Children 13 to 18 years

Helping teenagers, 13 to 18 years adjust to a cancer diagnosis.

Children’s understanding of illness and the implications of bad news varies depending on their age and family experiences. The information below gives an overview of the needs of teenagers, 13 to 18 years, which can be helpful when working out what to say to them and how you might respond to lessen the impact of bad news on them. Professional help may benefit a child who does not seem to be coping.

Understanding of cancer:

Teenagers are capable of abstract thinking: they can think about things they have not experienced themselves. They are also starting to think more like adults and may want lots of information about the diagnosis.

Teenaged children are able to understand that people are fragile and the 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. Teenagers may talk to friends about what is happening, and act as though their friends are more important than their family.

Possible reactions:

• 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.

Suggested approaches:

• 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 credible 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.

What should I say to teenagers about cancer?

It’s often hard to find the right words to start or continue a conversation. These ideas may help you work out what you want to say. Although grouped by age, you may find that suggestions in a younger or older age bracket are more suitable.

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.”

What do teenagers, 13-18 years, understand about death?

Teenagers understand death as much as an adult, but may not have the emotional capacity to deal with its impact.
Research suggests that teenagers need preparation for a parent’s death as much as possible. They’re often more distressed when their parent is ill than after the death.

Possible reactions:

• May deny their feelings or hide them in order to protect you.
• May not look to others for support thinking they can handle it alone.
• May distance themselves from their family and talk to their friends instead.
• Struggle with not being able to do their normal social activities.
• Worry that death is frightening or painful.

Suggested approach:

Encourage children to talk about their feelings to friends or another trusted adult. Be sensitive and negotiate role changes in the family.