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Jennifer Brown, RN, BSN, CPN, CPHON is the Childhood Cancer Survivorship Nurse for a Cancer Survivorship Center in the Texas Panhandle. She has worked as a pediatric nurse for 16 years, taking care of pediatric hematology/oncology/stem cell transplant patients in some capacity her entire career. Having been a caregiver to two family members with cancer, Jennifer is dedicated to raising awareness for all types of cancer.

Lost in the Shuffle

Childhood cancer is a family diagnosis. Healthy siblings can often be overlooked when one child has cancer, leading to emotional issues. 
PUBLISHED: 5:00 AM, MON APRIL 10, 2017
“What about me?”  “Why is he getting all the attention?” These are hard questions to answer when one of your children has just been diagnosed with cancer. Your other children may not fully comprehend what’s happening. All they know is that suddenly mom and dad’s world revolves around their brother and him being “sick.”  I’ve heard the phrase “childhood cancer is a family diagnosis.” Truer words have never been spoken.

Parents are faced with the unthinkable task of deciding whether or not to tell their other children that their sibling has cancer, wanting to protect them.  In turn, children, noticing changes in their day-to-day routine, may be afraid to ask questions, fearing the answer. If parents decide to tell their other children, they often struggle with what to say and how to say it. Whether the other children are told about their sibling’s cancer or not, the impact of the illness on the family will be felt. It can impact the other children physically and emotionally, manifesting in a variety of ways, from emotional outbursts to withdrawing from family members.

How an individual deals with stressful situations is determined by many factors, one being age. Studies show that siblings below school age tend to experience behavioral problems immediately after diagnosis, but the symptoms tend to subside with time. School-aged siblings, on the other hand, tend to experience more problems which problems last longer. They can exhibit conduct problems, learning difficulties, and impulsive behaviors. Recurrent themes regarding the stress siblings experience are fear of death, fear of change, fear regarding their own health, and anxiety related to social isolation. In addition to these fears, they often experience jealousy, guilt, poor self esteem, decreased academic performance, and feel uninformed about their sick sibling’s health situation. 

Considering all this, what can be done to try and facilitate a more positive response to a sibling’s cancer diagnosis? Healthcare providers spend so much time focusing on the needs of the sick child that the sibling’s needs are often overlooked, that is, until they are already coping in the only way they know how, by acting out. If we, as healthcare providers, would keep that key phrase in the back of our minds — “childhood cancer is a family diagnosis” — we could possibly help lessen or alleviate the siblings distress. Providing age-appropriate education soon after the sibling’s diagnosis can make them feel more involved in what’s going on. This is especially important with school-aged siblings, who often report feeling uninformed. Knowing that decreased academic performance could occur, communication with the sibling’s school should be a priority. Providing the family with contact information of licensed counselors should be a priority during treatment. Older children often do not feel comfortable expressing their feelings to their parents, so providing an outlet where they can speak freely about how the change in their family is affecting them is so important. 

We, as healthcare providers, know all too well that cancer affects the entire family. Broaden your focus. Help these parents advocate for not only their sick child, but their other children as well.

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
More from Jennifer Brown RN, BSN, CPN, CPHON
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Who ever said that cancer patients, young or old, don't have sex?
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PUBLISHED: Tue June 13 2017
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