Psychosocial
Relationships
Family relationships, friendship, marriage, and sexuality are consistent areas of concern when cancer treatment is complete and survivors grow into adulthood. Relationships can be complicated by psychological developmental disruptions, chronic medical conditions, and delays in achieving autonomy from the nuclear family.
Family relationships are forever changed once a child has cancer. During treatment parental distress levels directly affect the development and emotional adaptability of the young patient, and can lead to diminished self-concept, a result that may persist in the long term 23. During diagnosis and treatment, a child’s closest relationships are often with their parents and this enmeshment can continue well beyond completion of treatment. This can compromise the survivor’s ability to reach their fullest potential, as well as the parent’s perception of their child’s current status. Parent’s may become overprotective, set unrealistic goals, or minimize their child’s capabilities 26.
The dynamics of relationships with siblings are changed by cancer. Some siblings may have difficulties coping and adapting to changes in the family and psychosocial difficulties may remain over the long term. Some siblings have reported positive changes, such as increased compassion and empathy. As families mature, siblings may participate or take over the role of caregiver for their brother or sister when independent living is not an option.
Many families adapt and are able to define a new normal. This may consist of new roles within the family, lifestyle modifications, strategies for coping, development of support systems, and newfound advocacy skills 26.
Although many survivors generally do not differ from their peers in their relations to others, evidence has emerged suggesting otherwise.
Childhood cancer survivors report having fewer friends, difficulties engaging with and forming close friendships, and being less likely to spend their leisure time with friends 27, 28. Survivors also report feelings of not fitting in, loneliness, and social isolation. Survivors of brain tumours and those who receive cranial radiation are less likely to have close friendships. Forming friendships is a critical developmental task that promotes social competence, psychosocial adjustment and mental health.
Childhood cancer survivors are less likely to marry when compared to siblings as well as national averages. Survivors of brain tumours appear to be at highest risk, but survivors of lower extremity bone tumours, ALL, and AML, also have lower marriage rates 29, 30.
Reassuringly, adult survivors of childhood cancer who marry do not experience more divorce than the general population, and no cancer or treatment factors are associated with marriage dissolution 31.
Some childhood cancer survivors have challenges with intimate relationships and their sexual life. In one study, 20% of survivors had limitations in their sexual life due to their illness 32. Childhood cancer survivors tend to be older at the ages at which they have their first boyfriend or girlfriend and experience sexual intimacy 28, 32.
