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Article Excerpt
This study examined the long-term impact of parental cancer during childhood. Nineteen female and 8 male adults who had a parent with terminal or nonterminal cancer during childhood participated in face-to-face interviews during which they discussed how their parent's cancer affected their lives. Their interview responses were transcribed and analyzed using a constant comparative method of analysis. Posttraumatic growth experiences were reported by 44% of participants, and 59% reported adverse consequences. Future research should examine ways to identify factors that can help affected children experience posttraumatic growth while minimizing the adverse consequences of having a parent with cancer.
Keywords: cancer, parent, child, posttraumatic growth, qualitative
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Despite the prevalence of cancer among adults (Ries et al., 2006) with young children, there has been limited research on children's psychological adjustment to parental cancer (Faulkner & Davey, 2002). The available research has focused on the negative impact of parental cancer on children and is inconclusive. Some evidence suggests that affected children's behavior is comparable to their peers (Harris & Zakowski, 2003; Huizinga, van der Graaf, Visser, Dijkstra, & Hoekstra-Weebers, 2003), whereas other evidence links parental cancer with psychological distress in children. Noted symptoms of children affected by parental cancer include depression, anxiety, behavioral problems, and lower self-esteem (Armsden & Lewis, 1994; Birenbaum, Yancey, Phillips, Chand, & Huster, 1999; Compas et al., 1994; Nelson, Sloper, Charlton, & While, 1994; Siegel et al., 1992; Visser, Huizinga, van der Graaf, Hoekstra, & Hoekstra-Weebers, 2004; Welch, Wadsworth, & Compas, 1996; Zahlis, 2001) as well as a heightened perception of their own cancer risk (Harris & Zakowski, 2003) that may extend into adulthood (Van Oostrom et al., 2006).
A number of variables have been found to be associated with children's coping and psychological adjustment to parental cancer (Su & Ryan-Wenger, 2007). These characteristics include the child's age, gender, which parent has cancer, time since diagnosis, family makeup, parent's physical and mental health, marital satisfaction, and family communication (Compas et al., 1994; Nelson et al., 1994; Siegel et al., 1992; Visser et al., 2004; Welch et al., 1996). Alterations in family functioning as a result of parental cancer may also affect children's adjustment. Cancer is a risk factor for depression in both the cancer patient (White & Macleod, 2002) and their spouse (Compas et al., 1994; Given et al., 1993). Parental depression in turn may lead to poor parenting characterized by psychological unavailability, inattentiveness, impaired family communication, as well as inconsistent discipline and increased irritability (Christ, Siegel, & Sperber, 1994; Cummings, Davies, & Campbell, 2000; Garber, Robinson, & Valentiner, 1997; Lewis & Hammond, 1996). Even in the absence of depression, heavy treatment demands or parents' preoccupation with the cancer may make parents physically and emotionally unavailable to their children (Faulkner & Davey, 2002). Lower parenting quality is in turn associated with lower self-esteem in adolescent children of breast cancer patients (Lewis & Hammond, 1996) and externalizing symptoms including disobedience and aggression in children of breast cancer patients (Sigal, Perry, Robbins, Gagne, & Nassif, 2003). There is also evidence suggesting that children hide their distress from their parents and parents may be unaware of their children's distress (Davey, Askew, & Godette, 2003; Helseth & Ulfsaet, 2003), which may also prevent children from getting the support they need.
Little is known about long-term effects of varying types of parental cancer on children (Visser et al., 2004) or potential positive psychological change, known as posttraumatic growth, that children may have experienced as a result of a parent's cancer (Calhoun & Tedeschi, 2001; Mosher & Danoff-Burg, 2005; Tedeschi & Calhoun, 2004). A growing literature in psychology documents the potential for greater appreciation for life, increased personal strength, strengthened personal relationships, awareness of new life possibilities, and spiritual development following a traumatic experience (Calhoun & Tedeschi, 2001; Tedeschi & Calhoun, 1996). However, the evidence is still inconclusive as to whether such experiences are in turn related to better psychological functioning. A recent meta-analysis suggests that whereas posttraumatic growth is associated with less depression and more positive well-being, it is also associated with more intrusive and avoidant thoughts about the stressor and not related to global quality of life (Helgeson, Reynolds, & Tomich, 2006).
A few studies have examined posttraumatic growth experiences in children who have had a parent with cancer during their childhood, including two that used qualitative analyses. These studies have found that some children demonstrated better school performance, greater social competence, and improved parent-child relationships following their parent's illness (Fitch, Bunson, & Elliot, 1999; Gates & Lackey, 1998; Hoke, 2001; Lichtman et al., 1984). It is important to note that a greater appreciation for life, increased inner strength, and closer relationships have also been documented in adult women with parental cancer histories (Leedham & Meyerowitz, 1999). These findings suggest that there may be enduring positive changes that occur in some children who have a parent with cancer. However, in the Leedham and Meyerowitz (1999) study, women were specifically prompted to discuss positive changes resulting from their parent's cancer, so this leaves open the possibility that this aspect of the methodology may have influenced the findings.
In sum, the body of literature regarding the effects of parental cancer on children is inconclusive, with some studies suggesting adverse effects on children's well-being and other studies suggesting that children may experience positive change in response to a parent's illness. More qualitative research is needed to also examine the long-term impact of parental cancer on children, including the extent to which children...
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