Cognitive Behavioral Therapy in Pediatric Oncology: Flexible Application of Core Principles

  • Christina G. SalleyEmail author
  • Corinne Catarozoli
Part of the Autism and Child Psychopathology Series book series (ACPS)


Children and adolescents with cancer are at risk for a host of social, emotional, and behavioral issues given the impact of their disease and treatment on all domains of their lives. Experts agree that children with cancer should have access to psychosocial interventions to mitigate these difficulties. Cognitive behavioral treatment strategies can be used to address these challenges and serve as a nonpharmacological intervention for pain and other physical side effects in this population. Treatment planning with flexibility is key as adaptations to CBT will be necessary to best serve children with cancer and their families. However, with some tailoring, fundamental CBT components can be utilized and have been shown to be effective. This chapter highlights many of the common concerns arising for children with cancer and provides suggestions for how to address them from a CBT framework sensitively and effectively while avoiding pitfalls and making appropriate modifications.


Pediatric cancer Adjustment Intervention Pediatric psycho-oncology Cognitive-behavioral therapy Coping 


  1. Aldridge, A. A., & Roesch, S. C. (2007). Coping and adjustment in children with cancer: A meta-analytic study. Journal of Behavioral Medicine, 30(2), 115–128. Scholar
  2. Burish, T. G., & Jenkins, R. A. (1992). Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. Health Psychology, 11(1), 17–23.CrossRefGoogle Scholar
  3. Compas, B. E., Jaser, S. S., Dunn, M., & Rodriguez, E. M. (2012). Coping with chronic illness in childhood and adolescence. Annual Review of Clinical Psychology, 8, 455–480. Scholar
  4. Compas, B. E., Desjardins, L., Vannatta, K., Young-Salame, T., Rodriquez, E. M., Dunn, M., et al. (2014). Children and adolescents coping with cancer: Self- and parent reports of coping and anxiety/depression. Health Psychology, 33(8), 853–861. Scholar
  5. Coughtrey, A., Millington, A., Bennett, S., Christie, D., Hough, R., Su, M. T., et al. (2018). The effectiveness of psychosocial interventions for psychological outcomes in pediatric oncology: A systematic review. Journal of Pain and Symptom Management, 55(3), 1004–1017. Scholar
  6. Dahlquist, L. M., Gil, K. M., Armstrong, F. D., Ginsberg, A., & Jones, B. (1985). Behavioral management of children’s distress during chemotherapy. Journal of Behavior Therapy and Experimental Psychiatry, 16(4), 325–329.CrossRefGoogle Scholar
  7. Dixon, S. B., Bjornard, K. L., Alberts, N. M., Armstrong, G. T., Brinkman, T. M., Chemaitilly, W., et al. (2018). Factors influencing risk-based care of the childhood cancer survivor in the 21st century. CA: A Cancer Journal for Clinicians, 68(2), 133–152. Scholar
  8. Dolgin, M. J., Katz, E. R., Doctors, S. R., & Siegel, S. E. (1986). Caregivers’ perceptions of medical compliance in adolescents with cancer. Journal of Adolescent Health Care, 7(1), 22–27.CrossRefGoogle Scholar
  9. Duff, A. J., Gaskell, S. L., Jacobs, K., & Houghton, J. M. (2012). Management of distressing procedures in children and young people: Time to adhere to the guidelines. Archives of Disease in Childhood, 97(1), 1–4.CrossRefGoogle Scholar
  10. Figueroa-Moseley, C., Jean-Pierre, P., Roscoe, J. A., Ryan, J. L., Kohli, S., Palesh, O. G., et al. (2007). Behavioral interventions in treating anticipatory nausea and vomiting. Journal of the National Comprehensive Cancer Network, 5(1), 44–50.CrossRefGoogle Scholar
  11. Hamner, T., Latzman, R. D., Latzman, N. E., Elkin, T. D., & Majumdar, S. (2015). Quality of life among pediatric patients with cancer: Contributions of time since diagnosis and parental chronic stress. Pediatric Blood & Cancer, 62, 1232–1236. Scholar
  12. Harper, F. W. K., Penner, L. A., Peterson, A., Albrecht, T. L., & Taub, J. (2012). Children’s positive dispositional attributes, parents’ empathic responses, and children’s responses to pain pediatric oncology treatment procedures. Journal of Psychosocial Oncology, 30(5), 593–613. Scholar
  13. Hockenberry, M. J., McCarthy, K., Taylor, O., Scarberry, M., Franklin, Q., Louis, C. U., et al. (2011). Managing painful procedures in children with cancer. Journal of Pediatric Hematology/Oncology, 33(2), 119–127. Scholar
  14. Howard Sharp, K. M., Rowe, A. E., Russell, K., Long, A., & Phipps, S. (2015). Predictors of psychological functioning in children with cancer: Disposition and cumulative life stressors. Psychooncology, 24(7), 779–786. Scholar
  15. Jay, S. M., Elliott, C. H., Ozolins, M., Olson, R. A., & Pruitt, S. D. (1985). Behavioral management of children’s distress during painful medical procedures. Behaviour Research and Therapy, 23(5), 513–520.CrossRefGoogle Scholar
  16. Jay, S. M., Elliott, C. H., Katz, E., & Siegel, S. E. (1987). Cognitive-behavioral and pharmacologic interventions for childrens’ distress during painful medical procedures. Journal of Consulting and Clinical Psychology, 55(6), 860–865.CrossRefGoogle Scholar
  17. Jay, S. M., Elliott, C. H., Woody, P. D., & Siegel, S. (1991). An investigation of cognitive-behavior therapy combined with oral valium for children undergoing painful medical procedures. Health Psychology, 10(5), 317–322.CrossRefGoogle Scholar
  18. Jay, S., Elliott, C. H., Fitzgibbons, I., Woody, P., & Siegel, S. (1995). A comparative study of cognitive behavior therapy versus general anesthesia for painful medical procedures in children. Pain, 62(1), 3–9.CrossRefGoogle Scholar
  19. Jenkins, B. N., Granger, D. A., Roemer, R. J., Martinez, A., Torres, T. K., & Fortier, M. A. (2018). Emotion regulation and positive affect in the context of salivary alpha-amylase response to pain in children with cancer. Pediatric Blood & Cancer, 65(6), e26973. Scholar
  20. Kamen, C., Tejani, M. A., Chandwani, K., Janelsins, M., Peoples, A. R., Roscoe, J. A., et al. (2014). Anticipatory nausea and vomiting due to chemotherapy. European Journal of Pharmacology, 722, 172–179. Scholar
  21. Kazak, A. E., Abrams, A. A., Banks, J., Christofferson, J., DiDonato, S., Grootenhuis, M., et al. (2015). Psychosocial assessment as a standard of care in pediatric cancer. Pediatric Blood & Cancer, 62, S426–S459. Scholar
  22. Kearney, J. A., Salley, C. G., & Muriel, A. C. (2015). Standards of psychosocial care for parents of children with cancer. Pediatric Blood & Cancer, 62, S632–S683. Scholar
  23. Kuppenheimer, W. G., & Brown, R. T. (2002). Painful procedures in pediatric cancer: A comparison of interventions. Clinical Psychology Review, 22(5), 753–786.CrossRefGoogle Scholar
  24. Levin, T. T., & Applebaum, A. J. (2014). Acute cancer cognitive therapy. Cognitive and Behavioral Practice, 21(4), 404–415. Scholar
  25. Levine, D. R., Mandrell, B. N., Sykes, A., Pritchard, M., Gibson, D., Symons, H. J., et al. (2017). Patients’ and parents’ needs, attitudes, and perceptions about early palliative care integration in pediatric oncology. JAMA Oncology, 3(9), 1214–1220. Scholar
  26. Miller, E., Jacob, E., & Hockenberry, M. J. (2011). Nausea, pain, fatigue, and multiple symptoms in hospitalized children with cancer. Oncology Nursing Forum, 38(5), e382–e393. Scholar
  27. Okado, Y., Howard Sharp, K. M., Tillery, R., Long, A. M., & Phipps, S. (2016). Profiles of dispositional expectancies and affectivity predict later psychosocial functioning in children and adolescents with cancer. Journal of Pediatric Psychology, 41(3), 298–308. Scholar
  28. Samsel, C., & Muriel, A. C. (2017). Risk factors and treatment for steroid-related mood and behavior symptoms in preschool children with leukemia: A case series. Pediatric Blood & Cancer, 64, 343–345. Scholar
  29. Scialla, M. A., Canter, K. S., Chen, F. F., Kolb, E. A., Sandler, E., Wiener, L., et al. (2017a). Implementing the psychosocial standards in pediatric cancer: Current staffing and services available. Pediatric Blood & Cancer, 64(11), e26634. Scholar
  30. Scialla, M. A., Canter, K. S., Chen, F. F., Kolb, E. A., Sandler, E., Wiener, L., et al. (2017b). Delivery of care consistent with the psychosocial standards in pediatric cancer: Current practices in the United States. Pediatric Blood & Cancer, 65(3), e26869. Scholar
  31. Selove, R., Kroll, T., Coppes, M., & Cheng, Y. (2012). Psychosocial services in the first 30 days after diagnosis: Results of a web-based survey of Children’s Oncology Group (COG) member institutions. Pediatric Blood & Cancer, 58, 435–440. Scholar
  32. Shockey, D. P., Menzies, V., Glick, D. F., Taylor, A. G., Boitnott, A., & Rovnyak, V. (2013). Preprocedural distress in children with cancer: An intervention using biofeedback and relaxation. Journal of Pediatric Oncology Nursing, 30(3), 129–138. Scholar
  33. Steele, A., Mullins, L. L., Mullins, A. J., & Muriel, A. C. (2015). Psychosocial interventions and therapeutic support as a standard of care in pediatric oncology. Pediatric Blood & Cancer, 62, S585–S618. Scholar
  34. Wakefield, C. E., McLoone, J., Goodenough, B., Lenthen, K., Cairns, D. R., & Cohn, R. J. (2010). The psychosocial impact of completing childhood cancer treatment: A systematic review of the literature. Journal of Pediatric Psychology, 35(3), 262–274. Scholar
  35. Ward, E., DeSantis, C., Robbins, A., Kohler, B., & Jemal, A. (2014). Childhood and adolescent cancer statistics, 2014. CA: A Cancer Journal for Clinicians, 64, 83–103. Scholar
  36. Wiener, L., Kazak, A. E., Noll, R. B., Patenaude, A. F., & Kupst, M. J. (2015). Standards for the psychosocial care of children with cancer and their families: An introduction to the special issue. Pediatric Blood & Cancer, 62, S419–S424. Scholar
  37. Zeltzer, L. K., Dolgin, M. J., LeBaron, S., & LeBaron, C. (1991). A randomized, controlled study of behavioral intervention for chemotherapy distress in children with cancer. Pediatrics, 88(1), 34–42.PubMedGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Child and Adolescent PsychiatryNYU School of Medicine and Hassenfeld Children’s Hospital at NYU LangoneNew YorkUSA
  2. 2.Weill Cornell MedicineNew YorkUSA

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