The impact of parental cancer on adolescent and young adult offspring

Abstract

A parent’s cancer is linked to a variety of psychological, behavioural, and physical problems in their offspring. Despite what is already understood about parental cancer, there is a dearth of research specific to offspring aged in their adolescence and young adulthood at the time of their parent’s illness. Understandings are also undermined by an absence of Australian data concerning the number of offspring whose parents have cancer. Furthermore, research in the area is limited by an overwhelming focus on offsprings’ psychopathology, which overshadows the possibility of adaptive outcomes that may occur. This research therefore aims to improve understanding of how offspring in their adolescence and young adulthood at the time of parental cancer are impacted; enumerate and describe the cohort in Australia; and investigate adaption to parental cancer in terms of emotion, posttraumatic growth, and resilience. Three independent but related research papers are produced. Study One is a systematic review of the psychological, social, and behavioural impact of parental cancer on offspring in their adolescence or young adulthood at the time of their parent’s diagnosis. The majority of adolescents and young adults were significantly impacted by their parent’s cancer. Daughters and offspring who experienced a greater number of problems at their parent’s diagnosis were most impacted. Offspring refrained from communicating their disease-related concerns to their parents, but simultaneously expected open communication from their parents. Turning to oneself and peer-support were commonly-used coping strategies. Study Two is a retrospective cohort study using linked whole-population data from the Western Australia Data Linkage System. From 1982 to 2015, 57,708 offspring were impacted by 34,600 parents’ incident malignant diagnoses. The most common diagnosis was breast cancer (19%). Most families resided in regional areas (60%) and were of high or middle socioeconomic status (76%). Cox proportional hazard models indicated significant predictors of earlier parent death included low socioeconomic status and geographic remoteness. Study Three is an online survey examining how coping predicts adaption to parental cancer in terms of resilience, emotion, and posttraumatic growth among (n = 244) adolescent and young adult offspring. Adaptive coping was associated with increased posttraumatic growth, resiliency, and positive affect; whereas maladaptive coping was associated with decreased resiliency and greater negative affect. Females and offspring who did not access support in relation to their parent’s cancer reported higher adaptive coping. Offspring bereaved by parental cancer reported higher maladaptive coping, whilst those whose parents’ cancer was of shorter duration and those who lived with their ill parent had lower adaptive and maladaptive coping. Results of this research highlight the burden that parental cancer has on adolescent and young adult offspring, and has implications for supportive care. First, the proportion of maternal diagnoses demonstrate a possible need for practical support for offspring to alleviate caregiving burden. Second, socioeconomically disadvantaged and geographically isolated offspring may benefit from support that augments face-to-face delivery (i.e. internet-based), especially if they are bereaved. Third, adaption to parental cancer may be improved through interventions that aim to increase adaptive coping, as this was linked to positive emotion resilience, and posttraumatic growth.