Grieving in the shadows: A systematic review of invisible losses in siblings of pediatric cancer patients

Abstract

Childhood cancer profoundly alters family dynamics, concentrating emotional and institutional resources on the affected child while generating symbolic and relational losses for healthy siblings that often remain invisible to healthcare systems. This systematic review examines disenfranchized grief among siblings of children with cancer, a population underrepresented in pediatric psycho-oncology. Following PRISMA 2020, a systematic search (2020–2025) was conducted in PubMed and ProQuest. Twelve empirical studies were included, examining the emotional experiences of healthy siblings during the illness, excluding post-death bereavement. Siblings showed elevated psychological distress, including anxiety, stress, guilt, and emotional suppression, associated with ambiguous loss, disrupted family routines, reduced parental emotional availability, and limited social recognition. Emotional validation, open family communication, and psychosocial support emerged as protective factors. Findings highlight the need for a systemic, sibling-inclusive approach in Pediatric Psycho-Oncology, including structured psychosocial risk screening to enable early identification, intervention, and prevention of long-term psychological sequelae.