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BACKGROUND: Current advances in medicine determine the higher survival rate of children with various nosological forms of malignant tumors, which shifts the focus of attention of specialists from the development of treatment protocols to the study of early and long-term effects of antitumor therapy in children and their families. One of the urgent problems of psychological and social rehabilitation in pediatric oncology is the analysis of the psycho-traumatic factors of treatment and the long-term medical and social consequences for the childs family when developing a strategy for effective psychological support for this observation group at the treatment stage. OBJECTIVE: We aimed to study the specifics of living with losses in families raising a child with oncopathology and the features of the childs re-adaptation and resocialization after overcoming an oncological disease (at the remission stage). MATERIALS AND METHODS: A retrospective analysis of data obtained in the course of a sociological study of parents (n=1298) whose children completed treatment for various malignant tumors is presented. The study, carried out by a questionnaire survey of mothers (n=1131) and fathers (n=167) living in 78 regions of Russia, made it possible to qualify the problems of family members of a child with cancer in terms of multiple loss and grief and substantiate the strategy of psychological assistance to this group. RESULTS: During the establishment of the oncological diagnosis of the child and their antitumor treatment, the family experiences some traumatic events associated with drastic changes in their lives. According to the findings of the study, the deterioration in normal life concerns health (in total, a third of the respondents: 12.9% of mothers noted a deterioration in their general health and in 15.2% of women, serious reproductive health disorders); work (leaving and dismissal from work affected 25.3% of mothers and 2% of fathers, 11.4% of mothers and 9.6% of fathers were forced to change their job or place of work); and a drop in the level of family income (the proportion of low-income families in the sample was significantly higher than in the Russian population as a whole 41.8 and 31.4%, respectively, social benefits and pensions accounted for a significant share of income in 57.3% of female respondents and 26.3% of men, and there were changes in life prospects due to graduation, relocation, divorce, and severance of relations with relatives and friends). Each of these events is perceived as stress/loss and triggers a grieving process in family members (primarily parents) that requires the professional help of a clinical psychologist. In general, the range of events triggering the grieving process in the families of the study group is much wider, but the quality and volume of psychological care in domestic cancer hospitals are still extremely low. CONCLUSION: The dynamics of the development of psychological and social rehabilitation in domestic pediatric oncology determine the need to develop strategies and methods of psychological support for family members of a sick child at the treatment stage, taking into account the early and long-term medical and social consequences of antitumor therapy.

Стратегии репродуктивного поведения изучались в России и за рубежом в семьях с детьми, имеющими тяжелые, в том числе онкологические, заболевания. Показано, что решение о рождении ребенка в этих семьях связано больше с эмоциональной, чем с рациональной компонентой диспозиций репродуктивного поведения семьи. С целью изучения диспозиций репродуктивного поведения предпринято анкетирование 992 матерей в возрасте от 25 до 45 лет (медиана 36 лет), чьи дети завершили противоопухолевое лечение. В качестве контроля применен вторичный анализ результатов общероссийского выборочного исследования. Статистическая обработка проводилась в программе SPSS 17.0 с использованием непараметрических методов. Стратегии репродуктивного поведения семьи изучались в контексте разных видов злокачественной опухоли у ребенка: лейкозы, лимфомы, опухоли ЦНС, другие солидные опухоли. Показано, что при существенно более высоких, чем в популяции, репродуктивных установках (ср. желаемое число детей – 2,59 и 2,28; ср. ожидаемое – 2,05 и 1,72, p < 0,01) и детности (ср. число рожденных детей 1,75 и 1,28, p<0,01) в исследуемой группе 21,2% семей хотят, но откладывают рождение ребенка, что связано больше с иррациональными страхами, подкрепляемыми мифами и стигмами диагноза «Рак». Специфические факторы, связанные с видом злокачественной опухоли у ребенка, не играют определяющей роли в репродуктивном поведении семьи, однако могут способствовать изменению установок на тайминг рождений. Необходима медико-социальная и психологическая помощь родителям на всех этапах проведения противоопухолевого лечения, а также информирование населения с целью искоренения из общественного сознания мифов и стигм в отношении онкологических заболеваний.

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Relevance. The experience of loss by a child receiving antitumor treatment is a factor in the development of psychopathologies.Purpose to study is to study the specifics of family losses in pediatric oncology; to trace the dynamics of grief during analytical psychotherapy in children who have lost one or both parents.Materials and methods. The study of the specifics of family losses was carried out by the method of retrospective analysis of the dynamics of family relations in 1298 families. To study the dynamics of grief in the process of psychotherapy, 13 children aged 3 to 13 years who lost one or both parents were selected.Results. Antitumor treatment of the child is accompanied by prolonged separation from one, less often both parents, and, in 13.3 %, the loss of a mother or father as a result of a divorce/death. Burning in all the examined children was complicated with the appearance of a number of somatic, emotional-behavioral, mental symptoms that worsen their physical condition and psycho-emotional status. As a result of psychotherapy, the child can react to suppressed negative emotions, which leads to the disappearance of symptoms of grief.Conclusion. The interaction of pediatricians, clinical psychologists, social work specialists is productive in order to provide timely psychotherapeutic assistance to the child before the manifestation of symptoms of complicated grief manifestation.