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April 13, 2006 -- The words "you have cancer" will change anyone's world in an instant, but parents diagnosed with cancer face the extra challenge of helping their kids deal with the news.
What should I tell the kids? What should I leave out? How should I tell them? Parents facing a new cancer diagnosis are usually not prepared to answer these questions, and they need better support to help them, a new study suggests.
Researchers in Oxford, England, interviewed 37 mothers with a new diagnosis of breast cancer and 31 of their children between the ages of 6 and 18.
They found that even young children were much more aware of cancer as a life-threatening illness than their parents or other adults realized.
More Support Needed
The kids learned much of what they knew prior to their mother's diagnosis from television, public health campaigns, and the experiences of celebrities and adults they had known with cancer.
Because of this, many of the children associated the word cancer with death and would have benefited from more education about cancer in general and breast cancer specifically, the researchers concluded.
"Children who knew of someone else with cancer could mistakenly assume that their mother's experience would be the same," researcher Gillian Forrest and colleagues wrote in the April 14 online edition of the British Medical Journal.
"Parents are often unaware of how much their children know and, often reeling from the diagnosis themselves, may not be in the best position to decide what and how to tell them. Our results suggest that many parents would benefit from preparation to tell their children and consider the ways children at different developmental stages might react."
Tell the Truth
Cancer is not uncommon among women who are at the age where they are raising their children. The American Cancer Society reports that one in seven women in the U.S. will develop breast cancer during their lifetime, and roughly a quarter of them will do so while they still have children living at home.
When Wendy Schlessel Harpham, MD, learned she had non-Hodgkin's lymphoma 16 years ago, she and her husband faced the twin challenges of battling the disease and helping their three young children, then 5, 3, and 1, understand what was happening.
Harpham later wrote the book, When a Parent Has Cancer: A Guide to Caring for Your Children, to help others learn from what she went through.
She tells WebMD that one of the biggest mistake parents make is trying to hide the truth from their children.
"Even small children will figure out that something is wrong, even if you don't tell them," she says. "Kids are observant and smart, and if you give them too little information they will try to figure it out on their own. If you don't tell them, you lose control and you are less able to guide the child through the changes in their world in healthy and hopeful ways."
Another big mistake is lying to your child, she says. Harpham and her husband talked honestly about her condition with their children, who are now 17, 19, and 21, in the early years of her disease and during several recurrences of her cancer.
"They now tell me the thing that helped them most through the years of my illness was the knowledge that I would always tell them the truth," she says. "If you lie, children learn that they can't turn to you for answers. And you are the person who is in the position to help them most."
Understand Their Needs
Children process information about illness differently at different stages of their lives, and parents have to keep this in mind as they deal with their illness and recovery, she says.
Even though her son William had been living with her cancer since the age of 1 and "could spell cancer before he could spell cat," Harpham says he didn't really understand what it meant until age 6.
She says he came home from school one day crying because a classmate said his mom had cancer.
"I asked him why that upset him, and he said, 'Mom, it's so sad you are sick'," she says, adding that she was in full remission and feeling fine at the time.
"The last thing I wanted to deal with at that moment was a child upset about cancer," she says. "But I realized that for him it was like finding out for the first time. He had achieved the intellectual development to appreciate the implications of my illness."
Harpham says the greatest gift a parent can give a child is, "not protection from the world, but the confidence and tools to help them cope and grow with all that life has to offer."
SOURCES: Forrest, G, British Medical Journal, April 14, 2006; online edition. Wendy S. Harpham, MD, FACP, author and cancer survivor, Richardson, Texas. American Cancer Society, breast cancer statistics, 2005-2006.