Kate, Princess of Wales, recently revealed a cancer diagnosis and a course of chemotherapy. In a recent video, Kate said that it has taken time “to explain everything to George, Charlotte, and Louis,” her children with her husband William, Prince of Wales and heir to the British throne, “in a way that’s appropriate for them.”
Learn the best approach to this difficult conversation in this interview with Wendy Baer, MD, director of psychiatric oncology at Winship Cancer Institute of Emory University.
This interview has been edited for length and clarity.
What can you do to prepare for a conversation with your child about a cancer diagnosis?
It's really important to pause and understand where you are medically and what support you have before you decide to talk to your kids. It's really useful to know and understand your diagnosis and treatment plan before you share with other people. Hopefully having a sense of what your diagnosis is and what your treatment plan will be will help you stay calm.
Then, when you talk to your kids, you'll give them a sense of calm and give them a sense that things are going to be OK because you're going to do everything you can to take care of yourself and your health.
How do you start a conversation with your child about your cancer diagnosis?
Select a time and a place that's comfortable for your child – not when you're in the middle of doing dishes or running errands or trying to schedule appointments, but a time when you can sit down and be face-to-face with your child.
Start your conversation with the child by asking them what they've heard. Ask them if they've noticed anything different or if they've heard a doctor's office calling or if they've overheard you and your adult partner or other adult loved ones talk about cancer.
Once you have an idea of what they've heard, you can ask them what they're thinking and what questions they have. Try to answer their questions in age-appropriate language, depending on if they're a school age kid or a teenager, or a slightly older, young adult. Use language that you would use every day with your child so that they understand. It is OK to use the word "cancer."
Be honest with them, but don’t feel the need to share everything. Share just enough information to answer their questions. And it may not be the questions you think they have. Sometimes it's actually surprising that kids ask something that you weren't imagining they would ask.
When the child changes the subject, go with that. The conversation doesn't need to be the full backstory of everything you've read about your diagnosis and potential treatment plan or complications. It really needs to be what the child is wondering about – answering that question.
And then allow them to change the topic if they want to move on to what's for dinner or what they're going to watch on TV later that night. That's OK.
Read about how to tell your family and friends about your cancer.
What are some issues you may want to address?
It's OK to say you're going to the doctor, but try to reassure them that you're doing what you can to keep yourself as safe and healthy as possible. You also want to reassure kids that they're going to be safe, that there will be adults to look after them. There will be family members and friends that will be there for them.
Kids often wonder about their own routine and how their own days may be changed by a parent being in treatment. So the kids are going to want to know that their routines will carry on, which is developmentally the best thing for the child. So they'll still go to school, they'll still go to their activities, they'll still be able to go see their friends, and that will provide a sense of normalcy for the child while their parent is in treatment.
How would you explain something specific, like adjuvant chemotherapy?
You can tell them that cancer is a process where cells in our body are dividing too quickly and we need to stop those cells as much as possible. Explain that adjuvant chemotherapy, just like any chemotherapy, is a medicine to stop cells from dividing so quickly.
A change in the body from some chemotherapies that can be notable to children is hair loss. You can reassure your children that it's a change in your hair, but your hair will grow back.
Is it important to let your child know from day to day how you feel physically and emotionally?
No. There's a difference between the capacity of adults and children to tolerate information and carry emotions and people's lived experiences. We have partners and spouses and best friends and girlfriends or guy friends that we can trust and talk to. Children and teenagers are dealing with different kinds of emotional processes and different abilities to handle adult topics and themes.
Think about your kid: What are the things that they typically want to talk about? What do they typically want to hear about? What's typically soothing or stressful to them? And then tailor how much you share with them, depending on the ability of that child and the developmental stage of that child.
If you need to let your kid know that your treatment has tired you out for the day and you're not going to make the basketball game, that's very reasonable. Just let them know, but it doesn't have to be an explanation of how many percent of people in that chemotherapy regimen feel tired and therefore not able to go. It's just a simple, "I'm going to rest right now, but I hope you enjoy your game."
What do parents with cancer sometimes forget to do for their kids?
I think one of the important things for all caregivers, especially parents who are going through treatment, is to remind yourself that when you take care of yourself as a parent, your child tends to do better no matter what the parent is going through. So the more that the parent attends to their own well-being through their cancer journey, that time and energy will actually serve them well as a parent because they'll have enough headspace or enough emotional reserve to be able to be present for their child in the times that they are together.
