Explaining Cancer Recurrence to a Child and Helping Them Cope

When cancer comes back after treatment and after a period when the cancer couldn’t be detected or found, it is called recurrence. Learning that the cancer is back can be overwhelming. It can make a person feel sadness, grief, upset, or that their future is uncertain.

Explaining cancer recurrence to children can be overwhelming, especially when you are their parent and you have cancer, it might help to process your feelings first and talk to your cancer care team as you think about letting the children know about the recurrence. You could also reach out to your support system to help you talk to your children.

Some people might not want to tell their children that the cancer is back out of fear that this will upset the child or cause them to worry more. Even though it is true that children are likely to be upset when they learn the cancer has come back, keeping them informed of what is going on might help them worry less and build trust.

Here are some things to consider before or when telling children that a loved one’s cancer is back:

  • Reassure children that it is OK to feel angry, scared, or anxious. Encourage the children to talk about their feelings with a trusted adult. Help them think of ways to cope with these feelings such as drawing, keeping a journal, praying, or talking to a friend. It is also important to give them space and time to ask questions and express their feelings.
  • Try to find out what they remember from the last time this person had cancer. You may be surprised by some of their memories or things they misunderstood. Correct any wrong information and add to what they were told in the past. Explain that the cancer has now come back and will need to be treated again.
  • Make sure that children understand basic cancer terms. Even though they might be older than when the cancer was first diagnosed, don’t assume they understand cancer language.
  • Children need to be prepared so they’ll know exactly how treatment will affect their lives. This is especially important if the person with cancer lives in the same household. They need to know what the side effects of treatment could be, what changes in the family routine to expect, and when they might return to a more normal life again.
  • Try to make children part of the problem-solving process about how to manage the changes they’ll go through because of the cancer and treatment. This will make them feel less helpless, make them feel valued, and help them be part of the solution to any problems that come up.
  • Weekly or frequent family meetings are a good way to manage built-up anxiety, especially when the person with cancer lives in the same household as the children. Meetings can help everyone feel that their concerns are important, and they give others a chance to address these concerns.
  • If a parent has cancer, there might need to be changes in the way things are done. The family activity schedule may need to be changed to work around more intensive treatment. You might need to make other arrangements for the kids so that their routines can continue, with other people filling in, until you are feeling better. Even though you can’t do certain things, you might be able to substitute some activities that won’t take quite as much energy. Arrange times to be together to watch TV, read a book, make up a story, play a board game, or whatever else you can think of to spend time with your children. Kids would rather you be there even if you’re a little tired, than not there at all.

When thinking about helping children cope with this news, remember:

  • Children can’t always tell you in words but may show you how they feel. You might notice your child being more dependent, worrying more, or being out of character. They might also express themselves through drawing, coloring, or playing. It is important that the parents or guardians pay close attention to how and what the children are doing
  • Ask the children frequently how they are doing and what can be done to help them feel better.
  • Children might regress (act younger) when they are under stress. For example, a child who had just become toilet trained might start having accidents. Other children might begin to have separation anxiety or difficulty paying attention in school.
  • Children might worry about their loved one dying. When talking to a child about dying, be honest and let them know that sometimes people do die from cancer and while there is no way to know what’s going to happen, let the child know about the outlook of the person’s cancer in a way that is appropriate for their age, and let them know that if you find out something new or different, you will let them know. This does not mean that parents should tell their kids everything they know as soon as they know it. It means that children should be given truthful information when they need it to cope well from day to day. If the loved one is a parent or guardian, they might need to seek help from a professional to help them process their own feelings and discuss ideas to and tips for talking with their children.
  • Children thrive on routine and predictability. If the person whose cancer has come back lives in the same household as the child, try to keep their routine and way of life as close to normal as possible. Communicate with the child any expected changes. This will help increase their sense of security.
  • Children should be told that although no one knows for sure why some people get cancer, it’s certain that the child did nothing to cause the loved one’s cancer to come back.
  • Tell the children that it is OK for them to refuse to talk about their loved one’s cancer coming back with others.
  • Find out as much information as possible about how the child is doing. This could mean talking to the child’s teacher, guidance counselor, pediatrician, a coach, or a professional counselor. This will help you help the child cope better.
  • Consider using a children or teen's book about cancer to guide discussion. Your local librarian can help you find one.

Some children might have more trouble than others coping with the news that a loved one has cancer. Extra help, most times professional help, might be needed if a child:

  • Is unable to handle the feelings of sadness
  • Feels sad all the time
  • Cannot be comforted
  • Admits to thinking of suicide or of hurting themselves
  • Feels extra irritable
  • Becomes very angry very quickly
  • Has declining grades
  • Withdraws or isolates themselves
  • Acts very differently from usual
  • Has appetite changes
  • Has low energy
  • Shows less interest in activities
  • Has trouble concentrating
  • Cries more than usual
  • Has trouble sleeping

You might find it useful to talk with the child’s health care team, school counselor, a child psychologist or psychiatrist, or social worker or counseling staff at the hospital where the loved one is being treated. Get help immediately if a child admits to thinking of suicide or hurting themselves.

 

 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Cancer.Net. Dealing With Cancer Recurrence. 2019. Accessed at https://www.cancer.net/survivorship/dealing-cancer-recurrence on May 17, 2022.

Cancer.Net. How A Child Understands Cancer. 2019. Accessed at https://www.cancer.net/coping-with-cancer/talking-with-family-and-friends/how-child-understands-cancer on May 17, 2022.

Cancer.Net. How Cancer Affects Family Life. 2018. Accessed at https://www.cancer.net/coping-with-cancer/talking-with-family-and-friends/how-cancer-affects-family-activities on May 19, 2022.

Faccio F, Ferrari F, Pravettoni G. When a parent has cancer: How does it impact on children's psychosocial functioning? A systematic review. Eur J Cancer Care (Engl). 2018; 27(6)

Hauken MA, Senneseth M, Dyregrov A, Dyregrov K. Anxiety, and the quality of life of children living with parental cancer. Cancer Nursing. 2018; 41(1): 19-27 

National Cancer Institute. Recurrent Cancer: When Cancer Comes Back. 2010. Accessed at https://www.cancer.gov/types/recurrent-cancer on May 17, 2022.

National Cancer Institute. When your parent has cancer: A guide for teens. National Institute of Health. 2012; 12-5734: 54-55

Ojai C, Edbom T, Mansson J, Ekblad S. Informing children of their parent’s illness: A systematic review of intervention programs with child outcomes in all health care settings globally from inception to 2019. PLoS ONE. 2020; 15(5): 2.

The British Psychological Society. Talking to Children About Illness. 2020. Accessed at https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy-illness.pdf on May 17, 2022.

SannShah BK, Armaly J, Swieter E. impact of parental cancer on children. Anticancer Research. 2017; 37(8): 4025-4028. 

References

Cancer.Net. Dealing With Cancer Recurrence. 2019. Accessed at https://www.cancer.net/survivorship/dealing-cancer-recurrence on May 17, 2022.

Cancer.Net. How A Child Understands Cancer. 2019. Accessed at https://www.cancer.net/coping-with-cancer/talking-with-family-and-friends/how-child-understands-cancer on May 17, 2022.

Cancer.Net. How Cancer Affects Family Life. 2018. Accessed at https://www.cancer.net/coping-with-cancer/talking-with-family-and-friends/how-cancer-affects-family-activities on May 19, 2022.

Faccio F, Ferrari F, Pravettoni G. When a parent has cancer: How does it impact on children's psychosocial functioning? A systematic review. Eur J Cancer Care (Engl). 2018; 27(6)

Hauken MA, Senneseth M, Dyregrov A, Dyregrov K. Anxiety, and the quality of life of children living with parental cancer. Cancer Nursing. 2018; 41(1): 19-27 

National Cancer Institute. Recurrent Cancer: When Cancer Comes Back. 2010. Accessed at https://www.cancer.gov/types/recurrent-cancer on May 17, 2022.

National Cancer Institute. When your parent has cancer: A guide for teens. National Institute of Health. 2012; 12-5734: 54-55

Ojai C, Edbom T, Mansson J, Ekblad S. Informing children of their parent’s illness: A systematic review of intervention programs with child outcomes in all health care settings globally from inception to 2019. PLoS ONE. 2020; 15(5): 2.

The British Psychological Society. Talking to Children About Illness. 2020. Accessed at https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy-illness.pdf on May 17, 2022.

SannShah BK, Armaly J, Swieter E. impact of parental cancer on children. Anticancer Research. 2017; 37(8): 4025-4028. 

Last Revised: September 15, 2022

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