When cancer strikes, it can suddenly throw a family into crisis mode. A diagnosis affects the whole family, and it can be especially difficult for young children and teens to cope. How do we help them process this piece of news? What should be said and what's better left unsaid?
Helping a young person make sense of things, when their family member who has been diagnosed is unsure of what lies ahead, can be a big challenge to navigate. We hear a personal account from 17-year-old Adele*, who had to learn how to cope with her mother's diagnosis.
Credit: Adele
When a parent is diagnosed with cancer
Eight years ago, Adele's mother, Mrs Ong*, was diagnosed with stage two breast cancer. As she was only nine years old then, Adele did not fully comprehend what the cancer diagnosis meant. After surgery and chemotherapy treatment, Mrs Ong went into remission and family life returned to normal, but it was short-lived.
In 2016, after a series of fainting spells and falls, Adele's mother went to the doctor for checks. Investigations revealed that the cancer had returned, spread to her brain and progressed to stage four. The relapse was a major blow and the Ong family had to learn to cope with the physical, mental and emotional burdens associated with cancer recurrence.
Adele and her mother used to be close, with Adele sharing everything. "I would tell her about my day in school, the people I've met, and she would share with me about her work. I could have heart-to-heart conversations with her," described Adele.
Image of mother helping daughter with homework (Credit: iStock)
However, Mrs Ong's mental state deteriorated after the relapse and she could not relate to Adele's sharing like she used to. Adele, who was studying for her Primary School Leaving Examinations (PSLE) then, found herself at a loss and bottled up her emotions instead.
"I felt sad, like I lost a best friend."
In addition to coping with this loss, Adele could no longer rely on her mother's guidance with school work and was forced to become independent in her studies. "In the past, she would help me with subjects that she was good at, such as Chinese. After she fell ill, I realised that she could not do it anymore... so I started to be less reliant on her."
Adele recalls the moment when her mother's condition hit her.
"When my PSLE results were released, I did not want my friends to see my mom accompany me to school to get the results as I was embarrassed of how she looked. She had lost her hair due to the side effects of chemotherapy and at that point, it hit me that her condition was taking a toll on her."
A cancer diagnosis can come as a shock – not just to patients – but to their loved ones and caregivers too. Such diagnoses are often accompanied by a multitude of emotions.
Cancer is a complex, multi-faceted disease. As the cancer journey progresses, decision-making, treatment and related side effects can present a unique set of mental and physical challenges. Patients often cope with pain, hair loss, nausea, chronic headaches, mood swings and more. Even after treatment, survivors are faced with concerns related to rehabilitation, undergoing follow-up scans as well as worrying about the possibility of a relapse. Inevitably, family dynamics and relationships change as both patients and their family members learn to live with the unknowns and cope with changes.
For Adele, who shared a close knit relationship with her mother, the changes brought about by her mother's cancer and related treatment – coupled with the stark reality of the possibility of losing her when Mrs Ong fell critically ill – led Adele to develop self-harm tendencies; an eating disorder and social anxiety.
Image of teenager girl looking out the window (Credit: iStock)
Adele looked for different methods to cope with these challenges, but nothing really helped. "I went online and Googled solutions, adopting various ways to cope – meditating, breathing exercises, drinking a cup of water before sleeping – but the results were short-lived and did not provide a long-term solution."
This went on until Adele started receiving art therapy sessions at the National Cancer Centre Singapore (NCCS) as part of the Temasek Foundation ACCESS (Accessible Cancer Care to Enable Support for Survivors) programme in 2020. Under this pilot programme, a multidisciplinary team of healthcare professionals including physicians, nurses, social workers and rehabilitation professionals come together to provide integrated physical, psycho-social, spiritual and educational components of care, for patients, their caregivers and family members.
Support for family members
Adele's father who was worried about how his daughter was coping, shared her situation with the NCCS clinical team at his wife's clinic appointment. Advanced Practice Nurse (APN) and Senior Nurse Clinician (SNC) Xu Zhi Zhen from the Division of Supportive and Palliative Care suggested that Adele receive counselling support and attend art therapy sessions at NCCS to help her cope.
Image of a father comforting teenage daughter (Credit: iStock)
"After hearing that Adele had a few unsuccessful attempts in building a therapeutic relationship with other psychiatrists and counsellors, I suggested a session with one of our medical social workers to use art therapy as a coping mechanism," shared APN Zhi Zhen.
APN Zhi Zhen, an oncology and palliative care trained nurse, has over two decades of nursing experience and is a team member of the ACCESS programme at NCCS. She is trained to identify patients in high distress and their families, and provide relevant supportive care interventions to meet their needs.
With Mr Ong's consent, Adele began her monthly art therapy sessions at NCCS. During these sessions, that are up to two hours long on average, Adele would decide on the kind of art she would like to produce and was given free rein to unleash her creativity. Art and craft activities at the therapy sessions include painting, clay-making and using recycled items to construct items. Each session concludes with a reflective segment, aimed at giving participants a safe space to share and process their feelings.
The art of healing
Adele, who previously did not enjoy art, began to experience a positive impact from the therapy.
"After a few sessions, I started to find making art relaxing. It helps to clear my head as it draws my attention away from my problems and focus my time and energy on creating. I also feel a sense of accomplishment each time I complete a piece."
A canvas painting Adele made with her parents during one of the art therapy sessions at NCCS
(Credit: Adele)
Adele has since seen an improvement in her condition and has taken up art as a hobby, regularly painting, drawing and creating different art pieces.
Adele recently enrolled in her diploma studies and she has chosen to major in Nursing. She attributed the motivation behind this choice of course to her mother, who is currently in stable condition with her cancer under control. "As I learned to care for my mom over the years, I developed the desire and motivation to become a nurse. I hope I can better care for her and other people affected by disease."
* Names have been changed to protect their privacy
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