Practice and Perceptions of Alternative Psychotherapies in Pediatric Oncology: Experience from the Pediatric Oncology Unit at Aristide Le Dantec Hospital in Dakar

Introduction: A pediatric cancer diagnosis is a major psychological ordeal for the child and his or her family. This study aims to evaluate the integration, participation, and perception of alternative psychotherapies (art therapy, storytelling therapy, psychomotor therapy, and playgroups) within the Pediatric Oncology Unit (UOP) at Aristide Le Dantec Hospital in Dakar.

Materials and Methods: This was a prospective, cross-sectional, descriptive study conducted from January 1, 2021, to August 1, 2022 (20 months) among 87 patients treated at the UOP and their caregivers. Sociodemographic and clinical data, as well as assessments of treatments, were collected through telephone interviews and analyzed using Epi Info v7.

Results: The mean age of the children was 8.1 ± 3.8 years, with a male-to-female ratio of 1.1. The majority of patients lived in rural areas (55.2%) and were primarily diagnosed with acute leukemia (42.5%) or nephroblastoma (28.7%). Mothers accounted for 58.8% of respondents. Attendance was particularly high for art therapy (97.7%) and psychomotor therapy (90.8%). Art therapy was identified as the most beneficial (71.3%). A high level of satisfaction was reported (90.8%), and 97.7% of respondents perceived an improvement in the child’s psychological state (mean score of 8.0 ± 1.8 out of 10).

Conclusion: Alternative psychotherapies provide significant psychosocial benefits in the management of pediatric cancers in Senegal. Increasing the frequency of sessions and strengthening material and human resources remain key priorities for ensuring the long-term sustainability of this program.

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Pediatric cancer is the leading cause of disease-related death among children worldwide. Its global annual incidence is approximately 400,000 children and adolescents. In the United States, between 12,500 and 15,780 children under the age of 20 are diagnosed each year, with cancer also being the leading cause of disease-related mortality among children there. Although medical advances and multicenter clinical research protocols have led to five-year survival rates exceeding 80% in high-income countries, the disease and the intensity of treatments impose a major physical and psychosocial burden on patients and their families [1].

This burden is particularly disproportionate in low- and middle-income countries, especially in sub-Saharan Africa (SSA) and the Middle East and North Africa (MENA) region, where cancer care faces significant structural disparities. In sub-Saharan Africa, only 15% of countries have a population-based cancer registry, which significantly limits epidemiological surveillance and care planning. Similarly, in the MENA region, projections predict a major increase in cancer incidence by 2030. Meta-analytic studies reveal an extremely high psychiatric burden among cancer patients in this region, with overall prevalences of 44% for depression, 47% for anxiety, and 43% for psychological distress [2,3].

However, although the Working Group on Human Rights of the International Society of Psycho-Oncology (IPOS) asserts that psychosocial care is a fundamental human right, Africa remains the most underrepresented continent in terms of the organization of psycho-oncological care, with Nigeria being one of the few countries in sub-Saharan Africa to have established a national society of psycho-oncology as early as 2009 [3].

A cancer diagnosis represents a major disruption in the life course of a child and their family, affecting the young patient’s body, emotional experience, and both conscious and unconscious psychological reality. Internationally, at least 25% of children with cancer develop significant mental health disorders (anxiety, depression, PTSD), and up to half of parents experience acute psychological distress at the time of diagnosis [4-6].

Pain in pediatric oncology is part of the concept of “total pain,” in which somatic suffering is intertwined with procedural anxiety and sociocultural factors. In sub-Saharan Africa, the management of this pain faces severe constraints, including legislative restrictions on opioids and the lack of morphine availability in hospitals. Furthermore, the diagnosis is frequently made at an advanced stage of the disease due to multiple barriers: lack of awareness of symptoms, the cost of care, distance from specialized centers, and delays in treatment [3,7,8].

Sociocultural factors play a decisive role in shaping the experience of illness:

1. Family structure and collectivism: In Arab-Muslim and African cultures, medical decisions and support rely on the extended family and social circle. However, the fear of bringing dishonor to the family or being stigmatized by the community constitutes an additional source of stress for patients and their loved ones.
2. Stigma and taboos: Seeking mental health care remains a widespread taboo in many societies across the MENA region and sub-Saharan Africa. Furthermore, certain conditions associated with increased cancer risk, such as albinism or HIV infection, are subject to significant social stigma, leading patients to delay seeking medical care.
3. Instability and armed conflict: In several areas of the MENA region (Palestine, Iraq, Syria), the psychological impact of cancer is greatly exacerbated by trauma related to armed conflict, political instability, and the dismantling of healthcare infrastructure [2,3].

Psychosocial Care Standards, Disparities, and Implementation Challenges. In light of these vulnerabilities, international guidelines recommend the integration of universal psychosocial support, structured according to risk models such as the Pediatric Preventative Psychosocial Health Model (PPPHM).

The effectiveness of targeted interventions has been demonstrated by randomized controlled trials:

• Problem-solving skills training (PSST) and CBT/family programs (SCCIP) [6,8].
• Cognitive-behavioral therapies, music video mediation, and Make-A-Wish programs [5].
• Interventions by pediatric psychologists in the management of procedural pain, cognitive remediation, and grief counseling [6].

However, there is a significant gap between these international standards and their implementation in the Global South. Research in psycho-oncology in the MENA and ASS regions remains largely descriptive and suffers from a lack of intervention studies. Furthermore, most tools for assessing distress (HADS, PHQ-9, BDI) were developed in Western contexts and often lack validation or cultural adaptation to local dialects and perceptions of mental illness. Although pioneering centers of excellence exist, such as the King Hussein Cancer Center in Jordan, the Children’s Cancer Hospital Egypt 57357, and the Tunisian Society of Psycho-Oncology, psycho-oncology services remain highly fragmented and underfunded in most African and Arab countries. It is therefore crucial to train healthcare professionals in psychosocial and palliative care, while building bridges between conventional medicine and community-based and traditional support systems [2,3].

To overcome the barriers to verbalization—which are particularly pronounced in children and reinforced by cultural taboos surrounding mental illness—nonverbal interventions play a central role. Play therapy provides a transitional space where children can reenact traumatic experiences and resume an active role in coping with their illness [2,3,7].

Similarly, Dance/Movement Therapy (DMT), defined as the psychotherapeutic use of movement to promote emotional, physical, cognitive, and social integration, is part of a holistic view of the child and their community (“Whole Child, Whole Family, Whole Staff”). In situations involving painful medical procedures, Multisensory Dance/Movement Psychotherapy (MSDMT) combines movement, music, touch, and breathing to act as an “embodied analgesic.” By redirecting attention away from pain toward soothing bodily sensations, it helps regulate the nervous system and prevent the entrenchment of traumatic memories. This embodied and expressive approach is particularly well-suited to African and Middle Eastern sociocultural contexts, where movement, music, and the body serve as primary channels for emotional regulation and social connection [1,9].

Optimal care for childhood cancer therefore requires integrating medical treatments with international standards of psychosocial care, appropriate psychotherapeutic interventions, and mind-body approaches such as dance/movement therapy.

The objective of this study is to examine how these approaches can be applied in a complementary manner, taking into account the epidemiological realities, structural constraints, and sociocultural specificities of populations in Africa and the MENA region, to provide each child and their family with equitable, humane support tailored to their lived experiences.

Results

Sociodemographic and clinical profile

During our study period, 88 sessions of alternative psychotherapy were conducted with 894 participants.

Of the 264 regular participants, 88 deaths were recorded, 67 patients had no valid phone contact information, and 22 could not be reached. A total of 87 patients were included in the study.

The mean age was 8.1 ± 3.8 years (range: 2 to 18 years; median: 8 years). There was a slight predominance of males, with a sex ratio (M/F) of 1.1 (52.9% boys).

More than half of the patients lived in rural areas (55.2%), with the majority coming from the regions of Dakar (35.6%) and Diourbel (17.2%).

Regarding the respondents’ educational background, 31.0% had received a Koranic/Arabic education, 29.9% had completed primary school, 17.2% had no formal education, 11.5% had completed secondary school, and 10.3% had completed higher education. (Table 1).

Table 1: Sociodemographic and clinical profile
Characteristic	Count (N=87)	Percentage (%)
Zone de résidence
• Rural	48	55,2 %
• Semi-urban	23	26,4 %
• Urban	16	18,4 %
Profile of respondents (n=68 respondents out of N=87)
• Mother	40	58,8 %
• Father	15	22,1 %
• Grandmother	5	7,4 %
• Brother / Sister	4	5,9 %
• Uncle / Aunt	4	5,9 %
Diagnosis
Acute Leukemia	37	42,5 %
Nephroblastom	25	28,7 %
Maligne Non-Hodgkin-Lymphome	5	5,7 %
Germinal Tumors	5	5,7 %
Hodgkin's Lymphoma	4	4,6 %
Sarcomas	4	4,6 %
Ovarian tumors	3	3,4 %
Neuroblastoma	2	2,3 %
Retinoblastoma	2	2,3 %

Acute leukemia (42.5%) and nephroblastoma (28.7%) were the most common diagnoses.

Workshop participation and attendance

The average number of sessions attended per patient was 10 ± 6.9 (median: 8; range: 1 to 28 sessions).

• Art therapy: 97.7% participation rate (n=85).
• Psychomotor therapy: 90.8% participation rate (n=79).
• Storytelling therapy: 80.5% participation rate (n=70).
• Free play groups: 47.1% participation rate (n=41).

Assessment of benefits and satisfaction

Overall assessment: 89.7% of respondents rated these approaches as “very useful” (32.2%) or “useful” (57.5%). The overall satisfaction rate was 90.8% (35.6% very satisfied and 55.2% satisfied). (Figure 1).

Figure 1: Caregiver-Reported Utility of Alternative Psychotherapies.

Art therapy was identified by 71.3% of respondents as the most beneficial method, followed by psychomotor therapy (47.1%), storytelling therapy (35.6%), and play groups (25.3%). (Figure 2).

Figure 2: Alternative Therapies Perceived as Most Beneficial (%).

Clinically, 97.7% of caregivers perceived a favorable change in the child’s psychological state. The perceived improvement scale (0 to 10) had a mean of 8.0 ± 1.8 (median: 8/10). (Figure 3).

Figure 3: Caregiver Satisfaction Levels (%).

Identified strengths and areas for improvement

The strengths reported by families were:

• Providing opportunities for the child to relax (56.3%).
• Helping the child find joy again (52.9%).
• Temporarily taking the child’s mind off their illness and pain (40.2%).
• Stimulation of cognitive and creative abilities (16.1%) and self-expression through drawing and painting (13.8%).
• Reassuring support provided to parents (12.6%).
• Strengthen social interaction and solidarity (5,7%)

The suggestions for improvement made by 50.6% of respondents focused primarily on increasing the number of weekly sessions (63.6%), improving equipment and toys (20.5%), and increasing the number of care staff (13.6%). (Table 2).

Table 2: Suggestions for Improving Alternative Psychotherapies
Suggestions	Frequency (n=44 out of N=87)	Percentage (%)
Increase the number of sessions of alternative psychotherapy	28	63,6
Improving the conditions for the practice of alternative psychotherapies	9	20,5
Reinforcing Play Equipment	9	20,5
Strengthening the workforce to implement alternative psychotherapies	6	13,6
Giving Gifts to Children	3	6,8
Focus on the language you are most fluent in, namely Wolof	3	6,8
Introducing Music Therapy	1	2,3

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