































18

The Impact of  Childhood Cancer on Family Functioning: 
A Review

Tamaki Hosoda
Feinberg School of  Medicine, Northwestern University

Family functioning can influence the adjustment of  children with cancer. In order to provide effective interventions 
for the family, it is important to recognize how family functioning, including parental adjustment and distress, can 
change during the course of  treatment. Upon review of  current literature, some variations in findings in family func-
tioning due to childhood cancer were found. While some families showed resiliency (a non-disorganizing impact), 
others showed signs of  impairment throughout the treatment (a disorganizing impact). Moreover, some families 
even exhibited improvement (an organizing impact). In addition, it was found that such outcomes were related to 
different research methodologies (i.e., quantitative, qualitative, cross sectional, longitudinal). Based on these meth-
odological distinctions, this review attempted to seek links between specific research designs and particular results in 
order to delineate a clearer picture of  the dynamic transitions within families and their function over the course of  
childhood cancer treatment. Considering an overall trend of  family functioning associated across studies of  varied 
methodologies, this review speculates that while families with high family functioning might receive appropriate so-
cial resources and strengthen their internal bonds during the course of  treatment, families with low family function-
ing might experience difficulties coping with adverse events and fail to reestablish a new pattern of  family function-
ing. This review also indicates that such changes in family functioning occur on both practical (e.g., reassignment 
of  family role) and existential levels (e.g., exploration of  the meaning of  illness) in the context of  childhood cancer. 

The Impact of  Childhood Cancer on Family 
Functioning 
 Due to remarkable advances in childhood cancer 
treatment, the five-year survival rate for all cancer sites 
(including leukemia, cancer of  the brain and other 
nervous system, renal tumors, and other cancers) has 
increased to 79% (Jemal et al., 2006). This improve-
ment in the survival rate causes long-term repercus-
sions on the lives of  children and family (McCubbin, 
Balling, Possin, Frierdich, & Bryne, 2002). McCubbin 
et al. (2002) argue that recurrent admissions, invasive 
treatments for the child, role shifts within the fami-
ly, and the uncertainty of  prognosis can be stressful 
for the family, thereby debilitating family functioning. 
Additionally, Kinahan et al. (2012) indicate that physi-
cal disfigurements, especially cranial and spinal defor-
mities, and hair loss due to treatments, on childhood 
cancer survivors might have significant psychological 
impacts. Such physical disfigurements might increase 
the risks of  developing anxiety, depression (Kinahan 
et al., 2012), and more negative self-image (Jamison, 
Lewis, & Burish, 1986), thereby impairing child pa-
tients’ quality of  life. Given that these physical charac-
teristics might remind the family of  the child’s cancer, 
they could also have a psychological impact on the 

family (Björk, Wiebe, & Hallström, 2005; Quin, 2008). 

Impact of  Childhood Cancer Over the Treat-
ment Phases
 Alderfer and Kazak (2006) describe the impact 
of  childhood cancer on families through the four 
phases of  treatment: diagnosis, treatment initia-
tion, illness stabilization, and the end of  treatment. 
 Diagnosis phase. Because common childhood 
cancer symptoms, such as fatigue and joint pain, are 
often overlooked in the diagnosis phase, parents of-
ten wait days or weeks before taking their children to 
a hospital. This delay may increase a sense of  guilt in 
the parents. When parents do visit physicians, they 
often see their children undergo painful, invasive di-
agnostic procedures. Meeting with unfamiliar multi-
disciplinary professionals and receiving an immense 
load of  information about the illness may overwhelm 
parents and increase their anxiety (Alderfer & Kazak, 
2006). Similarly, siblings may also feel that their lives 
are disrupted due to the illness, as they worry about 
the survival and health of  their ill brother or sister. At 
the same time, the siblings may be, or feel, somewhat 
excluded by their families because parents’ attention 
tends to focus on the ill children and those siblings 
may not receive sufficient information about the ill-
ness from their parents, preventing them from having 
a complete and accurate understanding of  the experi-
ences of  their ill brother or sister. This may be a scary 

Correspondence concerning this article should be ad-
dressed to Tamaki Hosoda, Northwestern University, Fein-
berg School of  Medicine, 710 N. Lake Shore Drive, Chicago, 
IL 60611. Email: tamakihosoda2014@u.northwestern.edu.

Graduate Student Journal of  Psychology
2014, Vol. 15

Copyright 2014 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University



19

HOSODA

feeling for those children (Havermans & Eiser, 1994). 
Treatment initiation phase. In the treatment initia-
tion phase, families’ daily lives may begin to revolve 
around treatment. Parents see their children man-
ifest side effects (e.g., nausea, rashes, poor appe-
tite) and begin or continue painful treatments (e.g., 
surgery, chemotherapy, radiation therapy), which 
might cause families anxiety and feelings of  guilt 
as the experience of  watching the child suffer takes 
its toll on parents’ psychological wellbeing (En-
skar, Carlsson, Golsater, Hamrin, & Kreuger, 1997). 
 Illness stabilization phase. During the ill-
ness stabilization phase – generally weeks or 
months after diagnosis, although relapse and 
severe side effects may occur – treatment be-
gins to be more fully incorporated into families’ 
new daily life patterns (Alderfer & Kazak, 2006). 
 The end of  treatment phase. At the end of  
treatment – usually months or years post-diagnosis – 
intense treatment is replaced by periodical follow-up 
visits. During this period, the families’ overall burden 
may decrease. However, this often causes mixed feel-
ings in parents, namely anxiety at the same time as feel-
ings of  joy (Katz & Jay, 1984). Through the course of  
treatment, families may increase their dependency on 
medical care and staff, preventing them from facing 
the fear of  relapse. Therefore, the end of  treatment 
can make families feel that they have lost the sense of  
security and protection that they enjoyed while their 
children were under constant care, causing more anx-
iety (Alderfer & Kazak, 2006; Katz & Jay, 1984). In 
addition, families have to flexibly recreate their every-
day life pattern without the regularity of  the previous 
cancer treatments. Since families may have by this 
point successfully incorporated treatment regimens 
into their lives, including diet restrictions and limited 
physical activities, changing these patterns could also 
be challenging (Ostroff, Ross, & Steinglass, 2000). 
 Even after the completion of  treatment, the fear 
of  death, relapse, and lasting negative side effects, 
such as growth disorder and infertility caused by 
treatment, can persist in the minds of  families (Byrne 
et al., 1987; Hutchinson, Willard, Hardy, & Bonner, 
2009; Ostroff  et al., 2000; Vannatta, Salley, & Ger-
hardt, 2009). Thus, families’ experiences may change 
dramatically during the course of  treatment because 

each phase of  childhood cancer treatment has a dif-
ferent and significant impact on their functioning.  

Family Functioning and Childhood Cancer 
Treatment 
Since health care providers have frequent contacts 
with the family over the course of  treatment, espe-
cially during hospitalizations or intense treatment, 
they may often see childhood cancer’s impact on the 
family. For example, the demands of  treatment might 
force the parents to change their jobs in order to be 
available for their child’s frequent hospital visits, or to 
seek a relative’s support for siblings’ care. Likewise, 
the potential disruption in the balance of  family re-
lationships could lead to an eventual divorce (Kupst 
& Schulman, 1988; McCubbin et al., 2002). Concerns 
about financial difficulties might also increase as the 
treatment is prolonged, placing further strain on fam-
ily functioning (Kalnins, Churchill, & Terry, 1980; 
Kupst & Schulman, 1988; McCubbin et al., 2002). 
 Upon seeing such familial problems through the 
treatment, health care providers often mistakenly link 
worsening family relationships (e.g., divorce) or pa-
rental distress (e.g., depression) to childhood cancer, 
rather than truly grasping the underlying complexi-
ties of  such issues (Cadman, Rosenbaum, Boyle, & 
Offord, 1991). It is important for health care pro-
viders to appropriately consider family functioning 
in addition to physical symptoms, since it may influ-
ence current and later psychological adjustment of  
ill children and their treatment in both direct and in-
direct ways. (Drotar, 1997; Katz & Jay, 1984, Kazak 
et al., 2011; Pelcovitz et al., 1998; Pless, Roghmann, 
& Haggerty, 1972, Trask et al., 2003; Wallander & 
Varni, 1998). For instance, when the family is coop-
erative and has open communication concerning the 
illness, the child might be better able to acknowledge 
the situation (DiMatteo, 2004; Sobo, 2004). On the 
other hand, if  psychosocial problems in the family 
(e.g., neglectful childcare, parental depression) deter 
the parents from regularly attending hospital vis-
its and seeking medical consultation, pediatricians 
might not be able to smoothly proceed with treat-
ment (Sobo, 2004). Moreover, when the child of  
such parents sees other parents visiting their own 
children, he might feel lonely or jealous, potentially 



20

IMPACT OF CHILDHOOD CANCER ON FAMILY: REVIEW

worsening the existing relationships between him and 
other pediatric patients. In addition, if  parents fail to 
understand complicated medical regimens, such as 
food restrictions, the treatment may not proceed in 
an appropriate manner (DiMatteo, 2004; Sobo, 2004).
 There is a lack of  research investigating the effect 
of  parental mental health problems on children diag-
nosed with cancer. Nevertheless, one could speculate 
that excessive anxiety and fear might drive the parents 
to share information about their child’s poor progno-
sis with other parents, unsettling other parents and 
creating a negative environment for both other pedi-
atric patients, their families, and the health care pro-
viders. As such, health care providers should consider 
family functioning and appropriately introduce psy-
chological treatment to the family, as well as patients, 
not only as addition to the physiological treatment 
they administer, but as part of  the same regimen.

Limitations of  Research
 Serious limitations exist among previous studies 
exploring the impact of  childhood cancer on family 
functioning. Specifically, the use of  heterogeneous 
methodologies makes a comprehensive examination 
of  research findings difficult (Grootenhuis & Last, 
1997). First, the utilization of  different psychometric 
measures may affect the research outcomes by limit-
ing the ability to generalize across studies. While some 
researchers utilize quantitative research with different 
psychometric scales, moreover, others employ quali-
tative research methods, such as interviews. A further 
important limitation is that most previous studies are 
limited by small, site-specific sample sizes (i.e., fewer 
than 50 participants) (Drotar, 1994; Pai et al., 2007). 
 Another issue affecting the generalizability of  
previous research can be found in the discrepancies 
concerning variables (e.g., the types of  cancer, ex-
istence of  ongoing treatment, and amount of  time 
following diagnosis) that may influence the specific 
research findings (Kupst, & Schulman, 1988). For 
example, families with on-treatment or off-treatment 
status may have or have had different experienc-
es (Cadman et al., 1991; Hutchinson, Willard, Har-
dy, & Bonner, 2009; Sawyer, Antoniou, Toogood, 
Rice, & Baghurst, 2000; Sloper, 2000). Yet most 
studies under review do not take such information 

into consideration in examining their outcomes. 
Other factors limit the generalizability of  existing 
studies. For example, the decision  to incur revers-
ible and/or irreversible physical disfigurement (e.g., 
weight or hair loss, cranial or spinal deformities, am-
putation of  limbs) or impairments (e.g., thyroid dys-
function, infertility, growth disorder) can pose signifi-
cant stress on the patient and their family (Alderfer & 
Kazak, 2006; Kinahan et al., 2012; Long & Marsland, 
2011; Oberfield & Sklar, 2002; Patenaude & Kupst, 
2000; Vannatta et al., 2009). The studies reviewed 
here do not take account of  these decisions. Like-
wise, many researchers point out that the availability 
of  social support from workplaces and profession-
als, including psychologists, social workers, and child 
psychiatrists, may affect family functioning. (Ferrel, 
Rhiner, Shapiro, & Dierkes, 1994; Fife, Norton, & 
Groom, 1987; Kupst & Schulman, 1988; McCubbin 
et al., 2002; Speechley & Noh, 1992). While some 
studies include such information, others do not (Pai 
et al., 2007). These limitations should be taken into 
account in the examination of  research outcomes.
 Among relevant studies, some variations in find-
ings can be found. While some families show resil-
iency, others show signs of  impairment throughout 
the treatment (Long & Marsland, 2011; McCubbin et 
al., 2002). Different research designs may affect these 
results. Yet there is a lack of  research that seeks links 
between specific research designs and particular re-
sults. In order to fill this gap, this review examines 
the effects of  varied research methodologies on study 
outcomes in order to depict a clearer picture of  the 
dynamic transitions within families and their func-
tion over the course of  childhood cancer treatment

Method

 A literature search was conducted using PsycIN-
FO, PubMed, and Web of  Science with the following 
search terms: “childhood cancer,” “family function-
ing,” “parents,” “psychological adjustment,” and “dis-
tress.” The titles and abstracts of  studies concerning 
families experiencing childhood cancer published 
from 1980 to 2012 were reviewed. In order to iden-
tify relevant sources, citations of  reviewed studies 
were also investigated. In the review, research dealing 



21

with the psychosocial issues of  child, parent, sibling, 
and family related to childhood cancer were available. 
Among these studies, the following inclusion criteria 
were used: (a) the sample of  pediatric patients of  age 
18 or younger; (b) patients with any types of  can-
cer (e.g., leukemia, brain tumor); (c) studies written in 
English; (d) studies focusing on family functioning, 
especially parental experiences. The following exclu-
sion criteria were used: (a) studies focusing on the 
experiences of  patients or their siblings; (b) studies 
focusing only on fathers, not parents or mothers; (c) 
studies focusing on gender differences of  parents; (d) 
studies focusing on treatment approaches; (e) stud-
ies focusing on parental bereavement following pa-
tients’ death; (f) studies focusing on marital quality 
without the inclusion of  family functioning. Using 
these criteria, 30 studies (18 quantitative studies and 
12 qualitative studies) were included for the review. 

Review 

Impact of  Childhood Cancer: Methodologies
 Among previous studies, three types of  family 
functioning outcomes were found: disorganizing (im-
pairing), non-disorganizing, and organizing effects of  
childhood cancer (McCubbin et al., 2002; Pai et al., 
2007). To investigate the impact of  childhood can-
cer on family functioning, it is necessary to analyze 
the components that caused these three different 
outcome directions in terms of  research methods. 
Impact of  childhood cancer found in quantitative 
studies. Among quantitative studies, the impacts of  
childhood cancer on family functioning are discussed 
in both longitudinal and cross-sectional studies.  
 Longitudinal studies. Many researchers who 
used psychometric measures found the signs of  
impairment in family, including parental poor men-
tal health and worsened relationships among family 
members. Concurrently, their outcomes have multi-
ple variations. In particular, the passage of  time fol-
lowing diagnosis can be an important factor leading 
to varied outcomes (Ostroff  et al., 2000; Pai et al., 
2007). That is, many researchers corroborate the 
argument of  Pai et al. (2007) that parental distress 
tends to increase at the point of  diagnosis, but grad-
ually decreases throughout a year following diagnosis. 

 During the diagnostic phase, Manne et al. (1996) 
found that the majority of  the parents report mild 
depressive symptoms and these symptoms remain at 
the same level or are reduced after 6 months post-di-
agnosis. One year after diagnosis, Sawyer, Antoni-
ou, Toogood, Rice, and Baghurst (1993) found that 
although most parental psychosomatic symptoms 
were attenuated, parents of  children with cancer di-
agnoses still had more symptoms than the control 
group. Fife, Norton, and Groom (1987) show the 
overall stability of  family functioning through the 
treatment, after the diagnosis was received. Most 
families maintained their function except during 
the diagnosis phase and did not experience drastic 
changes in their family structure (e.g., divorce, sepa-
ration). Simultaneously, Fife et al. (1987) found that 
families with concurrent problems prior to diagno-
sis (e.g., having a family member in psychiatric care) 
showed lower family functioning after the diagnosis. 
 Within 18 months following diagnosis, on the 
contrary, Sloper (2000) found that the distress level 
of  most parents did not decrease and some parents 
showed enhanced distress levels related to family cohe-
siveness and repeated hospitalizations. Thus, although 
most researchers share the argument of  definite neg-
ative impacts of  childhood cancer experiences during 
the diagnostic phase, divergent family functioning out-
comes after this phase were found in different studies. 
 In the illness stabilization phase, while most 
families may show good adaptation, others may not. 
During the two years following diagnosis, Sawyer, 
Antoniou, Toogood, Rice, and Baghurst (2000) iden-
tified the successful adaptation of  families. According 
to them, the psychological adjustment and function 
of  families with childhood cancer gradually improved 
and became closer to the level of  control groups in 
four years. On the other hand, some researchers 
identified both good and poor adaptations by fami-
lies. Over the course of  5 years following diagnosis, 
Wijnberg-Williams, Kamps, Klip, and Hoekstra-Wee-
bers (2006) found that while the distress in most par-
ents was alleviated, some parents who experienced 
the repeated deterioration of  their child’s condition 
exhibited elevated distress levels. Moreover, Kazak 
(1989) suggests that families that were low-function-
ing prior to diagnosis may adjust poorly to the illness 

HOSODA



22

after the end of  treatment. Similarly, Maurice-Stam, 
Oort, Last, and Grootenhuis (2008) found that al-
though parental psychological distress tends to re-
turn to a normal level, families with a passive reac-
tion pattern tend to have higher distress levels than 
families with an optimistic reaction pattern. Thus, 
while the passage of  time seems to attenuate disor-
ganizing effects on family functioning, some families 
still experience detrimental impact on their function. 
 Cross-sectional studies. Similar to the afore-
mentioned longitudinal studies, cross-sectional stud-
ies, which do not take the passage of  time post-di-
agnosis into consideration, show both good and 
poor adaptation of  parents in response to their 
child’s diagnosis. Dockerty, Williams, McGee, and 
Skegg (2000) found that the parents of  children with 
childhood cancer reported significantly higher dis-
tress levels and poorer mental health in comparison 
with the control group. On the other hand, Wright 
(1993) examined the transition of  the parents’ qual-
ity of  life and found that the parents still perceived 
their current quality of  life to be satisfactory even 
though they felt that their quality of  life had become 
significantly poorer in the context of  the treatment. 
 Moreover, Cadman et al. (1991) add to the liter-
ature by considering the impact of  psychosocial ser-
vices. They conducted a survey of  parents whose chil-
dren had chronic illnesses or physical disabilities and 
found that the functioning of  these families was not 
different from that of  control group parents. Based on 
this conclusion, they warn of  the risk that health care 
providers simply assume that such parents have de-
pressive feelings, which do not always exist. They also 
explain that parents whose children have such illness-
es or disabilities have a greater access to psychosocial 
services during their children’s treatment. Increased 
access might have attenuated the impact of  childhood 
cancer on family functioning. Given the possibility 
that utilization of  psychosocial services might have 
improved the family’s coping capability, the fact that 
their function was at the same level with the control 
group may not necessarily mean that the parents had 
not experienced depressive feelings or that the family 
did not need support. It may only mean that they had 
more resources than families in the control group.
 Impact of  childhood cancer in qualitative 

studies. Similar to the quantitative studies under re-
view, qualitative studies revealed variations in family 
functioning due to childhood cancer. As a variation 
of  disorganizing effects, many qualitative studies 
acknowledge impairing effects on parental psychol-
ogy when treatment is prolonged, such as depres-
sion (Clarke-Steffen, 1997; Knafl, Breitmayer, Gallo, 
& Zoeller, 1996; Patterson, Holm, & Gurney, 2004; 
Ward-Smith, Kirk, Hetherington, & Hubble, 2005; 
Young, Dixon-Woods, Findlay, & Heney, 2002), de-
bilitated family cohesion, or worsened marital re-
lationships (Barbarin, Hughes, & Chesler, 1985). 
 Contrary to the quantitative studies, evidence 
of  potential positive effects as well as non-impair-
ing impacts of  childhood cancer on family func-
tioning was found among the qualitative studies. 
For instance, Kupst and Schulman (1988) found 
that in the six to eight years following diagnosis, 
some families experienced significant role transitions 
(e.g., divorce, remarriage, career changes). Yet most 
families regained their original function and stabili-
ty despite these transitions. Moreover, McCubbin et 
al. (2002) also found that families showed resiliency 
by maintaining functional integrity during the treat-
ment phases. Additionally, Quin (2008) found that 
one-third of  families perceive their child’s cancer 
experiences positively, by feeling that the family be-
came closer overall and were more likely to ‘live in 
the present’ in response to the difficult situation. By 
contrast, just over one-quarter of  the participants ex-
perienced negative reactions of  insecurity and fear. 
 In particular, unlike the quantitative studies, most 
qualitative studies under review found a change of  
existential meaning due to childhood cancer experi-
ences. For instance, by interviewing the parents of  
children with chronic renal failure, Type 1 diabetes, or 
childhood cancer, Gannoni and Shute (2010) identi-
fied positive changes in the realms of  self-esteem and 
assigning meaning to the illness. While experiencing 
severe distress, parents of  children with these illnesses 
generally improved their self-esteem and were able to 
assign a meaning to the illness by observing their chil-
dren’s emotional growth and self-regulated behavior. 
The parents also described their efforts to strengthen 
family functioning in order to cope with adverse situ-
ations by supplementing the partner’s role (e.g., a par-

IMPACT OF CHILDHOOD CANCER ON FAMILY: REVIEW



23

ent attends a medical appointment when the partner 
is too depressed or emotionally exhausted to do so). 
 Björk et al. (2005) present a complementary 
finding. Although parents may lose their uncon-
scious belief  in immortality when confronted with 
childhood cancer, by learning about cancer and 
strengthening their relationships with healthcare 
providers and family members, they may establish 
beliefs more applicable to their situation, thereby 
beginning to regain their control and original ca-
pabilities. Graves and Aranda (2008) indicate that 
when facing relapse, families may live with both 
fear and hope, and that hope might not dispel fear. 
They therefore suggest that health care professionals 
need not only to help families stay hopeful but also 
to support them in living with both hope and fear. 
 Thus, the difficult circumstances of  childhood 
cancer did not always have negative impacts on fami-
ly functioning. In many cases, parents found a way to 
maintain their families, both by developing positive 
perceptions of  their child’s illness and by adjusting 
the assignment of  roles within the family. For exam-
ple, parents may have intimate conversations and help 
each other to overcome the difficulty, which could im-
prove their relationship and self-esteem. In this vein, 
family cohesion and marital relationships can in fact be 
strengthened by the experience of  childhood cancer 
after diagnosis (Barbarin et al., 1985; Delden, & Gry-
pdonck, 2008; Kars, Duijnstee, Pool, & Quin, 2008). 
 When considering positive effects of  childhood 
cancer on family functioning, it is important to ex-
amine exogenous factors that may have contributed 
to such positive results. For instance, in terms of  
marital relationships, the fear of  the child’s mortali-
ty may divert the parents from facing their own dis-
cord, thereby causing them to evaluate their marital 
relationships more favorably (Barbarin et al., 1985). 
Furthermore, the retrospective nature of  qualitative 
interviews often leads participants to recast their 
experiences in a more favorable light (McCubbin et 
al., 2002). Therefore, positive changes recorded by 
some studies should be attributed to the nature of  
their design, rather than to childhood cancer as such. 
 Differences in outcome by methodology. 
While some quantitative studies show impairing ef-
fects on family functioning due to childhood can-

cer, others show non-impairing effects. Acknowl-
edging the impairing effects on family functioning, 
by contrast, some qualitative studies found that 
childhood cancer actually has positive effects on 
family functioning, including the change of  exis-
tential meaning. In other words, while quantitative 
studies tend to focus on disorganizing or non-dis-
organizing effects, qualitative studies tend to fo-
cus on organizing effects on family functioning. 

Factors That Lead to Different Family Func-
tioning Outcomes
 Given the discrepancy of  outcomes seen 
among families, it is important to identify fac-
tors which influence consequences in fam-
ily functioning (Long & Marsland, 2011).
 Demographic characteristics. Interestingly, 
many researchers indicate that the demographic char-
acteristics of  families are not significantly related to 
family function consequences (Robinson, Gerhardt, 
Vannatta, & Noll, 2007; Thompson, Gustafson, 
Hamlett, & Spock, 1992). For instance, Robinson, 
Gerhardt, Vannatta, and Noll (2007) found that the 
child’s gender and age were not significantly related to 
maternal distress levels, although they were associated 
with the wellbeing of  the child and father (i.e., the old-
er the child was, the lower the distress levels of  both 
the child and fathers were). While this study deals with 
cystic fibrosis, not cancer, Thompson, Gustafson, 
Hamlett, and Spock (1992) also found that demo-
graphic characteristics (i.e., children’s age and gender, 
families’ socioeconomic status) or objective severity 
of  illness were not strongly associated with maternal 
psychological distress. These findings imply that fac-
tors other than demographic characteristics may more 
affect on the outcome direction of  family functioning.
 Psychosocial support. Many researchers sug-
gest that psychosocial support for families can con-
tribute to the improvement of  parental wellbeing and 
family’s capabilities (Barbarin et al., 1985; Fife et al., 
1987; Hoekstra-Weebers, Jaspers, Klip, & Kamps, 
2000; Kupst & Schulman, 1988). For instance, good 
communication with health care providers as well 
as within families might contribute to the enhance-
ment of  family functioning (Shapiro, Perez, & War-
den, 1998). Additionally, psychological support from 

HOSODA



24

relatives or friends  can help the parents develop a 
positive interpretation of  their child’s illness and 
reconstruct a new schema (McCubbin et al., 2002), 
thereby helping them stay hopeful (Fife, 1994). 
Health care providers and mental health profession-
als could also share information concerning the treat-
ment with the family, thereby helping the family to 
see prospects of  treatment and enhance their sense 
of  control of  the situation (Patterson et al., 2004). 
 Existing factors in the family. Kupst and Schul-
man (1988) indicate that parental coping skills can be 
a key component for positive outcomes. Such skills 
might include an ability to seek psychosocial support, 
as well as the ability to handle the situation by them-
selves. In addition, within marital relationships, open 
dialogue, coping skills of  other family members, par-
ents’ trait anxiety, freedom from financial difficulties, 
and the existence of  ongoing treatment can also be 
factors for family coping and functioning outcomes 
(Dockerty et al., 2000; Hoekstra-Weebers, Jaspers, 
Kamps, & Klip, 1999; Kupst & Schulman, 1988; Manne 
et al., 1996; Ostroff  et al., 2000; Sawyer et al., 2000). 
 Pre-existing factors in the family. Poor ad-
justment during the diagnostic phase may also pre-
dict family functioning after diagnosis (Dockerty et 
al., 2000; Manne et al., 1996; Ostroff  et al., 2000). 
Fife et al. (1987) found that while most families 
maintained their function except during the diagno-
sis phase, families with psychosocial problems before 
diagnosis showed a further debilitation in their func-
tion. Kazak (1989) also suggests that low-function-
ing families prior to diagnosis may adjust poorly to 
the illness after the end of  treatment. Considering 
these studies, it can be assumed that family function-
ing before diagnosis influences its future direction.

Impact of  Childhood Cancer on Family Func-
tioning Across Treatment Phases 

 This paper presents a comprehensive picture 
of  the dynamic transitions of  family functioning 
over the course of  treatment by linking study out-
comes to heterogeneous research methodologies. A 
review of  the literature distinguishes two import-
ant perspectives: a perspective that examines the 
change of  family functioning at multiple levels (i.e., 

practical and existential) instead of  a linear level 
(i.e., disorganizing or organizing) and a perspective 
that considers family functioning before diagnosis. 

Practical and Existential Layers 
 Although no study explicitly outlined the tran-
sitions of  family functioning in terms of  two layers, 
practical and existential, the changes within these 
two layers of  family functioning during the treat-
ment phases are seen in our sample of  studies. The 
presence of  this thread across studies can lead one 
to theorize that changes of  family functioning may 
occur both in a practical layer  (e.g., divorce or re-
assignment of  family role due to the burden of  fi-
nance and transportation) and in an existential layer 
(e.g., exploration of  the meaning of  illness, emo-
tional growth, restructuring values, self-blame). 
 Specifically, research has explored the extent to 
which childhood cancer impacts family functioning 
based on a linear perspective (disorganizing, non-dis-
organizing, or organizing) (Pai et al., 2007). Some 
studies indicate that disorganizing, non-disorganiz-
ing, and organizing impacts can coexist in different 
layers. Goldbeck (2006) suggests that parents with 
newly diagnosed chronic ill children can exhibit a 
mixed psychological state involving depression ac-
companied by debilitated physical daily functioning, 
along with a sense of  satisfaction with their families. 
That is, the co-occurrence of  a disorganizing impact 
(depression) and organizing impact (satisfaction) can 
be found in these parents’ reactions. Based on these 
findings, changes in family functioning can occur in a 
parallel fashion across practical and existential layers.
 Furthermore, it can also be inferred that illness 
affects the two layers differently. For instance, de-
teriorated illness conditions might increase paren-
tal burden in the practical layer, whereby family’s 
capability and self-esteem could be impaired in the 
existential layer. Otherwise, even if  the family func-
tioning or parental distress level in the practical layer 
does not change throughout the course of  treatment, 
the quality of  family functioning or parental distress 
might change if  parents positively integrate their 
traumatic experience into their own lives (Fife, 1994). 
Relating to research methodologies, while studies 
administering quantitative measures emphasize ap-

IMPACT OF CHILDHOOD CANCER ON FAMILY: REVIEW



25

praisal of  practical-level changes (disorganizing or 
non-disorganizing), studies administering qualitative 
measures focus on appraisal of  value-oriented and 
existential-level changes (disorganizing, non-disor-
ganizing, organizing). More specifically, given the 
nature of  psychometric scales which have narrow-
ly-focused variables (Sawyer, 2000), it is conceivable 
that quantitative research tends to elicits factors in the 
practical layer. On the other hand, since qualitative 
research, especially interviews, can allow interviewees 
to express subtle, personal meaning of  life-threaten-
ing illness, it may elicit factors in the existential layer 
as well as in the practical layer. Conceivably, even if  
psychometric scales show a detrimental impact on 
family functioning due to childhood cancer expe-
riences, the family might also experience a positive 
impact on their function at the existential level. In 
short, disorganizing, non-disorganizing, and or-
ganizing effects might co-occur at different levels. 

Family Functioning and Diagnosis 
 Although the few aforementioned studies sug-
gest that inherent problems in the family could be 
predictive for family functioning outcomes (Fife et 
al.; 1987; Kazak, 1989), no study explicitly outlined 
how such pre-existing problems affect outcome di-
rections over the several phases of  treatment. Olson 
(2000) attmpts to remedy this gap by proposing a 
circumplex model, which conceptualizes family life 
course along three dimensions (family cohesion, fam-
ily flexibility, and communication). According to this 
model, while families balanced in those three dimen-
sions can adjust to a challenge by utilizing resources 
within the family, families lacking that balance may 
have difficulties coping with a crisis (Alderfer & Ka-
zak, 2006; Olson, 2000). Olson’s model does not fo-
cus on childhood cancer and therefore does not take 
the long-term treatment phases into consideration, 
but it can help explain the dynamic transitions of  
family functioning. To summarize, while a high-func-
tioning family may seek out social resources and 
strengthen the bonds within the family during the 
course of  treatment, low-functioning families may 
experience difficulties coping with adverse events and 
fail to reestablish a new pattern of  family functioning. 

Dynamic Transitions in Family Functioning
 On the basis of  the discussion above, it can be 
concluded that disorganizing, non-disorganizing, or 
organizing impacts on family functioning might co-oc-
cur in both practical and existential layers throughout 
childhood cancer. Simultaneously, while high-func-
tioning families before diagnosis might tend to en-
hance their functioning, low-functioning families be-
fore diagnosis might be more at a risk of  lowering their 
functioning through childhood cancer experiences.

Clinical and Research Implications

 Upon review of  the current literature, a dis-
crepancy between family functioning outcomes has 
been found: some families show resiliency and oth-
ers show impairment during the treatment phases. In 
the examination of  factors that caused this disparity, 
two perspectives that were not fully integrated into 
the previous literature are distinguished: a perspec-
tive that examines the change of  family functioning 
at multiple levels (i.e., practical and existential) and 
a perspective that considers family functioning be-
fore diagnosis. Based on this conclusion, this study 
has delineated a clearer picture of  the dynamic tran-
sitions of  family functioning over the course of  
treatment. That is, while families at risk might reveal 
their inherent problems in the treatment phases and 
their relationships might disconnect, consolidat-
ed and more functional families might strengthen 
their existing ties. Such changes may occur in the 
practical and existential layers in a parallel fashion. 
 As suggested in this review, having a compre-
hensive picture of  family over the pre-diagnosis 
and treatment phases may enable care providers and 
mental health professionals to deliver better screen-
ing and more effective interventions for the family. 
For instance, even if  the parents feel stressed due to 
financial strains caused by the treatment at a practical 
level, they might still have found some meaning of  
their child’s illness and improved their self-esteem at 
an existential level. An in-depth understanding of  the 
family might help mental health professionals iden-
tify such a positive change and equip them to help 
families to deal with stress due to financial strains. 
 At the same time, not all negative impacts should 

HOSODA



26

be attributed exclusively to childhood cancer. For ex-
ample, even if  the mother shows depressive symptoms 
in the treatment phases, a pre-existing problem (e.g., 
relationship with her own parents, domestic violence 
from her husband) might also have contributed to her 
depression. A more comprehensive understanding 
of  the family could help mental health professionals 
identify such a preexisting problem, which may ex-
acerbate the impacts of  childhood cancer by itself.
 As for screening, Kazak et al. (2011) suggest 
the use of  the Psychosocial Assessment Tool, a 
brief  screening tool based on obtained parental re-
ports. This tool aims to detect families at psychoso-
cial risk at the point of  diagnosis. Health care pro-
viders and mental health professionals could deepen 
the understanding of  the family by administering 
such a screening tool or interviewing the family. 
 Having a comprehensive picture of  family dy-
namics could also help mental health professionals 
choose an appropriate intervention. For example, 
Sahler et al. (2005) found that problem-solving skills 
training was efficacious when mothers with children 
newly diagnosed with childhood cancer encountered 
difficulties in medical contexts. Moreover, McCubbin 
et al. (2002) indicate the necessity of  strength-based 
interventions to elicit family resiliency. Since there 
are many intervention options, the identification of  
the characteristics of  a family and what they actu-
ally need at a practical level and/or existential level 
in the pre-diagnosis and treatment phases might al-
low mental health professionals to facilitate appro-
priate interventions corresponding to each family.
 Health care providers would also benefit from 
recognizing the mechanisms of  family function-
ing influenced by childhood cancer experience. 
Even if  psychosocial problems in the family (e.g., 
neglectful childrearing, parental depression) in-
terfere with smooth communication between the 
parents and health care providers, health care pro-
viders are required to communicate with the par-
ents in order to proceed with treatment (DiMatteo, 
2004; Kazak et al., 2011; Sobo, 2004). Therefore, if  
health care providers develop a better understand-
ing of  family’s characteristics and its problem, this 
might help them better communicate with parents.
 Furthermore, when health care providers see 

the worsened relationship between the parents in-
fluence the child’s psychological state, they might 
empathize with the child, which may lead to feel-
ings of  self-blame when they cannot help the child 
(Meadors, Lamson, Swanson, White, & Sira, 2009). 
However, if  health care providers recognize that 
family functioning could improve in the long-term 
and if  they have strategies to mediate such family 
problems, this might reduce their emotional pain. 
 These observations suggest that better recog-
nition about the mechanism of  family functioning 
will be useful for parents, children, and health care 
providers. Ultimately, understanding family function-
ing in light of  two perspectives - perspectives that 
examines family’s transitions at multiple levels (i.e., 
practical and existential) and that considers family 
functioning before diagnosis - will better equip care 
providers and mental health professionals for effec-
tive interventions into families with need.  Further 
research to examine these perspectives is also needed.

References 

Alderfer, M. A., & Kazak, A. E. (2006). Family is-
sues when a child is on treatment for cancer. In 
R. T. Brown (Ed.), Comprehensive handbook of  
childhood cancer and sickle cell disease: A bio-
psychosocial approach (pp. 53–74). New York: 
Oxford University Press. 

Alderfer, M. A., Mougianis, I., Barakat, L. P., Beele, 
D., DiTaranto, S., Hwang, W., … Kazak, A. E. 
(2009). Family psychosocial risk, distress, and 
service utilization in pediatric cancer: Predictive 
validity of  the Psychosocial Assessment Tool. 
Cancer, 115(18 Suppl), 4339–4349. doi:10.1002/
cncr.24587

Barbarin, O. A., Hughes, D., & Chesler, M. A. (1985). 
Stress, coping, and marital functioning among par-
ents of  children with cancer. Journal of  Marriage 
and the Family, 47, 473–480. doi:10.2307/352146

Björk, M., Wiebe, T., & Hallström, I. (2005). Striv-
ing to survive: Families’ lived experiences 
when a child is diagnosed with cancer. Journal 
of  Pediatric Oncology Nursing, 22, 265–75. 
doi:10.1177/1043454205279303

IMPACT OF CHILDHOOD CANCER ON FAMILY: REVIEW



Brinkman, T. M., Palmer, S. L., Chen, S., Zhang, 
H., Evankovich, K., Swain, M. A., … Gajjar, A. 
(2012). Parent-reported social outcomes after 
treatment for pediatric embryonal tumors: A 
prospective longitudinal study. Journal of  Clin-
ical Oncology, 30, 4134–4140. doi:10.1200/
JCO.2011.40.6702

Byrne, J., Mulvihill, J. J., Myers, M. H., Connelly, R. 
R., Naughton, M. D., Krauss, M. R., … Bragg, K. 
(1987). Effects of  treatment on fertility in long-
term survivors of  childhood or adolescent can-
cer. The New English Journal of  Medicine, 317, 
1315–1321.

Cadman, D., Rosenbaum, P., Boyle, M., & Offord, D. 
R. (1991). Children with chronic illness: Family 
and parent demographic characteristics and psy-
chosocial adjustment. Pediatrics, 87, 884–889.

Clarke-Steffen, L. (1997). Reconstructing reality: 
Family strategies for managing childhood can-
cer. Journal of  Pediatric Nursing, 12, 278–287. 
doi:10.1016/S0882-5963(97)80045-0

Combrinck-Graham, L. (1985). A developmental 
model for family systems. Family Process, 24, 
139–150. doi:10.1111/j.1545-5300.1985.00139.x

DiMatteo, M. R. (2004). The role of  effective com-
munication with children and their families in 
fostering adherence to pediatric regimens. Pa-
tient Education and Counseling, 55, 339–44. 
doi:10.1016/j.pec.2003.04.003

Dockerty, J. D., Williams, S. M., McGee, R., & Skegg, 
D. C. (2000). Impact of  childhood cancer on 
the mental health of  parents. Medical and Pedi-
atric Oncology, 35, 475–83. doi:10.1002/1096-
9 1 1 X ( 2 0 0 0 1 1 0 1 ) 3 5 : 5 < 4 7 5 : : A I D -
MPO6>3.0.CO;2-U

Drotar, D. (1994). Psychological research with pedi-
atric conditions: If  we specialize, can we gener-
alize? Journal of  Pediatric Psychology, 19, 403–
414. doi:10.1093/jpepsy/19.4.403

Drotar, D. (1997). Relating parent and family func-
tioning to the psychological adjustment of  
children with chronic health conditions: what 
have we learned? What do we need to know? 
Journal of  Pediatric Psychology, 22, 149–65. 
doi:10.1093/jpepsy/22.2.149

Enskar, K., Carlsson, M., Golsater, M., Hamrin, E., 

& Kreuger, A. (1997). Parental reports of  chang-
es and challenges that result from parenting a 
child with cancer. Journal of  Pediatric Oncolo-
gy Nursing, 14, 156–163. doi:10.1016/S1043-
4542(97)90051-5

Ferrel, B. R., Rhiner, M., Shapiro, B., & Dierkes, M. 
(1994). The experience of  pediatric cancer pain, 
part I: Impact of  pain on the family. Journal of  
Pediatric Nursing, 9, 368–379.

Fife, B. L. (1994). The conceptualization of  meaning 
in illness. Social Science & Medicine, 38, 309–
316. doi:10.1016/0277-9536(94)90400-6

Fife, B., Norton, J., & Groom, G. (1987). The family’s 
adaptation to childhood leukemia. Social Science 
& Medicine, 24, 159–168. doi:10.1016/0277-
9536(87)90248-6

Gannoni, A. F., & Shute, R. H. (2010). Parental and 
child perspectives on adaptation to childhood 
chronic illness: a qualitative study. Clinical Child 
psychology and Psychology and Psychiatry, 15, 
39–53. doi:10.1177/1359104509338432

Goldbeck, L. (2006). The impact of  newly diagnosed 
chronic paediatric conditions on parental quality 
of  life. Quality of  Life Research, 15, 1121–1131. 
doi:10.1007/s11136-006-0068-y

Graves, D. S., & Aranda, S. (2008). Living with hope 
and fear: The Uncertainty of  childhood can-
cer after relapse. Cancer Nursing, 31, 292–301. 
doi:10.1097/01.NCC.0000305745.41582.73

Grootenhuis, M. A., & Last, B. F. (1997). Adjustment 
and coping by parents of  children with cancer: A 
review of  the literature. Supportive Care in Can-
cer, 5, 466–84. doi:10.1007/s005200050116

Havermans, T. H., & Eiser, C. (1994). Sib-
lings of  a child with cancer. Child: Care, 
Health and Development, 20, 309–322. 
doi:10.1111/j.1365-2214.1994.tb00393.x

Hoekstra-Weebers, J. E., Jaspers, J. P., Kamps, W. A., 
& Klip, E. C. (1999). Risk factors for psycholog-
ical maladjustment of  parents of  children with 
cancer. Journal of  the American Academy of  
Child and Adolescent Psychiatry, 38, 1526–35. 
doi:10.1097/00004583-199912000-00014

Hoekstra-Weebers, J. E., Josette, E. H. M., Jaspers, J. 
P., Klip, E. C., & Kamps, W. A. (2000). Factors 
contributing to the psychological adjustment of  

HOSODA



28

parents of  pediatric cancer patients. In L. Baider, 
C. L. Cooper, & A. K. De-Nour (Eds.), Cancer 
and the family (2nd ed., pp. 257–272). West Sus-
sex, England: John Wiley & Sons.

Hutchinson, K. C., Willard, V. W., Hardy, K. K., & 
Bonner, M. J. (2009). Adjustment of  caregiv-
ers of  pediatric patients with brain tumors: A 
cross-sectional analysis. Psycho-Oncology, 18, 
515–523. doi:10.1002/pon

Jamison, R. N., Lewis, S., & Burish, T. G. (1986). 
Psychological impact of  cancer on adolescents: 
Self-image, locus of  control, perception of  ill-
ness and knowledge of  cancer. Journal of  Chron-
ic Diseases, 39, 609–617. doi:10.1016/0021-
9681(86)90186-4

Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., Smi-
gal, C., & Thun, M. J. (2006). Cancer statistics, 
2006. A Cancer Journal for Clinicians, 56, 106–
130. doi:10.3322/canjclin.56.2.106

Kalnins, I. V., Churchill, M. P., & Terry, G. E. (1980). 
Concurrent stresses in families with a leukemic 
child. Journal of  Pediatric Psychology, 5, 81–92.

Kars, M. C., Duijnstee, M. S. H., Pool, A., Van 
Delden, J. J. M., & Grypdonck, M. H. F. (2008). 
Being there: Parenting the child with acute 
lymphoblastic leukaemia. Journal of  Clinical 
Nursing, 17, 1553–1562. doi:10.1111/j.1365-
2702.2007.02235.x

Katz, E. R., & Jay, S. M. (1984). Psychological aspects 
of  cancer in children, adolescents, and their fam-
ilies. Clinical Psychology Review, 4, 525–542. 
doi:10.1016/0272-7358(84)90042-4

Kazak, A. E. (1989). Families of  chronically ill chil-
dren: A systems and social-ecological model 
of  adaptation and challenge. Journal of  Con-
sulting and Clinical Psychology, 57, 25–30. 
doi:10.1037//0022-006X.57.1.25

Kazak, A. E., Barakat, L. P., Hwang, W., Ditaranto, S., 
Biros, D., Beele, … Reilly, A. (2011). Association 
of  psychosocial risk screening in pediatric cancer 
with psychosocial services provided. Psycho-On-
cology, 20, 715–723. doi:10.1002/pon.1972

Kazak, A. E., Prusak, A., Simms, S., Beele, D., Ro-
urke, M., Alderfer, M., & Lange, B. (2001). The 
psychosocial assessment tool (PAT)©: Pilot data 
on a brief  screening instrument for identifying 

high risk families in pediatric oncology. Family 
Systems and Health, 19, 303–317. doi:10.1037/
h0089454

Kinahan, K. E., Sharp, L. K., Seidel, K., Leisenring, 
W., Didwania, A., Lacouture, M. E., … Krull, K. 
R. (2012). Scarring, disfigurement, and quality of  
life in long-term survivors of  childhood cancer: 
A report from the Childhood Cancer Survivor 
study. Journal of  Clinical Oncology, 30, 2466–74. 
doi:10.1200/JCO.2011.39.3611

Knafl, K., Breitmayer, B., Gallo, A., & Zoeller, L. 
(1996). Family response to childhood chronic ill-
ness: Description of  management styles. Journal 
of  Pediatric Nursing, 11, 315–326. doi:10.1016/
S0882-5963(05)80065-X

Kupst, M. J., & Schulman, J. L. (1988). Long-term 
coping with pediatric leukemia: A six-year fol-
low-up study. Journal of  Pediatric Psychology, 
13, 7–22.

Long, K. A., & Marsland, A. L. (2011). Family adjust-
ment to childhood cancer: A systematic review. 
Clinical Child and Family Psychology Review, 14, 
57–88. doi:10.1007/s10567-010-0082-z

Manne, S., Miller, D., Meyers, P., Wollner, N., Stein-
herz, P., & Redd, W. H. (1996). Depressive symp-
toms among parents of  newly diagnosed children 
with cancer: A 6-month follow-up study. Chil-
dren’s Health Care, 25, 191–209. doi:10.1207/
s15326888chc2503_3

Maurice-Stam, H., Oort, F. J., Last, B. F., & Groo-
tenhuis, M. A. (2008). Emotional functioning 
of  parents of  children with cancer: The first 
five years of  continuous remission after the end 
of  treatment. Psycho-Oncology, 17, 448–459. 
doi:10.1002/pon

McCubbin, M., Balling, K., Possin, P., Frierdich, S., 
& Bryne, B. (2002). Family resiliency in child-
hood cancer. Family Relations, 51, 103–111. 
doi:10.1111/j.1741-3729.2002.00103.x

Meadors, P., Lamson, A., Swanson, M., White, M., & 
Sira, N. (2009). Secondary traumatization in pe-
diatric healthcare providers: Compassion fatigue, 
burnout, and secondary traumatic stress. OME-
GA: Journal of  Death and Dying, 60, 103–128. 
doi:10.2190/OM.60.2.a

Newby, N. M. (1996). Chronic illness and the family 

IMPACT OF CHILDHOOD CANCER ON FAMILY: REVIEW



life-cycle. Journal of  Advanced Nursing, 23, 786–
91. doi:10.1111/j.1365-2648.1996.tb00052.x

Oberfield, S. E., & Sklar, C. A. (2002). Endo-
crine sequelae in survivors of  childhood can-
cer. Adolescent Medicine, 13, 161–170. Re-
trieved from http://www.ncbi.nlm.nih.gov/
pubmed/11841962

Olson, D. H. (2000). Circumplex model of  marital 
and family systems. Journal of  Family Threrapy, 
22, 144–167. doi:10.1111/1467-6427.00144

Ostroff, J., Ross, S., & Steinglass, P. (2000). Psycho-
social adaptation following treatment: A family 
systems perspective on childhood cancer survi-
vorship. In L. Baider, cary L. Cooper, & A. K. 
De-Nour (Eds.), Cancer and the family (2nd ed., 
pp. 155–173). West Sussex, England: John Wiley 
& Sons.

Pai, A. L. H., Greenley, R. N., Lewandowski, A., Dro-
tar, D., Youngstrom, E., & Peterson, C. C. (2007). 
A meta-analytic review of  the influence of  pe-
diatric cancer on parent and family function-
ing. Journal of  Family Psychology, 21, 407–415. 
doi:10.1037/0893-3200.21.3.407

Papadoppulos, L. (1995). The impact of  illness on 
the family and the family’s impact on illness. 
Counseling Psychology Quarterly, 8, 27–34. 
doi:10.1080/09515079508258694

Patenaude, A. F., & Kupst, M. J. (2000). Psychosocial 
functioning in pediatric cancer. Journal of  Pedi-
atric Psychology, 30, 9–27. doi:10.1093/jpepsy/
jsi012

Patterson, J. M., Holm, K. E., & Gurney, J. G. (2004). 
The impact of  childhood cancer on the family: A 
qualitative analysis of  strains, resources, and cop-
ing behaviors. Psycho-Oncology, 13, 390–407. 
doi:10.1002/pon.761

Pelcovitz, D., Libov, B. G., Mandel, F., Kaplan, S., 
Weinblatt, M., & Septimus, A. (1998). Posttrau-
matic stress disorder and family functioning in 
adolescent cancer. Journal of  Traumatic Stress, 
11, 205–21. doi:10.1023/A:1024442802113

Pless, I. B., Roghmann, K., & Haggerty, R. J. (1972). 
Chronic illness, family functioning, and psycho-
logical adjustment: A model for the allocation 
of  preventive mental health services. Interna-
tional Journal of  Epidemiology, 1, 271–277. 

Retrieved from http://www.ncbi.nlm.nih.gov/
pubmed/4669204

Quin, S. (2008). The long-term psychosocial effects 
of  cancer diagnosis and treatment on children 
and their families. Social Work in Health Care, 
39, 129–149. doi:10.1300/J010v39n01_09

Robinson, K. E., Gerhardt, C. A., Vannatta, K., & 
Noll, R. B. (2007). Parent and family factors asso-
ciated with child adjustment to pediatric cancer. 
Journal of  Pediatric Psychology, 32, 400–410. 
doi:10.1093/jpepsy/jsl038

Rolland, J. S. (1987). Chronic illness and the life cy-
cle: A conceptual framework. Family Process, 26, 
203–21. doi:10.1111/j.1545-5300.1987.00203.x

Sahler, O. J. Z., Fairclough, D. L., Phipps, S., Mul-
hern, R. K., Dolgin, M. J., Noll, R. B., … Cope-
land, D. R. (2005). Using problem-solving skills 
training to reduce negative affectivity in mothers 
of  children with newly diagnosed cancer: Re-
port of  a multisite randomized trial. Journal of  
Consulting and Plinical Psychology, 73, 272–83. 
doi:10.1037/0022-006X.73.2.272

Sawyer, M., Antoniou, G., Toogood, I., Rice, M., & 
Baghurst, P. (2000). Childhood cancer: A 4-year 
prospective study of  the psychological adjust-
ment of  children and parents. Journal of  Pe-
diatric Hematology/Oncology, 22, 214–220. 
doi:10.1097/00043426-200005000-00006

Sawyer, M. G., Antoniou, G., Toogood, I., Rice, 
M., & Baghurst, P. A. (1993). A prospective 
study of  the psychological adjustment of  par-
ents and families of  children with cancer. Jour-
nal of  Paediatrics and Child health, 29, 352–6. 
doi:10.1111/j.1440-1754.1993.tb00533.x

Shapiro, J., Perez, M., & Warden, M. J. (1998). The 
importance of  family functioning to caregiv-
er adaptation in mothers of  child cancer pa-
tients: Testing a social ecological model. Jour-
nal of  Pediatric Oncology Nursing, 15, 47–54. 
doi:10.1177/104345429801500107

Sloper, P. (2000). Predictors of  distress in parents of  
children with cancer: A prospective study. Journal 
of  Pediatric Psychology, 25, 79–91. doi:10.1093/
jpepsy/25.2.79

Sobo, E. J. (2004). Good communication in pediatric 
cancer care: A culturally-informed research agen-

HOSODA



30

da. Journal of  Pediatric Oncology Nursing, 21, 
150–154. doi:10.1177/1043454204264408

Speechley, K. N., & Noh, S. (1992). Surviving child-
hood cancer, social support, and parents’ psy-
chological adjustment. Journal of  pediatric psy-
chology, 17, 15–31. doi:10.1093/jpepsy/17.1.15

Thompson, R. J., Gustafson, K. E., Hamlett, K. W., & 
Spock, A. (1992). Stress, coping, and family func-
tioning in the psychological adjustment of  moth-
ers of  children and adolescents with cystic fibro-
sis. Journal of  Pediatric Psychology, 17, 573–85. 

Trask, P. C., Paterson, A. G., Trask, C. L., Bares, C. B., 
Birt, J., & Maan, C. (2003). Parent and adolescent 
adjustment to pediatric cancer: Associations with 
coping, social support, and family function. Jour-
nal of  Pediatric Oncology Nursing, 20, 36–47. 
doi:10.1053/jpon.2003.5

Vannatta, K., Salley, C. G., & Gerhardt, C. A. (2009). 
Pediatric oncology: Progress and future chal-
lenges. In M. C. Roberts & R. G. Steele (Eds.), 
Handbook of  pediatric psychology (4th ed., pp. 
319–333). New York.

Wallander, J. L., & Varni, J. W. (1998). Effects of  pe-

diatric chronic physical disorders on child and 
family adjustment. Journal of  Child Psychology 
and Psychiatry, 39, 29–46. doi:10.1111/1469-
7610.00302

Ward-Smith, P., Kirk, S., Hetherington, M., & Hubble, 
C. L. (2005). Having a child diagnosed with cancer: 
An assessment of  values from the mother’s view-
point. Journal of  Pediatric Oncology Nursing, 
22, 320–327. doi:10.1177/1043454205281682

Wijnberg-Williams, B. J., Kamps, W. A., Klip, E. C., 
& Hoekstra-Weebers, J. E. H. M. (2006). Psycho-
logical adjustment of  parents of  pediatric cancer 
patients revisited: Five years later. Psycho-oncol-
ogy, 15, 1–8. doi:10.1002/pon.927

Wright, P. S. (1993). Parents’ perceptions of  their quali-
ty of  life. Journal of  Pediatric Oncology Nursing, 
10, 139–145. doi:10.1177/104345429301000404

Young, B., Dixon-Woods, M., Findlay, M., & Heney, 
D. (2002). Parenting in a crisis: Conceptualising 
mothers of  children with cancer. Social Science 
& Medicine, 55, 1835–1847. doi:10.1016/S0277-
9536(01)00318-5

IMPACT OF CHILDHOOD CANCER ON FAMILY: REVIEW


