Parenting with Cancer I: Developmental Perspective, Communication, and Coping

Abstract

An estimated 2.85 million children in the United States are living with a parent who has been diagnosed with cancer [1]. One-third of patients with breast cancer have dependent children [2]. For these parents, often their biggest worry is what impact their cancer will have on their children. Unfortunately, it is not common for parents to receive support from clinicians about these concerns. Our aim for this chapter is to familiarize clinicians with the common worries that parents have and empower them with strategies they can use to help support parents in this difficult time. The content discussed in this chapter is derived from the accumulated clinical experience of the team of clinicians comprising the Parenting at a Challenging Time (PACT) Program at the Massachusetts General Hospital (MGH) [3–21]. This chapter will present information that clinicians can use to take a parenting history, and to use a developmental perspective to guide parents at different stages of illness, including new diagnosis, treatment, survivorship, and end-of-life. Practical strategies for parenting challenges such as communication with children about illness, preserving family time, and harnessing support networks will be addressed so that clinicians are equipped with tools they can use to directly impact parents with cancer.

Mary is a 45-year-old married mother of three children, 6 year old Sarah, 10 year old Katie, and 15 year old Ethan. She was diagnosed with breast cancer several months ago, and she and her husband have discussed the diagnosis openly with all three children. She comes to the clinic for her first chemotherapy infusion. When the nurse, who knows her well, inquires about how things have been going with her children, Mary starts to cry. She says that Sarah, her youngest daughter, has been asking a lot of questions that are hard to answer; particularly upsetting is the question, “Why did you get cancer mommy and when will I get cancer?” Katie, her middle daughter, has been very anxious about Mary losing her hair and wants her to wear her wig all the time. Mary promised Katie she would, but she wishes she could take the wig off at home. She’s not worried about her oldest, Ethan, because he is always out with his friends and never at home. She hasn’t been checking in with him, and is hoping he’s doing his schoolwork. She appreciates all the calls from neighbors and friends from church, but has been overwhelmed by the constant calls and offers of help.

Mary, Adult Cancer Patient