BRAF Mutational Status in Papillary Microcarcinoma: Diagnostic and Prognostic Potential

BRAF mutational status in papillary microcarcinoma is not enough on its own to predict aggressive tumor behavior, researchers reported during the 82nd annual meeting of the American Thyroid Association.

However, when BRAF mutational status is considered along with 3 other “modifiers” or histopathologic features of the microcarcinoma, the ability to predict how aggressive the tumor will be—and subsequently how aggressive treatment must be to prevent its spread—improves substantially. Together these 4 modifiers (BRAF mutation, location, multifocality, and fibrosis) effectively risk-stratify the 5% of papillary nodules that have the potential to metastasize from the other 95% which will have a predictably indolent course.

“The BRAF^V600E mutation is present in 50% of papillary microcarcinomas and is typically discovered incidentally,” Yuri E. Nikiforov, MD, PhD, professor of pathology at the University of Pittsburgh School of Medicine, explained in an interview. Nevertheless, if the mutation is present in a nodule, “there is a 99% chance that it is a cancer, and the nodule needs to be removed to cure the disease,” he said. Thus, the presence of the BRAF^V600E mutation is highly specific for the diagnosis of papillary microcarcinoma.  Marina Nikiforova, MD, associate professor of pathology at the University of Pittsburgh School of Medicine, stressed that detection of BRAF mutations must be performed at a CAP/CLIA-certified molecular diagnostics laboratory to ensure the information provided is clinically relevant.

The BRAF^V600E mutation is not only an important marker for diagnosing the disease, as noted by both speakers, but for detecting which microcarcinomas may be more aggressive in their behavior. In a recent study, Niemeier et al evaluated a combination of BRAF mutations with specific histopathologic features to better risk-stratify papillary microcarcinomas (Cancer. 2012;118:2069-2077). Investigators, including principal investigator Nikiforov, tested a group of aggressive papillary microcarcinomas and nonaggressive tumors using a molecular-pathologic score.

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Dr. Nikiforov on Molecular Testing of Thyroid Nodules

BRAF mutations were detected in 77% of aggressive papillary microcarcinomas as well as in 32% of the nonaggressive tumors (P = .001). However, several histopathologic features differed significantly between the aggressive and nonaggressive tumor groups. By using multivariate regression analysis, a molecular-pathologic score was developed by the team that included BRAF status and 3 additional histopathologic features: superficial tumor location, multifocality, and tumor fibrosis. “By adding these 3 histologic criteria to BRAF status, sensitivity increased from 77% to 96% and specificity increased from 68% to 80%,” investigators reported.

Analyses of an independent validation cohort also demonstrated that the same molecular-pathologic score stratified tumors into low-, moderate-, and high-risk groups with the probability of lymph node metastases or tumor recurrence in 0%, 20%, and 60% of patients, respectively.

“If a tumor has all of these 4 features—BRAF mutation, location, multifocality, and fibrosis—it has a very high aggressive potential,” Nikiforov reaffirmed. “So these are the 5% of microcarcinomas that need to be better treated to prevent complications, while the other 95% can be cured by simple surgery.”

This new molecular scoring system has been introduced at the University of Pittsburgh Medical Center, where it is currently being used to risk-stratify patients with papillary microcarcinoma.

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Niemeier LA, Kuffner Akatsu H, Song C, et al. A combined molecular-pathologic score improves risk stratification of thyroid papillary microcarcinoma. Cancer. 2012;118(8):2069-2077.

Marginal increase of sunitinib exposure by grapefruit juice

Marginal increase of sunitinib exposure by grapefruit juice

Novel genetic tools may shed new light in papillary thyroid carcinoma research

Next-generation sequencing analyses of the follicular variant of papillary thyroid carcinoma may elucidate the biological underpinnings and clinical behavior of an increasingly common disease, according to data presented at the 82nd ATA Annual Meeting in Québec City, Québec, Canada.
Papillary thyroid carcinoma, most common type of thyroid cancer, is the fastest growing cancer type in the United States and many other countries. The increase in incidence is largely attribute to a rise in the number of cases of follicular variant of papillary thyroid carcinoma. The follicular variant of papillary thyroid carcinoma is believed to behave in a clinical manner similar to usual or classical papillary cancer, but can be aggressive.RAS mutations are present in approximately 40% of follicular variant of papillary thyroid carcinomas, but little else is know about other mutations associated with the disease.
"A lack of understanding of molecular drivers of the follicular variant of papillary thyroid carcinoma greatly limits the ability to investigate reasons behind its increased incidence and hampers the development of more individualized management of patients," said Elizabeth Pearce, MD, of the Boston Medical Center and Program Co-Chair of the ATA annual meeting. "These new data suggest that novel genetic tools may shed new light in this important research area."
A team of researchers led by Lindsey Kelly, MD, at the University of Pittsburgh Medical Center, analyzed 501 samples of papillary thyroid carcinoma using a panel of next-generation sequencing tools. They found that 73% were positive for known mutations and 27% were negative for known mutations. The majority of the latter were determined to be follicular variant of papillary thyroid carcinoma. Further analyses of follicular variant of papillary thyroid carcinoma tumors revealed TPM3/NTRK1 fusion with a novel breakpoint, as well as several promising SNVs and SVs. These findings may allow better characterization of the biology and clinical behavior of follicular variant of papillary thyroid carcinoma.
Source: University of Pittsburgh Medical Center

CancerCompass: Cancer Survivors Prefer to Stay With Cancer Doctors: Study

How can this be a surprise to anyone?  No one knows the effects of chemo and radiation like one's oncologist.  I've had to deal with other medical professionals who I've had to educate in way too many things dealing with my follow-up care.  I'm much more comfortable going to my oncologist and having him send me to another medical professional if he thinks that's the better course.

JHH

Cancer Survivors Prefer to Stay With Cancer Doctors: Study

THURSDAY, Sept. 13 (HealthDay News) -- Even after cancer patients beat their disease, many still grapple with health issues related to their treatments, including cardiovascular and bone problems. But, survivors often say it's unclear which doctor to turn to for follow-up care.
A new study of 18 prostate and 24 breast cancer survivors suggests the majority would prefer to continue seeing their oncologists when health issues crop up, because they aren't confident their primary care physicians are equipped to address their post-cancer health needs.
Study author Dr. Shawna Hudson, an associate professor of family medicine and community health at The Cancer Institute of New Jersey, said the finds are concerning.
"For early stage cancer survivors, we expect your primary care physician is going to play a stronger role in follow-up after cancer treatment," said Hudson.
She said statistics show almost one-third of 36.6 million annual office visits made for cancer care are at primary care doctors' offices, and it's expected that number will increase by 2020, when a shortage of cancer specialists is predicted.
The patients in the study were all diagnosed in the early stage of their disease and had finished treatment two or more years before participating in the research, which was published online Sept. 10 and in the September/October print issue of the Annals of Family Medicine.
The participants, whose median age was 64 and three-quarters of whom were women, answered questions during an in-depth telephone interview. Fifty-two percent said they preferred to visit their cancer specialist for follow-up medical care, while 79 percent believed that cancer follow-up care requires a specialist's knowledge of cancer that primary care physicians do not possess. One-third did think there could be a role for their primary care doctors, as long as they were kept in the communication loop with oncologists.
One survivor quoted in the study said he would love to see a survivor plan be part of his treatment plan, so "everybody would be on the same page."
"Patients need a very clear road map about what to do," said Hudson.
Almost 70 percent of survivors have conditions that require a comprehensive approach to their care, including cardiovascular disease, kidney issues, diabetes and fertility-related problems, many related to chemotherapy and radiation treatments, Hudson explained.
"Follow-up care is not just about making sure your cancer's not back. It's about making sure you monitor and get care for problems like cardiovascular issues and bone density issues that might happen because of some of your cancer treatments. It's the health prevention piece that's usually done in primary care," Hudson said.
Dr. Catherine Broome, an associate professor of medicine and a medical oncologist at Georgetown University's Lombardi Comprehensive Cancer Center, said while the study is small, it does raise important issues.
"As a medical community in general, we've struggled with this question about follow-up care for a number of years. Economics and health care reimbursements are beginning to play a role in how we're asked to manage these patients," Broome said.
"I personally do like to try and follow my patients much longer than the first few years. When I see them, I may be a bit more focused on some of those things that might be overlooked by a primary care physician, like an early-stage breast cancer patient who got chemo and may be cured but who might experience long-term effects such as thyroid abnormalities," said Broome. "The subtle signs might be more obvious to us."
The LIVESTRONG Survivorship Center of Excellence, at the University of Pennsylvania's Abramson Cancer Center in Philadelphia, helps patients navigate the transition from cancer patient to cancer survivor. Survivors can visit the center if they want to develop a health care plan, or if they have specific medical concerns.
The center is staffed by experienced nurse practitioners, said director Dr. Linda Jacobs. "At our survivorship program here, we see a variety of patients under all different circumstances."
Patients who aren't comfortable asking their oncologists questions about fatigue, sleep issues or sexual function can come to the survivorship program for symptom-management help, said Jacobs. She and colleagues can refer them to nutritionists, physical therapists, cardiologists and endocrinologists, among other specialists.
Karissa Hahn, a 33-year-old breast cancer survivor from New Jersey who was diagnosed in 2009 when she was pregnant, underwent surgery, chemotherapy and radiation to treat stage 3 cancer. She said when her treatment ended, her oncologist recommended she check in with her every three months for the first six months, then every six months after that. When elevated blood pressure and an ear infection cropped up during that time though, Hahn went to see her primary care physician who helped her manage both conditions successfully. She also visited a midwife for other health needs.
She said it was up to her to decide where to get her care. "It was hard to know whether I should call my oncologist or my primary care physician," said Hahn, who recently learned her cancer has returned.
Study author Hudson said more bridges need to be built between oncologists, primary care physicians and cancer survivors.
"Right now, it's all on the patient," said Hudson. "The primary care physicians need a guide for care, especially for early-stage cancer survivors. We need practical guidelines that say, 'Here's what you do for this type of cancer patient.'"
In the meantime, she said patients can ask lots of questions. "They need to be proactive with their oncologists about asking them how and when they transition back to primary care."
More information
The U.S. National Cancer Institute has more on post-cancer care.
SOURCES: Shawna Hudson, Ph.D., associate professor, family medicine and community health, The Cancer Institute of New Jersey, New Brunswick, N.J.; Catherine Broome, M.D., associate professor, medicine, and medical oncologist, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, D.C.; Linda Jacobs, Ph.D., R.N., director, The LIVESTRONG Survivorship Center of Excellence, University of Pennsylvania, Abramson Cancer Center, Philadelphia; Karissa Hahn, New Jersey; September/October 2012, Annals of Family Medicine
Copyright © 2012 HealthDay. All rights reserved.

Socioeconomics & Thyroid Cancer | dailyRx

Socioeconomics & Thyroid Cancer

Thyroid cancer gets diagnosed later in lower socioeconomic patients

(dailyRx) Studies have indicated that people with money and insurance have higher rates of thyroid cancer. Turns out—they just go to the doctor sooner.
A recent study compared thyroid cancer stage diagnosis to socioeconomic status. The good news is—disparity rates are slowly declining year after year.

Stan Van Umm, MD, PhD, from the Schulich School of Medicine and Dentistry at the University of Western Ontario in Canada, led the investigation.
Program Co-Chair of the American Thyroid Association (ATA), Dr. Elizabeth Pearce said, “Socioeconomic status is an important health indicator for a number of cancers and other diseases.”
“These new data shed light on yet another area—the time of thyroid cancer diagnosis—in which there is a need to close the gap on this disparity.”
For the study, researchers looked at 1563 patients from a large thyroid cancer registry from 1998 to 2010 in Canada.
Each of the patient cases was evaluated for age of cancer diagnosis, stage of cancer at the time of diagnosis and socioeconomic status.
Socioeconomic status from the Canadian Census was found for 1,334 of the patients.
Authors concluded that the data clearly indicated an association between lower average household income and more advanced staged thyroid cancer at the time of diagnosis.
Study results also showed people were being diagnosed with advanced stage thyroid cancer at an older age.
But based on the cases that were diagnosed over the course of 12 years, researchers found a 4 percent decline in the odds of being diagnosed in the advanced stages of cancer.
This research was presented at the 82nd Annual Meeting of the American Thyroid Association September 19-23, 2012 in Quebec City, Canada. All research is considered primary until it has been published in a peer-reviewed journal.

 

Is Chemo-Brain Real? What Was the Question Again?

 Yes, Chemo-Brain is real:  I suffer from it myself, usually during the last week of my Sutent drug cycle.  It's very frustrating, to put it mildly.

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Friday, August 24, 2012

Is Chemo-Brain Real? What Was the Question Again?

By Heather Millar

I got an email this week from a clinical coordinator at UC San Francisco. It’s time for what I hope is the last of my clinical trial appointments: a series of cognitive tests that form part of a study to try to find whether there’s scientific evidence of chemo-brain, the cancer slang term for the brain fogginess that comes when the doctors are poisoning you to get rid of your cancer.
I met with this lovely young coordinator before I started chemo. She gave me a whole battery of tests: How many words can you think of that start with a particular letter? If I list a bunch of unrelated words, how many can you repeat back to me? How quickly can you connect dots according to a progression of letters or numbers? How well do you analyze little Lego-like shapes drawn from different points of view? I think these are the same kind of puzzles given to someone who’s being tested for Alzheimer’s.
The brainteasers take about an hour and a half. I took them again during chemo, then six months after chemo, then a year after. I’m now 18 months past my last chemo infusion, so it’s time for memory games again. I have no idea how I’ve done on the tests; I agreed not to know when I signed the study consent forms. But I hope it will help give the researchers what they need.
Because I bet there isn’t a cancer patient in the world who has gone through chemotherapy who wouldn’t ask this: How could you NOT think chemo-brain is real?
Of course, doctors insist on data, on evidence. They want answers to specific questions like these: Does the mental fogginess come from the chemo, or the cancer? Or might it just be a result of the stress of having cancer? Does chemo create physical changes in your brain that make it hard to think? Can other physiological changes linked to thinking problems be linked to chemo drugs? Which chemo drugs? At what doses? So far, the results of scientific studies have been mixed. Chemo-brain turns out to be very difficult to measure.
My own experience is just what researchers would call “anecdotal,” but I gradually became a bubblehead as I slogged through my six infusions of Taxotere and Carboplatin. Just before I was diagnosed, I had started writing a complicated magazine pitch about nanoparticles, teeny-tiny things being incorporated into consumer products. I tried to pick the proposal up halfway through chemo, one day when I was feeling ambitious. I could barely understand what I’d written. It got worse: By the last cycle of chemo, I was too tired and too fuzzyheaded even to read. By the time I got to the end of a paragraph, I couldn’t remember how it started. So I just sat dumbly in a recliner, sleeping, watching TV, or listening to NPR.
Things are much better now: I just finished a big, 5,000-word magazine piece based on that nanoparticle pitch. I’m sure I wouldn’t have understood a word of it while in treatment, much less been able to write it.
Today, I came across a small, recent study from the Cleveland Clinic. Dr. Halle Moore of the Clinic’s Taussig Cancer Institute recruited eight pairs, each composed of a chemo patient and a healthy friend. She gave the study subjects the same kind of tests that I’ve taken, but then she also measured the subjects’ brains with an “electroencephalogram” (EEG), a scan that measures brain function.
In June, at the annual meeting of the American Society of Clinical Oncology, Dr. Moore reported that her team had found significant changes in the brain activity of the subjects receiving chemotherapy. The EEG showed “high amplitude;” that is, more brain activity, when doing cognitive tasks. In other words, chemo patients had to work a lot harder to think.
If you’re going through chemo now, your reaction is probably a Homer Simpson, “Doh!” But to these researchers, I say, “Bravo.”
Hopefully, this will be the beginning of a body of evidence that proves chemo-brain is real. And that will lead, I hope, to insurance guidelines, workplace policies, and disability policies that recognize that cancer patients aren’t shirking when they plead chemo-brain.
What do you think? Have you suffered from chemo-brain? How does, or did, it affect your work and your life?

Photo: Top Photo Group

Posted by: Heather Millar at 6:39 am

MedWire News - Oncology - Vandetanib shows efficacy in thyroid cancer

Vandetanib shows efficacy in thyroid cancer

By Sarah Guy, medwireNews Reporter

24 August 2012

 

Lancet Oncol 2012; Advance online publication

 

medwireNews: The tyrosine kinase inhibitor vandetanib could significantly extend progression-free survival (PFS) in patients with locally advanced or metastatic differentiated radioiodine-refractory thyroid cancer, show results of a small phase II randomized trial.
Indeed, PFS was more than double in the trial group assigned to vandetanib compared with those assigned to placebo, report the researchers in The Lancet Oncology.
However, a greater number of patients in the vandetanib group developed adverse events after taking the drug versus those who took placebo, and two individuals died from treatment-related causes in the drug group compared with one in the placebo group.
Current therapies are largely ineffective in this group of patients, write Martin Schlumberger (Université Paris-Sud, France) and team who believe that vandetanib is "the first targeted agent to demonstrate improved PFS in patients with locally advanced cancer in a randomized phase II study."
After a median follow up of 18.9 months, 113 of 145 thyroid cancer patients in the study had disease progression, measured using the Response Evaluation Criteria in Solid Tumors (RECIST), of whom 52 were assigned to once-daily oral vandetanib 300 mg, and 61 to placebo, report the researchers.
The median PFS was significantly longer in those who received the study drug compared with those who did not, at 11.1 versus 5.9 months.
Rates of adverse events leading to discontinuation of treatment, and rates of grade 3 or worse (according to US National Cancer Institute Common Terminology Criteria for Adverse Events) events were higher among patients who took vandetanib compared with placebo, and common events that occurred in the former group with a frequency of more than 10% were diarrhea, hypertension, and acne.
However, the authors note that none of these safety concerns were new compared with other studies of vandetanib in cancer patients. Furthermore, they remark that: "Incidence of diarrhea and rash are consistent with pharmacodynamic inhibition of EGFR [epidermal growth factor receptor] signaling with vandetanib and... were manageable by standard medical care."
The two deaths in the vandetanib group were a result of hemorrhage from skin metastases and pneumonia, and the death in the placebo group was attributed to pneumonia.
While "substantial" PFS would benefit patients with thyroid cancer, "meaningful assessment of PFS needs a randomized phase III study," the research team concludes.
medwireNews (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

ThyCa Shines Spotlight on Thyroid Cancer Awareness Month

ThyCa Shines Spotlight on Thyroid Cancer Awareness Month
Thyroid Cancer Survivors Urge Neck Checks

September is Thyroid Cancer Awareness Month, and survivors everywhere will be urging everyone to “Find It Early.”
Thyroid cancer is the fastest increasing cancer among both men and women. It is estimated that more than 56,000 people will be newly diagnosed this year in the United States alone, and more than 200,000 worldwide. Thyroid cancer affects people of all ages, from young children to seniors. Thyroid cancer differs from many other cancers in that it is increasing in incidence. But, like most other cancers, thyroid cancer is usually treatable when detected early. However, some thyroid cancers are aggressive and difficult to treat.
During the month of September, ThyCa: Thyroid Cancer Survivors' Association, Inc. participants in more than 96 countries around the world will participate in the annual international grassroots effort to:

• raise awareness of the importance of early detection, treatment, and lifelong monitoring;
• inform the public about thyroid cancer and the free support services, resources, and educational events with experts;
• and increase awareness of the need for more thyroid cancer research.

ThyCa, sponsor of Thyroid Cancer Awareness Month, encourages people to ask for a neck check each time they visit their doctor. Signs to discuss with the physician include a lump or fullness in the neck, lymph node swelling, difficulty breathing or swallowing, or voice changes. These are signs of a possible thyroid nodule. Most thyroid nodules are benign, but some are cancer.
“Health care professionals are essential to the detection of thyroid cancer,” says ThyCa Executive Director Gary Bloom of Olney, Maryland, himself a thyroid cancer survivor. “Done properly, a neck check can be as simple as touching the neck and watching the patient swallow. This can be done very quickly and won’t cause any delays for the medical office, but that 30 seconds could make all the difference in the world when it comes to diagnosing thyroid cancer.”
A few of the many grassroots activities that volunteers have organized:

• In Texas, a mother who is a survivor of thyroid cancer and her children are going to neighborhood pharmacies each weekend in September to give out wallet cards and Neck Check cards.
• In Virginia, a hospital staff member has developed a Thyroid Cancer Awareness Display.
• In Connecticut, a school staff member is giving materials to students and staff.
• Volunteers in more than 90 local ThyCa support groups in the United States, Canada, Costa Rica, and Philippines, provide telephone and e-mail support and hold support group meetings.
• Around the world, thyroid cancer survivors, caregivers, and friends wear Neck Check shirts, wristbands, and pins, and give awareness materials to their friends and family.

Since 1995, ThyCa has been providing free support and information on thyroid cancer. Hundreds of pages of thyroid cancer information and free downloadable materials are available in English, Chinese, French, Japanese, and Spanish on ThyCa’s web site, http://www.thyca.org/.
On October 19-21, 2012, the 15th Annual International Thyroid Cancer Survivors’ Conference will take place in Chicago, Illinois, with more than 35 distinguished experts speaking.
Free materials and information are available from the nonprofit ThyCa: Thyroid Cancer Survivors’ Association, Inc., by e-mailing thyca@thyca.org, calling toll free 1-877-588-7904, faxing to 1-630-604-6078, writing to ThyCa, PO Box 1545, New York, NY 10159-1545, or visiting our website.

Children and Cancer - How to Tell Your Children that You Have Cancer

This is a pretty good article.  It's still hard to talk with my sons about my on-going cancer treatment, even after 5 years.

How to Tell Your Children That You Have Cancer

By Lisa Fayed, About.com Guide

Updated September 09, 2009


Telling your child that you have cancer may be one of the most difficult conversations that you will have as a parent. We instinctively try to protect our children from things that could hurt them or their feelings. When diagnosed with cancer, parents may try to protect their children by not telling them, but it may do more harm than good. What is the best way to tell your child that you have cancer? Should you not tell your child?

How to Tell Your Child That You Have Cancer

Wait Until You Have All of the Details. Before you tell your child that you have cancer, experts recommend waiting until you have as much information about your type of cancer, treatment, and prognosis as possible. This way you will be able to address questions that your child may have about your cancer diagnosis. Children understand best when they can see the whole picture, not just little pieces. If you have a lot of knowledge about cancer and your treatment, you will appear more confident to your child. When you are confident, this makes them feel more secure, which is essential for children faced with a crisis.

Don't Assume Your Child Knows What Cancer Is. Don't assume your child knows about cancer -- even older children. Children hear the term cancer in the media and on television, but still may not exactly know what cancer is and how it affects the body. They may even have an inaccurate idea about what cancer is. Explain the physical process of how cancer develops in a simplified version that is age appropriate.

Let Them Know that Cancer Is Not Contagious. It's also important for them to know that your disease is not contagious, and it won't affect them physically. This may even be one of the first questions they ask you. They are not being selfish. Children often hear about people catching a cold or the flu and naturally assume it may be the same for cancer.

Make the Conversation Age Appropriate. How you explain it to your children and what information you choose for them to know depends on their age. If you have any questions about telling your children, consult a child psychologist or pediatrician. These are great resources who can can lend their wisdom on the subject. School psychologists and members of the clergy are also excellent support resources you can turn to for advice.

Don't Be Alarmed If It Is a One-Sided Conversation. Your child may be quiet and not ask any questions during your initial conversation. This is completely normal and is their way of processing the information you have just presented them. Do not push them to reveal their feelings, but reiterate that they can talk to you and ask questions anytime they need to. Sometimes it is easier for children to discuss their emotions with someone other than a parent. Again, school psychologists, the clergy, and trusted friends and family are great people that kids can open up to about your diagnosis.

Get Help If Your Child Is Not Coping Well. If it appears that your child is not coping well, do not hesitate to get him help through your pediatrician. He can recommend a child psychologist or family therapist who has experience in helping children cope with cancer.

Common signs of coping issues include being quiet and withdrawn and surprisingly, hyperactivity. They may also have trouble concentrating at school or misbehave in class. These are all signs that they are having trouble coping and need help. Keep in mind that it is normal for children to "act out" their emotions, but still need professional guidance to help them cope.

Be on the lookout if your child is coping too well. Children who appear to be taking it all in stride can be masking their emotions. Again, this is also common, and children who are exhibiting this type of behavior also need help.

Common Questions Children May Have About Your Cancer Diagnosis

Children may ask questions that may be difficult to answer if you are not prepared. There may be questions that you do not have the answer to, but do not be afraid to say, "I don't know." Some common questions that your child may ask include:

• Are you going to die?
• Will I get cancer too when I grow up?
• Will your hair fall out?
• Do I have to tell my friends?
• Who will take care of me if you can't?
• Why did you get cancer?
• If something happens to you, what happens to me?
• When will your cancer go away?

Choosing Not To Tell Your Child That You Have Cancer

Some parents choose not to tell their children about their cancer diagnosis. This is a personal decision and one that should not be made without research and deep thought.

Children are clever and intuitive, picking up on clues that something is not right within the family. By not telling them, it may lead to undue anxiety and fear. Children thrive on emotional stability and if they suspect that something is being kept from them, then they feel insecure.

Many parents who choose not to tell their children because their prognosis is good. Why burden the child when there is no need to? However, you have to take into consideration that "what if's":

What if you health takes a turn for the worse? How will you explain that you are suddenly very sick to your child? This may leave little time for them to adjust and cope to the changes that are occurring quickly in the family. Ultimately, in this scenario, not telling them may do more emotional harm than protecting them.

What If They Find Out You Have Cancer? This is a common issue when people withhold information about their cancer diagnosis to their children. Children may find out through eavesdropping or perhaps, another adult may accidentally tell them about your cancer, or even through "snooping." Feelings of rejection and mistrust may be the result and are difficult emotions for a child.

Some parents do not tell their children because it is such a difficult, heart-wrenching task. Please don't let this prevent you from making the right decision. If you cannot tell your children, enlist the help of a trusted friend, family member, or member of the clergy. Together, you can all sit down and discuss your cancer and what changes the child can expect because of it.