Teenagers, thirteen to eighteen years

• They are capable of abstract thinking: they can think about things they have not experienced themselves.
• They are starting to think more like adults and may want lots of information about the diagnosis.
• They are able to understand that people are fragile.
• They are able to understand complex relationships between events.
• They are able to understand cause and effect, that is, relating to symptoms and illness or between action and outcome.
• They are more likely to deny fear and worry to avoid discussion. They may talk to friends about what is happening, and act as though their friends are more important than their family.

• Want to be more independent and treated like an adult.
• Anger and rebellion.
• Critical of how adults react to or handle the situation.
• Depression or anxiety.
• Worry about being different.
• Poor judgment and risk-taking behaviour (e.g. binge drinking, smoking, staying out late, unsafe sex).
• Withdrawal
• Apathy
• Physical symptoms from stress (e.g. stomach-aches, headaches).
• More likely to turn feelings inward (so adults are less likely to see reactions).
• Regression: some lapse into previous behaviours, such as watching children’s TV shows or being very insecure and dependent on parents.
• Worry that they will also get the cancer, particularly if they’re a daughter of a woman with breast cancer.

• Encourage them to talk about their feelings, but realise they may find it easier to confide in friends, teachers or other trusted people.
• Provide plenty of physical and verbal expressions of love.
• Talk about role changes in the family.
• Provide privacy as needed.
• Encourage them to maintain activities and friendships. Talk about finding a balance between going out and staying at home.
• Set appropriate limits.
• If there are problems, provide opportunities for counselling.
• Don’t rely on them to take on too many extra responsibilities.
• Provide resources for learning more about cancer and getting support.
• Make agreements that you don’t always want to talk about cancer – you still want to talk about homework, sport, friends, boyfriends/girlfriends, their part-time job, etc.

In upper primary and high school, children have a more complex understanding of illness and issues affecting them and their families. Teenagers are starting to think more like adults. Explanations about the cancer can be more detailed. Children of this age not only need reassurance about their own well-being, but also about the person with cancer.

About cancer:

“We’ve had some bad news. I’ve got cancer. We don’t know what we’re dealing with yet, but I’m going to have surgery so that the doctors can have a look and find out.”

“You know that Mum has been sick a lot lately. The doctors told us today that the tests show she has cancer. The good news is that she has an excellent chance of beating it.”

To address misunderstandings:
“There are lots of different types of cancer and they’re all treated differently. Even though Uncle Bob had cancer, it might not be the same for me.”

“The doctor doesn’t know why I got cancer. It doesn’t mean that you’ll get cancer too. It’s not contagious (you can’t catch it) and the cancer I have is not genetic (it doesn’t run in families).”

“Even though Grandma has cancer, the doctors say she’ll probably be okay because she was diagnosed early.”

To explain changes and reassure them:

“Things will be different at home when Dad’s having treatment but we’ll be able to visit him at the hospital often.”

“After my operation, there’s a few things I won’t be able to do for a while, like lifting things and driving. So you’ll all have to pitch in at home, and Dad will leave work early to take you to your after-school activities.”

“Whatever happens, you will always be cared for and loved. We will tell you what’s going on as soon as we are told.”

“If you think of any questions or have any worries, you can come and talk to me. It’s okay if you want to talk to someone else too.”