This month’s Editor’s Choice from Palliative Medicine . . .
Dr Eliza (Leeza) M Park Department of Psychiatry and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, explains the background to a longer article selected as ‘Editor’s Choice’ in the March 2017 issue of Palliative Medicine.
As a practising adult psychiatrist working in oncology, I find that parents with advanced or incurable cancer who also have dependent children can be the hardest to treat. In addition to the physical symptoms, functional limitations, and spiritual distress caused by their disease, these patients also experience extraordinary psychological suffering related to parenting. Parents have immediate and future concerns about their children and profound anguish about their inability to raise their children during their illness and into adulthood. Parental worries about the impact that their death will have on their children can be intense and these worries may shape decision-making about how aggressively to pursue anti-neoplastic treatment options. 1 The intensity of parental worries may also be linked to their co-parent’s mental health in bereavement. 2
Parental cancer is also common. Across many American and European countries, cancer remains a leading cause of early parental loss. In the United States, cancer is the number one cause of non-accidental death for persons aged 25-54 years. Despite the prevalence of parental advanced cancer, there is little research to guide clinicians on how to best meet the unique needs of this patient population. Thus began my foray into clinical research.
With a multidisciplinary team at the University of North Carolina, we conducted a cross-sectional pilot study on the supportive and palliative care needs of parents with advanced cancer. Using in-depth, semi-structured interviews, our aim was to describe the experience of being a parent while living with advanced cancer and to explore how these experiences differed by functional status. Our results revealed that parents with advanced cancer have broad worries about the impact of their illness on their parenting responsibilities and on their children; poorer functional status intensified these psychological concerns. Parents experienced sadness, guilt, and worry about dying before their children reached pivotal life milestones or adulthood. For many of these individuals, identification with the parental role was critical to their approach to cancer treatment decision-making but was rarely discussed with their provider as they assumed they already understood their issues.
Depending on an individual’s prognosis and course of treatments, patients with advanced but incurable cancer are often treated for months or years. For those still raising children at home, this time frame offers an opportunity to discuss parenting-related concerns with their healthcare providers. Ideally, these discussions would inform treatment decisions and prompt parents to take steps to address their psychological concerns. We suspect, however, that this rarely takes place in a systematic manner. However, we remain hopeful that more can be done to alleviate the heartbreak of a parental advanced cancer diagnosis.
- Check DK, Park EM, Reeder-Hayes KE, Mayer DK, Deal AM, Yopp JM et al. Concerns underlying treatment preferences of advanced cancer patients with children Psycho-oncology. 2016; May 26; doi:10.1002/pon.4164
- Park EM, Deal AM, Yopp JM, Edwards TP, Wilson DJ, Hanson LC, et al. End-of-Life experiences of mothers with advanced cancer: perspectives of widowed fathers. BMJ Supportive & Palliative Care. 2016; 6 (4): 437-44.
Read the full article in Palliative Medicine
This blog post relates to the longer article, ‘Parenting While Living with Advanced Cancer: A Qualitative Study’ by Eliza M Park, Devon K Check, Mi-Kiyung Song, Katherine E Reeder-Hayes, Laura C Hanson, Justin M Yopp, Donald L Rosenstein, Deborah K Mayer published in Palliative Medicine 2017, Vol. 31 (3) 231–238. DOI: 10.1177/0269216316661686.
How to download previously published ‘Editor’s Choice’ articles
EAPC members and registered users of the EAPC website can download all ‘Editor’s Choice’ papers free of charge from the EAPC website but you will need to register or login first. Please follow the instructions in the top right-hand corner of the EAPC home page and scroll down to the article. Click here to view other EAPC-originated papers.
Read earlier Editor’s Choice posts on the EAPC Blog.
Call for papers – Special issue on palliative care in dementia in Palliative Medicine. Last date for submissions 31 March 2017
Find out more and submit your paper on the Palliative Medicine website or read the post by Julian C Hughes and Jenny T. van der Steen published on the EAPC Blog.