Photography Darren Chang
Your doctor has just dealt you the dreaded C word. How do you break the news to your children? EVELINE GAN finds out.
A cancer diagnosis is a frightening experience. Throw young children into the equation, and navigating the life-threatening illness often becomes more complex. Parents who have been hit by the disease tell Young Parents that one of their topmost concerns following their diagnosis is: Should I tell the kids? Kelvin Choo, 50 (pictured overleaf), chose not to share the news with his four children while he was battling advanced colon cancer in 2012 and 2013.
As part of his treatment, the primary-school teacher had surgery to remove 15cm of his large intestine and undergo chemotherapy. His reason: At just two to seven years old then, they were too young to understand the gravity of the situation. “My wife and I just told them that I was not feeling too good and needed some time to recover,” says Kelvin, who is one of the 17 ambassadors for Run For Hope 2016.
The annual run, which took place in January, was organised by Four Seasons Hotel Singapore, Regent Singapore and the National Cancer Centre Singapore (NCCS) to raise awareness and support for cancer research. Another parent, Janice (not her real name), kept her condition a secret up until a few weeks before her death. The 40-something did so to protect her only child from the horrors of the disease, which could not be contained despite aggressive treatment.
But when she called her 10-year-old son to her bedside in the last weeks of her life, he rejected her. By then, she had physically deteriorated so much that she was a shadow of her former self, shares Jayne Leong, manager of Psychosocial Services at the Singapore Cancer Society (SCS), which had provided home hospice support to Janice’s family. “Nobody told or prepared the boy earlier. The dying mother wanted her son to be near her. But to the child, witnessing his mother’s physical change must have been frightening,” says Jayne.
When secrecy backfires
Despite parents’ good intentions to protect their child, counsellors say hiding the disease beneath a shroud of secrecy can backfire. This is because children, even the really young, are able to observe what is happening around them, shares Travis Loh, principal medical social worker from the division of psychosocial oncology at NCCS.
“Children can recognise that ‘something is not right’ when their parents are sick,” adds Saryna Ong, principal medical social worker from the division of psychosocial oncology at NCCS. When not given the right information, kids become more frightened. In addition, says Jayne from SCS, trust may be broken if the child hears about the diagnosis from another person other than the parent himself.
Sharing information about the illness early – in an ageappropriate manner (see How to break the news) – opens the door for communication between parent and child. It also addresses any misconceptions the child may develop when they are being kept in the dark, Travis adds. “Parents want to protect the child, not realising that kids need help to make sense of reality,” Jayne says.
A case in point: In his naive 10-year-old mind, Janice’s son had blamed himself for his mother’s cancer. “He thought his mother was very sick because he was naughty. Children may think their parent’s illness is their fault, when not given information and assurance,” Jayne adds.
Why we told the kids Senior enrolled nurse Zulfa Anas, 47, has seen first-hand the lasting regret secrecy can cause. She was diagnosed with a rare bone cancer in 2006 and has suffered two cancer relapses since then. A mother of two boys aged 12 and nine, Zulfa shares: “My friend didn’t tell her teenage sons she had cervical cancer until it was too late. At her wake, her children were so angry that they were not informed about her illness earlier. They also had a lot of regrets about not spending more time with their mum.”
12,000 The number of new cases of cancer diagnosed each year between 2010 and 2014, a fourfold increase from about four decades back, according to figures from the Singapore Cancer Registry.
Photography Darren Chang
“My wife and I just told (the kids) that I was not feeling too good and needed some time to recover.”
Cancer survivor Kelvin Choo with his family.
Saryna from NCCS says giving children appropriate and timely updates on their parents’ disease helps minimise the shock they may experience if bad news is broken to them suddenly. For that reason, Zulfa has openly shared and involved her sons in her cancer journey.
She has even informed them who will take care of them, in the event that she passes away. “I don’t want my kids to blame me or feel lost if I’m no longer around,” says Zulfa, who is currently on maintenance treatment. Her condition is stable, but the doctor has not given her the all-clear. Similarly, being upfront about her illness was a necessity for Sandar Myint, 45, who is currently battling Stage 3 breast cancer. Her three children are aged 14, nine, and five years old.
“They realised very early on that their mother was seriously sick when we brought them along to the hospital during her treatments because no one else could care for them,” shares Sandar’s husband, Nay Myo Hun, 38. “The illness has also affected our finances, so we had to explain why we could not afford many things when the new school term started. I felt embarrassed telling the kids about our financial struggles, but it was necessary for them to understand.”
Life still goes on While it might not always be possible, maintaining normalcy in your child’s schedules will help him feel more secure. Despite having no domestic help at home, Kelvin and his wife, a 42-year-old insurance agent, tried to stick to their children’s regular routine as much as possible.
They formed a tag-team, working out a schedule to manage the kids’ routines, their work and Kelvin’s treatments. “The children were very young. It was important for me to juggle between their daily life and my recuperation. The only setback was not being able to take them out during my treatment. But we made up for it by watching movies or playing educational games together at home,” says Kelvin, who is currently cancer-free and does not require further treatment.
He eventually told his children about his brush with cancer, when the topic of death came up after his father passed away from prostate cancer last year. “They are now older and at an age where they would ask many questions. We explained what cancer is, and they have also found out more information about the condition through the media,” he says.
Kids need support Telling your children about your illness is important; so is offering them ample support. But for parents struggling to cope with their disease, that can be a huge challenge, according to counsellors. Jayne of SCS advises parents to rope in professional help – available at the society and all restructured hospitals with a team of medical social workers – if they are unable or do not know how to do this.
They should also watch for changes in their child’s behaviour – it may affect their academic performance, regular activities and mood. “The ways children cope with difficulties in their lives can be very different from that of adults. They do not necessary always verbally share their feelings and struggles. Hence, engaging them through non-verbal means, such as through play and art, can be more effective at times,” notes Travis.
SCS and NCCS currently have support programmes in place to help children cope. About 100 kids have gone through NCCS’ art therapy and bereavement programmes. Its medical social workers also provide counselling and psychosocial support to children affected by their parent’s illness. Over at SCS, the Help the Children and Youth Programme comprises educational financial assistant schemes, free home tuition programme and activities such as camps, book prizes and family engagement programmes.
“Through these day trips and activities, we try to bring the family together and let them experience what life was probably like before cancer. Very often, families affected by cancer focus on the treatment plan and forget the need to have fun, too,” says Jayne.
A silver lining
While some parents prefer to protect their children, Zulfa and Myo Hun say sharing information with their little ones has its silver lining. Myo Hun notes that his oldest child seemed to have “grown up” after learning about his mother’s illness: “He has become more understanding and proactive. Previously, he left all the household chores to his mother but, now, he helps out at mealtimes. He has also been working harder in school.”
Zulfa shares that her illness has drawn the family closer. “Every day, the children, especially my older boy, still tell me they love me very much before I leave for work. “Every birthday celebration I can enjoy with my kids is a huge bonus. Through this cancer journey, we’ve learnt to really treasure the time we have together as a family.”
How to break the news
Cover the following basics:
• The type of cancer
• Where the cancer is in the body
• What will happen with treatment
• How your child’s life is expected to change Depending on your child’s age, consider different approaches.
IF YOU HAVE A PRESCHOOLER
• Use age-appropriate words and short sentences. For example, say “medicine” instead of “chemotherapy”. You may use the word “cancer” to explain that it is something that makes Mummy or Daddy sick.
• Prepare your child before your treatment, particularly if there will be changes in your physical appearance during treatment.
• Talk about changes at home For example, you could say “Mummy is sick and needs more rest, so I have less time to play with you.”
• Tell your child while in a safe environment, for instance, when your spouse and other signifi cant family members (such as grandparents whom the child is close to) are present.
IF YOU HAVE A PRIMARY SCHOOLER
• At this age, your child can comprehend simple medical terms, so provide more details to help him understand the disease better. For example, explain what cancer is by using a simple analogy of a battle between “good cells” and “bad cells”, and how having treatment will help you beat the bad cells that are making you ill. Consider using children’s books.
• But don’t overload information Share the information in parts, over time, so that he has time to digest the information.
• After sharing, ask him how he feels about the news and if he has any queries. Establishing open communication helps children feel safe.
• Try not to tell only the older children This may place a huge emotional burden on them.
Sources No One Walks Alone cancer care kit by Singapore Cancer Society (SCS), Jayne Leong, manager of Psychosocial Services at SCS, and Travis Loh and Saryna Ong, principal medical social workers from the division of psychosocial oncology at National Cancer Centre Singapore .