© 2007 European Society for Medical Oncology
editorials |
Parental cancer and its effects on adolescents and their families
Department of Individual and Family Studies, University of Delaware, 110 Alison Hall, Newark, DE 19716-3301, USA
E-mail: ohanness{at}udel.edu
During adolescence, important fundamental changes take place in the family. The level of family conflict typically increases as adolescents negotiate with their parents for increasing amounts of autonomy. The development of adolescent autonomy is an important developmental task and it requires both subtle and not so subtle distancing between adolescents and their parents. In line with these changes, several studies have shown that adolescents tend to view the family more negatively than do their parents [1–4]. Today, adolescent–parent discrepancies in perceptions of the family typically are viewed as normative as the adolescent negotiates increases in autonomy and moves toward adulthood. A number of investigations, however, have shown that discrepancies in adolescent–parent perceptions of the family also may be related to poorer adolescent psychological adjustment [1, 4, 5]. This research indicates that in the short-term, adolescent–parent discrepancies in perceptions of the family may be associated with higher levels of stress within the family and to adolescent adjustment problems. In the long-term, adolescent–parent discrepancies in perceptions of the family appear to be adaptive by encouraging the development of autonomy in the adolescent and the eventual realignment of family relationships.
It is important to realize that when a family faces a difficult challenge, such as cancer in one of the parents, the normal developmental tasks that families experience may be put on hold. In this issue of the Annals of Oncology, Gazendam-Donofrio et al. [6] report on 209 families of 11- to 18-year olds who had a parent diagnosed with cancer. Their results indicate that families of adolescents that have a parent with cancer are relatively more expressive, cohesive, organized, and social. In addition, they appear to be characterized by lower levels of family conflict in comparison to ‘normal’ families. Moreover, in contrast to the literature [1, 4, 5], Gazendam-Donofrio et al. found that in their sample of adolescents who had a parent with cancer, adolescent–parent discrepancies in perceptions of the family were not consistently related to the adolescents’ psychological adjustment.
These results may indeed mean that families that include a parent with cancer may experience more positive family functioning than normal families. Alternatively, the lack of consistent associations observed between adolescent–parent discrepancies and adolescent adjustment in the Gazendam-Donofrio et al. investigation may be due to some limitations of the study. One critical limitation of their study is that the relations between adolescent–parent discrepancies in perceptions of family functioning and adolescent adjustment were not examined by gender. This is an important point since previous research has indicated that discrepancies in perceptions of family functioning between adolescents and their parents are much more likely to be negatively related to adjustment for girls than for boys [5, 7]. It has been suggested that these gender differences occur because parents tend to expect more autonomous behavior from sons than from their daughters and therefore parents are more tolerant of discrepant perceptions with their sons than with their daughters [2]. In line with this hypothesis, research has shown that adolescent boys have more negative perceptions of parent–adolescent relational quality than do adolescent girls [8]. In addition, the associations between mothers’ and father's perceptions of the family have been found to be stronger than the associations between adolescents’ perceptions with their parents, especially for boys [9]. Another possible explanation for these gender differences is that discrepancies in adolescent–parent perceptions may be more harmful for girls than boys because the development of the self is tied to attachments and relationships with others for girls, but not for boys [10]. It is not clear whether the same pattern of relations also would be observed in families that include a parent with cancer. Perhaps, boys’ autonomy in these families is not encouraged as all family members are needed to provide instrumental and emotional support as well as care for the ill parent. Moreover, boys in such families may remain attached to their ill parent as the very existence of the adolescent–parent relationship is threatened.
It also is important to note that the majority of patients in the Gazendam-Donofrio et al. study were female. Prior research has shown that the gender of the parent should be considered when exploring the relations between adolescents’ and parents’ perceptions of family functioning and adolescent adjustment. For example, in a study conducted by Rodrigo et al. [3], discrepancies in perceptions of family conflicts were most pronounced in mother–daughter dyads. This is not surprising given that females tend to be more relationship oriented than males. Therefore, girls may struggle more to achieve autonomy from their mothers than from their fathers. In families where a parent has cancer, the health status of the parent also should be taken into account. For example, it may be that adolescents in such families have more discrepant perceptions with the healthy parent than with the ill parent since the adolescent may not want to be involved with any kind of conflict with the ill parent. In these families, there may even be unusually elevated levels of conflict in the adolescent–parent relationship with the healthy parent as the adolescent attempts to appropriately displace some of his/her emotions.
In the Gazendam-Donofrio et al. study, the sample of the adolescents ranged from 11 to 18. Although mean differences in perceptions were examined in relation to the stage of adolescence (early, middle, and late adolescence), the associations between discrepancies of adolescent–parent perceptions and adolescent adjustment were not examined by the specific developmental stage of the adolescent. The broad age range assessed may not fully capture developmental differences that typically occur within the adolescent period. Over the course of adolescence, adolescents develop advanced cognitive abilities and better coping skills. Therefore, an individual just entering early adolescence will cope with having a parent with cancer much differently than one who is close to adulthood. In addition, it is more likely that discrepancies in adolescent–parent perceptions will occur early in adolescence as the adolescent struggles with issues relating to behavioral and emotional autonomy in comparison to late adolescence. It is not clear whether this developmental trajectory holds true for families of adolescents who have a parent with cancer since normal developmental tasks of the adolescent and the family may be postponed.
In addition to considering the specific developmental stage of the adolescent, it would be critical for future research to take into account the stage of the parent's cancer, whether or not the parent is or has been in remission, and the length of time that the parent has had cancer. It is imperative to follow these families over time as typical and atypical challenges are faced and as the cancer in the parent progresses or remits. Although results from the Gazendam-Donofrio et al. study indicate that adolescents who have a parent with cancer function positively, it is important to note that their study was cross-sectional. Therefore, it only provides a snapshot in time. It is possible that families experiencing parental cancer may function less positively as the cancer progresses, remits, or after the parent succumbs to cancer. It also would be informative to explore whether adolescents who have a parent in remission begin to resemble adolescents from normal families. These adolescents actually may start to view the family more negatively once they are able to pull away from the family more and focus more on their own normal developmental tasks, such as the development of autonomy and identity. Clearly, longitudinal research is needed to more thoroughly explore the short-term and long-term effects of parental cancer on the adjustment of adolescents and their families.
funding
National Institutes of Health (K01-AA015059).
References
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