As a social worker in a breast cancer clinic, Liz Farrell meets a lot of young mothers. Her job is to sit beside them after they’ve received a diagnosis and guide them through the next step: telling their children—a process that can be more difficult than hearing the news themselves.
Catherine, Princess of Wales, recently had to do just that. In a video released last Friday, the princess shared that she had been diagnosed with cancer and is undergoing preventative chemotherapy treatment. She did not say what kind of cancer she has. Explaining her diagnosis to her three children, who are respectively 10, eight and five years old, has been challenging and taken time, she said in the video.
An estimated 20 million people around the world were diagnosed with cancer in 2022. And according to the World Health Organization, one in five people will develop some form of the disease in their lifetime. To understand how parents with cancer can best share the sobering news with their children, Scientific American spoke with Farrell, who works at the Dana-Farber Cancer Institute in Boston.
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A transcript of the interview, edited for clarity and brevity, follows.
How long is it appropriate for a parent to wait to tell their child about a cancer diagnosis?
I don’t think there’s a one-size-fits-all time frame, but in general, the sooner the better. Kids are incredibly observant, and they’re going to notice that the environment has shifted and that something’s off at home. The longer they sit in the uncertainty, the greater their anxiety will be. That being said, when somebody gets a cancer diagnosis there’s usually a bit of lag time between when they find out about the cancer and when treatment actually starts—usually a couple of weeks. So I typically say that patients should take that period of time to adjust to the news themselves and wait until they have more information about what their treatment process is going to look like before sharing it with their kids.
How should a parent discuss their cancer diagnosis with children of different ages?
For children who are preschool age or younger, I encourage parents to tell them about their diagnosis—independent from older siblings—with only very basic information. They can understand only so much. But if the kids are, say, kindergarten [age] and above, I encourage people to have a more detailed conversation [in which members of the family are] all together so that the kids are hearing the same information at the same time and there’s opportunity for questions. Although these days, parents also have to be ready for their children—especially the older ones—to turn to Google for answers. Even if they don’t have phones yet, they have computers and Chromebooks at school that they can use to look up information. So it’s good to say things like “I know you’re probably going to want to look this up, and I’m not telling you that you can’t. But it’s very important for you to understand that every situation is different. And I really want you to also come to me with your questions.”
A parent may not want to share information about their cancer diagnosis outside of the family. How can they instruct their children to speak or not to speak about it with others?
This is really challenging because a patient should always be able to have as little or as much privacy as they want to have. But when you introduce kids to the mix, it can get a little complicated, and you can’t always control who they talk to about it. A student may walk into their kindergarten class and announce that their mom has cancer and is losing her hair or something else unfiltered. I tell parents to just always be prepared for that and to ask their children to tell them who they’ve talked about it with. There’s also a possibility that a child may have a friend or classmate who says something like “my grandma had cancer, and she died,” and that can stir up a lot of emotions and confusion. In that case, I advise parents to assure their child that every cancer situation is different and that they shouldn’t be worried about how another person’s cancer experience reflects theirs.
How honest should a parent be with a child about their own fears of their cancer?
I think it’s about finding a balance between being honest about your feelings and not making your kids feel like they need to be caretakers for you emotionally. You don’t want to be dishonest about the situation by acting like there’s not a worry in the world because that can send a message to your child that it’s not okay for them to be concerned. At the same time, you don’t want to fully unload on them and stress them out more. So it’s really about finding a medium place where you speak truthfully to your child and answer their questions without making them the sole recipient of your feelings. Sometimes incorporating a trusted friend or family member into the conversation can help.
How should a parent talk to their child about the possibility of needing their help in a medical emergency?
If there is genuine concern that you, as a cancer patient, may not be well enough to be on your own with the kids at home, try your best to recruit a caretaker or another trusted adult to be at the house in case of an emergency. But if that’s not an option or something truly unpredicted happens, make sure that your kids have access to a phone and the appropriate numbers to dial. In fact, it’s good for them to know emergency protocol even if cancer isn’t involved. If you haven’t had that conversation with your kids, here’s a reminder.
Is there a circumstance in which it is not appropriate for a parent to disclose their cancer diagnosis to their child?
Sometimes there are rare situations in which both a parent and a [health care] professional believe that telling a child about their parent’s cancer diagnosis would do more harm than good. For instance, if your child has their own mental health issues or developmental disabilities and the news could be severely disruptive, it may not be appropriate to disclose your diagnosis.
What types of resources are available for children of people with cancer?
The American Cancer Society’s website has an incredibly robust number of resources on how to talk to children about your cancer depending on what age and developmental stage they’re in. There are also books on parenting that include sections about navigating sickness around your children. And if you’re lucky enough to be getting treatment at a major hospital or cancer center, [such facilities] often have staff—like we do at Dana-Faber—who can support and guide you through these conversations.