Therapeutic Interventions Benefit Kids of Parents With Ca

AMELIA ISLAND, Florida—A research-based psychosocial intervention especially geared to the needs of children whose parents have cancer is of great benefit, offering emotional support at a time when their fears can be overwhelming, Peter van Dernoot said at the American Psychosocial Oncology Society Third Annual Conference (abstract V-1).

Mr. van Dernoot is the founder, chairman of the board, and executive director of The Children's Treehouse Foundation, (CTF), headquartered in Denver. The Foundation's mission, he said, "is to ensure that every child whose parent is diagnosed with cancer is given the early tools and the emotional support to cope with the repressive anxieties, confusion, anger, and even a sense of guilt that children will often have."

There will be many such children, he said. "The need is absolutely enormous. According to the American Cancer Society, virtually every single year more than 315,000 parents up to age 54 will be diagnosed with invasive cancer, and these parents have more than 582,000 children under the age of 18. In Colorado, it's 51,000 parents every single year and more than 4,000 children to age 18."

As part of its efforts to help these children and their parents, the CTF trains oncology support personnel (ie, nurses, social workers, psychologists) to implement an intervention program called CLIMB (Children's Lives Include Moments of Bravery). The program meets once a week for 6 weeks and improves the children's capacity to learn how to express, communicate, and cope with feelings. "Children find the program very fulfilling. They may be the only kid in their class who has a parent with cancer. CLIMB helps them realize they are not alone," Mr. van Dernoot said.

Alternative Interventions

In a related presentation, Kathleen McCue, MA, LSW, of The Gathering Place, Cleveland (a community-based cancer support center), described other types of therapeutic activities besides support groups that help children whose parents or other significant adults in their lives have cancer (abstract V-3).

"Support groups don't always work, despite our good intentions and no matter how hard we try," Ms. McCue said. The reasons such groups may be hard to manage are numerous: "Because patients live too far apart; because families are in such chaos they can't get together on a Wednesday night on a regular basis; because groups are not a familiar thing to certain cultural groups; because children are at so many different levels of development, so if you put a 5-year-old together with a 12-year-old and a 16-year-old, it just doesn't make sense; or because the disease or prognosis is so different," she commented.

Four Strategies

She outlined four alternative intervention strategies to help children cope.

• Family workshop. The first is a monthly 3-hour family workshop, where the focus is on expressing feelings, feeling in control, self-esteem, and communication within the family. These workshops are mobile and so can be taken to settings such as inner-city hospitals, where people are less likely to join support groups, Ms. McCue noted.

• Sleepovers. Another activity is sleepovers for adolescents and preadolescents. "We do them at our center; we don't have showers, it's only one night, and we have smelly kids in the morning, but that's ok. We do one for boys and one for girls each summer. We may try to do more as time goes on—they're extremely popular," Ms. McCue said.

The boys never sleep, she added. "We do a lot of very physically active stuff with the boys. One of the things that happens in families when an adult has cancer is that kids need to be more contained, and the way they would normally deal with their anxiety has to be held under control, so we allow them to have a pretty wild time."

The girls, on the other hand, are nurtured. "Our teenage girls have taken on a lot of parental roles, so we spoil them. We have cosmetologists who come in and do nails and hair. We do good food, whatever they choose. We have scavenger hunts, where different, self-revealing questions have to be answered at different points along the hunt. The older girls sleep, at least a little bit."

The mornings of the sleepovers are powerful times for the children, she said. "They've been with each other for 15 or 16 hours, and as they start to get up, they begin to talk over the breakfast table, and that's where what's really going on in each kid's family comes out."

• Play groups. For very young children, there are play groups. "We see lots of expressions of aggression. There are punching bags all over the place. We do a lot of medical play. The playroom has a one-way mirror; the kids all know that, so that when they are engaged in that kind of activity, I can join them," Ms. McCue said.

• Animal camp. This is a week-long day camp that uses animals as a catalyst for getting the children to talk about important things in their lives. The children take care of an animal that is "theirs" for that week. "They get to know that animal, they bond with it, they name it, and some even write up some dream for that animal, and then they say goodbye to that animal at the end of the week. As you can imagine, that is a challenge," Ms. McCue said.

Therapeutic horseback riding is part of animal camp (see photograph on page 27). Ms. McCue told of one child's response to the therapy. "We had a little girl who was 7 years old, whose father had died 3 weeks before camp," she said. "The child chose to still come, but at that point was still sleeping in her mom's bed and was very frightened, sad, and overwhelmed by what had happened in her family." When the child first started to ride, she needed people on both sides of her and also leading the horse to be able to do it. "On the second day, she asked for one of the side walkers to not be there anymore," she said. "On the third day, when I asked her if she wanted me to walk next to her she said to me, 'No, you know people have to learn to handle their fears. I want to do it by myself.' That night, she told her mother she wanted to sleep in her own bed."

At the end of animal camp, the children say goodbye. "It's a very difficult time, but that's the exact experience we give them. They can cry, they can struggle with goodbye, and we're right there with them; we let them do what they need to do, and then we make sure they have a good fun afternoon before camp ends," Ms. McCue said.

Both parents and children have praised the programs, she added. A 10-year-old boy who attended the family workshop told her, "It's so good to be here because if you're sad at school, you can't cry because everybody will make fun of you, but here everybody knows how you feel so it's okay to show it."