Grief After Loss of a Child to Cancer: Gender Differences

Fran Lowry

December 02, 2019

After losing a child to cancer, the factors that affect the time that parents grieved differed between mothers and fathers, a Swedish study found.

For mothers, good communication within the family and trust that the healthcare team had made every effort to cure their child predicted lower levels of prolonged grief symptoms.

For fathers, it was saying farewell to their child in the way they wanted and feeling that they had received practical support from the healthcare team.

The findings "may have implications for design of family bereavement support within pediatric oncology care, including addressing the differing needs of mothers and fathers more effectively," write the authors, led by Lilian Pohlkamp, MSc, Ersta Sköndal Bräcke University College, Stockholm, Sweden.

The study was published online November 14 in the Journal of Clinical Oncology.

Most bereaved parents eventually adjust to the loss of a child, but some have persistent and pervasive grief reactions or prolonged grief, the authors write.

To examine factors associated with such prolonged grief, the researchers studied data from a population-based nationwide survey of 133 mothers and 92 fathers who had lost a child to cancer 1 to 5 years earlier.

This time lag between the child's death and the survey is one of the limitations of the study. The responses may have been affected by the time that had passed, as well as the ongoing grieving process, the authors comment.

Information from the survey was obtained via face-to-face interviews with the bereaved parents. The mean age of the mothers was 45 years, and that of the fathers, 47 years. The mean age of the children was 10 years at death.

The researchers used the Prolonged Grief Disorder–13 tool, which they had validated in an earlier study, to assess the parents' prolonged grief symptoms

Factors that contributed to symptoms of prolonged grief for mothers were feeling that their child suffered from anxiety during the illness trajectory or from pain during the last month of life, and feeling that they had not received sufficient information on how to take care of their child or handle acute problems related to the illness.

For fathers, factors that contributed to symptoms of prolonged grief were feeling that they had an inadequate level of responsibility for their child's care during the last month of life, a perception that they had received insufficient information about their child's illness trajectory, and not getting sufficient information on where to turn for their own psychosocial support.

"The association between lower levels of prolonged grief symptoms in mothers and being able to talk within the family indicates that facilitating communication about feelings among family members during times of emotional upheaval might reduce long-term distress in bereaved mothers," Pohlkamp and colleagues write.

In addition, the fact that mothers who trusted that the healthcare team had done everything possible to cure their child were found to have lower levels of prolonged grief symptoms shows the importance of establishing strong therapeutic alliances in pediatric oncology, the researchers add.

"Clinicians should be aware that parents want to feel that every effort is made to alleviate their child's suffering from pain or anxiety, even when cure is not possible," they write.

The finding that fathers suffered prolonged grief because they were not able to say goodbye to their deceased child in a way they wanted suggests that clinicians should "support fathers in prognostic awareness throughout the difficult journey toward their child's death, and to ask questions about their needs and wishes during the end-of-life period," they write.

Another limitation of the study could be that parents with high levels of prolonged grief symptoms perceive their experiences during the child's illness and death in a more critical light than those with lower levels of grief symptoms, the authors suggest.

The study was supported by the Swedish Childhood Cancer Foundation, the Galo Foundation, and Ersta Sköndal Bräcke University College.

J Clin Oncol. Published online November 14, 2019. Abstract

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