Supportive Care in Cancer

, Volume 26, Issue 1, pp 287–295 | Cite as

Communication with children about a parent’s advanced cancer and measures of parental anxiety and depression: a cross-sectional mixed-methods study

  • Claire E. HaileyEmail author
  • Justin M. Yopp
  • Allison M. Deal
  • Deborah K. Mayer
  • Laura C. Hanson
  • Gili Grunfeld
  • Donald L. Rosenstein
  • Eliza M. Park
Original Article



Parents with advanced cancer are faced with difficult decision-making about communication about their illness with their children. The objectives of this study were to describe how parents communicated with their children about advanced cancer and to explore associations between communication and parental depression and anxiety.


This was a cross-sectional, mixed-methods study of 42 patients with stage IV solid tumor malignancies who had at least one child less than 18 years of age. Participants completed a semi-structured interview and the Hospital Anxiety and Depression Scale (HADS). We used multiple linear regression to evaluate the association between extent of communication and HADS Anxiety and Depression scores. Interview data were analyzed using standard qualitative content and thematic techniques and triangulated with survey data.


Higher HADS Anxiety scores, but not HADS Depression scores, were cross-sectionally associated with greater extent of parental communication (p = 0.003), even when controlling for performance status and children’s ages. In qualitative analyses, parents who acknowledged the terminal nature of their illness or experienced higher symptom burden were more likely to report that they also communicated more extensively with children. A third of parents (n = 14, 33%) described difficulty with illness-related communication with their children.


In this pilot study, parents with advanced cancer who reported more illness-related communication with their children also reported more symptoms of general anxiety. Future interventions should address psychological distress relevant to parenting and further assess how parental communication may be linked to parental mood symptoms.


Cancer Neoplasm Parent Child Communication 



The authors wish to gratefully acknowledge the patients who participated in this study and who gave their time to share their experiences. We also thank Sarah Frances Nemeroff, Alonso Saldana, and Marcia Alvarez for their assistance with subject recruitment and Paul Mihas, MA, for his assistance with interview guide development.

Compliance with ethical standards

The UNC Institutional Review Board reviewed and approved the study.

Conflict of interest

The authors declare that there is no conflict of interest.


This work was supported by the North Carolina University Cancer Research Fund, the Doris Duke Charitable Foundation (Grant 2015213), the National Center for Advancing Translational Sciences (NCATS), and National Institutes of Health, through Grant Award Numbers 1UL1TR001111 and 1KL2TR001109 to Dr. Park.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


  1. 1.
    Weaver KE, Rowland JH, Alfano CM et al (2010) Parental cancer and the family: a population-based estimate of the number of US cancer survivors residing with their minor children. Cancer 116:4395–4401CrossRefGoogle Scholar
  2. 2.
    Heron M (2015) Deaths: leading causes for 2012. NVSS 64:1 (Last accessed September 28, 2016)Google Scholar
  3. 3.
    Nilsson ME, Maciejewski PK, Zhang B et al (2009) Mental health, treatment preferences, advance care planning, and location and quality of death in advanced cancer patients with dependent children. Cancer 115:399–401CrossRefGoogle Scholar
  4. 4.
    Turner J, Clavarino A, Yates P et al (2007) Development of a resource for parents with advanced cancer: what do parents want? Palliat Support Care 5:135–145CrossRefGoogle Scholar
  5. 5.
    Muriel AC, Rauch PK (2003) Suggestions for patients on how to talk with children about a parent's cancer. J Support Oncol 1:143–145PubMedGoogle Scholar
  6. 6.
    Elmberger E, Bolund C, Lutzen K (2000) Transforming the exhausting to energizing process of being a good parent in the face of cancer. Health Care Women Int 21:485–499CrossRefGoogle Scholar
  7. 7.
    Helseth S, Ulfsaet N (2005) Parenting experiences during cancer. J Adv Nurs 52:38–46CrossRefGoogle Scholar
  8. 8.
    Turner J, Kelly B, Swanson C et al (2005) Psychosocial impact of newly diagnosed advanced breast cancer. Psycho-Oncology 14:396–407CrossRefGoogle Scholar
  9. 9.
    Northouse LL, Mellon S, Harden J et al (2008) Long-term effects of cancer on families of adult cancer survivors. In: Miller SM, Bowen DJ, Croyle RT, Rowland JH (eds) Handbook of cancer control and behavioral science. American Psychological Association Press, Washington, D.C., pp 467–485Google Scholar
  10. 10.
    Semple CJ, McCance T (2010) Parents’ experience of cancer who have young children: a literature review. Cancer Nurs 33:110–118CrossRefGoogle Scholar
  11. 11.
    Stiffler D, Haase J, Hosei B et al (2008) Parenting experiences with adolescent daughters when mothers have breast cancer. Oncol Nurs Forum 35:113–120CrossRefGoogle Scholar
  12. 12.
    Davis Kirsch SE, Brandt PA, Lewis FM (2003) Making the most of the moment: when a child’s mother has breast cancer. Cancer Nurs 26:47–54CrossRefGoogle Scholar
  13. 13.
    Billhult A, Segesten K (2003) Strength of motherhood: non-recurrent breast cancer as experienced by mothers with dependent children. Scand J Caring Sci 17:122–128CrossRefGoogle Scholar
  14. 14.
    Kennedy VL, Williams ML (2009) Information and communication when a parent has advanced cancer. J Affect Disord 114:149–155CrossRefGoogle Scholar
  15. 15.
    Rosenheim E, Reicher R (1985) Informing children about a parent’s terminal illness. J Child Psychol Psychiatry 26:995–998CrossRefGoogle Scholar
  16. 16.
    Huizinga GA, Visser A, van der Graaf WTA et al (2005) The quality of communication between parents and adolescent children in the case of parental cancer. Ann Oncol 16:1956–1961CrossRefGoogle Scholar
  17. 17.
    Korff ME (2006) Our services. Parenting at a challenging time program. Accessed 28 Sept 2016
  18. 18.
    Rauch PK, Muriel AC, Cassem NH (2002) Parents with cancer: who’s looking after the children? J Clin Oncol 20:4399–4402CrossRefGoogle Scholar
  19. 19.
    Hymovich DP (1993) Child-rearing concerns of parents with cancer. Oncol Nurs Forum 20:1355–1360PubMedGoogle Scholar
  20. 20.
    Visser A, Huizinga GA, Van der Graaf WTA et al (2004) The impact of parental cancer on children and the family: a review of the literature. Cancer Treat Rev 30:683–694CrossRefGoogle Scholar
  21. 21.
    Grenklo TB, Kreicbergs UC, Valdimarsdottir UA et al (2013) Communication and trust in the care provided to a dying parent: a nationwide study of cancer-bereaved youths. J Clin Oncol 31:2886–2894CrossRefGoogle Scholar
  22. 22.
    Leedham B, Meyerowitz BE (1999) Responses to parental cancer: a clinical perspective. J Clin Psychol Med Settings 6:441–461CrossRefGoogle Scholar
  23. 23.
    Huizinga GA, Visser A, Van der Graaf WTA et al (2005) Stress response symptoms in adolescent and young adult children of parents diagnosed with cancer. Eur J Cancer 41:288–295CrossRefGoogle Scholar
  24. 24.
    Park EM, Deal AM, Check DK et al (2016) Parenting concerns, quality of life, and psychological distress in patients with advanced cancer. Psychooncology 25:942–948CrossRefGoogle Scholar
  25. 25.
    Park EM, Check DK, Song MK, et al (2017) Parenting while living with advanced cancer: a qualitative study. Palliat Med 31:231-238CrossRefGoogle Scholar
  26. 26.
    Bjellanda I, Dahlb AA, Haug TT et al (2002) The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 52:69–77CrossRefGoogle Scholar
  27. 27.
    Muriel AC, Moore CW, Baer L et al (2011) Measuring psychosocial distress and parenting concerns among adults with cancer: the parenting concerns questionnaire. Cancer 118:5671–5678CrossRefGoogle Scholar
  28. 28.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655CrossRefGoogle Scholar
  29. 29.
    Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32:705–714CrossRefGoogle Scholar
  30. 30.
    Hewitt-Taylor J (2001) Use of constant comparative analysis in qualitative research. Nurs Stand 15:39–42CrossRefGoogle Scholar
  31. 31.
    Sandelowski M (1995) Qualitative analysis: what it is and how to begin. Res Nurs Health 18:371–375CrossRefGoogle Scholar
  32. 32.
    Denzin NK, Lincoln YS (2011) The SAGE handbook of qualitative research, 4th edn. SAGE, Thousand OaksGoogle Scholar
  33. 33.
    Siegel K, Mesagno FP, Christ G (1990) A prevention program for bereaved children. Am J Orthop 60:168–175CrossRefGoogle Scholar
  34. 34.
    Russell KS, Rauch PK (2012) Parenting with cancer I: developmental perspective, communication, and coping. Adv Exp Med Biol 732:131–140CrossRefGoogle Scholar
  35. 35.
    Rauch PK, Muriel AC (2005) Raising an emotionally healthy child when a parent is sick. McGraw-Hill Professional Publishing, New YorkGoogle Scholar
  36. 36.
    Hoke LA (2001) Psychosocial adjustment in children of mothers with breast cancer. Psycho-Oncology 10:361–369CrossRefGoogle Scholar
  37. 37.
    Beck TC (1999) Maternal depression and child behaviour problems: a meta-analysis. J Adv Nurs 29:623–629CrossRefGoogle Scholar
  38. 38.
    El-Jawahri A, Traeger L, Park ER et al (2014) Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer 120:278–285CrossRefGoogle Scholar
  39. 39.
    El-Jawahri A, Traeger L, Kuzmuk K et al (2015) Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 50:1119–1124CrossRefGoogle Scholar
  40. 40.
    Chan WC (2011) Being aware of the prognosis: how does it relate to palliative care patients' anxiety and communication difficulty with family members in the Hong Kong Chinese context. Palliat Med 14:997–1003CrossRefGoogle Scholar
  41. 41.
    The psychosocial needs of cancer patients: meeting psychosocial health needs (2008) In: Adler NE, Page AEK (eds) Cancer care for the whole patient. National Academies Press, Washington, DC, pp 23–49Google Scholar
  42. 42.
    Salvo N, Zeng L, Zhang L et al (2012) Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer. Clin Oncol 24:139–148CrossRefGoogle Scholar
  43. 43.
    Glare P, Sinclair C, Downing M et al (2008) Predicting survival in patients with advanced disease. Eur J Cancer 44:1146–1156CrossRefGoogle Scholar
  44. 44.
    Christ GH, Siegel K, Freund B et al (1993) Impact of parental terminal cancer on latency age children. Am J Orthopsychiatry 63:417–425CrossRefGoogle Scholar
  45. 45.
    Welch AS, Wadsworth ME, Compas BE (1996) Adjustment of children and adolescents to parental cancer: parents’ and children’s perspectives. Cancer 77:1409–1418CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.School of MedicineUniversity of North CarolinaChapel HillUSA
  2. 2.Comer Children’s HospitalUniversity of Chicago MedicineChicagoUSA
  3. 3.Department of PsychiatryUniversity of North CarolinaChapel HillUSA
  4. 4.Biostatistics Core Facility, Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA
  5. 5.School of NursingUniversity of North CarolinaChapel HillUSA
  6. 6.Division of Geriatrics, Department of MedicineUniversity of North CarolinaChapel HillUSA
  7. 7.Division of Hematology/Oncology, Department of MedicineUniversity of North CarolinaChapel HillUSA

Personalised recommendations