Teen Tribulations

"You’re going to change.”

That’s what 16-year-old Marlene Pierce would tell a fellow teenager whose parent is diag­nosed with cancer. She knows only too well about the changes. In July 2007, her 44-year-old father, Russell, learned he had liposarcoma, a rare cancer he is still fighting that causes tumors in the soft tissue.

A parent’s cancer is a “curveball life throws at you—and it hits you in the face,” says Pierce, who lives in Lake Stevens, Washington. When her parents told her the news, she cried for 10 minutes. She’s seen her “mountain man” dad weakened by chemotherapy and hobbled by the cancer that’s spread to his bones. She tries to be open with her friends, but a lot of them “don’t want to talk about it.” For a while, she became a germaphobe and washed her hands until they bled. She drew comfort from mindless games of Tetris. And she asked her dad to be her date for a school dance.

So yes, you are going to change. But that doesn’t mean you won’t recognize yourself. “Underneath it all,” says Pierce, “you’re still that person you were before your parent was afflicted.”

Of course, change is never predictable, especially when cancer is the catalyst. Parents and teens alike might expect that the bleaker the diagnosis, the more intense the emotional reaction. They would be wrong.

A study published in the Scandinavian Journal of Psychology looked at 54 adolescents coping with a parent’s cancer and found the parent’s “physical health” does not correspond to the child’s “mental health. Even if a diagnosis is “dire,” the family might tune in to the reaction of adolescent children and be “emotionally available” to them, explains Paula Rauch, MD, assistant professor of psychiatry at Harvard Medical School and director of the PACT program (Parenting at a Challenging Time) at the Massachusetts General Hospital Cancer Center. On the other hand, if the prognosis is positive, the parents might focus on the logistics of treatment and underestimate the impact of the news on the children. If the parents aren’t aware of the burden on their adolescents, a teenager may suffer more distress or act out.

Underneath it all, you’re still that person you were before your parent was afflicted.

A complicating factor is the nature of adolescence. Teenagers are forging an independent identity. “The normal separation adolescents go through is short-circuited when a parent or close relative gets cancer,” says Sally Benson, LCSW, a clinical social worker who is the program director of Gilda’s Club Seattle. The result can be guilt or anger: Maybe I should ditch my friends and spend more time with my family. But I don’t want to.

The teenager’s personality will also influence his or her behavior. An anxious kid could grow more anxious, a gregarious kid will keep talking, a child prone to risky behaviors may not be inclined to reform.

In addition, parents need to remember that teenagers are, for lack of a better word, teenagers. “They have a tendency to revert to a 3-year-old, self-centered level,” says Martha Aschenbrenner, program director of the Kids Need Information, Too program at M.D. Anderson Cancer Center in Houston. “The initial reaction is: ‘How will this impact me? Who will give me a ride to my events?’ I tell parents this is normal.”

An information gap looms. A teen who feels out of the medical loop may need to say to a parent, “I worry you’re not telling me everything.”

Parents may need more than a good opening line. “By nature teenagers don’t talk to their parents,” says Aschenbrenner. “Having a parent with cancer doesn’t change that.” If parents have a track record of speaking openly about sad as well as happy things, that “creates an environment in which unpleasant things can be raised,” suggests Richard Ogden, a psychologist in private practice in Bethesda, Maryland, whose wife died of breast cancer when the couple’s three children were 6, 13, and 17. If, after a cancer diagnosis, the parents continue to express the “full spectrum of emotions,” he says, they can serve as a model for their children.

If a teen exhibits antisocial or destructive behavior, parents might seek a mental health expert who works with adolescents and cancer issues. A cancer center is a potential resource. Aschenbrenner is frank with the kids she counsels: “Alcohol, drugs, or sex will alleviate your pain for a while but won’t take the pain away.” Talking does.

Then there are teens who seem oblivious or disinterested. “As my dad was getting sicker, I very selfishly pushed away my own grief by going out with friends rather than spending more time at home,” says Katie Nelson, 19, of Bellevue, Washington, whose father died of cancer in 2007. Avoidance may stem from love, not indifference. “Sometimes the child wants to preserve the picture of the parent at the top of their game,” says Rauch.

A parent might tell a teen who’s in denial: “I’m confused you’re not making any changes in what you do.” Suggesting a “date”—Sunday dinner with the family—could encourage the child to reconnect.On a more mundane level, tensions may arise over a teen’s failure to pick up household tasks that Mom or Dad usually handles. “Expecting a teenager to be on call for chores rarely goes well,” says Rauch. Posting a to-do list with a time frame gives the teenager flexibility.

There’s one friend I’ve always been open with. If I didn’t have him, I probably wouldn’t have been able to get through it. Once or twice I cried in front of him, and he didn’t think any less of me.

At the same time, parents shouldn’t expect teens to become indentured home helpers. Even though Travis Barnett’s mother was wiped out by chemo for breast cancer, she’d tell her teenage son, “Go out with your friends, get your mind off stuff.” So he did.

Outside the home, a teen can build a support network of sorts. Aschenbrenner urges kids to “think of somebody they feel safe talking to: an aunt, uncle, teacher, coach, pastor, a best friend’s parent. Somebody [to whom] you would feel comfortable saying, ‘I’m scared.’ ”

Teens may be embarrassed to tell schoolmates because, really, who wants to hang around someone whose parent has cancer? “It labels them as being different,” says Benson. “They want to be like everyone else.” Still, some teens do find a peer to confide in—perhaps a pal who faced a family crisis, though not necessarily involving cancer.

“There’s one friend I’ve always been open with,” says Barnett, now 19, of Winnipeg, Manitoba, whose mother died in 2007. His confidant had lost his own mother, who battled alcoholism, a few years earlier. “If I didn’t have him, I probably wouldn’t have been able to get through it,” says Barnett. “Once or twice I cried in front of him, and he didn’t think any less of me.”

In theory, a support group could help. But groups are difficult to find, and teens may not be easily convinced to attend. Yet if parents can prevail, the results can be positive.

After his mother was diagnosed with breast cancer in 2005, Alexander Kosnick-Dobson, then 14, went to Kids Can Cope, a support group in Winnipeg offered by CancerCare Manitoba. “My mum made me,” he says. “The first time was awkward.” Yet he kept going and the group filled a void: “It was good to know they were going through the same stuff I was. It ended up being pretty nice, even just to chill once a week.”

But like adults, teens aren’t always eager to discuss their feelings. After the Nelson sisters lost their father to cancer, Katie’s younger sister, Hadley, tried a support group. “It was weird,” recalls Hadley, now 15. “I started fencing classes,” she says. “Fencing was more therapeutic than talking about it.”

Online support is another option. Aschenbrenner of M.D. Anderson likes the nonprofit Kids Konnected (www.kidskonnected.org), which includes resources for teens facing a parent’s cancer diagnosis, and a British site called riprap (www.riprap.org.uk), which offers advice and also fields questions.

Even when the parent survives, there are lingering effects on the teenagers. Deb Stewart, a Baltimore nurse, was diagnosed with breast cancer in 1979 and had a recurrence in 1999, when her son, Bill, was 15 and her daughter, Anna, was 13.

“I think it impacted my son in a big way,” says Stewart, who is today in good health at age 56. “He’s very in the moment.” He loves to surf, and works so he can travel to places like Hawaii and Costa Rica to support his hobby.

Anna came away from the experience with a deep appreciation for her mom’s positive attitude and her dad’s support. Anna’s advice for teenagers who, like her, face a parent’s cancer: “Just be nice to them. Teenagers are such jerks, especially to their parents. If they can stop thinking about themselves, and avoid adding one more stressor on their parent, that’s really important.”

That’s music to any parent’s ears.