The diagnosis of cancer affects the entire family. For the
siblings, the initial period can be a time of
. Children, even young ones, are sensitive to what is
happening. They are aware of a brother's or sister's
hospitalization and of trips to the doctor and clinic. They notice
their parents crying and trying to comfort one another. They may
overhear parts of conversations that are difficult to understand.
Children often conspire to figure out what is going on. Pieces of
information are gathered, pooled, and analyzed. Because of this, it
is important to take time early in the diagnosis and treatment
process to have an honest discussion of the situation with the
siblings. Encourage them to ask questions and answer these as
honestly as possible.
Explain the facts about cancer, keeping in mind the
of each child, and update the information
periodically as the siblings and patient get older and are able to
understand more.If the siblings are very young, it may be enough to
say that their brother or sister is sick, will have to stay in the
hospital for a while, and will need to take medicine for a long
time. Older children will require more detailed information about
cancer and its implications. Siblings should be prepared for
physical changes in the patient, such as hair loss or amputation.
If you wish, the doctors or nurses who care for the patient may be
called upon to explain the diagnosis, prognosis, and treatment to
the siblings or to discuss it with the entire family.
All of the children need to know that cancer is not contagious
and that they will not become sick from contact with the patient.
They need to be reassured that they are healthy themselves and that
the possibility of cancer running in the family is highly unlikely.
Siblings also need to be told emphatically that they are in no way
responsible for the illness. Angry outbursts, such as "Drop dead! "
or "I hate you," which are said by all normal children at one time
or another, frequently haunt a child after learning about a
sibling's illness. Feelings of guilt or wrongdoing need to be dealt
with immediately. Failure to do so may result in problems later
Feeling left out
Siblings of cancer patients may have many different feelings
about the patient, the illness, and the attention the patient
receives. While sympathizing with their brother or sister who is
ill, they may still feel some
and believe that
they are being neglected. In many cases, this is true. During times
of hospitalization or when the patient is not feeling well,
attention may focus on the sick child. As parents, you may not be
able to pay as much attention to the siblings as you did before.
You may have to miss school functions or ball games in which the
siblings are participating. You may have little emotional reserve
left after dealing with your sick child to talk with siblings about
their concerns, to play with them, or help with their homework.
When you do have the energy, try to make special time for the
siblings. Encourage them to become involved in outside activities
and make a point of recognizing their achievements. When you can,
make plans to spend time alone with them and do things that
Others may focus special attention on the sick child. It is not
unnatural, then, for siblings to resent the "privileged status" of
the sick child in the family, neighborhood, and school and the lack
of attention to their own needs. Talking with siblings about the
special attention paid to the sick child, letting them know that
feelings of resentment are natural, and enabling them to share in
the family crisis will encourage healthy growth and maturity.
Efforts should be made to give equal attention or explanations when
this is not possible.
Get them involved
One way to help them to understand their brother's or sister's
illness is by involving them in the treatment. Older children in
particular welcome the opportunity to be taken into their parents'
confidence and will often respond in helpful ways. Finding things
for them to do for their sick brother or sister, or their worried
parents, gives many young people a sense of belonging and
usefulness that might otherwise be lacking in the family's focus on
Siblings may accompany you to the clinic when the patient gets
treatment or, if possible, visit when the patient is hospitalized.
This will allow them to see for themselves what the hospital,
clinic, and treatment are like. If this is not possible because of
distance, try to describe the setting and situation.
may also be helpful.
Siblings may need such concrete experiences or explanations to
prevent the construction of fantasies about the hospital and the
hospital experience. Fantasies may range from fearing that the
patient is being tortured to believing that the patient is having a
good time; siblings may be terrified or jealous.
Remember, the patient's brothers and sisters may be asked
questions about the illness by schoolmates or others in the
community. They should have enough information to answer these
questions. In fact, you might want to help them anticipate
questions or comments and discuss possible answers.
Behavior changes among siblings of young people with cancer are
common and can indicate that they are having trouble dealing with
the situation. They may become
, or begin to have
problems in school
can help them cope with their
feelings, and treatment center staff can help with this. If their
teachers are aware that a brother or sister has cancer and that
this might affect the student, teachers can alert you if problems
arise at school. Remember that siblings, like all children, don't
care about tomorrow and want equal treatment and attention today.
It helps to appreciate them as individuals and to make a special
effort to keep in touch with their needs.