Cancer in Young Adults: Through Parents’ Eyes

5. The effect on siblings: managing conflicting demands

The majority of narratives that mentioned the presence of siblings in the family addressed some sort of problem for the siblings arising as a result of the illness. It appears that whatever the age of the siblings, whether they are younger and need parental care or whether they are older and away from home, the effect of their brother or sister’s illness can be far reaching.

Much of the material from the narratives supports the literature (Spinetta 1999, Riches and Dawson 2000), and the experiences of George’s family. Siblings have experienced a range of problems and emotions, they have felt marginalised and isolated, and some have felt that they have ‘lost’ a parent as well as a brother or sister. They have also experienced fear and anxiety for their own health. However, in addition to documenting the problems from the siblings’ perspective, we can see that these same problems cause the parents a considerable amount of additional distress.

Many of the narratives have indicated that parents feel guilt at having to divide their time and attention between their sick child and their other children. The problem of ‘where to be’, and the feeling that wherever the parent is they are letting someone down, was expressed by in a number of the accounts. This problem is exacerbated when the parent – usually the mother – is single handedly caring for the family.

Anderson’s (2000) paper on responses to a death recognises the importance of the bereavement process within the family. In most cases Anderson suggests that the acceptance of the loss occurs naturally over time, but in the case of siblings there may be many conflicting feelings to manage. Research conducted by Cain, Fast and Erikson (1964) shows that the death of a sibling can be mourned for many years and can put a strain on other relationships within the family. This may become a problem if feelings about the death have not been addressed or resolved at the time, for example if the surviving sibling has ‘fallen out’ with their brother or sister before their death this may lead to prolonged feelings of guilt (Anderson 2000).

It seems unavoidable that siblings will be affected, and that parents will take on the responsibility for the adverse effects. However, rather than parents feeling guilt at their inability to protect their other children from pain, or to be in two places at once, it is perhaps better to recognise that whatever strategy is adopted, there will always be an effect.

In relation to health professionals and others involved in the care of the young adult with cancer it is important that their awareness extends to siblings in the family. This is of particular importance within the community setting. Even if the professionals are not in a position to offer any material assistance, they should be aware of the potential problems and reassure parents that they are ‘normal’ under the circumstances. As Sloper (2000) observes an important role for health professionals is to draw parents’ attention to the needs of siblings and to ensure that information and support is available to them.

In practical terms, for example in the case of single parents, other types of assistance may be offered. The NHS Cancer Plan (2000) emphasises the importance of care within the community. If such care is to be of real assistance to parents, health professionals must be equipped with appropriate information to support parents in both emotional and practical ways with the care of their other children.