The challenges of dealing with the diagnosis and treatment of childhood cancer also has implications for the coping and adjustment of siblings. During treatment, siblings of children with cancer may report:
- Higher levels of anxiety and loneliness than experienced by siblings of healthy children.[Level of evidence: II]
- Post-traumatic distress symptoms (reported by approximately 50% of siblings).[Level of evidence: II]
- Distress about family disruptions and separations.
- Lack of attention associated with the focus of other family members on the ill child.
- Negative interactions with family members.
- Fear of the sibling's death.
Siblings of children with cancer also report becoming more compassionate and perceiving that their families are drawn closer together through the experience.
The risk to families increases with the following conditions:
- Younger patient age.
- Longer duration of cancer treatment.
- Whether the child with cancer dies.
For siblings of children who undergo allogeneic hematopoietic stem cell transplantation, the risk for anxiety and lower self-esteem is higher for siblings who serve as hematopoietic stem cell donors, while non-donors are at higher risk of developing school problems. Social support programs such as sibling groups  or summer camp experiences  appear to result in reductions in reported anxiety and improved self-esteem in siblings of children treated for cancer.
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