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Section 11
Children & Parental Cancer, Part I

Question 11 | Test | Table of Contents

The Impact of Parental Cancer on the Family
According to family systems theory (Bowen, 1978), the condition of one family member influences the condition of other family members; family members operate as a set of interdependent units which are continuously maintaining a dynamic level of functioning that balances both constancy and responsiveness. Systems theory also states that all subsystems (parental, marital, child, and sibling) interact and influence each other; this systemic interaction determines the level of psychosocial functioning and well-being of family members (Issel et al., 1990; Veach, 1999).

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
Parental cancer can cause depressive mood or distress in both the afflicted parent and his or her spouse (Cunningham, Edmonds, & Williams, 1999; Gilbar, 1998; Leedham & Meyerowitz, 1999; Lewis, 1986; Lewis & Hammond, 1996). It has been established in the literature that depressed parents show impaired parenting characterized by less psychological availability, less communication, decreased supervision, lack of consistency in discipline and initiative, as well as more hostility, irritability, and coerciveness (Armsden & Lewis, 1994; Christ et al., 1994; Compas et al., 1994; Garber & Robinson, 1997; Garber, Robinson, & Valentiner, 1997). Even in the absence of depression, cancer can lead to parental inaccessibility. Treatment demands or preoccupation with the illness can make the parent physically or emotionally unavailable to the child or adolescent. Overall, parental illness has been found to cause parental withdrawal, indifference, unreliability, hostility, and coerciveness, which are linked to impaired adaptability of the child in the form of behavioral, social, and self-esteem problems. Conversely, children and adolescents with secure parental bonds demonstrate superior social competence and self-confidence (Armsden & Lewis, 1994; Christ et al., 1994; Compas et al., 1994; Garber & Robinson, 1997; Garber et al., 1997).

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
According to Compas et al. (1994), children whose parents are diagnosed with cancer experience substantial psychosocial stress. He and his colleagues assessed anxiety-depression and stress responses in adult cancer patients (n = 117), spouses (n = 76) and their children (n = 110, age 6 to 30 years old) shortly after the patients’ diagnoses to identify family members at risk for psychological maladjustment. Children, adolescents, and young adults reported moderate to high levels of emotional distress when their parent was diagnosed and treated for cancer. They found that both stress-response and anxiety-depression symptoms varied in children as a function of age, sex of the child, and sex of the parent who is ill. Adolescent girls whose mothers had cancer were the most significantly distressed.

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.

Personal Reflection Exercise #4
The preceding section contained information about the impact of cancer on the family.  Write three case study examples regarding how you might use the content of this section in your practice.

Mental Health Outcomes in Parents
of Children with A Cancer Diagnosis
in Sweden: A Nationwide Cohort Study

Liu, Y., Sundquist, J., Sundquist, K., Zheng, D., & Ji, J. (2022). Mental health outcomes in parents of children with a cancer diagnosis in Sweden: A nationwide cohort study. EClinicalMedicine, 55, 101734.

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.

Merluzzi, T. V., Philip, E. J., Heitzmann Ruhf, C. A., Liu, H., Yang, M., & Conley, C. C. (2018). Self-efficacy for coping with cancer: Revision of the Cancer Behavior Inventory (Version 3.0). Psychological Assessment, 30(4), 486–499.

How did young school-age children adapt to parental cancer? To select and enter your answer go to Test.

Section 12
Table of Contents