Commentary: Psychologists in Pediatric Oncology: Kudos, Criticism, and Courses for the Future

Abstract

The unique contribution of psychologists in pediatric oncology settings arises from the application of theorydriven and empirically validated models to the psychological functioning of children and family members facing the challenges of cancer treatment and its aftermath. Over the past two decades, some of the most recognized names in our field, the true leaders of a generation of pediatric psychologists, have dedicated their efforts to providing clinical service to children with cancer and their families, as well as conducting research in the field and teaching others advanced clinical and academic skills. I think psychologists who have contributed to this field are to be congratulated for elucidating a number of key issues related to the neuropsychological and socioemotional aspects of pediatric cancer, exemplifying the scientist-practitioner model, and keeping the standards of our field quite high. As pointed out by Armstrong and Reaman, there is no question that the Children’s Oncology Group (COG) and its prior constituent associations, the Pediatric Oncology Group, the Children’s Cancer Group, the National Wilm’s Tumor Study Group, and the Intergroup Rhabdomyosarcoma Study Group, conducted clinical trials that have led to impressive advances in survival among children with cancer. These cooperative groups derived the majority of their funding from the National Cancer Institute (NCI), which, as described at the National Institutes of Health’s website (www.nih.gov/icd), “leads a national effort to eliminate the suffering and death due to cancer.” In short, since its inception in 1937, the NCI has had as its major focus the finding of a cure for the group of diseases collectively referred to as cancer. While this is an admirable goal, it became clear nearly half a century into the endeavor that immediate cures were not to be forthcoming, and the NCI started to invest funds in “cancer control,” which encompasses areas of cancer prevention and treatment that do not focus directly on diagnosing or curing the illness. Psychological studies of the sequelae of disease and its treatment typically are considered cancer control studies. In its budget for 2005, the NCI has requested over $6.2 billion, $839 million (13.5%) of which is targeted for all aspects of cancer control (National Cancer Institute, 2004). When one further considers the relatively small percentage of those funds that are dedicated specifically to pediatric diseases, it becomes clear that what dollars are available for research in pediatrics would flow in line with the original intent of the NCI—to find cures for the diseases. Despite the relatively limited funding from the NCI for psychological studies within the context of pediatric cancer, a Medline search for the years 1966 to the present yielded some interesting findings. Entering the names of eight major psychologists—the former and current chairs of the various psychology sections of the clinical-trials cooperative groups (R. Mulhern, D. Copeland, B. Moore, F. D. Armstrong, R. Noll, and M. J. Kupst) and the two most recent editors of the Journal of Pediatric Psychology (A. Kazak and R. Brown)—yielded 490 citations. In a subsequent search, it was found that of the total of 440 citations for Pediatric Oncology Group, 5 included publications on which one of the above psychologists was a coauthor. Of the 330 citations for Children’s Cancer Group, another 5 were coauthored by one of the above, and none of the 24 articles for Children’s Oncology Group was cowritten by these prolific psychologists. In other words, there has been a great deal of productivity by these psychologists, virtually all of whom are full professors in their respective medical schools; yet very little research was generated within the cooperative-group mechanisms. The relative success of medical research within the pediatric oncology clinical-trials cooperative groups stems