In a recently released article in Pediatrics (10.1542/peds.2018-2605), Dr. Hannin Salem and a team of researchers based in Denmark have taken a thought-provoking approach to childhood cancer, and have examined the risk for first prescription of psychotropic medication among parents of children with cancer, as compared to parents whose children were cancer-free. One remarkable feature of population-based research conducted in Scandinavian countries is the presence of nation-wide health registries that capture multiple illness, wellness and demographic variables for almost every individual in the country. This rich database affords as unbiased and as large a sample as most researchers could dream of. Unique health system features add reliability, for example, psychotropic medication is only available through a medical doctor, and all redeemed prescriptions are recorded in the Danish National Prescription Registry, which distinguishes by code between anti-anxiolytics, hypnotics and anti-depressants. Regarding cancer diagnosis, the Danish Cancer Registry has recorded all diagnoses of cancer in children in Denmark since 1975, and in the Childhood Cancer Registry the authors could further find information on cancer type, relapse, and survivorship. Thus when the study team aims to capture psychotropic medication use as one measure of parental distress in childhood cancer, we should sit up and listen.
The authors compared 3290 parents of children under age 15 years who have a cancer diagnosis with 65,747 parents whose children were cancer-free. The results unfortunately confirm our fears: parents are distressed enough to not just seek psychological help, which is already a relatively high bar, but are accepting and filling prescriptions for medications to aid with anxiety, depression and sleeplessness. There was a statistically significant difference, particularly for hypnotics and anti-anxiolytics, and particularly in the first 2 years after diagnosis, in prescription medication fills for parents whose child had cancer, as compared to those whose child did not. Sub-population analyses provide details about parental and child cancer risk factors that impact prescription fills. These are helpful and interesting analyses and fill in important details.
This unique registry-based study speaks to all of us, including hematology-oncology specialists, trainees who care for children with cancer, and primary care pediatricians whose patients, and their families, receive a cancer diagnosis and endure treatment they hope beyond hope will be life-saving. The authors appropriately note that their study is essentially the tip of the iceberg, in that for every parent who actually fills a psychotropic prescription in order to “keep on keeping on,” it is likely that there are many others who are vulnerable, who suffer, and who need mental health care to aid with coping. A true medical home must include all of the child’s supporting cast of providers, and the parent/caregivers have the key role(s). This study is a definitive call to bring mental health care for parents of every child with cancer out of the shadows and into the mainstream of cancer care.