Learning Objective #1: Recognize the symptoms and the problem behavior in children who have a parent with cancer

Learning Objective #2: Gain evidence-based understanding of variables that impact children's responses to having a parent with cancer that may be useful for anticipatory guidance

---

Background: Cancer is the second leading cause of death in the United States. Approximately 128,089 children per year have a parent diagnosed with cancer. How well children cope with this pervasive stressor, and the effect on their body, mind and behavior is largely unknown. Theoretical framework: This study was based on an integration of Lazarus's cognitive appraisal theory of stress and coping, cognitive, social and emotional developmental theory, and physiologic stress response theory. The purpose was to characterize the stress-coping process of children ages 7-12 who have a parent with cancer. Methods: Based on a power analysis, a convenience sample of 51 school-age children were recruited for this descriptive, cross-sectional study. Recruitment sites included a University support group for children (new members only), oncology outpatient clinics and inpatient units. Data included children's appraisal of their parents' cancer, 3 morning saliva cortisol samples, a human figure drawing, children's self-report of concurrent stressors, coping, stress symptoms, and quality of their relationship with each parent, and parent-report of child problem behavior and quality of their own relationship with the child. Results: "Pray" was the most frequently used and effective coping strategy. The average cortisol level of the children was within the normal range. Stress symptoms were predominantly cognitive-emotional such as worried, cry or feel sad, afraid, nervous, bad, mad, and confused. More than half of the children's drawings revealed clinically significant emotional indicators. The better the child-mother relationship, the more the children believed that their parents' treatment would work, and the lower their problem behavior scores. Implications: Findings will increase nurses' awareness that the stressor of having a parent with cancer has been shown to lead to cognitive-emotional symptoms and problem behavior in children, and determining children's perceptions of the quality of their relationship with their mother may be useful for anticipatory guidance.