The present study showed that 82.5% of ill parents disclosed the diagnosis to their children sparing preschoolers in 61% of cases. Half of parents considered that the announcement procedure was stressfull despite de-dramatizing approach (41%). The parent’s cancer experience impacted children behavior in 96% of cases and divorced parent was significant predictive factor of behavior change.
In our study, It seems that the majority of patients disclose the truth to their children in Tunisia. Moore and al found that a fifth of parents had not used the word “cancer,” even three or more years after initial diagnosis [6].Not disclosing the illness truth was more registered in the preschoolers group.The literature relates the same ascertainment, it was reported that 61% of parents with cancer whose oldest child was 18–21 years think that open communication about the disease would benefit children vs only 42% with eldest child of 3–6 years [6].
De-dramatizing approach in our study was particularly seen with preschoolers. Similarly, Moore and al reported that only 27% of parents whose oldest child was between 3–6 yrs, vs. 92% of parents whose oldest child was 18–21 years, employed the word “cancer [6].
Hiding the truth or part of the truth could affect the trusting relationship between ill parent and children. In fact a study by Korneluk et al. showed that children and adolescents want honest, accurate, and complete information [7].
The announcement procedure was lived as a stressful and hard experience by half of our patientswhich could makingthem more vulnerable and increasing mental troubles. A study of 194 adults with cancer registered a decrease from 60–11% in “good”caring for their children, leading to an increase in anxiety and depression [8].
Thus, one of the first interventions is to start by taking care of parental mental health. Many studies found that better psychological functioning of the ill parent was associated with better psychological functioning of the child [9].
Many patients in our study (88.3%) reported communication disorderswith their children when referring to the parental illness.It is essential to give support to parents in how to clarify their diagnosis in an age-appropriate way and to provide children the possibility to express their questions and worries in order to adopt better coping strategies [10].
In our study, adolescents askedmore frequently about the parent’s illness than did school-aged children and preschoolerswhich could be explained by their maturity and background.On the other hand, adolescents look especially for long term implications of cancer and the possibility of inheritance [7, 11, 12].
In our study, anxiety and addiction were more observed with adolescents, school aged children express more depression and aggression.In the literature some quantitative studies did not report any differences in the prevalence ofbehavioural problems (delinquency or aggression) between school-aged or adolescent children of cancer patients and controlgroup [13, 14]. These findings seemed to be variable in function of cultural background
School failure is one of the redoubtable changes. In our study,it was reported in more than half of cases mainly seen in children aged 6–12 years. This scholar impact in this age group could be explained by the fact that elementary school-aged children feel responsible for their parent’s illness, and are more troubled by the visible physical changes such as hair loss and frequent vomiting [8, 15].
Moreover, Issel and al found that school-aged children report to have no one to help them cope with parent illness [16]conversely to adolescents how reported to have more people (parent, school nurse or counsellor, teacher) to count on [17].Chalmers and al reported also that school was an essential source of support for adolescents [18].
In our study, divorced parents reported more children behavior changes. Some studies showed that children from single parent families express lower global self-esteem and social acceptance and had higherbehavioural problems thanchildren of two-parent families [19, 20].This finding could be explained by the fact that children from single parent families are more involved in the illness process [21, 22].
In Tunisia access to psycho oncology consultation is difficult. In our study only 8.7% of parents consulted a pedopsychiatrist. Nowadays there is an increasing number of patients and families seeing psycho-oncologic services [23]. An adequate children care starts by looking after ill parents’ mental healths. A psychological support program should begin since diagnosis in order to help patients to accept the disease and to adhere to treatment .
Health and education ministries should collaborate and propose national support programs to children of ill parents by offering systematically pedopsychiatrist consultation since the diagnosis regardless of the age of children. These programs aim to detect children toubles, to educate parents on how to announce the diagnosis to children, how to answer their questions and to deal with behavior changes. Careful attention should be made to children of single parent families. Remedial courses at school and home during the period of parent’s treatment should also be programmed especially for children aged 6–12 years.
Government must provide also financial support, if needed, to families especially when ill parent used to work in order to maintain family’s financial balance which is important for children needs.
Our study focused on an understudied population. It included varied profiles. In the other hand, some limitations could be highlighted:This study is monocentric and the size of the studied population is limited. Larger studies with participation of different specialists (pediatricians, psychiatrists, pedopsychiatris and oncologists) are needed in order to identify different sides of the problem and to propose adequate solutions. Children did’nt participate in the survey and only parents respond to questions which can not be faithful to reality. Male patients were underrepresented; this is a selection bias since breast cancer is the predominant malignancy. The impact on children may be different if fathers were more represented because of the nature of Tunisian families functionning based more on mothers.