Parental Cancer: The Parent-Child Bond at Risk

Within the field of psycho-oncology, it has become increasingly apparent that cancer not only affects the patient, but disrupts the entire family unit, particularly adolescent children. The goal of the current study was to take the next step in this line of research by investigating mechanisms of influence for how parental cancer impacts adolescent adjustment. The framework of attachment theory was applied to make theoretically driven predictions and to create models for how and why these effects would occur. It was hypothesized that many of the adjustment problems found in teens dealing with parental cancer would be related to negative changes in the parent-child attachment relationship. Adults recently diagnosed with cancer, and their adolescent children were asked to complete measures assessing: adolescent and parent functioning, adolescent attachment, adolescent coping, and cancer specific variables. In addition, a matched comparison group completed similar measures (without cancer specific questions). As predicted, adolescents in the parental cancer group displayed more insecure attachment to parents. They also used more Secondary Control Coping (emotion oriented) while the comparison group tended to favor Primary Control Coping (problem focused). In contrast to prior research, we found no differences in adjustment between the two groups. However, after controlling for attachment style, adolescents with a parent with cancer actually reported fewer problems that those in the comparison group. Further, analyses with the groups combined confirmed that attachment style predicted coping, stress responses, and adjustment in the expected ways. Hypotheses were also tested within the cancer group alone to determine what aspects of parental cancer lead to teen difficulties. We found no effects for cancer stage or site, or parental mental health. The effects for perceived severity of illness, which has been widely documented in the literature, were unexpected and initially appeared contradictory. Adolescents who reported higher perceived cancer severity and higher impact of cancer on life in general, had better overall personal adjustment as well as more clinical symptoms. In addition, adolescent emotional symptoms were negatively associated with the amount of information a teen had been given, and positively associated with the number of cancer-related stressors reported. Additionally, attachment style fully mediated the effects of cancer-related stressors on adolescent-reported emotional symptoms. In conclusion, support was found for our hypothesis that many of the previously reported difficulties in teens dealing with parental cancer were actually due to changes in the parent-adolescent attachment relationship. Furthermore, within the cancer group, attachment style fully mediated the effects of cancer-related stressors on adolescent emotional symptoms. There were also interesting findings in this study suggesting posttraumatic growth in adolescents dealing with parental cancer. Several other important variables were predictive of adjustment, such as amount of information given to teens about cancer. This may provide some hope for families as well as implications for intervention and future research.