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Texas Hospitals Help Children Cope With a Parent’s Cancer

Monday June 2, 2008
Former M.D. Anderson patient Alicia Bennett with her two children.
Former M.D. Anderson patient Alicia Bennett with her two children.
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A parent’s cancer diagnosis affects the whole family, potentially damaging everyone’s physical and mental health. Parents anguish over what to say to their children. Stress of this kind understandably disrupts young children’s and teens’ overall performance and behavior. To help, CLIMB, a free support program, is offered by MD Anderson Cancer Center in Houston, The Presbyterian Hospital of Dallas and University Medical Center Southwest Cancer Treatment & Research Center in Lubbock, Texas.

Nurses helped develop CLIMB – Children's Lives Include Moments of Bravery – curriculum, provided by The Children's Treehouse Foundation. Typically, six to 10 children, ages 7 to 14, meet for weekly sessions that include discussions, tours and activities designed to teach them about cancer, coping and communicating. Parents gather informally to discuss the children’s session.

“CLIMB is as much for patients as their children,” says Joyce Lee, RN, OCN, an inpatient oncology nurse at The Presbyterian Hospital of Dallas. “It definitely impacts health if parents can’t focus on themselves and getting well.”

Children in CLIMB create masks showing their outside and inside feelings; make strong boxes and dice labeled with their strengths and positive stress responses; and write cards to their parent, completing phrases, “I wish you…” “Sometimes I worry…” “I want you to know…” and “I hope you….”

“Children [kept] in the dark can’t help, don’t visit, and they act out,” says Lee.
Parents may be denying reality, unwilling to worry children, or unsure how to handle questions. And, without answers, children may begin to believe that they’re unwanted and a burden.

“We must initiate conversations about children, because they won’t,” says Lee, who often refers patients to CLIMB. “They don’t realize a lot of parents have similar problems, and they’re embarrassed. One mother was in the hospital a lot, and her kids were looking for attention. While we were giving her pain meds, she’d be on the phone trying to discipline her kids for fighting and problems at school.”

As health advocates, nurses should ask parents how they’re coping with their own needs and if they’re getting help handling child-rearing demands, so neither is neglected.

“[CLIMB] was fun, but the best part was explaining my feelings to people who understood I was sad,” says Bailey Maxson, 11, who attended Presbyterian’s CLIMB program with his sister Audrey, 8, last year before their father, Paul, died. “I didn’t know any other kids whose parents had cancer. I talked to them about my Dad and how it felt.”

Their mother, Marla Maxson, said: “We were very open about my husband’s cancer, but CLIMB really helped our children. They covered a different emotion every week—happy, sad, angry. They liked going, and it was a good emotional outlet. They need to talk to someone other than parents.”

Asked and Answered

Children’s concerns range from simple to sophisticated. Kimberly Burns, APN, a women’s health nurse practitioner at MD Anderson Cancer Center’s outpatient clinic, answers CLIMB questions about symptoms, diagnosis, transmission, malignancy, and even donating bodies to science.

Children need reassurance that they can’t catch cancer from contact or sharing food, said Burns. They also ask about terminology and diagnostic procedures including imaging, biopsies and needle aspiration. Burns also shares children’s concerns with parents.
Alicia Bennett, a former patient at M.D. Anderson, said it was too difficult for her sons to ask her about death, but they were able to ask CLIMB volunteers.

“At 6, it was too gut-wrenching for my son Hayden to ask me about death, so he asked them,” she said. “CLIMB shows it’s OK to have feelings and how to manage them.”
Teaching children not to hide or ignore problems sets a healthy precedent.

“Keeping children in the dark will cycle back,” says Lee. “They’ll be afraid of hospitals, cancer, and things they can’t avoid.”

Wendy L. Bonifazi, RN, CLS, APR, is a senior staff writer for Nursing Spectrum and NurseWeek Magazines. To comment on this article e-mail editorSC@nurseweek.com.