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Helping Parents Help Children Cope with Cancer in the Family
Cancer & Children continuing education counselor CEUs

Section 12
Children & Adolescents of Cancer Patients:
The Impact of Cancer on the Family, Part II

CEU Question 12 | CE Test | Table of Contents | Cancer
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

Adolescent Gender Differences
Currently, researchers have suggested that, because the cognitive abilities of adolescents are more advanced, adolescents are better able to comprehend the illness and treatment processes and to identify the ramifications for current and future family life and relationships. Due to their developmental life stage, adolescents feel torn between the developmental tasks of adolescence (forming relationships outside the family) and the need to deal with the practical, psychological, and social tasks demanded by the illness (Christ et al., 1994). Therefore, adolescents may be more vulnerable to emotional distress when their parent is diagnosed and treated for cancer.

Research on parental illness also has suggested that, among adolescents whose parents have cancer, there are differences in the ways in which male and female adolescents cope with this stress. According to Northouse, Cracchiolo-Caraway, and Appel (1991), adolescent daughters want to support their mothers during the course of the illness, yet also feel anger and resentment and could withdraw from their mothers. These daughters may also fear the risk of inheriting the disease. Consequently, they could harbor resentment toward their mothers for contributing to their own genetic vulnerability or predisposition to cancer. Their anger is often expressed overtly through argumentativeness, or covertly through emotional and physical distancing.

Adolescent sons may also have difficulty adjusting to parental illness. Northouse et al. (1991) noted that adolescent males may avoid communication that directly addresses the illness and the situation. They may also want all information about the disease concealed from others outside the family. For adolescent sons, emotions are more likely to be acted out rather than expressed through open communication.

Lichtman et al. (1985) interviewed 78 breast cancer patients regarding perceptions of change in their relationships with their children. They found that the mothers’ relationships with their daughters were at a significantly greater risk than were the relationships with their sons. Seventeen percent of the breast cancer patients reported that their daughters were fearful, withdrawn, hostile, or rejecting; only 8% reported having problems with their sons. The most commonly reported problem with sons was their extreme fearfulness about their mothers’ prognosis. Sons tended to deny the cancer, remained aloof from their mothers, rejected their mothers, or both.

As for the daughters, they were also extremely fearful of their mother’s prognosis. The daughters were worried about inheriting breast cancer. Additionally, the mothers’ demands on their daughters for support were judged to be major contributing factors to the difficulties with these adolescent girls. Mothers of the adolescent daughters reported the most dramatic and rejecting responses. Therefore, the mothers’ demands on their daughters for emotional and physical support and the daughters’ fears of inheriting breast cancer were contributing factors to the difficulties experienced by both the adolescent daughters and their mothers. Three adolescent daughters moved out of the house, either temporarily or permanently (no son left home). From this review of the extant literature, there is evidence to suggest that adolescent females may have greater difficulty coping with their mothers’ illness.

Clinical Implications
Children’s and adolescents’ developmental needs will, in many ways, determine how best to clinically intervene when a parent has cancer. Helping seriously ill parents and their spouses support children’s and adolescents’ developmental needs is a salient goal of therapy (Cunningham et al., 1999; Leedham & Meyerowitz, 1999; Veach, 1999). The way a younger child reacts is most often reflected in his or her behavior. Young children may appear to regress in behavior if their world is threatened.

For example, children who are fully toilet trained may start having accidents. Two- and three-year-olds, who typically are adventuresome in exploring their environments, may become unusually clingy and dependent. First graders who have adjusted well to starting school may resist going to school and display exaggerated separation anxiety. For children who cannot talk about their worries, these behaviors clue parents and clinicians to anxieties about changes in the household or in their relationship to their parents.

During these times, parents may need to offer extra attention to their children. If a parent is feeling too ill, other family members may be called on to temporarily help. School-age children have the advantage of being able to verbalize their feelings and also have more resources outside of their immediate families to help them cope. School personnel should be informed of parental illness so the child’s responses can be understood within that context. Parental illness can be particularly difficult for adolescents, who are in a developmental stage of separation from parental figures. It is typical for teenagers to test parental limits, and to gradually achieve more self-confidence in their desire for independence. When this process is interrupted by illness, teenagers can experience ambivalence and resentment, especially if they are called on to take over parental responsibilities (Veach, 1999).

In cases where a parent is diagnosed with cancer, family therapists and other mental health professionals can provide emotional and social support to the family. A chronic illness like cancer impacts all families, even those families with good coping and adaptation. A collaborative oncology team (Yeager et al., 1999) comprised of oncologists, radiologists, and mental health professionals can also provide a valuable service of helping a family with children of varying ages navigate the stress of coping with cancer. First, family therapists can help the patient and spouse cope with the shock of diagnosis and treatment, then they can help the parents and children openly communicate about the illness in developmentally appropriate ways which will alleviate fears and anxiety the children may have about cancer.

When cancer strikes a family, parents might instinctively want to protect their children; however, children are good at sensing when something is wrong so, it is important for parents to talk it over with their children in developmentally appropriate ways. If parents keep the cancer diagnosis a secret, many children experience even more anxiety because they might imagine something worse than what is happening in the family. When parents are ready to tell their children about the cancer, there are ways to help them discuss it (Issel et al., 1990).

The following suggestions were taken from several clinical articles aimed at helping parents talk to their children about cancer (Cunningham et al., 1999; Leedham & Meyerowitz, 1999; Veach, 1999). Those authors made the following clinical recommendations: (a) explain to young children that cancer is not contagious; (b) remove any blame as children at younger ages might think they caused the illness; (c) if the ill parent is in the hospital for any extended period of time, the parent should stay in touch to reassure children that the parent’s illness has nothing to do with how much the parent loves them; (d) answer questions honestly because, for young children, the amount of information a parent gives them is usually less important than making them feel safe with what the parent says; (e) prepare the child and adolescent for the effects of treatment (physical changes like loss of weight and hair loss can sometimes frighten them); (f) let children and adolescents help but do not overburden them with responsibility.

- 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.

Personal Reflection Exercise #5
The preceding section contained information about adolescent gender differences in dealing with cancer in the family.   Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Egberts, M. R., Verkaik, D., Spuij, M., Mooren, T. T. M., van Baar, A. L., & Boelen, P. A. (2021). Child adjustment to parental cancer: A latent profile analysis. Health Psychology. Advance online publication.

Howard Sharp, K. M., Russell, C., Keim, M., Barrera, M., Gilmer, M. J., Foster Akard, T., Compas, B. E., Fairclough, D. L., Davies, B., Hogan, N., Young-Saleme, T., Vannatta, K., & Gerhardt, C. A. (2018). Grief and growth in bereaved siblings: Interactions between different sources of social support. School Psychology Quarterly, 33(3), 363–371.

Martire, L. M., & Helgeson, V. S. (2017). Close relationships and the management of chronic illness: Associations and interventions. American Psychologist, 72(6), 601–612.

Oberoi, A. R., Cardona, N. D., Davis, K. A., Pariseau, E. M., Berk, D., Muriel, A. C., & Long, K. A. (2020). Parent decision-making about support for siblings of children with cancer: Sociodemographic influences. Clinical Practice in Pediatric Psychology, 8(2), 115–125.

Online Continuing Education QUESTION 12
According to the Lichtman et al. study, what relationships were found to be at significant risk in families with cancer? Record the letter of the correct answer the CE Test

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