Processing a cancer diagnosis is daunting enough for the patient, but delivering the news to the children may feel even more overwhelming. How much should you share? What if they ask a question you can’t answer? Will they fall apart at the news? As you approach the conversation, it’s important that you be honest about your experience and your treatment, says Lynn Bornfriend, MD, Psychiatrist at our Philadelphia hospital. “Parents want to protect their kids, but often they overhear what’s going on. People like to think the kids don’t know. They know. They’re not stupid, and if you’re silent, they may feel like it’s worse than it actually is, or they may get distorted notions.”
“ Give age-appropriate information, and tell children where the cancer has been found in your body. Also, use the word, “cancer,” and tell them it’s not contagious. They may believe they caused it, so clarify that’s not true. Encourage them to express their feelings, and share your feelings. Tell them your health has changed, but your love for them hasn’t. Warn them about what to expect, like hair loss. Be honest about your feelings, but don’t burden them.” - Lynn Bornfriend, MD, - Psychiatrist at our Philadelphia hospital
Liv Arnold knows firsthand how intimidating, and how important, these conversations can be. In 2016, two days before her daughter’s 6th birthday, Arnold learned she had stage II breast cancer. Arnold’s son was 3 at the time. She and her husband talked to the children about the cancer “in bits and pieces,” and kept it factual. “I said, ‘I have cancer here in my right breast,’” Arnold recalled. “I showed them the bump. I said, ‘Can you feel this? This is what the doctor is helping me with.’ I told them about the mastectomy and that my body would change.”
The children weren’t too interested, she said, and they didn’t ask many questions until the side effects began kicking in. “My son freaked out when my hair was gone,” she said. “He hid and was nervous. And if we were at a school event and my daughter was having fun playing and I’d say we have to go home because I was tired, she’d cry and say she hated cancer. I’d say, ‘I hate it too, but this means the medicine is working.’”
Dr. Bornfriend encourages patients to be transparent with their children, saying it helps quell fears of the unknown. “I think it’s important to let them come to treatment, seeing what it is, what it isn’t, and that people know your parent and are taking good care of them,” she says. “Otherwise, you disappear somewhere, and they don’t know where you’re going and what that means.”
After her surgery, Arnold showed her kids the ports, drains and the burns caused by radiation. She wanted to help them understand why she didn’t feel well. But she always made sure to convey that everything she was doing was to become healthy again.
Transparency should extend to even the most difficult questions, says Dr. Bornfriend. “If they ask you if you’re going to die, reassure them that you and your doctors are doing everything possible to make sure that doesn’t happen,” she says. “Remind them that you have good doctors. If they ask what will happen to them if you die, who will take care of them, review what your plan is for them. Let the kids guide the conversation. If they have questions, it’s important to be honest. Children can sense when you’re not being truthful, and they need to be able to trust what you’re saying.”
Connecting them with adults they know and trust—a teacher, aunt, scout master or church leader, for example—may be helpful, providing the opportunity for a child to confide their fears and feelings in someone other than the patient. “Kids might want to talk about something that’s not appropriate to discuss in front of the patient, like if they’re scared the parent might die, or want to ask something they worry might sound selfish,” says Dr. Bornfriend.
Even when kids ask questions, don’t be surprised if they’re not be all that interested in the answers. “In the middle of an answer, they may walk away or change the subject, and that’s fine,” Dr. Bornfriend says. “They can take little bites of information, and then they’re done.”
Here is an at-a-glance summary of Dr. Bornfriend’s tips that may be helpful for talking to your children about your cancer:
- Be honest and use the word, “cancer.”
- Use age-appropriate language to explain where the cancer is and what the children can expect during treatment (“Mommy may need extra rest,” or “Mommy’s hair may fall out,” for example).
- Explain that cancer is not contagious, and it’s no one’s fault.
- Let them know their energy and playfulness encourage you to get well.
- Encourage them to share their feelings with you or other important people in their life.
- Give them opportunities to help you.
- Hug them daily and let them know that, while your health has changed, your love for them has not.