By: Aisha Siyal
Abstract
This report briefly explores some of the psychosocial issues that children and adolescents may experience when a parent or guardian is diagnosed with cancer. The purpose of this review is to highlight the impact of cancer diagnosis on children and the countless physical and mental challenges they may face. In addition to this, developmental activities are put on hold when a parent becomes ill, significantly impairing children’s normal growth and development. Recognizing these challenges and providing appropriate support can help mitigate the adverse
effects and promote healthier coping mechanisms. By fostering open communication and understanding, families can navigate this difficult journey together, ensuring that both parents and children are supported in their emotional well-being.
Keywords: parental cancer, diagnosis, children, teens
The Impact of Parental Cancer on Teens' Mental Health
Physiological Effect of Cancer Diagnosis
Receiving a cancer diagnosis is a traumatic event, eliciting difficult emotions such as denial, anger, anxiety, and/or depression. The patient may experience significant levels of distress, and these emotions may manifest in ways that psychologically affect children. When newly diagnosed, individuals often contemplate how to inform their family, especially if they are parents with dependent children. It can be challenging for them to explain cancer to their kids.
The diagnosis leads to changes throughout the family system, leading to turmoil for
adolescents when a parent is diagnosed with cancer. Physical, emotional, daily routine and financial changes related to the illness affect all family members, as they are interconnected, directly and indirectly. Sudden disruptions to daily life, financial stress, declining physical health, and reduced emotional availability can create additional stress and uncertainty for parents and adolescents.
Some may not tell children that they have cancer. In fact, parents may avoid using terms associated with cancer, such as chemotherapy, radiation, surgery, and even the word ‘cancer’ itself around their children as a means to protect their child(ren) from distress and disruption in their life, as well as avoiding questions about cancer and mortality.
Change in Family Dynamics and Parentification
To assess how parenting conditions impact parental distress levels, research indicates that patients with children over the age of 18 experience significantly higher levels of anxiety and depression. This distress often stems from both emotional and practical concerns related to their parenting roles. The parent with cancer must learn to negotiate between the duality of being a patient while fulfilling their responsibilities as a parent. As the illness progresses, the worry
about effectively fulfilling parental duties intensifies, potentially leading to shifts in family dynamics.
This may result in a change in family dynamics, e.g. children might become parentified. Onenotable consequence of the phenomenon of parentification, children assume caregiving roles traditionally held by parents. In this role reversal, the child may become responsible for caring for younger siblings or managing household tasks. Additionally, older adolescents might take on part-time jobs to help supplement the financial strain that the illness imposes on the family. The
parentification of children/adolescents obliges them to sacrifice aspects of their own development —socially, emotionally, and personally— as a result, leading to increased stress. Overall, the dynamics of the family can change significantly under these pressures, posing additional challenges for both parents and children.
Effect of Emotional Unavailability and Trust
One of the main concerns of parents is the perception of their parental efficiency,
understood as physical and emotional availability, which can be affected by frequent and repeated medical examinations and intense treatments that patients must constantly undergo. Such medical tests and treatments can make patients physically, emotionally, and psychologically less available to their children due to their inability to be responsive to the child’s/adolescent needs.
When a parent is emotionally absent, it can lead to insecure attachment in children. These children are perceptive and will start to question any changes, whether they are internal or external, such as significant changes in the home, alterations in their daily routine, or shifts in their parent’s emotional and behavioral state. Moreover, when appropriate information is withheld from a child or adolescent their fundamental view of their parent becomes misaligned. Young children may make assumptions that the cause of the changes/disruptions occurring is their fault, and this may result in the child becoming anxious or depressed.
Like any partnership, rapport and trust need to develop. A child-parent bond does not automatically happen. A parent must earn their child’s trust even from birth. Children, especially young children, need to feel secure in their attachment to their parent/caregiver. A study conducted on cancer survivors with minor and young adult children highlights how a reduced availability towards one’s family can decrease levels of trust in one’s parenting skills, becoming a major concern.
Behavioral Changes
Living with cancer poses unique challenges for parents and their families. On the one hand, the parent wants to protect their children from the consequences of their illness on their emotional development, but on the other hand, fatigue, pain, and loss of mobility can make them less available, with a consequent reduction in attention that was previously reserved for them.
Even when healthy parents must redefine their role, they often take on more
responsibilities than before, leading to an added burden that can significantly alter family dynamics.
In addition, the healthy parent may feel the need to compensate for the emotional unavailability of the sick parent. They may become a primary source of support and guidance for their teens, attempting to fill the gaps left by the parent's illness. This could exacerbate feelings of stress and burnout, as the healthy parent strives to provide stability and reassurance during an uncertain time.
Children, not wishing to further burden their parents, may not express their emotions. The internalization of emotions among family members, such as parents not discussing cancer to spare their child or children internalizing their feelings to avoid burdening their parents, leads to a lack of communication.
For adolescents, parental cancer disrupts typical developmental tasks, such as
independence from parents, increased attention to body image, and peer group membership. Although parental cancer affects children differently based on age, they are all known to be predisposed to countless developmental problems.
Changes in behavior in the home can often carry over into school or social environments. Children with a dressed or anxious mood withdraw from activities, act out, and have diminished academic performance. Research shows that adolescents, especially adolescent girls, exhibit more psychosocial distress than pre-adolescent children. Parents may be unaware of their child(ren)’s emotional distress, or have difficulty acknowledging it. Parental diagnoses, the threat of death, and disturbance in daily routine present stress factors for teens and children. This
emotional experience may be a trigger of PTSD symptoms and long-term psychosocial outcomes for young children and adolescents. Furthermore, Parents’ anxious attitudes are likely to negatively influence parenting (e.g., overprotective behavior), which, in turn, may cause more anxiety and worry in children.
Coping in Adoloscents
Lazarus defines coping as ongoing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Problem-focused coping is the management or alteration of the person-environment relationship that is the source of stress, and emotion-focused coping is the regulation of distinctive feelings and stressful emotions.
Adolescents with stressful emotions used problem-focused coping as they asked questions, read about the illness, and assumed responsibility for household chores or sibling care. They also reported using emotion-focused coping by refusing to think or talk about the illness and dual-focused coping (both problem- and emotion-focused in intent). emotion-focused coping is related to greater avoidance and higher symptoms of anxiety/depression in the adolescent.
Avoidance is a coping mechanism that people use to protect themselves from experiencing difficult emotions when they are not ready to confront and accept the reality of why they are having these emotions. Adolescents stressed the importance of family, friends, and the school system in providing a sense of normality in their lives, which helped them cope. Additionally, humor was used as a way of coping; friends were described as being supportive when they tried to be close, asked about their parents, and offered hugs and jokes.
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