[MOL] Caregiving Series-Coping within the family..... [01221] Medicine On Line

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[MOL] Caregiving Series-Coping within the family.....

Coping Within the Family

Although cancer has "come out of the closet," much of what we read in newspapers and magazines is about the disease itself-its probable causes or new methods of treatment. There is little information about how families deal with cancer on a day-to-day basis. This gap reinforces feelings that families coping with cancer are isolated from the rest of the world: that everyone else is managing nicely while you flounder with your feelings, hide from your spouse, and are incapable of talking to the children.

Cancer is a blow to every family it touches. How you handle it is determined to a great extent by how you have functioned as a family in the past. Families who are used to sharing their feelings with each other usually are able to talk about the disease and the changes it brings. Families in which each member solves problems alone or in which one person has played the major role in making decisions might have more difficulty coping.

Not Everyone Can

Problems within the family can be the most difficult to handle simply because you cannot go home to escape them. Some family members may deny the reality of cancer or refuse to discuss it.

It is not uncommon to feel deserted or to feel unable to face cancer openly. "My brother-in-law is suffering from cancer," one man confided. "The entire situation is depressing, and my reaction has been one of running and hiding. I have not visited them for I feel I have nothing to offer."

A woman with cancer found none of her family could help her. "My two wonderful sons tolerated their dad's heart surgeries very well, but now I have cancer, and they don't know how to act. Phone calls and letters expressing sympathy are not what I need. I've tried since last November to express my thoughts to my husband, but he shuts out what I'm saying. I know that he's uncertain about our future, but I can't seem to get through to him; I've learned from other patients that it's a common concern."

In these situations individual counseling or cancer patient groups can provide needed support and reinforcement. Moreover, these resources provide an outlet for the frustrations you are facing within the family.

Changing Roles

Families may have difficulty adjusting to the role changes that are sometimes necessary. One husband found it overwhelming to come home from work, prepare dinner, oversee the children's homework, change bedding and dressings, and still try to provide companionship and emotional support for his children and ill wife.

In addition to roles as wife, mother, and nurse, a woman might have to add a job outside the home for the first time. A spouse who was sharing the load sometimes becomes the sole breadwinner and home maker. The usual head of the household might now be its most dependent member.

These changes can cause great upheavals in the ways members of the family interact. The usual patterns are gone. Parents might look to children for emotional support at a time when the children themselves need it most. Teenagers might have to take over major household responsibilities. Young children can revert to infantile behavior as a way of dealing with the impact of cancer on the family as a unit and on themselves as individuals. The sheer weight of responsibility can become insurmountable, destroying normal family associations, devouring time needed for rest and recreation, and depriving family members of wholesome opportunities for expressing anxiety and resentment.

The Health of the Family

Performing too many roles at once can endanger emotional well-being and the ability to cope. Examining what's important can solve the problem. For example, you can relax housekeeping standards or learn to prepare simpler meals. Perhaps the children can take on a few more household chores than they have been handling.

If a simple solution is not enough, consider getting outside help. Licensed practical nurses can help with the patient; county or private agencies might provide trained homemakers. If outreach is an important part of your church, feel free to ask for help with cooking, shopping, transportation, and other homemaking tasks. One family was adopted by the daughter's scout troop when the girls learned of the extra responsibility she had assumed. Everyone benefited from the relationship.

Let someone who can be objective help you sort out necessary tasks from those that can go undone. The financial cost of professional services needs to be compared with the emotional and physical cost of shouldering the load alone. You also may be able to obtain assistance from hospital, community, or self help groups or from a clergy member. It is important to remember that the family is still a unit. If the family strength is sapped, the patient suffers, too.

The San Diego chapter of Make Today Count, a mutual support group for patients and families, compiled a "Bill of Rights for the Friends and Relatives of Cancer Patients." Several items address the problems of family burdens:

Increased burdens and shifting responsibilities can occur whether the patient in the household is a spouse, a child, or an elderly parent. Each family member must take care to meet his or her own needs and those of the other healthy members of the family as well as those of the patient.

Help for the Children

Children might have difficulty coping with cancer in a parent. Mother or Dad may be gone from the house-in a hospital that may be hundreds of miles from home-or home in bed, in obvious discomfort, and perhaps visibly altered in appearance.

In the face of this upheaval, children often are asked also to behave exceptionally well: to "play quietly," to perform extra tasks or to be understanding of others' moods beyond the maturity of their years. The children may resent lost attention. Some fear the loss of their parent or begin to imagine their own death. Some children, formerly independent, now become anxious about leaving home and parents. Discipline problems can arise if children attempt to command the attention they feel they are missing.

It may help if a favorite relative or family friend can devote extra time and attention to the children, who need comfort and reassurance, affection, guidance, and discipline. Trips to the zoo are important, but so is regular help with homework and someone to attend the basketball awards banquet. If your efforts to provide support and security fail, professional counseling for a child, or child and parent together, may be necessary and should not be overlooked.

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