2012. Vol.3, No.12, 1027-1034
Published Online December 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.312154
Copyright © 2012 SciRes. 1027
Mother-Child Relationship as Perceived by Breast Cancer Women
Eva Mazzotti1*, Francesco Serranò2, Claudia Sebastiani1, Paolo Marchetti2
1Divisione di Oncologia e Dermatologia Oncologica, Istituto Dermopatico dell’Immacolata-Istituto di Ricerca e
Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
2Facoltà di Medicina e Psicologia, Università di Roma Sapienza, Rome, Italy
Received September 12th, 2012; revised October 13th, 2012; accep t e d N o ve mber 11th, 2012
Cancer can threat the stability of a mother’s parental role, undermining her ability to take care of her chil-
dren and keep the family together. We conducted face-to-face interviews to explore the experiences of
mothers with breast cancer. Some mothers tend to handle their disease as if it were a temporary event.
This strategy often implies a detachment from their children, in an attempt to protect them. Other strate-
gies are instead based on the awareness that, from that moment on, the life of a mother, and that of her
family, will have to go through important changes in the short and long run. The behaviors examined,
adopted to safeguard children’s wellbeing, can create or enhance dysfunctional and paradoxical commu-
nication strategies. The hospital staff can practically use the results of this study to help mothers success-
fully handle their family relationships.
Keywords: Breast Cancer; Narrative Interviews; Parenting; Qualitative Research; Mother-Children
Parents coping with cancer generally experience high levels
of distress throughout the diagnosis, treatment and prognosis
process as well as a sense of guilt about the impact of the dis-
ease on their children.
In this study, we focus on the strategies that women with
breast cancer adopt for involving their teenage children in the
management of their illness.
The theoretical framework of the study is based on literature
dealing with the impact of parental cancer on children and the
family. We have turned our attention to studies of different
approaches focusing on cancer, with particular regard to breast
In the last few years, many scholars have addressed these is-
sues. Some describe the experience of parents with cancer
(Elmberger et al., 2002; Helseth & Ulfsaet, 2003, 2005; Semple
& McCance, 2010), or focus in particular on the experience of
women with breast cancer (Billhult & Segesten, 2003; Öhlén &
Holm, 2006; Kaiser, 2008; Sadler-Gerhardt et al., 2010); others
examine how mothers with cancer deal with the responsibilities
connected with their parental role (Elmberger et al., 2005), or
consider the changes in a mother’s role (Fitch et al., 1999;
Adams & Dell, 2008).
Other areas of research include the communication between
parents and children about maternal breast cancer (Hymovich,
1993, 1995; Barnes et al., 2000; Elmberger et al., 2000; Shands
et al., 2000; Huizinga et al., 2005), the mother-child relation-
ship (Davis Kirsch et al., 2003; Walsh et al., 2005), and the
specific relationship between breast cancer survivors and their
daughters (Stiffler et al., 2008).
Scholars have also explored the impact of parental cancer on
children and adolescents (Lewis & Hammond, 1996; Visser et
al., 2004; Forrest et al., 2006; Osborn 2007; Schmitt et al.,
2008), the case of single women with breast cancer and their
relationship with children (Lewis et al., 1996), the reactions of
children to the diagnosis of cancer in a parent (Patenaude, 2000;
Clemmens, 2009; Kennedy & Lloyd-Williams, 2009a; Ken-
nedy & Lloyd-Williams, 2009b), the markers of psychological
distress in cancer patiens, spouses and children (Compas et al.,
1994, 1996; Grant & Compas, 1995; Huizinga et al., 2003;
2010; Visser et al., 2005, 2007, Edwards et al., 2008; Vannatta,
2008, 2010), and the children’s anxiety related to a parent’s
illness (Rosenfeld et al., 1983; Rosenheim & Reicher, 1985;
Kroll et al., 1998; Nelson et al., 2002; Edwards & Clarke, 2004;
Watson et al., 2006).
In this study, we focus on how women handle their being
mother over time, in relation to the cancer event. Their percep-
tion of the illness and representation of their children’s needs in
a particularly critical moment affect the involvement strategies
they adopt to help children cope with their disease.
We examine the impact of such strategies on the mother-
children relationship, both in the short and long term. Besides,
we show how certain behaviors aimed at protecting and safe-
guarding the wellbeing of children and of the whole family
from the stressful impact of cancer are not effective and do not
serve the purpose of creating and maintaining a good mother-
child relationship in particularly critical circumstances.
To elicit the women’s perspectives on their breast cancer ex-
periences, we adopted a qualitative approach (Silverman, 2010),
which is the most suitable method for gaining an understanding
of the meanings that people assign to their experiences (Polk-
inghorne, 1988). We used narrative interviews to develop in-
depth descriptions and to obtain rich, comprehensive, detailed
accounts of women’s experiences.
*Corresponding author. Narrative interviews provide informants with many opportu-
E. MAZZOTTI ET AL.
nities to select and order events themselves rather than to put
events into a pre o rd ai ne d structure.
Involving detailed examination of the participant’s lifeworld,
interviews make it possible to explore in detail how participants
are making sense of their personal and social world (Kvale,
1996). An interview is an interpersonal situation where the
relevant data are constituted by the interaction itself, in the
specific situation created between the interviewer and the inter-
viewee. Meaning is not elicited merely by apt questioning, nor
simply transported through respondent replies, but is actively
and communicatively assembled in the interview encounter.
After receiving approval from the Ethic Committee of the In-
stitute, we selected participants from the patient lists of the
outpatient clinic. We contacted eight Italian women, aged 26 -
58 years (average age 46), and all of them accepted to partici-
pate in the study. The years since their diagnoses ranged from 1
to 20. Breast cancer treatments included surgery (i.e. mastec-
tomy, quadrantectomy, lymphadenectomy), radiation and che-
motherapy, as well as various combinations of treatmens. At
the time of the interview, three participants were still carrying
out their work activities.
Eight women, all married at the time of the interview, had
children whose average age was 15 years (range 5 - 28). Most
of the children were living with their parents; others, now
adults, were already living on their own.
We approached the women during their visits to the outpa-
tient department. We fully informed them of the objective of
the study, of the interview method, and of how the collected
information would be utilized. We asked all informants permis-
sion to audio record the interviews and we obtained informed
written consent from them.
We informed all women of their rights to confidentiality and
that confidentiality would be maintained through the omission
of any personal references, and that to protect their identities all
participants would be assigned pseudonyms in the interview
transcript. We also told informants that their participation in the
study was voluntary and withdrawal or lack of participation
would not adversely influence their medical treatment. Infor-
mants received no payment for participating in the study.
We conducted all face-to-face interviews between November
2010 and January 2011 at the hospital where women had re-
ceived their cancer treatments. During the interview we asked
women to share their stories of breast cancer. We encouraged
each woman to reveal, in her own words, the meaning she at-
tached to the illness and to provide insight into the impact of
her illness on herself or her family. The idea was to encourage
informants to speak about the issues that were pertinent to their
experience of illness and to introduce ideas with which we were
not already familiar.
For this purpose, the first question of our interview was
open-ended (“I would like you to tell me about your experience
of illness, starting from when you first found out about it…”).
This kind of question not only activated a process of narrative
reconstruction of women’s experience, but also allowed the
interviewees to talk about the issues of concern to them rather
than what the researcher may have considered important, and to
explore the experiences of difficulties, as well as their chal-
lenges and strategies. The participants’ responses guided the
direction of the interview and were followed by questions for
elaboration or clarification allowing for promptings and explo-
ration of topics raised spontaneously. Finally, a period of de-
briefing occurred at the end of each interview to discuss any
feelings the participant might have experienced during the ses-
The average length of the interviews was approximately 50
We transcribed all interviews verbatim.
All interviews were conducted in Italian, and the excerpts in-
cluded in this article were translated into English by a profes-
To gain an understanding of the breast cancer experiences
emerging from women’s accounts, we adopted a narrative
analysis approach (Riesmann, 1990, 1993, 2002; Labov, 2010).
The underlying assumption of narrative research is that the
construction of a story by an individual serves a purpose and is
the primary way human beings make sense of their experiences.
According to Riessman (1993), the task of identifying narrative
segments and their representation is not a technical operation
but the stuff of analysis itself; the “unpacking” of structure that
is essential to interpretation. This form of interpretation is a
spiral process and starts with an initial reading to gain a sense
of the whole and to obtain suggestions for the next phase, the
structural analysis, where the text can be explained by identify-
ing meaningful parts and patterns.
We began the analysis with close reading and re-reading of
the women’s interviews so as to identify relevant parts of the
interviews that could help us reconstruct each woman’s story.
The women’s accounts were particularly meaningful because
they conveyed the representations, perceptions and attitudes
toward the disease that these women/mothers had at the time of
the interview. Our goal was to highlight, within each story, how
patients coped with the problems related to their disease in
relation to their family life, and how their different conceptions
of the disease, which also depended on the seriousness of their
clinical condition, affected their pe r sonal and fami ly life.
We highlighted sections on the transcripts, noting down our
initial impressions about the stories and any unusual feature. In
these constructed summaries we included the type of story re-
vealed, meanings of breast cancer shared, self-identities por-
trayed, how women’s experiences of breast cancer were situ-
ated in family life, the influence of structural factors, and the
general storyline that women used to explain their experiences
of breast cancer.
We also examined how the elements of the story fitted to-
gether, each storyline’s sequence of events, the repetition of
certain words, phrases and events, and how women transitioned
from one story to another throughout the interviews.
When a woman finds out she has breast cancer, her physical
and emotional stability is seriously affected. If the woman is a
mother, cancer is also a real threat to the stability of her paren-
Copyright © 2012 SciRes.
E. MAZZOTTI ET AL.
tal role, undermining her ability to take care of her children and
keep the family together. Cancer breaks in as a traumatic event,
striking a woman and her whole family with all its destructive
force, and producing a moment of crisis that interferes with the
stability of family relationships and makes it necessary to go
through an important phase of change.
Starting from the experiences reported by mothers who have
survived cancer, in this article we reconstruct the history of
their disease (Williams, 1984), from the moment of diagnosis
on, and analyze the strategies they adopted to handle this trau-
matic event, with specific regard to their relationship with their
young or teenage children.
Through the following excerpts taken from the women’ ac-
counts, we examine the different strategies that women adopted
to handle the relationship with their children, and we point out
some interesting dynamics that might be worthy of further in-
A Personal Battle
When a mother finds out she has breast cancer, roles and
family relationships change and adapt to the reality of the dis-
ease. Depending on the seriousness of the clinical picture, and
on her personal and family history, each woman experiences a
series of emotions related to her situation, and develops her
own conception of the disease, temporarily becoming the ful-
crum around which the people who support her in the battle
against cancer revolve.
Excerpt 1: Clelia, 40 years
In that moment
I was actually at the centre of the world.
So I had to show my strength somehow,
and also repay, I guess,
the love of the people around me,
so the only way was to fight,
but with that sort of lightness, as I said.
I mean, I fought so hard.
In this excerpt, Clelia describes her experience in the days
after surgery. Using a spatial metaphor, she puts herself at the
centre of a network of people who are around her in the crucial
moment of the traumatic event, providing her with emotional
support and with the necessary strength to fight her personal
battle against cancer. As we observed in our interviews, from
which the present excerpt is taken, when it comes to talking
about particularly critical moments related to their illness,
women almost alway s refer to the most significant persons, the
“indispensable” family members or friends who supported them
in those moments. By making reference to the “indispensable”
ones, to how they were there for her, showing their love and
providing support, they implicitly evoke the “most notable
absent players” in this phase: their children. This clear-cut at-
tempt of Clelia to keep her children at a distance probably de-
pends on her parental role, as if it were a way to defend her
children from what she considers a grown-ups business, which
only involves a close circle of people who support her in her
The non-involvement of children is also evident in the con-
tinuation of the account, where Clelia says that the first thing
she did as soon as her clinical situation made it possible was to
accompany her daughter on her first day of school, being pre-
sent in a moment that she thought was important for her.
Excerpt 2: Clelia
After the first six rounds of chemo,
I had surgery.
On the 13th of September
I left the hospital with drainage tubes still attached.
On the 15th of September I took my daughter to school.
She was starting the 3rd year of middle school.
I mean, with no difficulties,
I mean, with drainage tubes in the pockets of my jeans...
It was perfectly normal for me.
Bald, in front of Anna’s school.
And she, even she... I think I was a lesson
to my daughter, too. It meant a lot to me.
It was vital for me to come out of this story,
um, as a winner.
I mean, to tell the truth,
I’ve often thought about it, so...
Anna has never cried in front of me,
probably because I’ve never cried in front of her.
So, of course not, she’s always seen a strong mother.
But then she cried at school,
because the teachers, I mean, the schoolmistresses
told me so.
The physical presence of Clelia at school, with her body
visibly tried by chemotherapy and surgery, is a key episode in
her account. What emerges is the particular drama of her suf-
fering as well as the strength and the courage that Clelia attrib-
utes to herself when she participates in a situation where she
can and must present herself as a winner. Her description fol-
lows a precise temporal sequence of events culminating in the
identification of a specific date, which represents the most cru-
cial moment in her battle and allows Clelia, in spite of her visi-
ble physical suffering, to present herself as a winner.
In Clelia’s description of this traumatic event, we can iden-
tify a double level of analysis. Her battle against cancer has to
do with her medical condition and with the drama of her physi-
cal devastation, but there is also an emotional level, where the
lightness with which she confronts her “enemy” mitigates the
emotional impact of the disease and apparently eases its cones-
The event that Clelia describes is also supposed to have an
educational value for Anna, her daughter. The gesture of her
mother, who is with her on her first day of school, becomes a
sort of reassurance provided by the fact of being there, no mat-
ter how. While the mother emphasizes her ability to maintain a
sort of normality in her life, focusing on a symbolic dimension
—her being there—, her daughter probably has a different per-
ception, giving more importance to her mother’s inability to
show emotional closeness, rather than to her physical presence.
For Clelia it is normal to take her daughter to school in pre-
carious health conditions, but her daughter might feel that there
is nothing normal in seeing her mother bald and with drainage
tubes because of a disease that she does not have the courage to
share with her: a disease that has temporarily pushed her
mother away from her and that makes her look disfigured,
forcing her into a personal battle that does not allow her to ex-
press her feelings.
Copyright © 2012 SciRes. 1029
E. MAZZOTTI ET AL.
In the following excerpt we see a different way to handle the
traumatic event. Here, the main point of concern is the selection
of people to be involved and the need to keep the disease secret
by controlling the information to be shared.
Excerpt 3: Livia, 42 years
I didn’t tell anyone about it,
except for the closest circle of people around me.
The wig allowed me to live among the people
Actually, well, with my way of smiling,
of being nice, everybody said...
everybody always told me:
You look so good, you look so good,
but I was getting chemo, I wasn’t good at all,
but even so, I tricked the tumor.
Well then, you didn’t get your way! (she laughs.)
In Livia’s account, the circle of people who know about her
cancer is quite narrow. She doesn’t involve her children. In this
case, cancer becomes a personal battle that, unlike the case we
examined before, consists in a silent resistance against its dev-
astating force, which destroys her physically, but must not
compromise Livia’s social life. The information control and the
use of the wig do not prevent Livia from smiling. However,
resorting to these sorts of artificial ploys, she actually shows the
weakness of her family life, where such a dramatic situation
inevitably aff ec ts her children’s wel lb eing.
Excerpt 4: Livia
The closeness of my children who, well...
They didn’t even know what a tumor
or the chemo was, they would get scared otherwise...
I told them I had...
Mum had a cyst, she had surgery.
So the doctors, to prevent it from happening again,
gave me this treatment,
and I lost my hair and I suffered a lot,
but don’t worry, don’t worry.
Then, when they actually realized
that after four or five days I felt better,
and I started smiling and everything,
they stopped worrying...
So, their normal presen c e, the total normality
of their cheerful ness, their tears, their anger
when something went wrong at school,
well, normality made me... made me strong, um,
and there are also three... two or three friends of mine
who know about it and they...
Of course, they are people I’ve chosen myself, so...
Even in this case, the concept of normality is particularly
important. Livia thinks that her two teenage children (eleven
and twelve years old) are not aware of the suffering she is going
through, just because they do not know the full circumstances
of her disease.
This sort of communication that a mother establishes with
her children in an attempt to protect them is dysfunctional: not
only it does not serve the purpose of protecting the children, but
it also causes chaos, feelings of guilt, and shows the limits and
weaknesses of a strategy based on the involvement/non-in-
volvement of children in a critical family environment.
Excerpt 5: Livia
Yes, I involved them and I didn’t let them get scared.
I say yes, I was sick, I am sick right now,
but you know that in two or three days
I’m going to be fine.
I mean, after all it’s a disease, it’s a strong treatment,
but we can get over it,
I mean, I wanted them to be sure
that they could get over
the pain, the disease, the physical suffering, um...
So, when they looked at me, and they were scared,
I was always able to tell them
I’ll be fine in a moment,
I’ll be fine in a moment, um ...
And then, well, I wanted them to go out.
My husband took them around in those afternoons.
They didn’t stay with me 24 hours a day,
because, I mean...
I believe we have to make our children strong.
We have to...
help them relieve anxieties, as far as possible,
because all of us have our own, it’s inevitable…
We can’t avoid that.
Maybe the anxiety and fear of... of... of-
makes you grow up in another positive way,
but, in general, they- well... they saw I was fine
and so they were fine, too,
because they trust me.
Even in this latter excerpt, the paradoxical situation de-
scribed by Livia reveals the ineffectiveness of a strategy that
only relies on handling the most acute stage of the problem. Her
attempt to preserve an image of invulnerability and an appear-
ance of normality despite her evident psychophysical suffering
shows all its weakness.
The situation described by Livia is paradoxical because she
is actually unable to control the effects of chemotherapy, and
when she goes through long periods of suffering her children
take care of her without even knowing what is happening to her,
or why she minimizes her condition and tells them not to worry
when she is actually suffering so much.
This sort of minimization, or even denial of her condition,
inevitably affects the emotional relationship between mother
and children in a moment when they should instead grow closer
and strengthen their relationship. Liva acts as if it were possible
to avoid the emotional distress associated with her disease by
simply keeping information under control.
This kind of communication is also dysfunctional with re-
gard to Livia’s educational purposes: with her behavior, she
thinks she can make her children understand that it is possible
to get over difficulties; and she is convinced that all anxieties
and fears associated with her condition can help them grow
stronger and enhance their mutual trust.
In the following excerpt, a newly-diagnosed mother points
out the necessity of informing her children about her condition.
Excerpt 6: Sara, 36 years
I talked with them... because, especially in those days,
I was sick,
so I had to tell them something (in Roman dialect)
Copyright © 2012 SciRes.
E. MAZZOTTI ET AL.
I mean... something... well, just like
some sort of warning that mum wa sn’t feeling well,
I think it was necessary.
I mean, they too,
just like all of us, need some time to take it in, don’t they?
I mean, to... to... understand. No, not to understand,
but to enter this world in some way, right?
So they had to be warned, yes.
Assuming that a three-year-old may be warned.
So, “warned” in a manner of speaking.
As we can see from this account, before telling her children
what is happening, Sara makes a personal evaluation of the
situation: when she explains to them why she has to go into
hospital and stay away from home to receive treatments, or
when she has to justify her physical suffering to them, she takes
account of their ability to understand, which depends on their
age. In the following excerpt, Sara talks about how she ex-
plained her condition to her children (three and four years old).
Excerpt 7: Sara
I told them that mum had pain in her breast,
because, I mean, they saw me, they see me.
I’ve never been ashamed to share things with them, so...
I told them that I had this problem,
that the doctor hadn’t been able to solve the problem,
so I had to see some other doctor. I had to justify
that I was taking medicine, to begin with,
and that unfortunately
I couldn’t be with them all the time...
It was inevitable, so...
But now, for example, I don’t tell them everything.
In that critical phase
I felt I had to warn them in some way,
but now, for example,
when I go to therapy every week,
I don’t say anything to them.
Every once in a while I tell them I’m going to the doctor.
Some other times I tell them I’m going out for a visit…
ehm, I have to go to some office and wait in line for…
Mum has something to see to, things like that.
I mean, they know it, but...
Sara’s account has some similarities with the ones we exam-
ined before, with regard to the amount of information to be
shared with children and to the modes of communication.
Whenever it is not possible to do otherwise, children are pro-
vided with confused and fragmentary pieces of information
about their mother’s condition, which are supposed to justify
her temporary absence when she goes into hospital, and her
frequent absences during the treatment.
The control over the information to be shared acts as a filter
that allows children to only gain a partial understanding of the
problem, turning them into passive spectators with no possibil-
ity of reaction. This mode of communication has a profound
impact on the emotional state of teenagers who go through a
similar experience, and results in a sense of guilt and punish-
ment, because they feel helpless in front of their mother’s suf-
fering, while their mother conceals her real state of health from
In the above-mentioned cases, the mothers themselves admit
their communication failures and the presence of conflicting
information in their relationship with children. They realize
they have not been clear enough, they acknowledge their ineffi-
ciency and sometimes extend the information control to people
outside the family, because they are aware that their children
understand most of what they are trying to conceal. The fol-
lowing excerpt perfectly exemplifies this sort of attitude.
Excerpt 8: Sara
I actually talked wi th th ei r teachers
and told them about the situation
they were going through.
Even if they are not full y aw are of it,
I think they feel it,
also because when I take cortisone for my therapy,
my hair stands on end all day (she laughs), so...
Well, they are aware of it,
I mean, of course they are aware of it.
The mother is aware that there are situations where her sys-
tem of protection does not work properly. Some treatments
make it impossible for her to keep the disease secret and to
remain physically unchanged. So the mother looks for emo-
tional support in the children’s places of socialization. This sort
of behavior comes from her need to keep children’s reactions
under control, and to understand whether the pieces of informa-
tion provided and the ones filtered out still make it possible for
her to handle an ever-changing situation that could easily slip
out of her hands, regardless of the level of protection she adopts.
Our objective is not to criticize the solution adopted, but to
point out that, in all likelihood, this behavior, protective as it
may be, is part of a strategy aimed at giving an active role of
control to other people who are close to her children. Children,
although relegated to a passive role, certainly have a clear idea
of their mother’s disease, which is also reinforced by the ele-
ments that their mother tries to keep under control in an attempt
to protect them.
So far we have examined a series of dysfunctional models of
behavior. We now focus on a case where, instead, a mother
immediately involves her children in the management of her
disease, thus contributing, in the long run, to create a family
situation that is closer to “normality”. The following excerpt is
about Romina (ten years after the diagnosis), who describes her
routine check-ups and talks about the moment when she in-
formed her youngest daughter (sixteen years old at the time of
the interview) about the negative results of her medical tests:
Excerpt 8: Romina, 42 years
My daughter, the little one, recently told me,
when I gave her the latest news:
Yes, mum, we are used to it by now.
And this thing made me...
Um, in a sense, I was glad about it, and not because...
Since the very first day I knew about this thing,
I did... I told it to my daughters,
even if they were little.
I felt like it was fair for them to know about it
So I thought it was better,
after talking with my husband,
to tell them about it clearly,
with a few words, a few simple words,
Copyright © 2012 SciRes. 1031
E. MAZZOTTI ET AL.
because we used to talk about everything else,
I used to talk with my daughters,
so I couldn’t do otherwise.
Romina’s family life revolves around her periodic screening
tests. In other parts of the interview, Romina says that both
before the visit and after, when she was waiting for the results,
she involved the whole family. Both parents have jointly
adopted this involvement strategy since the diagnosis. Being
used to talking with her daughters (nine and six years old at the
time of the diagnosis), she informs them about her state of
health with a few simple words. This choice has proved to be
effective over the years, allowing Romina to face both the nu-
merous rounds of chemotherapy and the threat of new thera-
peutic treatments without feeling lonely.
This involvement strategy gives an active role to all family
members and, in the long run, allows the daughters to partici-
pate in the history of her mother’s disease, which evolves par-
allel to the history of the family, also contributing to establish-
ing a dynamic form of adaptation to the crisis. In the following
excerpt, Romina talks about the normality of her family life,
from the initial moment of crisis to the changes in the family
roles and relationships occurred during the process of adapta-
tion to the reality of the disease.
Excerpt 9: Romina
Over the years I’ve tried to-
to live my life, um, as normally as possible
as peacefully as possible, without... um
The dis-[ease], the problem shouldn’t have to...
How can I say?
...to cast a shadow over the whole family,
to create that sort of... of...
I think I did my best to... to keep on... um
(1.0) to keep them... not to make them... I don’t know...
how- how to explain... um
not to make them grow up in a world... well...
where... it was the disease that... I mean...
How can I say? (in Roman dialect)
...it was predominant in the house, ok?
So, yes, it was part of our lives,
but it didn’t have to take us over completely.
What my daughter told me made me think that
I had achieved the goal I had set for myself,
to just let them live their childhood
as peacefully as possible, until they grow up,
and I think I made it.
Romina says she is glad her daughter has got used to her
disease. She believes she has achieved her goal, allowing her
children to live their childhood peacefully in spite of her dis-
Romina’s attitude toward the disease, the involvement of her
husband and the explanations given to her children appear as a
good strategy to handle cancer. This strategy is not limited to
the acute stage of the disease, but involves the whole family in
a wider perspective, also attributing an active role to children.
The stories we have examined so far show different ways to
handle the crisis arising after a breast cancer diagnosis. When
diagnosed with cancer, patients seem to focus on how to handle
the temporary moment of emergency. They often forget that,
from that moment on, their life, and the life of their fami ly, will
have to go through significant, long-term changes. The desire to
protect their children from suffering and to preserve their role
as mothers, in a moment when their vulnerability is evident and
the “normality” of the family is compromised, is not always
consistent with the behaviors performed to achieve such goal.
These stories show that, when cancer breaks in a
woman’s/mother’s life, emotions related to fear, to death, and
sometimes to the expectations for the outcomes of surgery, can
affect her perception of reality, leading her to only focus on
how to handle an emergency situation, instead of developing an
overall strategy able to take account of the problems arising
immediately after the diagnosis. Even if the quality of a
woman’s life after the treatment certainly depends on her
physical ability to withstand pain and exhaustion and on the
seriousness of the clinical picture, when diagnosed with cancer,
a woman probably does not realize that she will have to go
through cyclical treatments and periodical check-ups, which
can be painful and eventually compromise the relationship with
her children. When a woman only focuses on how to handle an
emergency situation, i.e. on the acute stage of the disease, chil-
dren can become a problem to be handled, too. In the long run,
the lack of projection into the future, the inability to foresee the
changes brought about by the disease, can affect the ability to
handle the crisis and meet the needs of the family, of children
in particular. In these cases, the behaviors that a woman en-
gages in to temporarily safeguard children’s wellbeing can
create or enhance dysfunctional and paradoxical communica-
tion strategies, especially when the personal and family situa-
tion is already problematic. In other cases, these behaviors
make it more difficult to handle a situation of chronic disease,
which evolves parallel to the family life.
This tendency to only focus on the immediate future proba-
bly also depends on how doctors communicate prognostic in-
formation to their patients. Unlike their colleagues from other
countries, Italian doctors tend not to provide enough informa-
tion about the long-term development of treatments or the ac-
tual possibilities of recovery.
Whatever the clinical course, gaining an insight into the fu-
ture development of the disease could contribute to building
solid family relationships based on mutual trust and concrete-
ness. A strategy aimed at involving all family members and
giving them an active role is not based on a protective detach-
ment, but on the emotional closeness of family members. An
emotional relationship based on mutual trust and transparency
also allows children, depending on their age, to have a clear
idea of what is really happening to their family. This way, chil-
dren are not a problem to be handled, but individuals able to
co-handle the problem.
Through women’s accounts, this study shows the process of
change in women’s identity triggered by the onset of the dis-
ease, which inevitably affects their life and the lives of their
Some mothers tend to handle their disease as if it were a
temporary event. This strategy often implies a sort of detach-
ment from their children, in an attempt to protect them. Other
strategies are instead based on the awareness that, from that
Copyright © 2012 SciRes.
E. MAZZOTTI ET AL.
moment on, their life, and the life of the whole family, will
have to go through important changes in the short and long run.
Although our findings are not statistically representative
compared to many others focusing on this theme, being only
significant in relation to the personal history of each individual,
they however help identify typical situations occurring when a
mother is diagnosed with breast cancer. For the sake of intel-
lectual honesty and methodological rigor, we cannot extend the
results of our analysis beyond the single stories collected and
partially reported, but we have nevertheless been able to high-
light representations, perceptions, emotional states and attitudes
associated with the onset of cancer, which are probably com-
mon to most of the people who experience similar events.
Our findings could be relevant for the hospital staff members
(doctors, nurses, psychologists, patient associations, etc.) who
are responsible for providing clear and detailed information on
surgical procedures and on the long-term development of
treatments. We suggest that the medical staff enhance their
communication skills to better address the emotional needs that
might require further psychological support and to cones-
quently improve the psychosocial wellbeing of the persons
In this perspective, nurses play a particularly significant role,
having more easily access to the patient’s experience and fam-
ily life. Acting as intermediaries between doctors, patients and
families, they could identify any problematic situation and
promote suitable intervention strategies.
One last suggestion concerns patient associations, which of-
ten operate parallel to hospitals and are therefore an important
source of support. It would be advisable for them to involve
specialized personnel staff able to provide adequate support and
assistance to families both in the short and long run.
As for further research perspectives, it would be interesting
to examine the cases of hereditary neoplasia and analyze the
relationships between parents and children in such circum-
stances. It would also be interesting to collect stories of women
with grown-up children and consider the perspective of children
and fathers/husbands. Finally, given that this study was con-
ducted in Italy,it would be interesting to further examine these
issues by analyzing cultural similarities and differences in other
We thank all the women who have dedicated their time to
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
The authors received no financial support for the research,
authorship, and/or publication of this article.
Adams, E., & Dell, P. (2008). Being a good mother: A discourse analy-
sis of women’s experiences of breast cancer and motherhood. Psy-
chology of Women Section Review, 10, 3-12.
Barnes, J., Kroll, L., Bruke, O., Lee, J., Jones, A., & Stein, A. (2000).
Qualitative interview study of communication between parents and
children about maternal breast cancer. British Medical Journal, 321,
Billhult, A., & Segesten, K. (2003). Strength of motherhood: Nonre-
current breast cancer as experienced by mothers with dependent
children. Scandinavian Journal of Caring Sciences, 17, 122-128.
Clemmens, D. A. (2009). The significance of motherhood for adoles-
cents whose mothers have breast cancer. Oncology Nursing Forum,
36, 571-577. doi:10.1188/09.ONF.571-577
Compas, B. E., Worsham, N. L., Epping-Jordan, J. E., Grant, K. E.,
Mireault, G., Howell, D. C., et al. (1994). When mom or dad has
cancer: markers of psychological distress in cancer patients, spouses,
and children. Health Psychology, 13, 507-515.
Compas, B. E., Worsham, N. L., Ey, S., & Howell, D. C. (1996). When
mom or dad has cancer: II. Coping, cognitive appraisals, and psy-
chological distress in children of cancer patients. Health Psychology,
15, 167-175. doi:10.1037/0278-6184.108.40.206
Davis Kirsch, S. E., Brandt, P. A., & Lewis, F. M. (2003). Making the
most of the moment: when a child’s mother has breast cancer. Can-
cer Nursing, 26, 47-54. doi:10.1097/00002820-200302000-00007
Edwards, B., & Clarke, V. (2004). The psychological impact of a can-
cer diagnosis on families: The influence of family functioning and
patients’ illness characteristics on depression and anxiety. Psycho-
Oncology, 13, 562-576. doi:10.1002/pon.773
Edwards, L., Wa tson, M., St. James-Roberts, I., Ashley, S., Tilney, C.,
Brougham, B., et al. (2008). Adolescent’s stress responses and psy-
chological functioning when a parent has early breast cancer. Psy-
cho-Oncology, 17, 1039-1047. doi:10.1002/pon.1323
Elmberger, E., Bolund, C., & Lützen, K. (2000). Transforming the
exhausting to energizing process of being a good parent in the face of
cancer. Health Care for Women International, 21, 485-499.
Elmberger, E., Bolund, C., & Lützen, K. (2002). Men with cancer.
Changes in attempts to master the self-image as a man and as a par-
ent. Cancer Nursing, 25, 477-485.
Elmberger, E., Bolund, C., & Lützen, K. (2005). Experience of dealing
with moral responsibility as a mother with cancer. Nursing Ethics, 12,
Fitch, M. I., Bunston, T., & Elliot, M. (1999). When mom’s sick:
Changes in a mother’s role and in the family after her diagnosis of
cancer. Cancer Nursing, 22, 58-63.
Forrest, G., Plumb, C., Ziebland, S., & Stein, A. (2006). Breast cancer
in the family—Children’s perceptions of their mother’s cancer and
it’s initial treatment: qualitative study. British Medical Journal, 332,
Grant, K. E., & Compas, B. E. (1995). Stress and anxious-depressed
symptoms among adolescents: Searching for mechanisms of risk.
Journal of Consulting & Clinical Psychology, 63, 1015-1021.
Helseth, S., & Ulfsæt, N. (2003). Having a parent with cancer; Coping
and quality of life of children during a period of serious illness in the
family. Cancer Nursing, 26, 337-344.
Helseth, S., & Ulfsæt, N. (2005). Parenting experiences during cancer.
Journal of Advanced Nursing, 52, 38-46.
Huizinga, G. A., van der Graaf, W. T., Visser, A., Dijkstra, J. S., &
Hoekstra-Weebers, J. E. (2003). Psychosocial consequences for chil-
dren of a parent with cancer: a pilot study. Cancer Nursing, 26,
Huizinga, G. A., Visser, A., van der Graaf, W. T., Hoekstra, H. J.,
Gazendam-Donofrio, S. M., & Hoekstra-Weebers, J. E. (2010).
Stress response symptoms in adolescents during the first year after a
parent’s cancer diagnosis. Supportive Care in Cancer, 18, 1421-1428.
Copyright © 2012 SciRes. 1033
E. MAZZOTTI ET AL.
Copyright © 2012 SciRes.
Huizinga, G. A., Visser, A., van der Graaf, W. T., Hoekstra, H. J., &
Hoekstra-Weebers, J. E. (2005). The quality of communication be-
tween parents and adolescent children in the case of parental cancer.
Annals of Oncology, 16, 1956-1961. doi:10.1093/annonc/mdi395
Hymovich, D. P. (1993). Child-rearing concerns of parents with cancer.
Oncology Nursing Forum, 20, 1355-1360.
Hymovich, D. P. (1995). The meaning of cancer to children. Seminars
in Oncology Nursing, 11, 51-58.
Kaiser, K. (2008). The meaning of the survivor identity for women with
breast cancer. S o c ia l Sc i en c e & Medicine, 67, 79-87.
Kennedy, V. L., & Lloyd-Williams, M. (2009a). How children cope
when a parent has advanced cancer. Psycho-Oncology, 18 , 886-892.
Kennedy, V. L., & Lloyd-Williams, M. (2009b). Information and com-
munication when a parent has advanced cancer. Journal of Affective
Disorders, 114, 149-155. doi:10.1016/j.jad.2008.06.022
Kroll, L., Barnes, J., Jones, A. L., & Stein, A. (1998). Cancer in parents:
Telling children. British Medical Journal, 316, 880.
Kvale, S. (1996). Interviews: An introduction to qualitative research
interviewing. Thousa n d O a ks , CA: SAGE Publishings, Inc.
Labov, W. (2010). Narratives of personal experience. In P. Hogan (Ed.),
Cambridge Encyclopedia of the Language Sciences. Cambridge:
Cambridge University Press.
Lewis, F. M., & Hammond, M. A. (1996). The father’s, mother’s, and
adolescent’s functioning with breast cancer. Family Relations, 45,
Lewis, F. M., Zahlis, E. H., Shands, M. E., Sinsheimer, J. A., &
Hammond, M. A. (1996). The functioning of single women with
breast cancer and their school-aged children. Cancer Practice, 4,
Nelson, E., & While, D. (2002). Children’s adjustment during the first
year of a parent’s cancer diagnosis. Journal of Psychosocial Oncol-
ogy, 20, 15-36. doi:10.1300/J077v20n01_02
Öhlén, J., & Holm, A. K. (2006). Transforming desolation into conso-
lation: Being a mother with life-threatening breast cancer. Health
Care for Women Internation a l , 27, 18-44.
Osborn, T. (2007). The psychosocial impact of parental cancer on chil-
dren and adolescents: A systematic review. Psycho-Oncology, 16,
Patenaude, A. F. (2000). A different normal: reactions of children and
adolescents to the diagnosis of cancer in a parent. In L. Baider, C. L.
Cooper, & A. K. De-Nour (Eds.), Cancer and the Family (2nd ed.,
pp. 239-253). Chichester: John Wiley and Sons.
Polkinghorne, D. E. (1988). Narrative knowing and the human sciences.
State University of Albany: New York Press.
Riessman, C. K. (1990). Strategic uses of narrative in the presentation
of self and illness: A research note. Social Science and Medicine, 30,
Riessman, C. K. (1993). Narrative analysis. Newbury Park, CA: SAG E
Riessman, C. K. (2002). Analysis of personal narratives. In J. D. Gu-
brium, & J. A. Holstein (Eds.), Handbook of interview research:
Context and method (pp. 695-710). Thousand Oaks, CA: SAGE Pub-
Rosenfeld, A., Caplan, G., Yaroslavsky, A., Jacobowitz, J., Yuval, Y.,
& LeBow, H. (1983). Adaptation of children of parents suffering
from cancer: A preliminary study of a new field for primary preven-
tion research. Journal of Primary Prevention, 3, 244-250.
Rosenheim, E., & Reicher, R. (1985). Informing children about a par-
ent’s terminal illness. Journal of Child Psychology and Psychiatry,
26, 995-998. doi:10.1111/j.1469-7610.1985.tb00613.x
Sadler-Gerhardt, C. J., Reynolds, C. A., Britton, P. J., & Kruse, S. D.
(2010). Women breast cancer survivors: Stories of change and
meaning. Journal of Mental H eal th C ou ns el ing, 32, 265-282.
Schmitt, F., Piha, J., Helenius, H., Baldus, C., Kienbacher, C., Steck, B.,
et al. (2008). Multinational study of cancer patients and their children:
Factors associated with family functioning. Journal of Clinical On-
cology, 26, 5877-5883. doi:10.1200/JCO.2007.12.8132
Semple, C. J., & McCance, T. (2010). Parents experience of cancer
who have young children: A literature review. Cancer Nursing, 33,
Shands, M. E., Lewis, F. M., & Zahlis, E. H. (2000). Mother and child
interactions about the mother’s breast cancer: An interview study.
Oncology Nursing Forum, 27, 77-85.
Silverman, D. (2010). Doing Qualitative Research: A practical hand-
book (3rd ed.) L ondon: SAGE Publishings, Inc.
Stiffler, D., Barada, B., Hosei, B., & Haase, J. (2008). When mom has
breast cancer: Adolescent daughters’ experiences of being parented.
Oncology Nursing Forum, 35, 933-940.
Vannatta, K., Grollman, J. A., Noll, R. B., & Gerhardt, C. A. (2008).
Impact of maternal breast cancer on the peer interactions of children
at school. Psycho-Oncology, 17, 252-259. doi:10.1002/pon.1232
Vannatta, K., Ramsey, R. R., Noll, R. B., & Gerhardt, C. A. (2010).
Associations of child adjustment with parent and family functioning:
comparison of families of women with and without breast cancer.
Journal of Development and Behavioral Pediatries, 31, 9-16.
Visser, A., Huizinga, G. A., Hoekstra, H. J., van der Graaf, W. T.,
Gazendam-Donofrio, S. M., & Hoekstra-Weebers, J. E. (2007).
Emotional and behavioral problems in children of parents recently
diagnosed with cancer: A longitudinal study. Acta Oncologica, 46,
Visser, A., Huizinga, G. A ., Hoekstra, H. J., van der Graaf , W. T., Klip ,
E. C., Pras, E., et al. (2005). Emotional and behavioural functioning
of children of a parent diagnosed with cancer: A cross-informant
perspective. Psycho-Oncology, 14, 746-758. doi:10.1002/pon.902
Visser, A., Huizinga, G. A., van der Graaf, W. T., Hoekstra, H. J., &
Hoekstra-Weebers, J. E. (2004). The impact of parental cancer on
children and the family: A review of the literature. Cancer Treatment
Reviews, 30, 683- 694. doi:10.1016/j.ctrv.2004.06.001
Walsh, S. R., Manuel, J. C., & Avis, N. E. (2005). The impact of breast
cancer on younger women’s relationships with their partner and
children. Families, Systems and Health, 23, 80-93.
Watson, M., St. James-Roberts, I., Ashley, S., Tilney, C., Brougham, B.,
Edwards, L., et al. (2006). Factors associated with emotional and
behavioural problems among school age children of breast cancer
patients. Britis h Journal of Cancer, 94, 43-50.
Williams, G. (1984). The genesis of chronic illness: Narrative recon-
struction. Sociology of Health & Illness, 6, 175-200.