Childhood Cancer

Childhood Cancer Survivors

Relationships with siblings

Childhood cancer touches all members of the family and can have especially long-lasting effects on siblings. The diagnosis, treatment, and aftermath can all create an array of conflicting feelings in siblings. Not only are they concerned about their brother or sister, but they usually resent the turmoil the family has been thrown into. They feel jealous of the gifts and attention showered on the sick child, yet feel guilty for having these emotions. Some siblings feel that the child or teen with cancer continues to consume most of the parents’ attention long after treatment ends. In other families, siblings and the child with cancer form deeper and closer relationships.

My son had panic attacks in college. During therapy, he learned it was from sublimated worry and anger about his younger sister’s cancer many years earlier. He’s 30 and it still occasionally appears. He says he can’t believe he’s this age and he still falls apart when something goes wrong. He’s had lots of help since then, but we didn’t know anything was wrong before. We thought everything was taken care of—there were loving friends. But the truth is, he was farmed out at the time. And he did resent it. And I realize now that it must have felt like the epitome of desertion.

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I have two older brothers. They were 13 and 11 when I was diagnosed. I haven’t ever had the best of relationships with my brothers. There was lots of sibling rivalry and fights. I didn’t notice any problems when I was sick, but my mother said my brothers were jealous of the attention that I was getting. When I went to the camp for kids with cancer, I didn’t let my brother come, I took a friend. I thought of the camp as my time to get away. I didn’t want him there with me. It’s been 13 years and we’ve never talked about it.

The most common reactions of siblings to their brother or sister’s cancer are concern, fear, jealousy, anger, guilt, fear of abandonment, sadness, and worry about their parents. Younger children may also feel that something they did caused their brother or sister’s cancer. These feelings can cause academic and social problems or feelings of anxiety and depression.

I have two older brothers—one was in ninth grade and one in his first year of college when I was diagnosed. My youngest brother and I were only 18 months apart and were always really close. It was hard for him when I was going through treatments and he lost a lot of attention. They also were left to fend for themselves because my father was stationed far away when I was sick. I think my younger brother resented it, and this came out when we attended camp together. He realized there that his feelings were shared by other siblings and were valid. He never expressed his resentment at the time, though, because he was old enough to know what I was going through was pretty difficult. And sometimes I milked it. I’d poke at them and make comments because they weren’t allowed to hit me.

Brothers and sisters within the same family can have markedly different reactions to their sibling’s cancer treatment and survival, depending on their age, temperament, and social support. Family therapy can be very effective in exploring the various reactions of members of the family and working out ways to communicate well and support one another.

My youngest daughter was 9 when her 13-year-old sister had her bone marrow transplant. They had always been close and we worked to maintain that. She really looked up to her older sister and wanted to be like her. She wanted a central line and went so far as to tape an external line with an empty attached bag to her chest when she accompanied us to clinic. She showed her stress by biting the skin around her thumb and fingers until they bled. She had never done that before the cancer. It’s improving now—after over 2 years—but she still does it when she’s stressed.

My son, on the other hand, was in eighth grade and I was pretty much gone until he was a sophomore. It was difficult for him, but he doesn’t talk about it. He thought being in the hospital was “boring” so he didn’t visit very often. I really missed sharing a lot of his life—all of the successes such as wrestling when he went to state, won the tournament, and got a trophy. I missed it all—I can never go back and experience it, it’s just gone. Over time, he chose to deal with our absence by spending less time at home and running with a new group of friends. He’s made some bad choices and it’s hard to know if it had anything to do with our disrupted life or if it’s normal teenage experimentation. We are really concentrating on encouraging him—and my other kids too—because they have so much potential. While he’s made some mistakes, he’s done some really neat things too, so we’re still hopeful. We’re just trying to reclaim all our kids and it’s been a real struggle.

Siblings also learn important lessons about compassion, sharing, and coping skills. Most realize that should they ever become as sick, the same attention would be paid to them and that all possible efforts would be made to help them survive. That can be a comfort when jealousy or feelings of neglect arise. Their empathy and compassion may grow through the crisis. Brothers and sisters of children with cancer sometimes feel that they benefited from the experience in many ways, such as increased:

  • Knowledge about health and disease.

  • Empathy for the sick or disabled.

  • Sense of responsibility.

  • Self-esteem.

  • Maturity and coping ability.

  • Family closeness.

Many of these siblings mature into adults interested in the helping professions such as medicine, social work, or teaching.

One experience in my life that was in no way comfortable for my family or myself and caused me a lot of confusion and grief was when my brother had leukemia. The Thanksgiving of my third-grade year, Preston became very ill and was diagnosed with cancer. Along with the disruption of this event, it also caused me to grow tremendously as a person.

When my brother had very little hair or was puffed out from certain drugs, I learned to respect people’s differences and to stick up for them when they are made fun of. Also, when Preston was in the hospital I was taught to deal with the great amount of jealousy that I had. He received many gifts, cards, candy, flowers, games, and so many other material things that I envied. Most of all, he received all of the attention and care of my mother, father, relatives, and friends. This is what I was jealous of the most. As I look back now, I can’t believe that I was that insensitive and self-centered to be mad at my brother at a time like that.

The thing that made this a graced period for me was the fact that it enabled me to be very close to my brother as we grew up. My brother and I are now good friends and are able to talk and share our experiences with each other. I don’t think we would have this same relationship if he never had leukemia and I think that has been a very positive outcome. Another thing that has been a positive outcome of this event is the people I’ve been able to meet. Through all the support groups, camps, and events for children with cancer and their siblings, I have met some people with more courage and more heart than anyone could imagine. In no way am I saying that I’m glad my brother had cancer, but I will say I’m very glad with some of the outcomes of it.

Survivors themselves often have strong feelings about the effect their cancer had on family functioning and the long-range effects on siblings.

It was only over the course of years that I realized how guilty I felt about my brother. I know that the year I was ill was one of terrible disruption for my family, and my brother really seems to have suffered for it. I won’t go into the nature of his emotional problems, but I realized that I held myself responsible—that I somehow felt that while my parents attended to my needs, they neglected my brother. Now I know this is not rational, but it feels so real.

I think these kinds of feelings are not uncommon in those touched by a life-threatening illness, but somehow surviving such an illness exacerbates and enhances them and sometimes traps us in them.

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In a focus group for adult survivors of childhood cancer, we recently started talking about sibling guilt. It’s been an enormous problem for me. My brother was 6 when I was diagnosed at 5. Even before I got sick, he was so smart and used to watch all of the science shows. He knew that I could die, and he lost a lot of attention when I was sick. He is still socially awkward (in his late 20s) and is still having problems sorting life out. We’ve never talked about it, but I think we should.