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Stomach ache and headache among the siblings of children with acute lymphoblastic leukaemia

Almost one-third of all survivors of childhood cancer have somatic complaints that lack a known medical cause ( I ) . Depression and psychosomatic symptoms have also been found to occur in all family members (2). In one report the siblings of children with other chronic life-threatening illnesses, but not leukaemia, had no more depression or anxiety than their healthy controls (3). We carried out a prospective, controlled survey of how a child with ledtaemia influences the symptomatology of other family members. Fifteen children with ALL (mean age 7.3, range 4.3-12.6 years) who were in remission and who were being treated at Oulu University Hospital, Finland, were monitored for 9063 days from November 1987 for as long as the chemotherapy continued or until December 1989 for the occurrence of symptoms. Eighteen siblings (mean age 10.6, range 2.8-23.3 years) were monitored for 9741 days and 29 parents (mean age 36.1, range 25.7-48.3 years) for 17 393 days. Twenty-six control families matched for numbers of children and age and sex were selected randomly from schools or family health centres. Twenty-six control children of the patients (mean age 7.0, range 3.9-1 1.8 years) were monitored for 9050 days, 29 control siblings (mean age 9.0, range 1.816.1 years) for 9692 days and 61 control parents (mean age 33.7, range 25.8-50.3 years) for 17 741 days. Socioeconomic status was the same in the index and control families. A diary of symptoms was completed for each member of the family each day and the parents completed the diaries for small children asking them their symptoms. The symptoms were calculated per patient year at risk, and their numbers were compared between children with ALL and their controls, and correspondingly for the siblings and parents. The test of comparison of two proportions was used in the statistical analysis. A more detailed description of the patients and methods has been published previously (4). The investigation was approved by the Ethics Committee of the Medical Faculty, University of Oulu, Finland, and informed consent was obtained from the parents. The siblings of the children with ALL had headache and stomach ache less than their controls, and they also had headache more often than stomach ache ( p < 0.05) (Table 1). The mean duration of headache was 1.4 (SD 0.9) days and stomach ache 1.4 (SD 0.5) days in the index siblings and 1.6 (SD 0.5) days and 1.7 (SD 1.1) days, respectively, in the controls. The parents of children with ALL had the headache for less days than their controls, but the number of days with stomach ache was similar in both groups (Table 1). The mean duration of headache was 1.7 (SD 0.8) days and stomach ache 2.6 (2.0) days in the index parents and 1.9 (SD 0.9) days and 1.8 (SD 1.3) days in the controls. The mean duration of headache was 1.8 (SD 0.6) days and stomach ache 2.2 (SD 1.1) days in the children with ALL and 1.5 (SD 0.6) and 1.5 (SD 0.7) days in the controls. Our finding of the siblings of the children with ALL experiencing less headache and stomach ache than their controls may be a true finding, but the other possibility is that minor symptoms in the siblings are ignored because the parents concentrate more on the symptoms of the patient and consider them more important. Headache and abdominal pain have been found to be related to depression in healthy adolescents (5). The siblings of children with cancer may experience anxiety, headache and abdominal pain even more than the patients themselves (6). In that study the siblings were interviewed when visiting hospital with the patient, which may have increased their anxiety. Siblings of children with chronic diseases other than leukaemia have been shown to have no more depression or anxiety than healthy controls (3). Yet the patient’s illness and the phase of the disease should certainly influence the symptoms experienced by siblings. The lack of symptoms may be caused by their lack of ability to express their depression and anxiety. However, the occurrence of headache and stomach ache is only one sign of psychosomatic distress. The parents of children with ALL had as much stomach ache as the control parents and less headache, in contrast to the results of Magni et al., who evaluated psychological distress in the parents of children with cancer and found that the parents of children with leukaemia suffered from more depression and anxiety than controls (7). It is probable that such parents deny their own symptoms and consider their sick child’s symptoms more important. Our finding that the children with ALL had headache and stomach ache for more days than their controls supports our expectations, as children with malignancies suffer from anxiety and depression (2,6) and experience somatic complaints of undetermined origin more than ageand sex-matched controls (1). On the other hand, Canning et al. found that children with cancer had fewer symptoms of depression than healthy controls, which could be related to a denial of distress (8).