents in the survey by Reshetnikov et al. reported a need for psychological assistance [1].

A pilot randomized trial by Kaushal et al. from India evaluated a parent–child conjoint psychological intervention module among children in maintenance phase of ALL, and showed the feasibility and early efficacy of such systematic intervention in improving psychosocial variables for both children and parents [5]. Such interventions should be expanded to other age-groups and malignancies and systematically studied in different socio-cultural backgrounds for discerning their efficacy and broader acceptability. Incorporation of psychologists as part of oncology care team, for providing necessary interventions for children and caregivers alike, would go a long way for improving holistic care for children with cancer.