Commentary: Contexts and Challenges in Pediatric Psychosocial Oncology Research: Chasing Moving Targets and Embracing “Good News” Outcomes

Abstract

Pediatric oncology provided one of the most impressive medical success stories of the latter half of the twentieth century. As recently as the mid-1960s, malignant diseases such as acute lymphocytic leukemia (ALL) were still almost universally fatal. For the parents of a child diagnosed with ALL, doctors could offer little more than palliative measures, and the tragic end often came quickly. By the early 1990s, an initial remission was obtainable for virtually all children with ALL, who now had a 75–80% chance of long-term survival. As we follow this story, we can only marvel, applaud, and be thankful. This incredible progress was achieved through a focused national effort and through the establishment of cooperative groups that allowed for treating nearly all children with cancer via large-scale clinical trials. Someone entering the field today might have a hard time appreciating just how rapid and dramatic such progress has been and, although survival rates have plateaued somewhat, how new approaches to resistant disease and significant advances in supportive care continue to be made. The rapidity of these medical advances, as wonderful as they are, have posed a challenge for the psychosocial researchers in this arena—namely, that of just keeping up. Our work is yoked to that of our medical colleagues, and, like it or not, we follow. However proactive we may wish to be, rarely are we in the position of setting the agenda. In truth, our primary recourse is to hitch our research wagons to the shooting star of the prevailing medical advances and follow where it leads. To do so is not easy. Psychosocial research takes time to develop, and having a moving target does not help. From this perspective, the accomplishments reviewed by Patenaude and Kupst (2005) and Kazak (2005) are all the more impressive. It is a testament to the alacrity, creativity, and adaptability of the early researchers in this area, one perhaps augmented by the occasional good luck of being in the right place at the right time. These two papers aptly review the brief history of pediatric psycho-oncology to date, the advances that have been made, the methodological obstacles that have been faced, and the challenges now on the horizon for future investigators. What perhaps is not fully appreciated is the context in which this work has taken place. In this paper, I add my impression to some of the contexts behind this history, not the least of which has been the challenge of chasing a rapidly moving target. This impression may be best illustrated by a once-common problem that was not addressed at length in either review: nausea and vomiting (NV). Today, when someone new to the field walks through a medicine room full of children receiving chemotherapy, they may fail to be impressed by the relative calm and by the absence of distress. Yet, over a decade ago, the sounds of retching were ubiquitous and accompanied by an unmistakable odor. The gallows humor of the day was all about vomit; “puke jokes” were in. The antiemetics at the time were not effective, and NV were a source of much suffering. This was clearly an area for psychology to make a significant contribution. When I began as a postdoctoral fellow, I worked on a study for Lonnie Zeltzer and Sam LeBaron, comparing hypnotic and nonhypnotic behavioral interventions for NV. Another mentor at that time, Michael Dolgin, was working on identifying correlates of anticipatory NV, such as motion sickness or sensitivity to odors. Likewise, when I began at St. Jude, this area was the primary research focus of my colleague Vida Tyc. Behavioral study of the problems of NV was indeed at the forefront of psycho-oncology research. Then, in the early 1990s,