Author: Joyce Kirkpatrick
Safe. It’s an important word and a concept with special significance
for a child whose parent has been diagnosed with cancer. That news transforms everything: not
only must families launch a search for answers about treatment and survivorship but they must
also face the many tough questions and the natural fear about the future that children placed in
this situation express. Suddenly, just feeling safe, if only for short periods of time, seems a major
About three and a half years ago, Teri Jennings, RN, OCN, director of clinical services at Cancer
Treatment Centers of America® (CTCA) in Tulsa, Oklahoma, noticed children crying in a family
break room in the treatment center. “Safe” did not seem to be what these kids, separated from their
mother who was undergoing treatment, were feeling.
At the time Jennings responded by searching for things to help distract the children and
ease their anxiety; later the image of them in that family room would not leave her mind. Soon
thereafter she discussed her experience with Lindsay Rehm, RN, OCN, education specialist; Margie
Taylor, MSW, social worker; and several other clinicians at CTCA in Tulsa and posed the question:
“How can we do more to help children cope with a parent’s illness and their own fears?”
Jennings’s question—and the discussion that would ultimately spur the creation of programming
for children of cancer patients at CTCA—is one that cancer treatment centers are increasingly
trying to answer as they work to help families of cancer patients.
Addressing a growing need
Meeting the needs of children whose parents have been diagnosed with cancer is a growing
concern. According to the American Cancer Society’s annual report, Cancer Statistics, 2012, there
will be 1,638,910 new cases of cancer this year; and a study conducted by the National Cancer
Institute reports that 22.4 percent (more than 367,000) of these cases will occur in individuals of
childbearing and parenting years.
Additional statistics released by the National Institutes of
Health reveal that an estimated 2.85 million US children under
18 are currently living with a parent who has been diagnosed with
cancer. Researchers estimate that nearly 562,000 of these children
are living with a parent who is in the early phases of cancer
treatment and recovery.
Families and children in this affected population experience a
variety of challenges, ranging from emotional distress to practical
concerns like finding appropriate childcare. Across the board,
these families confront questions about how to discuss a parent’s
diagnosis and how to manage the impact on the family.
Increasingly, treatment centers and hospitals are asking how
they can best serve these kids and families, an issue made complex
by the diversity of family dynamics, the fact that children in the
same family may react differently to the experience, and the
challenge of creating resources appropriate for children at various
ages and stages of social and emotional development.
Despite the challenges, many treatment centers, hospitals, and
independent organizations are recognizing this growing need and
are designing programs not only to entertain and care for these
children but also to help them understand the treatments their
parents are receiving.
Why are these resources for children so important? Rehm and
Taylor say that the impact of a parent’s diagnosis on children is
significant and can result in emotional, behavioral, and social
challenges and may even create physical symptoms—all of which
can vary depending on the child’s age and gender.
At CTCA the process of developing a program that would best
serve the needs of children evolved over time. “We began our
efforts to help address this issue by introducing solutions slowly,”
Rehm says. “First we provided younger children with activities that
would fit in backpacks. We chose items such as finger puppets and
books—things that would not be intrusive to others—and placed
them in colorful, lime-green, drawstring backpacks that the kids
could take with them. Those backpacks are still a big hit. Then we
started adding books to the patient library—books that kids can
borrow and enjoy.”
That simple beginning soon led to more discussions by the
CTCA team and eventually to the search for a comprehensive strategy
or program that would address more of the children’s needs.
“We saw a real need to help teens as well as young children,”
Taylor says, “and we found what we were looking for with the
CLIMB program.” According to Taylor, the CLIMB program,
created in 2001 in Denver, Colorado, by Peter Van Dernoot, BS,
founder of the Children’s Treehouse Foundation and author of
Helping Your Children Cope with Your Cancer: A Guide for Parents
and Families, is a “hospital-based, cancer-focused, psychosocial
intervention training program dedicated to improving the
emotional health of children whose parents have cancer. CLIMB
activities include forms of art therapy such as mask decorating
and group processing.” CLIMB is an acronym for Children’s
Lives Include Moments of Bravery. The Children’s Treehouse
Foundation provides professional education for staff at hospitals
and treatment centers and group support programming.
In 2010 Rehm and Taylor underwent extensive program
facilitation training under the direction of Sue Heiney, PhD,
RN, of the Children’s Treehouse Foundation and then brought
the CLIMB program to CTCA in Tulsa,
where they modified it to suit their needs.
“We adapted the program for children
ages five to 12; then we added a different
program for teens about cancer and a
parent’s diagnosis,” Rehm says, “so it just
makes sense to tailor the program a little
differently for them.” Ultimately, the
program was expanded, and it now serves
children and teens ages five to 18, who are
divided into two separate groups: one for
younger kids and one for teens.
The CLIMB curriculum includes a
lot of opportunities for kids of all ages to
discuss their feelings in age-appropriate
ways. “We talk with the teens, for
example, about all the emotions they
will have—that as a teenager they are
naturally happy because life is exciting
and they have friends and fun activities
but that the discovery of a parent’s illness
can create the emotions of confusion, fear,
and anger,” Taylor says. “We discuss that
all of these emotions come up at one time
or another, and sometimes they all come
up at the very same time. We explain
that it’s okay. You can almost see them
breathe easier when we explain this and
they learn that they are not the only ones
experiencing those emotions.”
All of the activities and discussions that
occur as part of the programming are
focused on helping the kids work through
their emotions, Taylor says, and to offer
them a chance to build community with
other kids. “CLIMB activities provide a
chance for them to be with other kids who
are going through the same thing. The
teens especially end up exchanging phone
numbers and Facebook information, and
several of them have taken on the role of
mentor to others in the classes. One thing we stress to all of the kids is that
it is important that they have somebody they can go to.”
New patients with children at CTCA generally learn about the CLIMB
program from a nurse navigator. Without exception the information is
welcome news, especially to parents who are uncertain about how to talk
about cancer with their children. “CLIMB is a safe place to share,” Taylor
says. “The kids can talk about anything there and know that it’s okay. That
aspect of the program is something we often hear the kids say is what they
appreciate about the program the most.”
Programs such as CLIMB are a welcome relief not only for the young
participants but also for their parents, who often struggle with what to
tell their minor children about their own or a loved one’s diagnosis and
treatment. This worry is added stress for parents already experiencing
anxiety about the transformative impact of a diagnosis on their parenting
activities, the family’s finances, and the future well-being of their
Perhaps the greatest benefit of these programs is the sense of security
they offer kids by providing a place where these young members
of the family can express their feelings without being afraid that they
will ask an ill parent the “wrong” question or burden their families—
a place where worried, bewildered, and sometimes frightened children
can simply feel safe.
Cancer Facts & Figures 2012. American Cancer Society website. Available at: http://www.cancer.org/
Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012. Accessed May 23, 2012.
Helping Children Cope When a Family Member Has Cancer. CancerCare website. Available at: http://
media.cancercare.org/publications/original/22-ccc_helping_children.pdf. Accessed May 23, 2012.
Hutchison C, Allen J. “Parents with Cancer: Millions of Patients Juggle Chemotherapy
and Childrearing.” ABC News website, June 28, 2010. Available at: http://abcnews.go.com/
story?id=11013334#.T71QbUWvJ8E. Accessed May 23, 2012.
Langlie Lesnik, C. “When a Parent Has Cancer: What to Tell the Kids.” Everyday Health Community
website. Available at: http://www.everydayhealth.com/blogs/against-all-odds-thoughts-of-an-appendixcancer-
survivor/when-a-parent-has-cancer-what-to-tell-the-kids. Accessed May 23, 2012.
Rauch PK, Muriel AC, Cassem NH. Parents with cancer: who’s looking after the children? Journal of
Clinical Oncology. 2003;21(9 Suppl):117s-121s.
Weaver KE, Rowland JH, Alfano CM, McNeel TS. Parental cancer and the family: a population-based
estimate of the number of US cancer survivors with their minor children. Cancer. 2010;116(18); 4395-
401. doi: 10.1002/cncr.25368.
When Your Parent Has Cancer: A Guide for Teens. National Cancer Institute website. Available at:
http://www.cancer.gov/cancertopics/coping/when-your-parent-has-cancer. Accessed May 23, 2012.
Resources for Kids and Families
Listed below are several national programs designed to help
children who are coping with cancer of a family member.
CancerCare provides free professional support services
to anyone affected by cancer: patients, caregivers,
children, loved ones, and the bereaved.
(800) 813-HOPE [800-813-4673]
Cancer Support Community provides parents and
children with access to free social and emotional support,
including Group Loop, an online community designed
to address the needs of teens 13 to 19 whose lives are
affected by cancer.
(888) 793-9355 or (202) 659-9709
CLIMB, a program of the Children’s Treehouse Foundation,
works to ensure that every child whose parent is
diagnosed with cancer is given the tools and emotional
support to cope. The program helps normalize feelings of
sadness, anxiety, fear, and anger of children whose parent
has cancer, while stimulating improved communication
between children and parents.
childrenstreehousefdn.org (includes lists of support groups
for children by state)
Kids Konnected offers programs and services for children
with a parent diagnosed with cancer. Eleven-year-old Jon
Wagner-Holtz established Kids Konnected in 1993 after
his mother was diagnosed with breast cancer. Jon felt
alone with his feelings, his friends didn’t understand, and
he really wanted to talk to other kids who might be going
through the same experience. “Kids helping kids is what
we’re all about,” he says. “Because of our ‘Konnection,’ you
don’t have to be alone anymore.”
KidsCope helps children cope with changes in the family
when a parent has cancer. Educational materials include
Kemo Shark, a comic book to help children understand
the psychological and physiological changes in a parent
undergoing chemotherapy, and a video, My Mom Has Breast
Cancer, which includes interviews with children and mothers
who have successfully weathered the experience.
SuperSibs! is a nonprofit organization ensuring that
siblings of children with cancer are supported, honored, and
recognized to help them redefine the cancer experience to
face the future with strength, courage, and hope. SuperSibs!
does what many overwhelmed families cannot, by focusing
on the well siblings who are feeling isolated and afraid.
(888) 417-4704 or (847) 462-4742