Over the last several years, a growing body of evidence from anatomical, physiological, and functional neuroimaging studies has increasingly indicated that the cerebellum is actively involved in managing higher order cognitive functions and regulating emotional responses. It has become clear that when children experience congenital or acquired cerebellar lesions, these injuries can lead to a variety of cognitive and emotional disorders, manifesting in different combinations. This underscores the cerebellum’s essential role not only throughout developmental stages but particularly in facilitating learning processes, highlighting its critical importance beyond its traditional association with motor control. Furthermore, the intricate neural circuits within the cerebellum are believed to contribute to the fine-tuning of motor actions and coordination but are also increasingly recognized for their involvement in cognitive processes such as attention, language, and problem solving. Recent research has highlighted the importance of cerebellar health and integrity for optimal functioning across various domains of the human experience.

Health-related quality of life (HRQOL) measurement has become an important health care outcome even in oncological pediatric scenario. During radiation therapy care path, pediatric patients and their relatives may suffer from emotional and psychosocial distress not only related to cancer diagnosis, but also due to the procedure and the required daily routine. Despite the high prevalence of psychosocial consequences in this setting, instruments that inquire pediatric HRQOL and healthcare satisfaction have rarely been studied in Italy. Purpose of this study was to investigate reliability and linguistic validation of the PedsQL™ healthcare satisfaction Hematology/Oncology module from its original English version to Italian language. Three phases standard procedure of cross-culture adaptation were used to create Italian version of PedsQL™ healthcare satisfaction Hematology/Oncology module. Forward translations and backward translations were performed. Finally, a pilot-testing for understandability of the ‘pre-final’ version was conducted with parents of children attending our Radiotherapy Center using two methodologies of Cognitive Interviewing (“Think-aloud Interviews” and “Respondent Debriefing”), in order to obtain the final Italian version of the PedsQL™ healthcare satisfaction Hematology/Oncology module. Twenty-five parents (2 father, 23 mothers) were recruited during their children’s radiotherapy treatment and the grammatically and conceptually acceptable pre-final version of the PedsQL™ Healthcare Satisfaction Hematology/Oncology Module was administered. The questionnaire was well understood reflecting its linguistic adaptation. Compliance with questionnaire administration was optimal. All subjects stated that the questions were interesting to express their opinion, most of them reported that all the questions of each section were clearly comprehensible and easy to understand, suggesting minimal changes that were double-checked with back translation. Furthermore, six of them spontaneously asked to complete the questionnaire in order to review the assistance received during radiotherapy. Our Italian version of the PedsQL™ 3.0 Healthcare Satisfaction Hematology/Oncology Module seems to be a valid and functional instrument to indagate Healthcare Satisfaction.

Healthcare professionals in pediatric oncology are at a high risk of burnout. Art therapy is being increasingly recognized as a potential tool for reducing stress and improving emotional well-being. The Art-Out pilot project aimed at nursing staff was initiated in a pediatric oncology unit. The staff members participating in the project were guided in a team-building course integrated with art and clay therapy, aiming to reduce burnout levels, improve emotional climate, and strengthen resilience. Methods: Burnout levels were assessed through the Maslach Burnout Inventory (MBI), alexithymia was measured with the Toronto Alexithymia Scale (TAS-20), and emotional regulation difficulties were evaluated through the Difficulties in Emotion Regulation Scale (DERS); these tests were assessed before (T0) and after (T1) the team-building course (Art-Out project). Results: Data analysis showed a significant reduction in burnout, alexithymia, and emotional dysregulation, highlighting the positive impact of this approach in improving team dynamics and emotional management. Conclusions: Our study confirms the high risk of burnout, alexithymia, and emotional dysregulation among pediatric oncology healthcare workers, underscoring the need for targeted interventions to prevent and mitigate these risks.

Background: Family members dealing with the devastating impact of a cancer diagnosis are now facing even greater vulnerability due to the COVID-19 pandemic. Alongside the already overwhelming trauma, they must also bear the distressing burden of the infection risks. The purpose of this study was to examine and explore the effects in parents of pediatric cancer patients two years after the start of the COVID-19 pandemic to compare these data with the previous data. Methods: We conducted a single-center prospective observational study, enrolling 75 parents of 42 pediatric oncology patients. Four questionnaires (IES-R; PSS; STAI-Y and PedsQL) were given to the parents 2 years after the first evaluation. Results: The bivariate matrix of correlation found a strong significant positive correlation between IES-R and PSS scores (r = 0.526, p < 0.001) as in T1. Stress symptoms (t = 0.00, p < 0.001) and levels of anxiety (trait) (t = 0.32, p < 0.001) remained unchanged; anxiety state levels appeared to have increased (t = 0.425, p < 0.001); there was a significant decrease in the PedsQL tot (t = 5.25, p < 0.001). Conclusions: The COVID-19 pandemic has influenced the levels of stress and anxiety of parents and the quality of life of patients, also correlating with the traumatic impact of the diagnosis.

Background: Pediatric radiotherapy is often associated with high levels of psychological distress and vulnerability, affecting both patients and their families. In younger children, sedation is frequently required to ensure safety and adequate immobilization during treatment. The original RADAR Project demonstrated that the Multidimensional Assessment for Pediatric Patients in Radiotherapy (M.A.P.-RT) tool accurately predicts the need for sedation in pediatric patients undergoing radiotherapy. The present study aims to extend the validation of the M.A.P.-RT, including a larger cohort of patients, to confirm the tool’s predictive robustness and to identify clinical and psychosocial factors associated with sedation requirements, and to profile psychosocial and behavioural vulnerability according to age and gender. Methods: Pediatric patients referred for RT were prospectively enrolled and assessed with the M.A.P.-RT schedule during the first multidisciplinary consultation. Two outcomes were analysed: the need for procedural sedation and the level of psychological support required (intensive vs. standard). The questionnaire items, domain scores, and total score were examined to identify the factors most strongly associated with these outcomes. Predictive models were then developed using the domain scores, while the total score was evaluated separately. Model performance was assessed by repeated, fully nested 10 × 10-fold cross-validation (internal validation only), and odds ratios with 95% confidence intervals were calculated to estimate the strength of the associations. Linear regression models with age group (children ≤ 11 years vs. adolescents and young adults ≥ 12 years), gender, and their interaction were then fitted to test demographic predictors of psychological difficulties and behavioural reactions at treatment entry. Results: A total of 268 patients (mean age 9.6 years, SD 5.7; 59.3% male) were included in the analysis. Procedural sedation was required in 22.8% of patients, while 51.1% received intensive psychological support. The M.A.P.-RT showed excellent ability to identify children requiring sedation, with previous collaboration during radiotherapy procedures, age-related discomfort, and higher questionnaire scores emerging as the main predictors. The overall questionnaire score alone also provided high predictive accuracy. In contrast, the tool was less effective in distinguishing patients who required intensive psychological support: it misclassified roughly one patient in three, with a significant bias toward over-classifying patients into the higher-need category. Age group, but not gender, predicted psychosocial vulnerability: compared with adolescents and young adults, children aged ≤11 years showed significantly greater psychological difficulties, parental anxiety, post-diagnosis distress, and externalising coping and patient-management difficulties and more pronounced reactions across all five dimensions of the Children’s Emotional Manifestation Scale (CEMS), included in the M.A.P.-RT, at treatment entry. Conclusions: In this large single-centre cohort, and under internal validation only, the M.A.P.-RT confirmed its value as a reliable tool for predicting the need for procedural sedation in pediatric radiotherapy, while its ability to predict the intensity of psychological support was more limited, indicating that it is better used to prompt psychological assessment than to allocate support; this was probably due to different properties of the two targets. Age was the main profiling variable, identifying younger children as systematically more vulnerable; sex was not associated with any outcome. These findings highlight that integrating structured psychosocial information into patient profiling may facilitate the early identification of individual vulnerabilities and support the delivery of more personalized psychosocial care. They also underscore the potential of multidisciplinary assessment tools to enable the early identification of individual needs and vulnerabilities, supporting the development of personalized supportive interventions to improve the radiotherapy experience of children and their families. Because validation was internal and conducted in a single centre, external validation remains necessary before the schedule is adopted elsewhere.

Background: Pediatric cancer is a highly stressful and potentially traumatic condition affecting physical health, emotional well-being, developmental trajectories, and family functioning. Hospitalization and intensive treatments often exacerbate emotional distress and symptom burden, negatively impacting quality of life (QoL). Integrating psychosocial and expressive interventions into pediatric oncology care is increasingly recognized as essential. Clay therapy is a multisensory, hands-on creative intervention that may promote emotional regulation, coping, and a sense of agency in hospitalized children. Objectives: This prospective pilot study evaluated the effects of clay therapy on emotional and physical well-being in pediatric oncology patients and explored potential indirect effects on caregivers’ emotional status. Methods: From December 2023 to December 2024, forty hospitalized children with onco-hematological diseases and one parent per patient were enrolled. Each child participated in a one-hour clay therapy workshop led by a professional ceramist. Emotional outcomes were assessed before (T0) and immediately after (T1) the intervention using the Visual Analog Scale (VAS) and the ArtsObs observational scale. Physical symptoms, including pain, fatigue, and nausea, were also evaluated. Results: Following clay therapy, children showed statistically significant improvements across all VAS emotional domains, independent of age and gender. ArtsObs assessments confirmed a significant increase in observed mood, with high levels of relaxation and engagement; female patients demonstrated greater mood improvement than males. Significant reductions in pain, fatigue, and nausea were also observed. Parents exhibited a significant improvement in mood following their child’s participation. Conclusions: These findings suggest that clay therapy is feasible and could be an effective supportive intervention in pediatric oncology, benefiting both emotional and physical well-being. Its integration into multidisciplinary, family-centered care models may enhance QoL during hospitalization and provide holistic support for children with cancer and their families.