Le vécu de la fratrie face au cancer pédiatrique : revue de la littérature systématique

Background and objectives

Pediatric cancer presents numerous challenges for the afflicted child and their family. While the impact on the ill child and their parents has been well-documented, there has been limited research focusing on the experiences of siblings coping with a family member's cancer diagnosis. Existing French-language studies primarily examine how siblings adapt to pediatric cancer and the potential benefits of support groups tailored for them. To our knowledge, there is currently no French-language literature review addressing this specific topic. This article aims to conduct a systematic review of existing literature to analyze and synthesize key findings, thereby enhancing our understanding of siblings’ experiences in this context.

Methodology

We conducted a systematic review of both national and international articles published between 2012 and 2022, utilizing specific keywords. Searches were performed on databases including PubMed, PsycINFO, PsycARTICLES, and Google Scholar. Our methodology adhered to the PRISMA guidelines (Preferred Reporting Items for Systematic Review and Meta-Analyses). The quality of each included article was assessed using the Mixed Methods Appraisal Tool (MMAT). In presenting the results, we initially conducted a meta-synthesis of qualitative studies, which were then supplemented by quantitative and mixed data, taking into account their complementary nature. This approach offers a comprehensive overview of the existing findings.

Results

Following the initial screening based on title and abstract, a total of 137 articles were identified. Upon thorough examination, 28 articles were deemed suitable for inclusion: comprising qualitative (n = 12), quantitative (n = 12), and mixed-methods (n = 4) studies. Through analysis and synthesis of these findings, we gained a deeper insight into the experiences of siblings facing pediatric cancer. Subsequently, we provide an overview of the studies’ characteristics, their quality assessed using MMAT, and the demographic details of the siblings involved. This sets the stage for a meta-analysis of the results, offering a comprehensive examination of the collective findings. Several themes emerge to elucidate the experiences of siblings. “The onset of cancer” delves into the effects of receiving the diagnosis and the ensuing emotional turmoil, some of which may have enduring ramifications. Subsequent discussions encompass the myriad repercussions, shedding light on the pervasive changes across various aspects of life. Themes such as “Unequal care: being abandoned, forgotten by parents”; “The impact on family relationships”; “Taking on new responsibilities”; “The impact on friendships”; “The impact on school and education”; and “Being a donor for the sick child” intricately describe and address the siblings’ journey. The presentation of these findings contributes to a deeper comprehension of ensuing themes: “Distress” and “Trauma”. Furthermore, our results spotlight the siblings’ resilience in “coping with cancer”, elucidating the array of coping mechanisms they employ to navigate the illness and its ramifications. Additionally, a theme titled “Support offered to siblings and their needs” affords insights into existing programs tailored to their requirements.

Conclusion

Siblings endure a plethora of challenges stemming from the moment of diagnosis through the entirety of the treatment journey, leading to multifaceted suffering. Primarily, the disease itself, including the announcement and treatment side effects, triggers difficult-to-handle reactions such as death anxiety and uncertainty, which can leave profound and enduring impacts. Additionally, parental absence, unequal care, and shifts in family dynamics introduce another layer of distress for siblings. Often, manifestations of anger, jealousy, and aggression surface, indicative of feelings of bewilderment, helplessness, and insecurity. Finally, siblings are profoundly impacted by the suffering of the sick child and parents, often oscillating between providing support to both the ill sibling and the parents while grappling with their own challenges to shield their loved ones. Consequently, these varied reactions and experiences often manifest in high levels of distress, anxiety-depressive symptoms, and post-traumatic stress. Further research is imperative to gain a deeper understanding of siblings’ experiences, including their effects on family dynamics and psycho-affective development. Additionally, psychological support and/or guidance from the moment of diagnosis are essential to address the complex needs of siblings coping with pediatric cancer.