The Experience of Alienation in Children and Adolescents With Cancer: A Systematic Review and Meta-Synthesis of Qualitative Studies.
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INTRODUCTION: A cancer diagnosis during childhood and adolescence, together with intensive treatment, imposes significant psychosocial challenges. Alienation is a key yet underexplored component of this experience and may adversely affect physical well-being, mental health, and social adjustment. This review aimed to systematically synthesize qualitative evidence on alienation experienced by children and adolescents with cancer. METHODS: We conducted a systematic search of PubMed/MEDLINE, Web of Science, EMBASE (Ovid), the Cochrane Library (Wiley), and CINAHL (EBSCO) from inception to 28 May 2025. Eligible studies were qualitative or mixed-methods research exploring the experience of alienation among children and adolescents with cancer. Two reviewers independently screened records, appraised methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research and extracted data. A meta-synthesis using the JBI meta-aggregation approach was undertaken. RESULTS: A total of 30 studies were included. Four synthesized findings and thirteen categories were identified: environmental alienation (e.g., locked up in hospital, being away from home, stuck in adult wards), self-alienation (e.g., caught in identity paradox, feeling like a stranger, walking alone in the shadow of fear), interpersonal alienation (e.g., they just don't get it, staying on the sidelines, trapped in my body, losing my place), and social alienation (e.g., life on pause, stuck between worlds, stamped with scars). CONCLUSIONS: Alienation in the pediatric oncology context is a profound and multi-dimensional phenomenon. Understanding and addressing this experience is crucial for improving the quality of life and promoting social integration. Findings should be interpreted in light of variability in study quality and contextual diversity.