How to Manage Family Dynamics During Cancer

Managing family dynamics during cancer can be complicated. 

Thomas Sager’s wife was diagnosed with pancreatic cancer in October 2010, and he, along with her adult son and daughter, braced himself for a nine- to 12-month ordeal. The day after Thanksgiving, when her children had packed up to go back to their respective homes several states away, his wife had a “breakdown.”

“She could not be consoled, and she blamed me,” Sager recalls. “She was convinced she would not live to see her children again,” though they had plans to spend Christmas together. She was so agitated that her sister took her to the hospital, and the rest of the family advised Sager to stay away since his presence seemed to set her off. “It was agonizing and hurtful,” he says. It lasted almost 10 days. 

Families and cancer are complicated. The unique dynamics that define each family are in precarious balance during good times and easily upset during crisis. In his book Cancer as a Turning Point, Lawrence LeShan, PhD, writes: “The stress of cancer may in one family bring about much fuller and deeper communication between members and in another family have the opposite effect.” 

The challenge for caregivers, then, is in trying to determine early on which type of family they have.

Healthcare professionals have known for ages that the well-being of patients and caregivers is intertwined, “a synergistic effect,” says James Zabora, ScD, dean of the National Catholic School of Social Service and Professor of Social Work at The Catholic University of America. For that reason, Zabora and a team of psychosociologist researchers have been training and testing caregivers for years to discern who needs help coping and how to deliver that help. 

What they found was that teaching family caregivers how to brainstorm constructively gives them confidence to make thoughtful decisions, which in turn reduces their stress. 

Families considered high-functioning, or “engaged,” as Zabora calls it, before the cancer event respond better to problem-solving training than maladjusted or “disengaged” families. The challenge is to identify which families need additional or remedial training and how frequently, Zabora says. 

A problem-solving therapy used to empower caregivers and reduce stress is referred to as COPE. The letters in the acronym stand for: “Creativity,” which refers to using different perspectives to view a problem; “Optimism,” having a positive but realistic attitude toward the problem-solving process; “Planning,” setting goals and defining steps to reach them; and “Expert information,” which means knowing when to seek professional help and when to rely on what you know or can readily find out. According to the National Cancer Institute, the COPE program “has been shown to decrease stress in some caregivers.” 

Medicine has become patient-centered, but when doctors talk about treating the whole patient, that has to include the whole family, Zabora says. “The next logical step would be to screen family caregivers,” he adds. “We showed a long time ago that it only takes a few minutes to determine who needs psychosocial education, and you want to have that information from day one.”

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