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The types of cancers that develop in children are different from the types that develop in adults. Although there are exceptions, childhood cancers tend to respond better to chemotherapy. Children also tolerate chemotherapy better than adults. But, because chemotherapy can have some long-term side effects, children who survive their cancer need careful attention for the rest of their lives.

Most children with cancer in the United States are treated at a center that is a member of the Children's Oncology Group (COG). All of these centers are associated with a university or children's hospital. As we have learned more about treating childhood cancer, it has become even more important that treatment be given by experienced experts. To find a listing of COG institutions by state, go to their Web site at http://www.curesearch.org/resources/cog.aspx.
What is childhood cancer?

 
About 10,730 children under the age of 15 in the United States will be diagnosed with cancer in 2008. Because of significant advances in treatment, 80% of these children will survive 5 years or more. This is a major increase from before the 1970s, when the 5-year survival rate was less than 50%.

Despite its rarity and the major advances in treatment and supportive care, cancer is still the leading cause of death from disease in children younger than 15 years old. About 1,490 children will die from cancer in 2008. Cancer deaths are second only to accidents in most age groups.

 

The types of cancers that occur in children vary greatly from those seen in adults. Leukemias, brain and other nervous system tumors, lymphomas (lymph tissue cancers), bone cancers, soft tissue sarcomas, kidney cancers, eye cancers, and adrenal gland cancers are the most common cancers of children. In contrast, skin, prostate, breast, lung, and colorectal cancers are the most common in adults. The stage of growth and development is another important difference between adults and children. The immaturity of children's organ systems often has important effects on treatment. 

American Cancer Society

 

 

 

 

The diagnosis of cancer in a child or teenager is a devastating blow to the parents and other family members who love the child affected. Cancer creates an instant crisis in the lives of the family. Ordinary daily life is no more. Parents must be away from work so they can be with their child. This may mean that siblings may be cared for by relatives or neighbors. The ill child or "the patient" becomes the major focus of family time and attention and other concerns are put on hold. Parents are given detailed information about the diagnosis and about available treatment. They must understand enough about the process to feel comfortable enough to give permission for tests and procedures, sign consent forms for treatment, and make important decisions about their child's care.

 

Generally, all of this happens in a very brief period of time. In the first days and weeks after the diagnosis, parents describe being on an emotional rollercoaster or simply feeling like they are in a bad dream.. The feelings they report seem universal to all parents going through such a difficult time. What they actually say or do to express these feelings differs. How they handle their emotions usually reflects unique life experiences, cultural differences, and their individual coping styles in response to major distress.

 

No one is ever prepared to hear that their child has a life-threatening illness. At first, depending on their knowledge or personal experience with cancer, they fear that their child is going to suffer, perhaps die. At the least their family will experience extended loss and upheaval. They often describe feeling numb or as if they have been hit over the head by a baseball bat or something like that. Parents also report feeling confused or being unable to hear, remember, or think clearly when they are given information about their child's diagnosis or treatment plan. This numbness allows them a little time to tolerate the painful feelings that tear through them. It gives parents time to gradually absorb and face these difficult emotions. 

 

Disbelief and Denial

 

When parents are first told their child has cancer, it just seems too horrible to believe. Their child may not seem sick enough, or look sick enough, to have such a terrible problem. They may question whether the lab could have made a mistake or if the test results are really those of another child. They may wish to check on the reputation of the staff or medical center. If a diagnosis is hard to make, they may wonder if the medical staff knows as much as they should. They may decide to seek a second opinion. Initial disbelief or denial, like shock, can buffer painful feelings. It is also a way for parents to gain time to adjust to the reality of their child's diagnosis and to confirm that their child will receive necessary and appropriate treatment. Denial is not a problem unless it interferes with timely treatment.

 

Fear and Anxiety

 

Being anxious and fearful when events and their outcomes are unfamiliar and beyond our control is a normal human reaction. Fear of cancer is universal. A family's only first-hand encounter with cancer may have been with an older family member (when it might have seemed more acceptable or understandable). There may be stories about the problems other family members or friends had with chemotherapy or radiation therapy, or beliefs that having cancer is a death sentence. If a child is diagnosed in a major medical center, parents may believe rumors they have heard that doctors in big hospitals "experiment" on patients. Since doctors cannot guarantee exactly how each person will respond to cancer treatment, fear of the death of a child or teenager is real. Relying on the knowledge and skill of others to protect the life of a much-loved child is frightening. Usually this is what the parent does. Now a parent must trust others to take care of their children. That's hard to do. Also, facing major changes in daily life is upsetting and parents worry that they may not be up to all the tasks that will be asked of them. They may also be worried about their child getting through the necessary treatment. They fret about the impact treatment will have on their child's body and self-esteem. Fear of intensive treatment, of an uncertain future, and of the unknown are all understandable fears.

 

 

Questions of guilt come up soon after parents accept that their child really does have cancer. Parents have the major task of protecting their child from danger. They may question what behavior or action of theirs may have contributed to their child having this life-threatening disease. Could this be "payback" for past sins or the result of drug or alcohol abuse? Has their smoking caused the cancer? Mothers sometimes wonder if something they did or failed to do during pregnancy may have made a difference. A family history of cancer may lead to feelings that one parent or the other has "bad" genes. They may question the safety of where they live, the water supply they use, or wonder about toxins in the environment or in their home. They are concerned about whether something related to their occupation might be responsible for causing the cancer. Parents also voice guilt about not paying enough attention to their child's symptoms. They worry that they did not seek prompt medical attention or that they did not demand a specialist see their child when symptoms persisted. While it is normal to try to understand the causes of a problem, the fact is we do not currently know what causes most cancers. Parents are not at fault for their child's cancer. Most children are diagnosed and begin treatment quickly. If you have feelings of guilt ask the medical team about your concerns.It is important not to let guilty feelings distract you from the many tasks you face when your child has cancer.

 

 

Of course you will feel sad when your child is diagnosed with cancer. Every parent hopes and dreams that their children's lives will be healthy, happy, and carefree. Cancer and its treatment change that dream. Parents will grieve for the loss of parts of those hopes. In grieving, they may have feelings of hopelessness about their child's recovery. They are also sad when they think about the difficult days of treatment that lie ahead. The intensity of their feelings generally matches their child's outlook for recovery, but also reflects their own temperament and personality. One parent may be more naturally optimistic, while another may react more negatively to any life problem. Parents may find it hard to eat or sleep. They may not have the energy they need for routine daily tasks or for facing all they need to do now that their child has cancer. Parents often report feeling overwhelmed by their child's diagnosis. Unfortunately, parents cannot be spared these painful and unpleasant feelings and will experience them throughout their child's illness.

 

 

The fact that cancer threatens the life of an innocent child makes parents angry at the cruel and random injustice of life. When someone we love is attacked, even by illness, it is easy to want to blame someone or ask why me or why us? This anger is sometimes directed at the doctors who made the diagnosis and outlined the difficult treatment. In other cases, God is the object of rage as parents question a world in which children become ill and suffer and die. Parents also feel upset at the experiences they know their child will face, including the diagnostic tests and invasive procedures. The daily frustrations of dealing with a large and complex health care system, strange surroundings, and numerous care providers are also sources of discomfort. Parents may feel resentful with one another over past or current issues that now affect their child's treatment. Anger also may be directed at family or friends who make thoughtless remarks or who are too busy to provide support. Parents are sometimes surprised and guilt-ridden to discover that they are even angry with the child whose illness is causing so many problems for the entire family or who is not cooperating with the doctors and nurses. Some parents hide their anger or even deny that they feel that way since they believe that such feelings are "not nice". Others express their anger in explosive and hostile ways, targeting particular individuals for blame. Sometimes other children in the family become a convenient target for that anger. Since parents and the care providers must work together to help the child or adolescent deal with the cancer and its treatment, it is important to find healthy ways to express anger and resolve valid complaints.

 

Most parents worry, privately or out loud, about their ability to "handle" the painful feelings that come with a child having a cancer diagnosis. However, most parents have great strengths when it comes to protecting and caring for their children that will overcome any personal pain. Developing trust in and using the available team of experts can be very helpful. Social workers, nurses, doctors, and others who are part of the health care team can help parents understand the variety of emotions and that what they are feeling is normal. Experts can also help teach new skills, such as relaxation and stress management. Parents also can learn to handle feelings if they take care of their personal needs regarding eating, sleeping, health problems, exercise, and taking breaks from caring for their child. They also may need to see their family doctor for any new personal health concerns.

 

Grandparents, aunts, uncles, or other close family relatives often have feelings similar to those of parents and may struggle to manage many of the same emotions. They usually will benefit from accurate information and being asked to provide practical help. Team members can also help them discuss and handle their feelings. Occasionally, parents wish to shield particular family members from the news of the diagnosis because of concern about its emotional impact. The health care team can offer help for parents who must address these sensitive issues. In general, secrets in a family tend to close communication down rather than open it up and that tends to make communication not as healthy as it could be.

 

Feelings often just appear whether we like it or not. How we choose to express them, however, generally is under our control. Reactions to a major life crisis such as the diagnosis of cancer in a child or teenager are upsetting and painful, but natural. Most patients and family members express their feelings and manage them the best they can. Parents can help their child by showing that they are not ashamed or afraid to show what they feel, but also by remaining in some control of their emotions and focusing on moving forward.