A new study by Dutch researchers has found that adolescents may suffer from severe symptoms of post-traumatic stress when a parent is recently diagnosed with cancer and that parents tend to underestimate the problems.

A cancer diagnosis is among those life experiences that can be so stressful that it is traumatic. While only a fraction of people who develop post-traumatic stress symptoms (PTSS) go on to develop post-traumatic stress disorder (PTSD), the symptoms can cause emotional problems later in life. Much is known about the psychological effect that cancer has on a patient and a spouse, but the consequences of a parent’s cancer on children are more poorly understood.

The study, presented today (Wednesday) at the European Cancer Conference (ECCO 14) in Barcelona, is the first to examine PTSS over time in adolescent children of cancer patients.

Dr Gea Huizinga, a health scientist and research fellow at the University Medical Center in Groningen, The Netherlands, examined the prevalence of PTSS, emotional and behavioural problems in 49 adolescents during the first year after a parent’s cancer diagnosis. The children and each of their parents completed questionnaires three times over the year – within four months after the diagnosis and at six and twelve months after the first survey.

“At the first assessment, 29 percent of the children reported clinically elevated PTSS, which means they needed psychological help, but the proportion suffering symptoms dropped to 16 percent at the second assessment and then to 14 percent at the third,” Huizinga said.

“PTSS levels shortly after the parent’s diagnosis appeared comparable to those seen in our earlier study of adolescents surveyed one to five years after their parent’s diagnosis,” Huizinga added. “The two studies together suggest that PTSS related to parental cancer fluctuate over time, decreasing during the first year after diagnosis and resurging during the years following.”

One of the most important findings of the latest study concerned how aware parents were of the magnitude of the effect the cancer had on their children.

“It appeared that parents were under the impression that children with more severe PTSS experienced problems in fewer emotional, behavioural and cognitive areas than the children themselves reported,” Huizinga said. “The results could indicate that the level of emotional and behavioural problems of children with more severe PTSS is underestimated by the ill parents and even more so by their partners.”

The study found that ill parents were more able to pick up on their children’s distress if the PTSS was particularly severe, but they still reported fewer problems than the adolescents themselves did.

Spouses did not observe any problems in their children in the period shortly after the diagnosis, although they noticed slightly more later in the year.

“It seems that ill parents were better able to judge the situation. They may be more alert to changes in their children’s behaviour than spouses because of a sense of guilt over their illness,” Huizinga suggested. “It may also be that spouses were less sensitive to their children’s functioning because they were often working outside the home, or more focused on the wellbeing of the partner with cancer, their own emotions and on increased household tasks.”

“Our study also found that children with more PTSS had more emotional and behavioural problems, and vice versa. This suggests that children who already have psychosocial problems have more difficulty in coping with their parent’s cancer than children who are doing well,” Huizinga said.

Emotional problems consist of withdrawal, physical complaints and anxiety or depression. Behavioural problems consist of actions that are aggressive or delinquent. Post-traumatic stress symptoms include recurrent and intrusive distressing memories of the event and avoidance of thoughts, feelings or conversations associated with it. Behavioural problems in adolescents with more PTSS were evident in the beginning of the study, but tended to disappear as time went on, while emotional problems seemed to persist.

Healthcare professionals should be made aware of the prevalence of PTSS in children of a parent with cancer, Huizinga said, adding that parents, particularly the spouses of the cancer patients, may benefit from information on children’s reactions and how to seek professional help, if necessary.

European CanCer Organisation