When a parent receives a cancer diagnosis, one of the first things that comes to mind is how much to tell the children, and if they are young, whether to withhold the information from them.
Nobody likes breaking bad news, especially to kids who may not fully grasp the implications of something as “big” or “scary” like cancer. In order to protect their children from stress and anxiety, some Asian parents may keep their conditions secret until it is necessary to reveal the truth. Others avoid heavy conversation by using euphemisms or making light of the topic.
To tell or not to tell is a personal choice. However, there is evidence that children who are told about their parent’s cancer have lower levels of anxiety than those who are kept in the dark.
In most cases, secrecy can make it worse. Children are very good at noticing that something at home is not quite right. Hushed conversations, whispering, sadness, the increased number of phone calls, and unexplained absences do not escape notice.
When children are not given an explanation, they tend to make up their own versions of the truth. These may turn out to be worse than reality. Young kids between the ages of three and five years are especially prone to “magical thinking” and may even believe that their bad thoughts or behaviors are the cause of this condition.
Older children may feel hurt that they have been excluded from such an important piece of news.
Wnen Mrs Tan, 40, was diagnosed with breast cancer two years ago, she was upfront with her two children. “My husband and I felt we ought to be honest as the diagnosis and subsequent treatment involved changes in how the household would be run,” she tells us.
“I waited till shortly before surgery (about six weeks from diagnosis) to tell them. I told them that I had cancer but I was going for surgery to ‘get rid of’ the cancer. After surgery, I showed them the wound site and told them that the cancer was gone. I also explained to them that the subsequent chemotherapy and radiation treatments were to make sure the cancer didn’t come back.”
The conversation helped Mrs Tan’s primary school-aged children understand and adapt to changes in the household routine. For instance, because of her body’s weakened immune system during chemotherapy, the children had to bathe after coming home from school before they could come into contact their mother. They also had to be careful with physical contact after the surgery as Mrs Tan had a wound to nurse.
Cancer patient Lily Lee, 43, who is a mother of two boys aged 10 and 13, advises working out a plan before breaking the news. “This way, you can tell the children that there is a treatment for your illness,” she says.
“Do not break the news without offering them a solution. That will leave them up in the air and they will be overwhelmed by whatever their imagination conjures. Plan on when and how you want to break the news. If possible, avoid breaking the news on ‘big’ days like birthdays or Christmas. You may also want to avoid times when it is stressful for the child, like exam periods or the start of a new term.”
What to say and how much to say depends on each person’s comfort level, and his or her family culture. The bottom-line: there is no right or correct way to talk to a child about cancer. Neither is there a perfect time for the conversation. If the patient feels unable to talk to the children for fear of being overly emotional, it is perfectly fine for another adult — preferably a caretaker or someone whom the children are familiar with — to step in.
How to get the conversation going
Julie Kaplow, a University of Michigan professor who is researching ways to help children cope with a parent’s cancer diagnosis, says that this conversation is not a “one-shot deal”.
“What you want to do is open up the door of communication,” she explains. “Approach the subject in a simple, more factual way, if possible, so as to not overwhelm your child with details. And then open it up for questions.”
The key to such sensitive conversations is to offer age-appropriate information.
Before sharing the news, consider these questions:
• How much can your child understand about cancer?
• How might he or she react to the news?
• What can you do or say to help your child?
Use picture books, dolls or stuffed animals to help young children visualise. Explain that unlike the flu, cancer is not contagious. Reassure your children that they will be taken care of. Let them know if a spouse or relative will be taking over any family duties, like cooking or taking them to school.
Encourage teenagers to talk about their feelings, but be sensitive to the fact that they may find it easier to confide in teachers and peers. You may wish to notify their teacher about the family situation.
While death is not a topic most people want to delve into with their children, it is crucial to let them know that this is something that they will not have to face anytime soon, especially with the advances in cancer treatment.
For late-stage cancer patients, however, Kaplow encourages enlisting the help of a spouse or another family member to talk realistically about what is going to happen. “The most important message you can convey to the child, though, is: ‘You will always be cared for, and we will always make sure you are safe and protected.’”
Ultimately, be honest and maintain trust. Your spouse can lead by prompting open communication within the family, as well as demonstrations of love.
Throughout Mrs Tan’s treatment, her husband encouraged the children to show their support for their mother. On her surgery day, each child prepared a little soft toy for her to take along. To the amusement of the hospital staff, the two soft toys have become Mrs Tan’s constant companions during her subsequent treatments.
With the right guidance and support, children are often more resilient than adults give them credit for. In the case of parenting through cancer, honesty can bring the family together during this tough time. “I don’t regret my decision to tell them,” says Mrs Tan, whose cancer is now in remission. “Though I still wish they didn’t have to deal with it.”