Old enough to know better: how teenagers cope with a parent's cancer

When his wife was undergoing treatment for breast cancer, Marc Silver admits he didn't always consider how her illness affected their two teenagers. Now he – and his elder daughter – have some advice for other families

Hard times: Marsha Silver during her treatment for cancer, in a family photo with daughters Maya (left) and Daniela (Washington Post)

My daughter Maya is in the family room watching TV. I'm heading out to buy ginger sweets for my wife, Marsha, who's upstairs in bed, feeling queasy after her latest round of chemotherapy.

"Going to get something for Mum; be right back," I call to my 15-year-old.

"How is she doing?" asks Maya.

In my head, I think: "Why don't you ask her yourself since she is just one flight of stairs away!" But I bite my tongue. I don't want to add to the tension that cancer has already brought to our home.

Looking back, I realise that Maya wasn't the only family member to avoid direct communication during the seemingly endless months of treatment for Marsha's breast cancer. Consumed with all things cancer, my wife and I never asked her and her younger sister, Daniela, who was 13 at the time: "How are you doing?"

Many families find themselves in a similar situation: parent with cancer, teens in the house, not a lot of cross-generational conversation. Tens of thousands of children live with a parent who is a cancer survivor. Roughly a third of those children are 13 to 17 years old. While parents pay a lot of attention to the needs of younger kids, they may figure, as we did, that teens are old enough to cope.

"Adolescents are an unheard group," says Shara Sosa, an oncology counsellor. Unfortunately, the nature of adolescence fights against openness of any kind, never mind the cancer in the family.

"With their kids locked behind a mask of teen indifference, parents are often intimidated and don't know how to talk to them," Ms Sosa says.

Teenagers are pulling away from the family, forging their own identity. The news that a parent has cancer yanks the adolescent back into the fold – exactly where they don't want to be.

The reaction of a teen to a parent's illness varies widely. Some respond with a disappearing act: after-school activities, shopping trips, sleepovers, you name it, they'll do it to avoid the uncertain environment at home. It doesn't mean they don't love and care about the parent with cancer – it's just their way of dealing with it all, says Maureen Davey, a family therapy Professor at the Drexel University College of Nursing and Health Professions, in Philadelphia.

Does that mean these kids are likely to turn to risky behaviour? Mental-health experts say that there are no data to quantify this and emphasise that most of the teens they work with do not act out. Yet typical teen temptations are always present.

Of the 100-plus teens who my daughter Maya and I interviewed for a book we wrote about teens and parental cancer, around 10 per cent confessed that they'd turned to drinking, drugs or vandalism as coping mechanisms.

Elissa Bantug, who was 12 when her mother was diagnosed with breast cancer 21 years ago, felt as if her mother had abandoned her. She drank, hooked up with an older boyfriend and forged her mother's name 36 times on notes to get out of school. When the school asked her mother to come in for a conference, she felt too exhausted from her cancer treatments to turn up.

It's impossible to say if Elissa would have acted out if her mother had been well. Still, looking back as an adult, Elissa says: "I felt like no one really talked to me."

And she had lots of questions: would her mother be OK? What does it mean to be a cancer survivor? How would their family life change in the short run and the long run? Her rebellion, she says, was sparked by a lack of information.

Others respond by defying their developmental stage, assuming responsibilities that normally fall to the parents. Out of sync with their peers, these kids sometimes talk about their real age and their "cancer age".

"I'm 16, and I have to act like I'm 40," a teenager named Lyndsey told me. While her mother is in treatment for breast cancer, she says, "I have to cook, clean, make sure my mum eats, my brothers are fed."

A "parentified" teen will inevitably feel frustrated. Teens may be "angry they have to take over everything and nobody appreciates that they're doing so much more than they used to," says psychiatrist Karen Weihs, medical director for supportive care at the University of Arizona Cancer Center in Tucson.

Stacy Hoover, a single mother, learned she had breast cancer when her daughters were 13 years old, and 18 months. She leaned on the older daughter, Megan, which took a toll. "Sometimes I wanted to go over to a friend's house, but I didn't want to leave my mum with the baby," Megan recalls. When chemo made her mother irritable, Megan says: "It was hard not to yell back."

No matter how the teenager responds, the parents can help shape the child's frame of mind. That means sharing information, regardless of whether the news is good or bad.

Indeed, several studies establish the value of honest communication above all. Medical psychologist Stacey Donofrio looked at nearly 300 adolescents in the Netherlands who were coping with a parent's cancer. She found that "the intensity of the parent's treatment" for illness was not as important in influencing adolescent reactions as the way parents talked to the kids about it.

"Adolescents may feel especially uncertain if they feel their parents are not being entirely open," she said.

Such an information gap elevated the tensions for Jackie Shmauch, a teenager whose father had leukaemia. One night, the 14-year-old fled her home in tears after eavesdropping on a call from her father's oncologist. Jackie thought her father's leukaemia was in remission, but she overheard a discussion of a bone-marrow transplant. After her parents found her at a friend's house, they explained that the transplant was a preventive measure, not a sign that the cancer was back. That's when Jackie delivered her ultimatum: "If there is information you have and you think you shouldn't tell Jackie, that's what I want you to tell me."

Yet not every teen is like Jackie.

"If your child says, 'Talking about this with you is not helpful to me', it's important to respect that," says child psychiatrist Paula Rauch, who directs the Marjorie E Korff PACT Program (Parenting at a Challenging Time) at Massachusetts General Hospital in Boston.

It is critical for parents to remember that, cancer or no cancer, they still need to keep an eye on their teenagers – no easy task, especially when one of the parents is ill. The key, Ms Sosa points out, is listening closely even though "your head is in so many different places" because of the cancer diagnosis. That means asking follow-up questions, even challenging your teenager at times. If teens know you're truly paying attention, she says, "they're going to tell you all sorts of things".

Some teenagers may just need a break from all the care-giving – perhaps by having other family members or friends shoulder the young person's chores from time to time.

"Just to be 12 again, that was really quite a blessing," recalls Bailee Richardson, now 19, who cared for her two younger sisters while her mother was being treated for breast cancer and her stepfather was working out of town.

A decade after my wife's diagnosis, Marsha is in good health, but she and I are just beginning to understand how the experience affected our daughters. Maya tells me how uneasy she was with her mother's bald head, courtesy of chemo, and that she found relief from the free-floating cancer anxiety that infiltrated our home by turning to friends, even if they didn't quite understand what she was going through. And she's sorry she didn't help out more.

I, too, was sorry she didn't step up. But I made the mistake of assuming that Maya and her sister could read my mind. I once exploded when my daughters didn't rush to my aid as I dragged in bags of groceries after a day of errands.

"Can't you give me a hand?" I yelled.

Maya calmly said: "We'd be happy to if you'd ask us."

Mark Silver is the author, with his daughter Maya, of 'My Parent Has Cancer and It Really Sucks'.

A version of this article first appeared in The Washington Post