Abstract
Silva-Rodrigues et al highlight the importance of considering pain as a significant adverse event during chemotherapy in children with acute lymphoblastic leukemia. 1 Their findings show that pain is not just a symptom but is also linked to longer hospital stays and increased treatment burden. This evidence emphasizes the importance of integrating effective pain management into pediatric oncology care. However, just as their results demonstrate how physical pain can influence clinical outcomes, unaddressed emotional and spiritual distress can similarly prolong suffering and hinder recovery. 1 In low- and middle-income countries (LMICs) like the Philippines, where collective resilience and faith traditions shape coping strategies,2,3 culturally sensitive approaches are crucial.
Although the prevalence of psychosocial distress among pediatric oncology patients is low in the Philippines, an estimated 6 million Filipinos live with depression or anxiety.2,3 Childhood cancer programs in the Philippines have made policy progress, like the Department of Health’s Childhood Cancer Program and the 2019 National Integrated Cancer Control Act, which expanded access and financial protection.3,4 However, psychosocial support is still inconsistently available and rarely institutionalized. Families often face emotional and financial challenges with limited professional guidance.3,4 Filipino culture’s strong family bonds and reliance on faith can help ease distress but may also conceal it.2-4 Parents might interpret their child’s suffering through spiritual beliefs, seeing illness as a test of faith, while the emotional needs of children and caregivers go unmet. 2
With support from local groups, culturally rooted play therapy, family-centered interventions, and community reintegration initiatives can enhance coping skills and boost treatment engagement among patients. 5 These programs, grounded in Filipino values such as bayanihan (collective support) and malasakit (empathy), show that culturally sensitive psychosocial care can be transformative for coping and treatment in resource-limited settings like the Philippines.3-5
To translate these insights and experiences from the Philippines into practice in other LMICs, several measures can be considered. First, pain and psychosocial symptoms can be assessed using domain-appropriate tools rather than a single combined scale. Using distinct instruments for pain and psychosocial screening, such as the Face Pain Scale and the Strengths and Difficulties Questionnaire, may improve assessment accuracy while minimizing inappropriate referrals and burden on limited human resources. Second, multidisciplinary teams, including nurses, psychologists, and social workers, should be trained to address pain and emotional distress simultaneously. Third, developing culturally adapted assessment tools that reflect community dynamics can help ensure their relevance to LMIC settings. Fourth, adapting international psychosocial support guidelines requires collaboration with local universities and stakeholders to account for LMICs’ cultural and religious contexts. Finally, fostering community-based reintegration programs that connect hospital care with social and educational recovery can strengthen the child’s sense of belonging after cancer treatment.
Overall, these steps show that suffering during and after treatment is essential to care. In LMICs, where cultural beliefs shape illness perceptions, integrating pain management and psychosocial support into cancer programs is vital. To help children thrive during and after treatment, psychosocial care and pain relief should be seen as part of restoring wholeness through culturally sensitive care.
