HELPING TEENS COPE WHEN A PARENT IS DIAGNOSED WITH CANCER

By Susan Ross, PhD

There is no one right way to talk to your teen about cancer just as there is no one right way for your teen to react to this news.  Both depend on:

1} the age of the teen (13 year olds' understanding and reactions can be very different than 16 year olds with "wheels" or than 18 and 19 year olds who may be away at college or living on their own.

2} the specific relationship between parent and teen

3} if the teen is living in a one or two parent family

4} what kind of cancer the parent has, the prognosis and the treatment

5} if there is an active support system (extended family, friends, siblings) who can share the emotional and physical responsibilities that may arise

6} how well or sick the person with cancer feels

7} the teen's personality, comfort expressing feelings, dependency needs, and flexibility.

To Tell or Not to Tell

Cancer is an impossible secret to keep.  Some parents fear their children will worry excessively if told of their parent's cancer diagnosis.  However, teens intuitively know when something is wrong-even if they don't know exactly what that something may be.  They sense that their parents are worried, tense, preoccupied, there may be a flurry of phone calls, doctors' appointments, etc.  They know something bad is happening and tend to fear the worst if left in the dark.  It also takes much effort for parents to keep such a secret and so energy is wasted that could have been used more positively elsewhere. You may want to wait until the cancer diagnosis is confirmed before saying anything to your child.   But once confirmed, if it remains a secret, the teen will eventually find out and possibly feel hurt, angry, resentful and betrayed, and distrust what you share in the future.  Many teens think of themselves as young adults and want to be treated as such.  They don't want to be "babied" and overly protected-they want to be included in important family matters. Withholding sends the message that the teen is not thought of as a strong, competent and trusted part of the family. Also, since our children learn not from what we say but from what we do, if we model secrecy and dishonesty, even for a very good reason, teens may learn it's acceptable to lie, hide, withhold and avoid in stressful situations.  A cancer diagnosis is an opportunity to communicate to your teen that you regard her/him as a mature, trusted and valued family member.

How to Tell Your Teen

Teens need to be told the truth but what you include and exclude depends on the circumstances and personality and maturity of your child.  In a two parent household, it is best if both parents are present when the teen is told and you spend a minute or two rehearsing what you will say.   It is best to tell the truth but in a way that the teen will understand with emphasis on preparing her/him for the changes about to occur in the family. A cancer diagnosis usually sets off much emotional intensity and some parents may worry about showing too much emotion in front of their teen.  Certainly you don't want to frighten your child by becoming hysterical or very negative and hopeless in her/his presence.  But shedding a few tears and allowing your teen to see that you are comfortable sharing honest emotion provides a positive model.   If you are unnaturally composed and nonchalant as you tell of the cancer diagnosis, this sends the message that showing feelings and emotions about your illness is not acceptable.  It may shut down the teen's willingness to share feelings with you in the future. If you drastically minimize the situation, the teen may take you literally and thus not show much emotion, compassion or concern as you go through treatment because they genuinely don't realize the gravity of the situation.

It is important that you do not tell your teen how to react.  Words like "don't cry, I'll be OK," or "I don't want you to worry about this," or "put a smile back on your face, I don't want to see you looking sad," send the message that normal feelings of emotion are not acceptable or comfortable for you. 

HOW MUCH DETAIL IS APPROPRIATE?

In general, you want to convey a positive mindset about the challenges ahead. Minimally, you need to tell your teen that you have been diagnosed with cancer, the name of the cancer (e.g. breast, colon cancer), the part of the body where the cancer is located, how it was diagnosed, how it will be treated, approximately how long treatment may take, and how their own lives might be affected.  Most of us like routine and teens need to know how and if anything will change in their daily lives. If so, what contingencies or preparations will be made to keep things as predictable and as possible?

How do parents deal with teens' questions regarding prognosis or the "are you going to die?" question.  You may explain to the teen that the diagnosis of cancer is no longer a death sentence.  Many people survive and thrive and after treatment resume their normal lives.  Depending on your prognosis, you may say some version of one of the following:

1. Cancer is a serious disease and sometimes people do die.  But the type of cancer I have usually can be cured with treatment.  The treatment may make me feel bad at times but once it's over, I am hopeful that the cancer will be gone.   

2. The doctors say that my chances of being cured are good. I'm going to believe this until I have reason to believe something else. I'll let you know if anything changes.

3. There is no way to know how I will respond to treatment.  I'll know more after my first treatments and I talk again with my doctor.  I'm going to take this one step at a time and not think too much about the next step until I get there.  If there is any change, one way or the other, I will share this news with you.  For now, I feel hopeful.

4. My cancer is a hard one to treat but I'm going to do everything I can to get better.  I don't know what will happen down the road.  If you have questions, please ask me and I will be honest with you.  If you are worried, please talk about your worries with me.  It will make me feel better, not worse, to know what you are thinking. Don't be afraid that your questions will upset me, they won't.

It is important that your teen knows that s/he can trust you to tell him/her the truth if your condition changes.    It is also very important that teens know they can be honest with parents and talk openly if they have questions and fears.  Such honesty is an opportunity and a gift.  Use it to foster a sense of responsibility, trust and deeper relationship.  Honesty, even about a poor prognosis provides opportunity - an opportunity for you and your teen to say important things to each other and exchange information about your family and childhood history, etc. that later may be deeply cherished by your teen.

How much detail to provide requires you to tread a thin line between providing the truth but not overwhelming your teen with more information and responsibilities than s/he should be expected to handle. If your teen asks how they can help, give them age appropriate tasks so they feel useful.  However, you want to avoid making your teen into "the little woman" or "little man" of the house.  Instead, accept help from adult family and friends when offered. Accepting help is a gift to the person offering.  It's a way of allowing them into your life.

On a slightly different note, since teens often see themselves as the center of their universe, some may feel responsible for a parent's illness.  Most teens get angry with parents at some point and say or do or think angry things.  They may need a word of reassurance from you that there is no connection between their thoughts, words or actions and your cancer diagnosis. They may feel embarrassed to reveal this guilt to anyone so reassure them even if they do not say anything about such feelings.

How Your Teen May React Once Told of the Cancer Diagnosis

Each teen reacts slightly differently to bad news depending on age, personality, how the news is told, how the news will affect his/her particular life and the teen's prior experience with critical illness or cancer.  While one teen may become very emotional, anxious, and physically clingy, another may not show any emotional reaction at all. This doesn't mean that s/he is not feeling a lot inside but rather s/he has learned not to show such feelings.  Initially, some may have a lot of questions, particularly about the treatment and prognosis.  Others may be silent, retreat into their bedroom and not say much over the next few weeks.  Being somewhat self-absorbed, some teens personalize the cancer diagnosis and become angry, "why did this have to happen to me---or to my family?" All will be nervous about the future, wonder if and how their lives will change, and, particularly in single parent homes, wonder who will take care of me.  Some may become withdrawn and avoid the discomfort of being around and emotionally interacting with the "sick person."   Others may become anxious, hyper vigilant and protective of the parent with cancer and want to physically take care of them and remain by their side.  Some may retreat into the world of school and friends and activities. 

Respect your teen's reaction whatever it may be.  If they need some space, allow them this.  Do not react to their every mood and emotion. Their mood and emotions may be all over the place for a while.  Do not allow them to become your personal caretaker but do give them a few age appropriate responsibilities while encouraging her/him to resume normal teen activities. However, if school grades drop significantly, if your child withdraws from all usual activities, if it is apparent that they are not sleeping night after night for weeks at a time, if they are not eating and lose significant weight, if they repeatedly express obsessive worry about you or the future, if they seem to have lost all pleasure or interest in usual activities, or if they avoid all talk or emotional recognition of the cancer diagnosis, then you may want to seek professional help. 

1. Helping Children When a Family Member Has Cancer: Dealing With Diagnosis, American Cancer Society, 2006.