Exploring the Struggles of Caregivers of Children With Acute Lymphoblastic Leukemia: Implications for Social Work Services in Malaysia
Main Article Content
Abstract
Childhood cancer can cause extreme discomfort and stress for the caregivers of affected children. These challenges affect caregivers and their children and need to be recognized and addressed. This study used individual, in-depth interviews to explore the challenges faced by caregivers of children with acute lymphoblastic leukemia (ALL) in Malaysia, to identify the social work services available to them, and to understand the support they need. The interviews with eight informants were transcribed, translated, and systematically analyzed using qualitative content analysis to identify emerging themes and patterns. The study highlights several issues and coping strategies: financial burdens from indirect treatment costs and job or income loss; medical caregiving responsibilities, including accompanying their child during admission, treatment, and prolonged hospital stay; difficulties in addressing and providing for their ill child’s emotional needs and those of their other children; social support received from close and extended family members, and friends. There are also coping strategies, such as comparing one’s child with other children in the ward who are in a more disadvantaged condition, talking to other caregivers, and sharing information and experiences. The study provides recommendations for oncology social work services in the country’s healthcare system.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
• Abdullah, N. N., Idris, I. B., Shamsuddin, K., & Abdullah, N. M. A. (2019). Health-related quality of life (HRQOL) of gastrointestinal cancer caregivers: The impact of caregiving. Asian Pacific Journal of Cancer Prevention: APJCP, 20(4), 1191–1197. https://doi.org/10.31557/APJCP.2019.20.4.1191
• Armstrong, G. T., Stovall, M., & Robison, L. L. (2010). Long-term effects of radiation exposure among adult survivors of childhood cancer: Results from the Childhood Cancer Survivor Study. Radiation Research, 174(6b), 840–850. https://doi.org/10.1667/RR1903.1
• Bekui, B. A. A., Aziato, L., Ohene, L. A., & Richter, M. S. (2020). Psychological and spiritual well-being of family caregivers of children with cancer at a teaching hospital in Ghana. International Journal of Africa Nursing Sciences, 13, Article 100231. https://doi.org/10.1016/j.ijans.2020.100231
• Bekui, B. A. A., Ohene, L. A., Badzi, C., Ampomah, M. O., & Aziato, L. (2023). Physical and socioeconomic burden of caregiving on family caregivers of children with cancer at a tertiary hospital in Ghana. Nursing Open, 10(2), 915–925. https://doi.org/10.1002/nop2.1359
• Chow, W. K., Hetherington, K., McGill, B. C., Sansom-Daly, U. M., Daly, R., Miles, G., Cohn, R. J., & Wakefield, C. E. (2022). “Like ships in the night”: A qualitative investigation of the impact of childhood cancer on parents’ emotional and sexual intimacy. Pediatric Blood & Cancer, 69(12), Article e30015. https://doi.org/10.1002/pbc.30015
• Coumoundouros, C., Ould Brahim, L., Lambert, S. D., & McCusker, J. (2019). The direct and indirect financial costs of informal cancer care: A scoping review. Health & Social Care in the Community, 27(5), e622–e636. https://doi.org/10.1111/hsc.12808
• Cox, T. (2018). Caregivers reflecting on the early days of childhood cancer. European Journal of Cancer Care, 27(1), Article e12499. https://doi.org/10.1111/ecc.12499
• Crabtree, S. A. (2005). Medical social work in Malaysia: Issues in practice. International Social Work, 48(6), 732–741. https://doi.org/10.1177/0020872805056991
• Da Silva, F. M., Jacob, E., & Nascimento, L. C. (2010). Impact of childhood cancer on parents’ relationships: An integrative review. Journal of Nursing Scholarship, 42(3), 250–261. https://doi.org/10.1111/j.1547-5069.2010.01360.x
• Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
• Fluchel, M. N., Kirchhoff, A. C., Bodson, J., Sweeney, C., Edwards, S. L., Ding, Q., Stoddard, G. J., & Kinney, A. Y. (2014). Geography and the burden of care in pediatric cancers. Pediatric Blood & Cancer, 61(11), 1918–1924. https://doi.org/10.1002/pbc.25170
• Galtieri, L. R., Fladeboe, K. M., King, K., Friedman, D., Compas, B., Breiger, D., Lengua, L., Keim, M., Boparai, S., & Katz, L. F. (2022). Caregiver perceived financial strain during pediatric cancer treatment: Longitudinal predictors and outcomes. Health Psychology, 41(1), 43–52. https://doi.org/10.1037/hea0001122
• Gise, J., & Cohen, L. L. (2022). Social support in parents of children with cancer: A systematic review. Journal of Pediatric Psychology, 47(3), 292–305. https://doi.org/10.1093/jpepsy/jsab100
• Hjelmstedt, S. K., Forinder, U. M., Lindahl Norberg, A. M., & Hovén, E. I. M. (2021). A balancing act: Working and caring for a child with cancer. Journal of Child and Family Studies, 30(8), 1881–1894. https://doi.org/10.1007/s10826-021-01997-1
• Hukdar, S. N. F., & Dewi, E. M. P. (2023). KOMPAK: The program to improve quality of life for parents of childhood cancer patients. ARRUS Journal of Social Sciences and Humanities, 3(2), 129–140. https://doi.org/10.35877/soshum1709
• Kakaje, A., Alhalabi, M. M., Ghareeb, A., Karam, B., Mansour, B., Zahra, B., & Hamdan, O. (2020). Rates and trends of childhood acute lymphoblastic leukaemia: An epidemiology study. Scientific Reports, 10(1), Article 6756. https://doi.org/10.1038/s41598-020-63528-0
• Lakkis, N. A., Khoury, J. M., Mahmassani, D. M., Ramia, M. S., & Hamadeh, G. N. (2016). Psychological distress and coping strategies in parents of children with cancer in Lebanon. Psycho‐Oncology, 25(4), 428–434. https://doi.org/10.1002/pon.3934
• Lilliehorn, S., Isaksson, J., & Salander, P. (2019). What does an oncology social worker deal with in patient consultations? An empirical study. Social Work in Health Care, 58(5), 494–508. https://doi.org/10.1080/00981389.2019.1587661
• Lim, B. E. (2007). Study on the job satisfaction and burnout among medical social workers in government hospitals in Malaysia [Master’s thesis, Universiti Sains Malaysia]. http://eprints.usm.my/9485/1/STUDY_ON_THE_JOB_SATISFACTION_AND_BURNOUT.pdf
• Maharjan, M., Rai, L., & Acharya, S. (2020). Lived experiences of mothers with leukemic children residing in Kathmandu. International Journal of Nursing Education, 12(2), 86–91. https://doi.org/10.37506/ijone.v12i2.4269
• Ministry of Health Malaysia. (2024). Summary of the Malaysia National Cancer Registry Report 2017–2021. https://nci.moh.gov.my/images/pdf_folder/SUMMARY-OF-MALAYSIA-NATIONAL-CANCER-REGISTRY-REPORT-2017-2021.pdf
• Molinaro, M. L., & Fletcher, P. C. (2018). The balancing act: Mothers’ experiences of providing care to their children with cancer. Journal of Pediatric Oncology Nursing, 35(6), 439–446. https://doi.org/10.1177/1043454218794667
• National Cancer Institute. (2024, August 2). Childhood acute lymphoblastic leukemia (PDQ®)–Patient version. https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq
• Ochoa, C., Chan, R. Y., Cervantes, L., & Miller, K. A. (2023). A qualitative study on caregiving social support among Hispanic/Latino parents of childhood cancer survivors in a safety-net hospital. Cancer Epidemiology, Biomarkers & Prevention, 32(1 Suppl.), Article B115. https://aacrjournals.org/cebp/article/32/1_Supplement/B115/712404/Abstract-B115-A-qualitative-study-on-caregiving
• Ostadhashemi, L., Arshi, M., Khalvati, M., Eghlima, M., & Khankeh, H. R. (2019). Social workers in pediatric oncology: A qualitative study in Iranian context. Asian Pacific Journal of Cancer Prevention: APJCP, 20(6), 1871–1877. https://doi.org/10.31557/APJCP.2019.20.6.1871
• Othman, A., Blunden, S., Mohamad, N., Mohd Hussin, Z. A., & Jamil Osman, Z. (2010). Piloting a psycho-education program for parents of pediatric cancer patients in Malaysia. Psycho‐Oncology, 19(3), 326–331. https://doi.org/10.1002/pon.1584
• Othman, A., Mohamad, N., Hussin, Z. A., & Blunden, S. (2011). Psychological distress and associated factors in parents of children with cancer. International Journal of Social Science and Humanity, 1(1), 37–42. https://doi.org/10.7763/IJSSH.2011.V1.7
• Perlmutter, E. Y., Herron, F. B., Rohan, E. A., & Thomas, E. (2022). Oncology social work practice behaviors: A national survey of AOSW members. Journal of Psychosocial Oncology, 40(2), 137–151. https://doi.org/10.1080/07347332.2021.1942386
• Peterson, E. B., Chou, W.-Y. S., Falisi, A., Ferrer, R., & Mollica, M. A. (2018). The role of medical social workers in cancer clinical trial teams: A group case study of multidisciplinary perspectives. Social Work in Health Care, 57(8), 688–704. https://doi.org/10.1080/00981389.2018.1477899
• Rajaratnam, S., & Azman, A. (2022). Refugee and asylum seeker women’s experiences with healthcare and social environment in Malaysia. International Journal of Environmental Research and Public Health, 19(11), Article 6542. https://doi.org/10.3390/ijerph19116542
• Rajaratnam, S., & Nordin, A. (2023). Research with cancer patients and their caregivers: A dyadic reflection by social work researchers. International Social Work. International Social Work, 67(4), 1084–1088. https://doi.org/10.1177/00208728231188210
• Robison, L. L., Armstrong, G. T., Boice, J. D., Chow, E. P. F., Davies, S. M., Donaldson, S. S., Green, D. M., Hammond, S., Meadows, A. T., Mertens, A. C., Mulvihill, J. J., Nathan, P. C., Neglia, J. P., Packer, R. J., Rajaraman, P., Sklar, C. A., Stovall, M., Strong, L. C., Yasui, Y., & Zeltzer, L. K. (2009). The Childhood Cancer Survivor Study: A National Cancer Institute–supported resource for outcome and intervention research. Journal of Clinical Oncology, 27(14), 2308–2318. https://doi.org/10.1200/JCO.2009.22.3339
• Seo, W., Buyuktur, A. G., Choi, S. W., Sedig, L., & Park, S. Y. (2021). Challenges in the parent-child communication of health-related information in pediatric cancer care. Proceedings of the ACM on Human-Computer Interaction, 5(CSCW1), Article 110. https://doi.org/10.1145/3449184
• Shokri, M., Tarjoman, A., Borji, M., & Solaimanizadeh, L. (2020). Investigating psychological problems in caregivers of pediatrics with cancer: A systematic review. Journal of Child and Adolescent Psychiatric Nursing, 33(4), 229–238. https://doi.org/10.1111/jcap.12269
• Smith, S. K., Nicolla, J., & Zafar, S. Y. (2014). Bridging the gap between financial distress and available resources for patients with cancer: A qualitative study. Journal of Oncology Practice, 10(5), e368–e372. https://doi.org/10.1200/JOP.2013.001342
• Sulkers, E., Tissing, W. J. E., Brinksma, A., Roodbol, P. F., Kamps, W. A., Stewart, R. E., Sanderman, R., & Fleer, J. (2015). Providing care to a child with cancer: A longitudinal study on the course, predictors, and impact of caregiving stress during the first year after diagnosis. Psycho‐Oncology, 24(3), 318–324. https://doi.org/10.1002/pon.3652
• Sutan, R., Al-Saidi, N. A., Latiff, Z. A., & Ibrahim, H. M. (2017). Coping strategies among parents of children with acute lymphoblastic leukemia. Health, 9(7), 987–1000. https://doi.org/10.4236/health.2017.97071
• uthahar, A., Gurpreet, K., Ambigga, D., Dhachayani, S., Fuad, I., Maniam, T., Osman, C. B., & Ainsah, O. (2008). Psychological distress, quality of life and coping in cancer patients: A prospective study. The Medical Journal of Malaysia, 63(5), 362–368. https://www.e-mjm.org/2008/v63n5/Cancer_Patients.pdf
• Tan, C.-E., Lau, S. C. D., Latiff, Z. A., Lee, C. C., Teh, K. H., & Sidik, S. M. (2022). Information needs of Malaysian parents of children with cancer: A qualitative study. Asia‐Pacific Journal of Oncology Nursing, 9(3), 143–152. https://doi.org/10.1016/j.apjon.2021.11.001
• Tan, C.-E., Lau, S. C. D., Tan, K. A., Latiff, Z. A., Teh, K. H., Lee, C. C., & Mohd Sidik, S. (2022). Development and validation of a caregiving knowledge questionnaire for parents of pediatric leukemia and lymphoma patients in Malaysia. Cureus, 14(10), Article e30903. https://doi.org/10.7759/cureus.30903
• Verulava, T., Asatiani, T., Dangadze, R., & Jorbenadze, R. (2019). The role of social workers in pediatric oncology. Archives of the Balkan Medical Union, 54(2), 315–319. https://doi.org/10.31688/ABMU.2019.54.2.14
• Vieira, A. C., & Cunha, M. L. D. R. (2020). My role and responsibility: Mothers’ perspectives on overload in caring for children with cancer. Revista da Escola de Enfermagem da USP, 54, Article e03540. https://doi.org/10.1590/S1980-220X2018034603540
• Wagner, J. L., Chaney, J. M., Hommel, K. A., Page, M. C., Mullins, L. L., White, M. M., & Jarvis, J. N. (2003). The influence of parental distress on child depressive symptoms in juvenile rheumatic diseases: The moderating effect of illness intrusiveness. Journal of Pediatric Psychology, 28(7), 453–462. https://doi.org/10.1093/jpepsy/jsg036
• Wiener, L., Battles, H., Zadeh, S., Pelletier, W., Arruda-Colli, M., & Muriel, A. (2017). The perceived influence of childhood cancer on the parents’ relationship. Psycho‐Oncology, 26(12), 2109–2117. https://doi.org/10.1002/pon.4313
• Williams, A. H., Rivas, S., Fuentes, L., Cáceres-Serrano, A., Ferrara, G., Reeves, T., Antillon-Klussmann, F., Rodríguez-Galindo, C., Mack, J. W., & Graetz, D. E. (2023). Understanding hope at diagnosis: A study among Guatemalan parents of children with cancer. Cancer Medicine, 12(8), 9966–9975. https://doi.org/10.1002/cam4.5725
• Yusof, Y., Ahmad Ramli, F. Z., & Mohd Noor, N. (2019). Mental health social work in Malaysia: A study exploring its importance. International Social Work, 62(1), 283–294. https://doi.org/10.1177/0020872817725139