The Father's, Mother's, and Adolescent's Functioning with Breast Cancer

THE FATHER'S, MOTHER'S, AND ADOLESCENT'S FUNCTIONING WITH BREAST CANCER* Frances Marcus Lewis and Mary A. Hammond" The current study used path analysis to examine the impact of early stage breast cancer on the functioning of families with adolescents. Results revealed that the illness-related demands that the mothers and fathers saw impinging on their family predicted higher levels of maternal depressive mood, poorer marital adjustment, and lower parenting quality. When parenting quality was lower, the adolescent scored lower on self-esteem. Family professionals can help couples gain cognitive behavioral control over their perceived illness-related demands, help husbands avoid transferring illness-related tension onto their appraisal of the marriage, and help adolescents appropriately interpret parenting behavior. Chronic medical illness in a parent has been studied primarily from the perspective of the diagnosed patient, not from the perspective of other household members (Hilton, 1989; Lewis, 1986, 1990; Lindsey, Norbeck, Carrieri, & Perry, 1981; Maguire et al., 1978; Peters-Golden, 1982; Wellisch, Fawzy, Landsverk, Pasnau, & Wolcott, 1983). Research on breast cancer has reflected this same pattern. Even when the window of observation into the family's experience with breast cancer has been expanded to include the spouse/partner (Carter, Carter, & Siliunas, 1993; Gotay, 1984; Lewis & Deal, 1995; Northouse, 1988; Northouse & Peters-Golden, 1993; Northouse & Swain, 1987; Sabo, Brown, & Smith, 1986; Wellisch, 1981; Wellisch, Jamison, & Pasnau, 1978; Zahlis & Shands, 1991, 1993), there has been extremely limited documentation of the child's or adolescent's adjustment to the illness (Armsden & Lewis, 1994; Lewis, 1996). Given that an estimated 184,300 women will be diagnosed with breast cancer in 1996 and an estimated 15 to 30% of them will have one or more children still living in the home, this represents a substantial number of potentially affected children (Parker, Tong, Bolden, & Wingo, 1996). Few researchers have examined the adolescent's response to cancer in a mother. Early clinical evidence of the impact of breast cancer on the adolescent was reported by Grandstaff (1976), who observed that adolescents, particularly males, had a difficult time adjusting to their mothers' breast cancer. More recent research has been data based (Lichtman et al., 1984; Wellisch, Gritz, Schain, Wang, & Siau, 1991, 1992). Wellisch et al.'s study, however, relied on the adult daughter's retrospective report of her response to her mother's breast cancer and aggregated data across children ages 0 to 20 years at the time of the mother's diagnosis. Lichtman's team studied the mother-daughter and mother-son relationship but relied on the mother's report of changes in the relationship that were consequent to the breast cancer (Lichtman et al., 1984). The study was also limited because, like Wellisch's research, it relied on retrospective reports and data were aggregated across a wide age span of children's ages. Not only has prior research given limited attention to the adolescent's experience with breast cancer in the mother, it has also overrelied on the diagnosed mother as the sole reporter for the family. With only one known exception, the father's report of his family's experience with breast cancer has received no attention (Lewis, Woods, Hough, & Bensely, 1989), but results from that prior study were limited to children ages 6 through 12. The purpose of the current study was to test a theoretical model of the impact of the mother's breast cancer in adolescent-rearing households from the mother's, father's, and adolescent's viewpoints. The theoretical model derives from stress and coping, developmental, and family systems theories (Brody, Stoneman, & Burke, 1987; Buckley, 1967; Hill, 1972; Kobak & Sceery, 1988; Kobak, Sudler, & Gamble, 1991; Lazarus & Folkman, 1984; Schwenk & Hughes, 1983). …