The “empty speech bubbles”: Explaining cancer through play. A pediatric oncology unit pilot experience

PURPOSE: This pilot study aimed at evaluating the feasibility and acceptability of a structured psycho-educational intervention designed to increase disease awareness in children with tumors. The primary objective was to promote psychological adjustment by supporting children's understanding of their illness and facilitating open parent-child communication about cancer. METHODS: Consecutive patients aged 6-11 years undergoing diagnosis or treatment for tumors at a single pediatric oncology center were invited to participate in a four-month period. The intervention consisted of three stages: (1) development of a mini guidebook for caregivers; (2) a psychologist-led meeting with parents focused on communication strategies; and (3) individual or group educational activities with children conducted by a multidisciplinary team. Child-centered, age-appropriate methods-including play, creative tasks, and anonymous "empty speech bubbles" for questions-were used to address disease etiology, diagnostic procedures, treatments, and terminology. RESULTS: Eleven children participated in the intervention. All engaged actively in the sessions and expressed reassurance and satisfaction with the information received. The use of anonymous question tools facilitated open expression of fears and doubts. Parents reported increased confidence and reduced difficulty in communicating with their child about the illness, valuing the structured guidance provided. CONCLUSION: This preliminary experience suggests that structured, interactive interventions promoting illness awareness are feasible and well accepted in pediatric oncology. Such approaches may support psychological adjustment in children with tumors and improve parent-child communication, representing a valuable component of holistic cancer care.