Use of Psychotropic Drugs for Acute Psychiatric and Behavioral Problems in Paediatric Oncology: A Multi-Center Study

Background/Objectives: : Children and adolescents diagnosed with cancer are forced in the most unexpected way to cope with an extraordinary, highly unlikely event. Such an experience can be extremely disruptive. When symptoms become pathological and impair a child's development and functioning, early intervention is warranted. Given that severe childhood and adolescent adversities may negatively impact adult mental health, our aim was to critically examine, the advantages and disadvantages of acute symptom management and (short-term) psychopharmacological interventions in these severely ill patients. Design/Methods: Twenty-one patients (1-18 years old) diagnosed with cancer were enrolled in five centers. Categorical variables were analyzed with descriptive statistics and open-ended questions were examined qualitatively. Because of the importance of developmental phase, patients were divided in three age groups: 1) aged 1-6: 2) >6-11; and 3) >11-18. Variables included age, gender, the type of cancer, treatment protocol, oncologic treatment complications, the use of corticosteroids, methotrexate and vincristine, first onset of psychiatric symptoms, treatment approach to symptoms, and the possible presence of side effects due to psychotropic drugs. Results: The development of psychiatric problems differed according to tumour type and treatment protocol. Also, age was an important factor: younger children (< 6 years) and adolescents (>12) were more vulnerable, especially when the CNS was directly or indirect involved. Finally, the necessity to use psychotropic drugs was related to treatment phase (the first six months of treatment), and to treatments involving corticosteroids. Conclusion: Psychotropic drug use in children is still extremely controversial, and seems like a catch-22, in which a true solution or desired outcome is almost impossible. However, efficient and prompt management of mainly acute behavioral or psychiatric symptoms during treatment might help improve quality of life as well as psychological, functional, and medical outcomes for a child or adolescent who is trying to handle their cancer.