Impact of Parental Cancer

The majority of cancers affect the elderly, but 22.4% of all cases occur in the ages of 21-55. This age range represents common childbearing and child-rearing years, which imply that many of these patients have minor children. Approximately 2.85 million children under 18 live with a parent affected by cancer. The Pubmed and Google Scholar were searched to identify literature on impact of parental cancer on children and potential interventions to support parents and children. We reviewed impact of parental cancer on daily routine, role changes, emotional problems and social functioning of children. We also discuss interventions that may be useful for parents and children. It is essential that we learn more about the impact of parental cancer on children and ways to support the families using evidence-based interventions.

How does parental cancer affect adolescent and young adult offspring? A systematic review

The impact of parental cancer on children and the family: a review of the literature

BackgroundA parental cancer diagnosis is a stressful life event, potentially leading to increased risks of mental and physical problems among children. This study aimed to investigate the associations of parental cancer with IQ, stress resilience, and physical fitness of the affected men during early adulthood.Materials and methodsIn this Swedish population-based study, we included 465,249 men born during 1973–1983 who underwent the military conscription examination around the age of 18 years. We identified cancer diagnoses among the parents of these men from the Cancer Register. IQ, stress resilience, and physical fitness of the men were assessed at the time of conscription and categorized into three levels: low, moderate, and high (reference category). We used multinomial logistic regression to assess the studied associations.ResultsOverall, parental cancer was associated with higher risks of low stress resilience (relative risk ratio [RRR]: 1.09 [95% confidence interval (CI) 1.04–1.15]) and low physical fitness (RRR: 1.12 [95% CI 1.05–1.19]). Stronger associations were observed for parental cancer with a poor expected prognosis (low stress resilience: RRR: 1.59 [95% CI 1.31–1.94]; low physical fitness: RRR: 1.45 [95% CI 1.14–1.85]) and for parental death after cancer diagnosis (low stress resilience: RRR: 1.29 [95% CI 1.16–1.43]; low physical fitness: RRR: 1.40 [95% CI 1.23–1.59]). Although there was no overall association between parental cancer and IQ, parental death after cancer diagnosis was associated with a higher risk of low IQ (RRR: 1.11 [95% CI 1.01–1.24]).ConclusionParental cancer, particularly severe and fatal type, is associated with higher risks of low stress resilience and low physical fitness among men during early adulthood. Men who experienced parental death after cancer diagnosis also have a higher risk of low IQ.

Australian population data regarding the number and sociodemographic characteristics of children affected by a parent's cancer are not currently available. Moreover, predictions that this population is increasing have not been tested. This study provides data on the number and sociodemographic characteristics of parents with cancer and their young children (aged 0-11years) in the state of Western Australia, and investigates whether long-term trends in this population have increased over time. Linked administrative data were used to describe parents with malignant cancer and their children aged 0-11years at the time of diagnosis between 1982 and 2015 in Western Australia. Parents and children were described overall and by year of diagnosis and sociodemographic characteristics. A Poisson regression was used to investigate trends in the number of children affected, accounting for population growth. Incidence counts of parental cancer characteristics were included. Between 1982 and 2015, 15,938 parents were diagnosed with a malignant cancer, affecting 25,901 children. In 2015, 0.28% of children in Western Australia experienced a parent's diagnosis. The number of children affected increased over time; however, this was accounted for by population growth. The majority of families lived in regional areas and were of high socioeconomic status. Older children and older parents most frequently experienced parental cancer. Skin and breast cancer were the most common diagnoses. A substantial number of families are affected by parental cancer. Results can guide intervention development and delivery to children of different developmental stages, and inform decisions regarding resource allocation and health service accessibility.

BackgroundAfrican American adults experience a disproportionate burden and increased mortality for most solid tumor cancers and their adolescent children are negatively impacted by the illness experience. The purpose of this randomized clinical trial is to evaluate the efficacy of a culturally sensitive family-based intervention program developed for African American families coping with solid tumor parental cancer using an intention-to-treat approach. Primary outcome is adolescent depressive symptoms at end of treatment.MethodsA sample of 172 African American families will be enrolled from two diverse oncology centers (Helen Graham Cancer Center in Newark, DE, and Kimmel Cancer Center in Philadelphia, PA). Eligible families will be randomized either to a 5-session intervention Families Fighting Cancer Together (FFCT) or a 5-session parent-only psycho-educational (PED) program. Assessments will occur at weeks 0 (baseline), 8 (end-of-treatment), 24, and 52.DiscussionTreatments to help African American adolescents cope with the impact of parental cancer are scarce and urgently needed. If successful, this proposed research will change the nature of intervention support options available to African Americans, who are overrepresented and underserved by existing services or programs.Trial registrationThis project is registered with ClinicalTrials.gov (Protocol #: NCT03567330).

The challenges of a parental cancer diagnosis not only affect the patients themselves, but the entire family. Moreover, there is evidence that family members are at increased risk of developing psychosocial problems. Therefore, the aim of the research projects presented within this cumulative dissertation was to obtain a better insight of the impact of parental cancer on the family and to develop, implement and evaluate interventions to support families in this exceptional situation. The first two publications cover results of the feasibility of and the lessons learned from a web-based intervention program during the first months of treatment. Furthermore, it reports on psychological adjustment in children of a parent with cancer, family satisfaction and communication, and on the effect of minimal contact interventions on the couple. Due to the low enrolment rate, feasibility of the web-based program was limited. Baseline data of the 28 participating children showed a good adjustment to the parental cancer diagnosis and high family communication levels. Couples showed signs of anxiety and decreased optimism scores at baseline, which slightly improved in patients. Feedback from participating families exhibit that the program was helpful for families with a newly diagnosed parent who are in need of specific information on cancer and family. The third publication discusses the feasibility and acceptability of a face-to-face short-term counselling intervention. Data showed a limited feasibility but good acceptability of the counselling. It was considered recommendable and helpful by nearly all participating families. The enrolment rate was low due to different reasons, such as having no need, lack of time, or local distance. Our research projects suggest that a parental cancer diagnosis may represent a burden, may trigger anxiety and may decrease optimism. Low-threshold interventions represent a helpful option to use at a time when needed.

233 Background: 1.2 million African American (AA) parents/guardians of school age children may be diagnosed with cancer in 2014. AAs have a disproportionate burden and mortality from solid tumor cancers. However, AAs are poorly represented in distress intervention studies, and psychosocial oncology support services may not be designed for culturally diverse populations. The goal of this pilot study was to gather feasibility data from a sample of AA medical providers and from a sample of 100 cancer patients. This approach aided development of effective structures and procedures to recruit AA cancer patients/guardians raising school-age children for a culturally sensitive family intervention program. Methods: We developed a focus group guide for AA medical providers to define best practices for recruiting AA cancer patients into an intervention program. The focus group of AA providers (4 oncologists, 3 primary care, and 3 family practitioners) first reviewed the treatment manual for cultural content. We then conducted an anonymous patient needs assessment, broadly sampling cancer patients from outpatient and inpatient settings (n=100). Results: Providers and patients identified transportation support, refreshments, and onsite care for young children as important. Both groups recommended targeting AA parents/guardians within the first months of diagnosis, when coping with a cancer diagnosis is acute. Parents/guardians who had current concerns about their children more often reported an interest in family support, and patients felt that a location other than the cancer center would be most comfortable for their children. Conclusions: Effective treatments to help children and adolescents cope with the impact of parental cancer are critical, particularly those targeting low-income AA populations. The provider focus group and patient needs assessment identified recruitment barriers in anticipation of a randomized control trial designed to address family distress after parental cancer diagnosis. This approach has the potential to impact the nature of treatment support options available to a group that is overrepresented and underserved by existing interventions.

Introduction: Due to the widespread prevalence of cancer, the number of parents with cancer who have a dependent child is increasing. Cancer in parents creates challenges for teenagers in the family and exposes them to mental and physical problems caused by the diagnosis of cancer in parents. In order to prevent negative consequences in children, it is necessary to understand more regarding the impact of parental cancer on children and their psychosocial needs. The present research was conducted to explain the psychosocial problems of adolescents whose parents suffer from cancer. Method: The current research was conducted using the qualitative content analysis approach. A total of 18 teenagers with cancer-afflicted parents were selected by targeted sampling method from the medical education centers of Tehran, and semi-structured interviews were conducted with them. At the same time as the data was collected, the findings were analyzed using the content analysis method and with the help of MAXQDA10 software. Results: After analyzing the interviews, 12 subcategories and five main categories, including "Mental rumination," "caregiving pressure," "parental cancer-related problems," "volatile social interactions," and "obstacles and facilitators of adaptation to the disease," were extracted, which can depict teenagers' experiences of having a parent with cancer. Conclusion: The results of this research indicated that teenagers face many challenges in the field of coping with their parents' cancer. The results of the current study can be applied to help formulate and implement educational intervention programs to reduce teenagers' mental conditions.

In-depth exploration of how the couple relationship is affected by parental cancer in couples with dependent children. Semi-structured interviews were carried out with a convenience sample of 17 parents with cancer who were in a couple relationship and had children aged 18 years or younger. Data were analysed using qualitative content analysis. The content analysis resulted in three categories representing areas in the couple relationship that had changed following the cancer diagnosis: Altered communication; Adapting to new roles; and A change in sex life, intimacy and fertility. The results illustrate a significant increase in the need for constructive communication when couples face a range of emotionally-charged topics that were made difficult to talk about due to the children being present. The results also showed that the experience of cancer had forced couples to adapt to new roles in their relationship, and in the family, in order to manage the complex practical issues of simultaneously being parents and dealing with cancer. Lastly, both physical and psychological aspects of cancer had affected the couples' sex life, intimacy and fertility including decreased sexual engagement and changed conditions impacting family planning. Results highlight the specific areas that are challenging for couples facing cancer who are parents of dependent children. Couples may need support to cope with these challenges due to the complexity of parenthood when managing cancer as a couple.

Research evidence suggests a debilitating impact of the diagnosis of cancer on the quality of life of the afflicted individuals, their spouses and their families. However, relatively few studies have been carried out on the impact on the QOL of adolescents living with parents diagnosed with cancer. This paper presents a sub- analysis on the impact of parental cancer (colorectal, breast and lung) on adolescents. This is a cross-sectional study on adolescents aged 13-18 years old. Upon ethical clearance obtained from UMMC Medical Ethics Committee, patients with colorectal, breast or lung cancer and their adolescent children were recruited from the Clinical Oncology Unit of University of Malaya Medical Centre. Respondents who gave consent completed a demographic questionnaire and the Pediatric Quality of Life Inventory, via the post, email, home visit or meetings at the clinics. 95 adolescents from 50 families responded, giving a response rate of 88 percent. The adolescent's mean age was 16 years (ranging between 13-18 years). Adolescents with parental cancer had the lowest mean score in emotional functioning (p<0.05). Male adolescents had significantly higher quality of life overall and in physical functioning compared to female adolescents. Adolescents with a father with cancer had better school functioning compared to adolescents whose mothers had cancer. Families with household income of RM 5000 and above have significantly better quality of life compared to families with lower household income. Adolescent sons and daughters of parents with a cancer diagnosis show lowered QOL, particularly with reference to emotional functioning and school performance. Addressing the needs of this young group has been slow and warrants special attention. Revisiting the risk and resilience factors of adolescents might also inform tailored programs to address the needs of this neglected adolescent population.

This chapter reviews key issues of concern for parents with cancer, recognizing that addressing these parenting concerns as part of routine cancer treatment has the potential to alleviate an important source of patient distress. Research literature on the impact of parental cancer on children’s adjustment, and factors associated with better coping, is briefly reviewed. Practical suggestions are made for promoting open communication between parents and children about the parent’s illness and for supporting day-to-day family functioning, particularly when a parent’s prognosis is poor and survival time may be much shorter than hoped. Tables summarize child concerns common to each developmental stage and options for supports at each stage, communication strategies, and suggestions for preparing children for separations and hospital visits.

(1) Receiving an oncological diagnosis involves countless physical and mental challenges for those who become ill. In addition to this, developmental activities are put on hold when a parent becomes ill, significantly impairing children's normal growth and development. The purpose of this review is to highlight the psychological impact of cancer on children, with particular attention to differences based on the age of the child and the stage of the parent's disease. (2) Articles published on PubMed up until October 2023 were searched. Qualitative and quantitative studies were included in this review after an evaluation of the full text. The study selection process was undertaken by two researchers, and articles for which there was unanimous agreement between researchers were included in the review. (3) Children's psycho-emotional responses differ based on their age and the disease stage. In general, good communication and a supportive family environment that understands everyone's needs seem to constitute important protective factors that favor the adaptation of the entire family to the disease. (4) The family, as an evolutionary system, finds itself facing phases typical of development. Knowing the variables that intervene in the process of adaptation to the disease will allow us to design specific and differentiated clinical interventions based on the needs of not only the patient but also the entire family.

Despite the emotional impact for children with a parent with advanced cancer, most families receive limited information and support to assist them. A project is underway to determine the acceptability and effectiveness of a supportive and educational intervention for parents with advanced cancer to be delivered by specially trained oncology nurses. To assess the perceptions of oncology nurses about this role, explore potential challenges, and understand their educational needs, oncology nurses were recruited from three metropolitan hospitals to participate in focus groups. This data was supplemented with data from individual interviews conducted with rurally based nurses unable to participate in focus groups held in a metropolitan location. Four focus groups were held, with 24 participants. Individual telephone interviews were conducted with five nurses. Nurses identified the emotional burden of the supportive care role as a key challenge, along with health care systems which were not attuned to the needs of families. Attention to self-care and professional confidence, and access to role-models emerged as key elements required in education, along with information about the impact of parental cancer on children and their developmental stages, and ways to promote more open parental communicate with children.

Listen to ASCO’s Journal of Clinical Oncology essay, “The Heritability of Cancer” by Dr. Leeat Granek, Associate Professor at York University in Toronto, Canada. The essay is followed by an interview with Granek and host Dr. Lidia Schapira. Granek shares how her mother's diagnose with breast cancer continues to shape her own life and experiences.