Talking about cancer with your child
How do I tell my children I have cancer? And what if it's them who are sick, how do I tell them what is going on with them? We have interviewed Laia Jané, psychooncologist and coordinator of the Psicoemotional Support Area, since 2007, of the Family and Friends of Oncological Children Association in Catalonia (AFANOC).
When your son or daughter has cancer...
- Leo, former Severe Combined Immunodeficiency patient
- David, a bone marrow aplasia patient, at the hospital with the Theodora Foundation clowns
- Guzmán, former acute lymphoblastic leukaemia patient, sitting with his sister Martina
- How can I tell my child that he/she has cancer or a serious illness? How do I have to vary the explanation depending on the age?
First of all, as a parent of this child or adolescent, you will have to know the real medical information to be able to understand and comprehend what is happening. This way, you will be able to adapt the information your child needs and want to know. It is advisable that the information is as close to reality as possible and that the vocabulary used is known by the family closest to the child. It's important that the information is transmitted gradually and always at the rhythm the child demands.
- How does an adolescent confront a diagnosis of this kind?
When such a disease interrupts the life of a teenager, they tend to live it like an obstacle of their development as a person and of their autonomy. The disease, suddenly, stops them from doing those things which, until that moment, were important, such as friends and studying. They can feel a lot of rage and impotence for what is happening and depending on how the disease and the necessities of the treatment received evolve, there can be frustration for projects that have been interrupted (some temporarily and others, definitively). It is important that throughout the whole disease, the contact with friends is encouraged because they are one of the most important pillars during this stage.
- How can I help my son or daughter to not be scared of the medical tests?
It isn't so much helping them so they aren't scared but helping them express and deal with that fear. It's important to listen to the child about what aspects worry him/her and what things can help lower those levels of anguish. The information will have to be adjusted to the necessities of every kid for, generally, the fact of knowing and understanding is what will help them increase the feeling of control and, therefore, the experience will be easier.
- How can I entertain his daily routine in the hospital?
Depending on the child's age, a certain routine will have to be planned during the day, for that provides them a feeling of safety. As far as possible, there will have to be a schedule (waking up, hygene, meals, classes, ludic activities, visits from friends and relatives, relax, moments of privacy (specially for teenagers)... There will have to be some flexibility for, some times, the treatment's secondary effects stop the kids from doing a lot of things, but moments of distraction are necessary and beneficial, as well as going on with the routines that are familiar for the children.
- How can I explain to a child that he or she has to keep going to class inside the hospital?
In fact, the hospital teachers are there because it is obligatory for children between 6 and 16 years old to keep receiving an education. When they are smaller, it is important that the kid's teacher is available and keeps sending the school assignments to the family so that the child can, every time he or she is up for it, keep doing the homework at the hospital. Kids usually don't have a rought time accepting it and they even feel grateful that the school keeps contact and helps them keep up.
- How can the children confront going back to school and facing the rest of the kids, once they beat the illness?
It is very important that the child is able to keep in touch with the other kids throughout the illness for that will make the return to school much easier. First, because the rest of the kids will be informed of what has happened to their friend and, second, because if there is an important physical change (loss of hair, corporal volume change, scars, amputation...), it will be less of an impact (both for the affected child as for the rest of the children). Also, they will be able to understand better what their friend is feeling if they have been accompanying him or her since the start of the illness.
- How do you speak to them about death?
I don't know how to anwer this question in a few words for we could write pages and pages on this topic. Talking about death is complex and more so when the person who's dying is a child or a teenager. It's complex due to the family's and patient's suffering and we also have to keep in mind our own difficulties, for we deal directly with death as professionals.
To be able to accompany the child during this process we have to work with our own difficulties, be honest and sincere with ourselves and know until what point it is necessary that we help and when do we have to stop. Many times they ask us what we tell the family in these difficult times, and the truth is most of the time it isn't necessary to say anything, we just have to be there.
Normally, the kids talk to the people closest to them, the father or mother. Maybe they don't talk directly about death but in some way, through their behaviour, they let us know that they are preparing for this moment. We have to be very aware to see where they're at and what they need. The professional's attitude has to be a close one but without intruding, always with respect so that the family feels they can ask for whatever they need.
- How can I explain the symptoms they are going to start feeling or the treatment's secondary effects (hairloss, etc.)?
These aspects are usually explained by the doctors treating the children. As psychologists, we can talk to them about what worries them regarding this explanation. For example, regarding hairloss, we can ask the parents how they want to do it and explain to them that it is important that the child can pick if he wants to wear a wig, a scarf or nothing at all.
- Will the relationship with his or her siblings change? How can I explain the situation to them?
The siblings have to be informed of what is happening so they can live the situation as normally as possible. The information has to be offered gradually and always according to the age of the child. The siblings feel and become aware that their parents are no longer there for them the same way they used to be and, if this is not treated correctly, it can generate great concern for them. They have to feel they are part of the family, that they are taken into account, that they have some alone time with their parents and that their day to day is also important. This is easily said but hard to do. It is important though, to keep it in mind and give them as much attention as possible, in spite of the day to day difficulties.