Systematic Review: Family Resilience After Pediatric Cancer Diagnosis

Marieke Van Schoors, MSc; Line Caes, PHD; Lesley L. Verhofstadt, PHD; Liesbet Goubert, PHD; Melissa A. Alderfer, PHD


J Pediatr Psychol. 2015;40(9):856-868. 

In This Article


This systematic review provides general evidence of family resilience after a pediatric cancer diagnosis; however, more work is needed to best understand this phenomenon. While we are starting to acknowledge and understand individual strengths, less is known about family-level strengths after the experience of pediatric cancer (i.e., family resilience). To further this field of inquiry, future work should be theory-based, match the unit of measurement with the unit of interest (i.e., include all/many family members), and use appropriate statistical methods to nest data from family members within families.

The conclusions of this review are hampered by a few factors. We considered families as resilient if they returned to, sustained, or achieved competent levels of functioning after childhood cancer diagnosis. However, data regarding the functioning of the family before cancer, longitudinal data examining changes in the family over time after diagnosis, and criteria for judging whether the functioning of the family is "competent" were rarely available. We frequently relied on comparisons between families of children with cancer and controls/norms to determine resilience; however, one could argue that competent functioning in the context of pediatric illness may be different from the functioning of families in which the children are healthy (see Alderfer & Stanley, 2012). For example, perhaps a more enmeshed or rigid pattern of functioning is adaptive in the face of cancer, at least for a certain period following diagnosis (Olson, 2000).

Our ability to draw conclusions about the resilience of families facing pediatric cancer was also hampered by the relative lack of studies using this framework as a basis for their research approach. In fact, other conceptualizations of family resilience could not be applied to the existing literature. For example, various family resilience theories (McCubbin & McCubbin, 1988; Patterson, 2002; Rolland & Walsh, 2006) do not see family functioning as the outcome of interest. Instead, family functioning is conceptualized as the process or means through which families achieve resilience. In these models, other outcomes are evidence of resilience, such as the family's ability to successfully meet future challenges (Rolland & Walsh, 2006), to maintain the family unit, or to promote the development of individual members (Patterson, 2002). These outcomes are rarely, if ever, assessed in the context of pediatric cancer diagnoses. Other definitions of resilience in the context of pediatric illness, such as successful management of illness and treatment demands (Mitchell, Murdock, & McQuaid, 2004), are rarely examined as an outcome of family-level processes (e.g., effective communication).

Suggestions for Future Research

To parallel the movement toward conceptualizing individual responses after pediatric cancer within a resilience framework, future research regarding family-level responses to pediatric cancer needs to adopt family resilience models. This change would require research to involve multiple members within families, assessed over time. More homogenous samples or samples large enough to examine heterogeneity (e.g., time since diagnosis, age of children) are recommended. Mixed qualitative and quantitative methods, along with observational methods, are needed to assess the full range of relevant constructs including objective and subjective characterization of the demands of pediatric cancer, capabilities, characteristics, and key processes of functioning within the family, and short- and long-term family-level outcomes indicative of resilience. Research aimed at uncovering factors capable of identifying those families who might struggle to achieve resilience and isolating the mechanisms underlying family resilience would be most helpful for informing intervention.

Implications for Clinical Practice

Despite gaps in the current literature, adoption of a family resilience framework and the findings of our review have implications for clinical practice. First, attention should be focused on the impact of cancer on the functioning of the family and family functioning should be routinely assessed in this population. Some families may need assistance in rallying their resources, developing a shared perspective of their experience and working together effectively to meet the demands of cancer. Such difficulties may simultaneously jeopardize cancer treatment and important longer-term family outcomes. Relevant empirically based family-level intervention approaches are described in the literature (e.g., Rolland & Walsh, 2006; Saltzman, Pynoos, Lester, Layne, & Beardslee, 2013). Second, clinical work with families should be sensitive to possible cultural differences, should consider the family within its larger socio-ecological context, and attend to subgroups that might be at elevated risk (e.g., families of children with brain tumors). Finally, based on our review, conflict within the family during treatment and communication with and support of siblings may be areas of common difficulty for families of children with cancer that should specifically be assessed and addressed as needed.