Dr.Sorayya Hematipour

The Position of the Psycho-Oncologist in the Multidisciplinary Team of Pediatric Oncology: Integrating Art Therapy with Medical Care

Publication date : 1405/7/5

Caring for a child with cancer is a complex process that requires simultaneous attention to the physical, psychological, family, social, and developmental dimensions of the disease, and for this reason, the multidisciplinary pediatric cancer team plays an essential role in providing comprehensive care. In this framework, oncologist, surgeon, nurse, psychologist, social worker, nutritionist, rehabilitation, art therapist, and other specialists participate in the treatment process based on the child's needs, and the psycho-oncologist can play an important role in linking the child's psychological needs with the medical program. The theoretical basis of this position is based on a biopsychosocial model that considers cancer beyond a physical disorder and as a multidimensional experience. Cancer diagnosis and treatment may be associated with anxiety, fear, pain, body image impairment, decreased sense of control, communication problems, disruption in daily activities, and worry about the future, and mere attention to medical indicators cannot cover all aspects of this experience. By assessing the child's psychological distress, emotional state, cognitive needs, family circumstances, supportive resources, and coping capacities, the psycho-oncologist provides important information to the treatment team and can help to coordinate psychological interventions with the medical treatment process. In the meantime, art therapy can be included as a complementary intervention in the structure of multidisciplinary care, giving the child the opportunity to express his difficult experiences in a non-verbal way through painting, art play, collage, music, storytelling, drama, and other creative activities. This is especially important in children, as the ability to verbally express experiences such as fear of injections, fear of surgery, pain, separation from parents, or worry about body changes may not be appropriate for their developmental stage. Based on the clinical evaluation, the psycho-oncologist can set specific psychological goals for the artistic intervention and accompany the art therapist in implementing an activity tailored to the child's needs. For example, in a child with pre-chemotherapy anxiety, artistic activity can be designed to reduce distress, increase a sense of control, and psychologically prepare for the treatment process, while for a child with body image problems, the activity can focus on accepting physical changes and rebuilding identity. In children with fear of relapse, art can also be used to express concern about the future and identify sources of support and coping strategies. Therefore, art therapy should be implemented in connection with a specific therapeutic goal and in coordination with the child's medical condition. The relationship between the psycho-oncologist and the oncologist is particularly important, because medical information about the stage of the disease, the type of treatment, possible complications, and physical limitations can be effective in the selection and timing of artistic activity. On the other hand, psychological information about the child's anxiety, cooperation, fear, or emotional state can help the medical team to make the way of communication and care more appropriate. This two-way interaction can provide the basis for more comprehensive and child-centered decision-making. Nurses also play an important role in identifying behavioral and emotional changes in the child and can provide the psycho-oncologist with valuable everyday information about the child's response to treatment. The social worker can include family issues, economic circumstances, access to social services and support in the care process, and cooperation with a rehabilitation professional can also strengthen the link between artistic activities and the child's return to daily activities. In this system, the family is also an active member of the care team, and the psycho-oncologist can guide parents on the importance of emotional support, how to communicate with the child, and appropriate participation in artistic activities. Joint artistic activity between the child and the parent can create an opportunity for emotional interaction, but it should not become a tool for pressure on the child or forced interpretation of his or her work. One of the important principles in this approach is to maintain the child's authority and agency; choosing the type of activity, color, subject, or tool can give the child a greater sense of participation and control. In a hospital setting, art activities can help reduce the monotony of the treatment experience, provide opportunities for communication, support emotion regulation, and maintain some age-appropriate activities, but their duration and intensity must be consistent with the child's fatigue, pain, nausea, and physical condition. Important challenges to this integration include differences in professional perspectives, lack of uniform protocols for interdisciplinary collaboration, and differences in the way in which the outcomes of art therapy are assessed. The limited research evidence in some areas, the heterogeneity of interventions, and the differences in children's characteristics also limit the possibility of generalizing the results. Also, in some settings, access to a specialist psycho-oncologist or art therapist may be limited, making it difficult to implement integrated models. To develop this approach, it is important to co-educate team members, develop specific referral pathways, use standard distress screening tools, and establish regular coordination meetings between specialists. Future research could also investigate the implications of integrating art therapy into multidisciplinary care on anxiety, quality of life, emotion regulation, co-therapy, body image, and child adjustment. The design of longitudinal and multicenter studies and the use of standardized indicators could provide more rigorous evidence to determine the place of these interventions. In general, the psycho-oncologist in the multidisciplinary pediatric cancer team can play the role of a link between the child's psychological experience, family, and the medical process, and by purposefully integrating art therapy with medical care, provide a more comprehensive and child-centered field of care. In such an approach, art is not considered a part of cancer treatment, but rather a complementary tool to support the child's mental health, communication, participation, adaptation, and quality of life alongside medical care.