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Parental Grief After Losing a Child to Cancer: Impact of Professional and Social Support on Long-Term Outcomes

Ulrika C. Kreicbergs, Patrizia Lannen, Erik Onelov, Joanne Wolfe

From the Phyllis F. Cantor Center; Department of Pediatric Oncology; the Center for Outcomes and Policy Research, Dana Farber Cancer Institute; Department of Medicine, Children's Hospital, Boston, MA; Department of Women and Child's Health; Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden; and the Department of Psychology, Universität Bern, Berne, Switzerland

Address reprint requests to Ulrika Kreicbergs, RN, PhD, The Phyllis F. Cantor Center, Dana Farber Cancer Institute, 44 Binney St, CP 306, Boston, MA 02115; e-mail: ulrika_kreicbergs{at}dfci.harvard.edu

Purpose It is still uncertain whether or not parents can ever come to terms with the loss of a child and whether professional or social support facilitate the long-term grief process.

Methods A Swedish population-based study, which sent an anonymous, mail-in questionnaire to parents who had lost a child to a malignancy 4 to 9 years earlier, gained the participation of 449 (80%) of 561 parents. Parents were asked whether, and to what extent, they had worked through their grief. Questions were also asked regarding those who provided parents with support. We examined candidate factors to determine their associations with greater likelihood of working through parental grief.

Results Overall, most parents (74%) stated that they had worked through their grief "a lot" or "completely" at the time of the follow-up. Parents who had shared their problems with others during the child's illness (fathers: relative risk [RR], 3.0; 95% CI, 1.8 to 5.0; mothers: RR 1.9; 95% CI, 1.2 to 2.8) and who had access to psychological support during the last month of their child's life (fathers: RR 1.4; 95% CI, 1.0 to 1.8; mothers: RR 1.3; 95% CI, 1.1 to 1.6) were more likely to have worked through their grief. In cases where health care staff offered parents counseling during the child's last month, the parents were more likely to have worked through their grief (fathers: RR 1.5; 95% CI, 1.2 to 1.8; mothers; RR 1.2; 95% CI, 1.1 to 1.4).

Conclusion Most parents eventually work through the grief associated with losing a child to cancer. In the long term, sharing the emotional burden with others facilitates the grieving process.

Supported by grants from the Swedish Children's Cancer Foundation, the Swedish Society for Medical Research, the Swiss Cancer League (KLS-01645-02-2005), the National Cancer Institute (NCI 5 K07 CA 096746), and a Child Health Research grant from the Charles H. Hood Foundation.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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