Child

Scenario

A 29 woman with metastatic melanoma (in brain) explains that she and her husband have not told their 10 year old son and 8 year old daughter about her problem because it will cause too much distress.

Tasks

• Talk to the oncology psychologist about this scenario, and report back a summary of her thoughts.
• Describe the mechanisms that lead a doctor to consider a clinical diagnosis of brain metastases.

Opinion

What the oncologist had to say .... will be coming later!

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The decision to talk to children about a cancer diagnosis is complicated by the child and the parent. In order to tell a child about a cancer problem, you have to face it yourself. Otherwise it is easy to find a number of excuses 'preventing' you from having the discussion. Things like "too young", "too distressing", "too early", etc.

All of these excuses however remain just that … excuses. Does the child have a right to know about the parent's disease? Well, it is probably not about rights and no rights. It's probably more about honesty (which is what we try to teach our children), facing our fears front on (which is what we try to teach our children), enjoying each day (which is what we try to teach our children) … strange how repetitive this is!

The bottom line is two fold:

1. you have a relationship with your child, and important things in a relationship are supposed to be shared
2. in the not too distant future, this child is going to be motherless, and then she/he is going to ask the unanswerable - "why didn't you tell me my mother was dying?" Suddenly the telling doesn't seem to really have any excuses associated that could be acceptable. In later life the child might also say "If I had known, I would/wouldn't have ……." then insert some action, approach or event that the other will assess as important.

And years down the track, the boy is married and in a strange, dark twist of fate, his wife develops metastatic melanoma in the brain. Now I ask you, what did his mother teach him? And what will he do as a result? Won't happen, maybe, maybe not.

Important thing for you to understand is that the lack of saying its name does not take it away or make it not happen. They say that there are only two certainties - death and taxes, and the fact is that only one is certain and it comes to all of us at some time. The only issues up for grabs are the HOW? and the HOW?. That is, 'by what method?' and 'with what preparation & dignity?'

Brain metastases will lead a doctor to consider the clinical diagnosis when they cause symptoms or signs. These symptoms and signs will arise from a few mechanisms:

1. pressure effects from a mass related to volume (headache, ventricular obstruction, LOC)
2. neurological effects related to site (motor, speech, sensory & visual disturbance)
3. neurophysiological effects related to function (fits)