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Psychosocial Care has been an integral part of the overall treatment in pediatric oncology for 25 years. The need for it and its effectiveness are well documented in several reputable studies and psychosocial service has proved its worth in everyday clinical settings. In order to secure comparable quality standards and in consequence of reorganisations within the health-care system a position paper has been prepared and adopted by the Psychosoziale Arbeitsgemeinschaft in der Pädiatrischen Onkologie und Hämatologie (PSAPOH), the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH). The following article gives a short survey of this position paper and provides insight into the goals, conditions and outcomes of psychosocial care in pediatric oncology and hematology.

Oncological diseases in children and adolescents represent a considerable burden for the children themselves and for their families. In order to position such concomitants of a life-threatening disease appropriately among the diagnostic options of psychosocial cancer care one is repeatedly confronted with the issue of giving a diagnosis from the area of reactions to burdens and adaptive disturbances (ICD 10: F: 43 ff). This touches the question of whether or not confronting a life-threatening disease in and by itself suffices to fully justify establishing one of the psychiatric diagnoses mentioned, which would imply that the intensity of the burden experienced justified the assumption of a psychiatric disturbance in the person affected. Whereas considerable effort is regularly spent on taking action and giving support and care, and reactions occasionally exceed the appropriate degree, a fair majority show no pathological processes that would justify determining a psychiatric diagnosis as a rule. Ultimately, one would arrive at a false interpretation of actually altogether adequate reactions of the patient to the burden. The ICD and DSM classification systems, however, do not provide for diagnoses other than those allocated disease status; it must therefore be considered whether it may be better in these cases to speak not of a reaction to a burden or an adaptive disturbance in the sense of the ICD 10, Section F, but rather of a sustained reaction to a burden. This opinion is increasingly gaining acceptance in pediatric oncology.

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