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The Impact of Parental Cancer on the Family
A review of the literature has suggested that, when a parent is diagnosed with cancer, all family members are affected by the illness. For example, research on parental cancer has revealed that the quality of the marriage can affect the parent’s or patient’s well-being and health (Compas,Worsham, & Howell, 1996; Lewis & Deal, 1995; Lewis & Hammond, 1996; Lewis, Hammond, & Woods, 1993; Mireault & Compas, 1996). Studies also have suggested that the parent’s cancer and the quality of the parents’ marriage can affect the child’s or adolescent’s psychological functioning (Armsden & Lewis, 1994; Christ, Siegel, & Sperber, 1994; Compas et al., 1994, 1996;Northouse & Peters-Golden, 1993; Veach, 1999).
Even though this article will draw on the extant literature to explore how these factors might affect the psychosocial development of children and adolescents, there are many unanswered questions about parental cancer, for example: (a) What is the effect of parental cancer on the household? (b) What are the effects of parental cancer on the child and adolescent? (c) What are the mechanisms by which the cancer affects children’s and adolescent’s functioning? These questions can be answered only with longitudinal research specifically designed to reveal the effect of cancer on the household, focusing on children’s and adolescents’ functioning.
The Effect of Cancer on Parenting
The marital tension produced by parental illness may also result in adjustment difficulties for the child and adolescent in the family. Marital discord has been associated with more frequent punishment (Jew & Green, 1996; Lewis & Deal, 1995). The parental atmosphere of marital strife may promote anxiety in children and adolescents as well as concerns about the future and their family’s stability. Children and adolescents may misinterpret decreased parental accessibility and believe that they are not loved or valued by the parent. This perceived unworthiness may also be internalized by the child as his or her own self-appraisal, leading to reduced levels of selfesteem (Compas et al., 1996; Garber & Robinson, 1997; Garber et al., 1997; Lewis & Hammond, 1996).
Children and Adolescents of Cancer Patients
Despite the prevalence of research on how children cope with stress, research on this particular issue—how children cope with parental cancer— has been sparse (Compas et al., 1996). In reviewing how families cope with parental cancer, Northouse (1988) noted that, although the children are an integral part of the family system, little attention has been given to the impact of cancer on their lives. The lack of research in this area is not surprising since, for years, children have been treated as tangential to or even excluded from their parents’ treatment plans.
Armsden and Lewis (1994) have provided the most detailed information about the effect of parental cancer on children. They described the ways in which school-age children cope with their mothers’ breast cancer and the ways in which their families help them cope. The results are based on semistructured interviews with 81 children, 6–20 years old, from 50 families in which the mother had been diagnosed with breast cancer within the past 2½ years. In their study, children were divided into three age groups: young school-age (7 through 10 years old), older school-age (10 through 12 years old), and adolescent (14 through 19 years old). They conducted a series of interviews in which the children were asked to verbalize their concerns and feelings about their mothers’ illness. Each group provided responses consistent with their stage of psychosocial and cognitive development. Those authors found that it was difficult for young school-age children to understand the concept of cancer due to their concrete mode of thinking. They often described the illness as "it" and their emotional responses were concerned primarily with fear, loneliness, anger, and uncertainty about the future.
The older school-age children acknowledged that they had to take on more responsibilities, such as household chores, which took time away from their own interests and activities. These children displayed developmentally appropriate responses to their parents’ cancer as they were more concerned with playing and their own activities than with empathizing and helping out at home. Therefore, they maintained an egocentric position on the process, relative to their own stage of cognitive and psychosocial development. According to Northouse, Caraway, and Appel (1991), adolescents found their lives to be complicated by their mothers’ illness. Adolescents, typically struggling for independence and the formation of a separate identity, reported feelings of conflict between the desire to break away from the family of origin and the knowledge that they were needed at home both emotionally and physically. This particular age group often felt burdened with additional roles and responsibilities (Cain & Staver, 1976; Compas et al., 1996; Gilbar, 1998; Veach, 1999). Therefore, a parent’s medical condition can keep adolescents more closely aligned with the family at a time when developmentally they should be pulling away from the family to progress toward autonomy. This may also negatively affect self-concept.
From a family systems perspective, the stress of parental illness affects the equilibrium or balance in the system, which may lead to a family member adopting inappropriate behaviors. Johnston, Martin, Martin, and Gumaer (1992) suggested that, in cases of parental illness, there is a strong likelihood of role reversal in which the "sick" parent may become the child, and the adolescent may become the "parent." Those authors stated that such role reversals may have strong ramifications for the spousal relationship, because the child has assumed a parental role. In these instances, the developmental tasks of children are often compromised. Stress for the child may become overwhelming and affect physical and psychological health, including emotional distress and feelings of stress, fear, guilt, depression, and anxiety (Miller, Wilcox, & Soper, 1985).
- Faulkner, Rhonda & Maureen Davey; Children and adolescents of cancer patients: the impact of cancer on the family; American Journal of Family Therapy; Jan/Feb 2002; Vol. 30; Issue1.
Reflection Exercise #4
Online Continuing Education QUESTION 11
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