Self-Esteem and Social relationships in Preadolescents and Adolescents Who Survived Pediatric Leukemia

Introduction: Self-esteem refers to the level or degree to which one values or likes oneself. The “self’” evolves through a cognitive developmental maturation process (Harter, 1985) and continues to be influenced by an individual’s direct and indirect experiences with his/her environment (Bracken, 1996). Adolescents with cancer may face added burdens in the process of creating an identity and self-esteem (Evan et al., 2006), especially if females (Mertens et al., 2014) who underwent a central nervous system treatment. The literature also showed social difficulties as a consequence of the illness and of the associated isolation from peers (Tremolada et al., 2016) in this population. This study aims to screen the preadolescents and adolescents more at risk in their self-esteem perception and to evaluate their present social relationships and wellbeing post 5 years from the stop of the therapy and to identify possible disease risk factors. We expected to find a lower global self-esteem in these boys and girls, in particular in interpersonal and bodily experience areas and a significate association of their own self-esteem reports with their general social functioning and well-being. Method: Participants: Twenty-five preadolescents and adolescents healed from leukemia were recruited at the Haematology-Oncologic Clinic of the Department of Child and Woman Health, University of Padua, during their follow-up after 5 years from the stop of the therapy. Children’s mean age was 13.64 years (SD = 3.08, range = 10-19 years), mostly treated for Acute Lymphoblastic Leukemia (ALL) (84%) and the 12% treated for Acute Myeloid Leukemia (AML). Children were quite equally distributed by gender with 11 girls and 14 males. Procedure: This study belongs to an ample longitudinal project that assessed leukemic children’s and families’ adaptation and quality of life throughout their treatment steps. The healed patients were contacted by the clinical psychologist during their check-up and informed consent was asked for. Childhood cancer survivors filled in Multidimensional Self- Esteem test (Bracken 1992; Italian version Mazzeo, 2003) and were interviewed adopting the Ecocultural Family Interview-Cancer (EFI-C) -pediatric cancer survivors’ version. Results: Global self-esteem reported by the ex-patients attested mostly below the 50° percentile (58.5%), especially in the following scales: interpersonal relationships (75%), environmental control competence (62.5%), academic success (62.5%), family life (75%), bodily experience (50%) and emotionality (37.5%). Mann Whitney U test showed the following significant mean differences in the self-esteem scales considering survivors’ type of leukemia: global scale (U = 14.5; p = 0.04), emotionality (U = 12; p = 0.03) and bodily experience (U = 14.5, p = 0.04). Examining the mean ranks, survivors of AML showed lower scores in the self-esteem scales. Pearson’s correlations showed a significant association of Interpersonal self-esteem reports with two EFI-C dimensions: “Social and love relationship” (r = 0.61; p = 0.001) and “Present wellbeing” (r = 0.42; p = 0.03), showing a good convergent validity of the two different instruments. Conclusion: Childhood AML preadolescent and adolescent survivors attested at the clinical levels in their self-esteem perceptions, especially influenced by their low levels of social relationships and by their managing of emotions related to the illness and to the Clinic at the stop therapy time. Preventive interventions focused on increasing their self-esteem and their social wellbeing should be improved before re-entry to their daily life.