Abstract. Background It is estimated that 10.4% of newly diagnosed cancer patients are between the ages of 18-55, with 22.4% of all cancer cases occurring in individuals aged 21-55 (1). This range represents common childbearing and child-rearing ages which suggest a significant portion of these patients may have minor children. In fact, in 2010 it was estimated that 2.85 million children under the age of 18 lived with a parent who was diagnosed with cancer in the US (2). Over the last 30 years, overall cancer survival rates have increased with the 5-year survival rate rising 20% across all races (3). The increasing survival rates suggest a concomitant increase in prevalence of cancer survivors with minor children.A cancer diagnosis can affect the whole family, not just the afflicted parent (4, 5). Multiple studies demonstrate that children in particular have a higher risk of emotional and behavioral problems (6, 7). The disruption of schedules and daily routine, shifting of household roles, financial stress, and the physical and emotional availability of either parent all contribute to these emotional and behavioral problems (7-9). These problems, if overlooked or untreated, can persist into adulthood (10).
Daily RoutineA daily routine is an important part of life for preschoolers, grade-schoolers, and adolescents for both structural stability and social behavior guidance (7, 11). A parental cancer diagnosis can disrupt the daily routine or schedule due to frequent clinic visits, unexpected hospital admission, and the home turning into a place of care (9, 12, 13). The disruptions also promote problems sleeping in preschoolers and increased post-traumatic stress symptoms as well as internalizing and externalizing behaviors in adolescents (6,7,14). Adolescents also report the impact that physical unavailability has on their emotional well being including the ill parent no longer driving them to school, to extracurricular activities, or even packing lunches (12, 15).
Role ChangesIt has long been known that parental roles change as one parent becomes a caregiver and the ill parent becomes less available physically and emotionally, having fewer opportunities to interact while placing increased demands on their children (12). However, children of patients with cancer frequently change roles within their family as well, absorbing more responsibility while one parent cares for the ill parent (4, 16). The literature shows that both children and adolescents have increased personal responsibilities, resulting in a decrease in social activity and subsequent loss of childhood at a time when peer groups are essential for social development (4,10,14,17). Adolescent truancy rates increase and overall attendance decreases as they need to care for their younger siblings or pick-up extra work shifts to help combat the financial burden cancer puts on a household (11, 13).
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