A cancer diagnosis can abruptly and durably alter the course of daily life—not just for the person diagnosed but also for family members. New research presented by Sinen Korbi, MD, and colleagues at the European Society for Medical Oncology (ESMO) Congress 2021 examined the coping mechanisms of Tunisian children whose parents had cancer (Abstract 1489P_PR).
In 2020, an estimated 4.6 million individuals globally aged 20 to 54 years were diagnosed with cancer at a time in their lives when they are most likely to be raising children. The impact of parental cancer on a child’s development varies according to the child’s age and the evolution of the illness but also, crucially, on how the child has been included in the parent’s disease journey.
Sinen Korbi, MD
Carlo Alfredo Clerici, MD
Giving bad news to their children and addressing the distress this may cause them is one of the most daunting tasks parents face at a time when they must process their own emotions about the disease. Yet, according to Carlo Alfredo Clerici, MD, a clinical and child psychology expert from the University of Milan who was not directly involved in the study, “Current psychological perspectives see a certain degree of information to children about their parents’ disease—and about the possibility of their death—as useful and protective against traumatic phenomena.”
Cultural Norms in Tunisia
The social and cultural resistance that often stands in the way of this type of dialogue with children is evident from the results of a survey of 103 patients in Tunisia. Almost 90% reported having trouble communicating about the subject of the parent’s illness, and more than 40% chose not to disclose the whole truth about their disease. According to Dr. Korbi, of the Institute Salah Azaiez, Tunis, the idea is widespread among patients that they are protecting their children’s psychosocial equilibrium by shielding them from the reality of the illness.
“This was cited as a concern by 7 of the 18 parents in our study who chose to conceal the truth from their children entirely,” he reported.
The study participants included 75 women (72.8%) and 28 men (27.2%); the mean age was 43 years. A total of 40% of the patients had adolescents (aged 12–18 years), 35% had school-aged children (6–12 years), and 25% had preschoolers (< 6 years). Most of the children who were not aware of their parent’s diagnosis were of preschool age (61%); the reasons given by the parents in these cases were the young age of their children and the fear of generating emotional and behavioral trauma as well as threatening their psychosocial equilibrium.
Almost all study participants (96%) observed behavioral changes in their children: anxiety was seen in 35.1% of children; depression, in 21.6%; violent behavior and aggression, in 21.6%; emotional dependency, in 10.3%; and addiction, in 6.2%. Only nine parents consulted a child psychiatrist. Parent gender and educational level did not appear to significantly predict behavioral changes in their children.
“Many people think they can handle these issues on their own or with help from relatives, but they need to be encouraged to report these problems to us so we can refer them to specialists if needed…. This can be as simple as asking patients how their children are doing every time we see them,” said Dr. Korbi.
“This study makes clear the need to increase knowledge about the role of psychological and emotional dimensions in people's lives. Efforts should be made to better understand and take into account—in a way that is compatible with social and cultural perspectives—the fact that children build their own interpretation of life and they can suffer significantly when they do not have adults helping them to stay in contact with reality,” added Dr. Clerici. “Future research should also aim to capture traumatic phenomena that unfold over time and are associated with more worrying long-term consequences than the individual symptoms of distress reported here.”
Disclosure: For full disclosures of the study authors, visit oncologypro.esmo.org.
