The perception of a sick person regarding the changes occurring in the family when cancer appears

Introduction

The family is considered the basic unit of social life, forming a complex ensemble of elements that constitute a certain whole. The family system consists of individual people, family members who interact during their shared life, but it is more than just a collective personality – it is a distinct whole. The family behaves according to the strategy of the so-called family homeostasis, where its members strive to maintain balance and stability in their mutual relationships. If the family equilibrium is threatened by destabilization, all family members should collectively take action to sustain it [1]. Every event that deviates from the accepted standards and patterns of behavior within the family causes a disturbance and disrupts its normal functioning. It may manifest, for example, through a change and intensification of emotions among the members of the family system. Family systems, according to de Barbaro [2], have many adaptive mechanisms for coping with stress; however, when the stress is too intense, those mechanisms become overloaded. The onset of cancer in the family completely changes the life not only of the patient but also of the entire family system, which as Pietrzyk [3] highlights, depends on the cancer stage and therapy. Regardless of whether the cancer affects a young or older person, it is an existential experience of particular significance for the entire family system, always causing changes in mood, thoughts, feelings, actions, and the hierarchy of goals and values. The diagnosis and treatment of an immediate family member account for a significant psychological burden, triggering intense coping strategies related to the loved one affected by cancer [4].
Medical personnel often focus on the diagnosis and treatment methods, frequently overlooking the family system. They often struggle to support the families of the sick.
Although there is an increasing number of studies in the literature dedicated to the problems faced by families with patients undergoing oncology treatment, these studies mainly rely on the analysis of family members’ feelings [5–7].
A cancer diagnosis impacts not only the individual but also their family, friends, and wider community [5–7]. The illness and its treatments often bring significant changes in daily life and evoke a range of emotional reactions, which can be particularly challenging for families to navigate. Patients diagnosed with cancer experience an alteration in their life course, modifying some levels/aspects of their lives: physical, psychological, social, work, and economic. This situation also affects their families or close relatives who act as caregivers [5]. Moreover, caregivers often have higher levels of distress than the patients. They have more frequent symptoms of depression and anxiety. Additionally, the presence of anxiety and depression can significantly diminish the quality of life for those caring for cancer patients [5, 6].
Everyone copes with difficult emotions in their own way, and while suppressing feelings can serve as a protective mechanism, it ultimately has negative effects on mental health. The extent to which patients hold back negative emotions can shape how they perceive various aspects of family functioning – for example, denying the diagnosis, their spouse’s or partner’s worries about financial stability, the need for children to limit social interactions, and the children’s inclination to compensate for the parent’s illness. When a parent is diagnosed with cancer, it can be especially challenging for children, who may struggle to grasp what is happening and what the diagnosis means [7]. Open and honest communication with children is crucial, ensuring they feel involved and have a basic understanding of the situation.
To our knowledge, there are no studies that capture the family experience from the patient’s viewpoint.
This study aimed to assess the patient’s perception of the family affairs and the changes that have occurred within the family and society due to the onset of cancer.

Hypotheses

H1: Main hypothesis
There is a significant correlation between a cancer patient’s perceptions of their family’s reaction to the illness and the patient’s psychological state.
H2: Partner’s reaction and patient well-being
A patient’s perception of their spouse’s/partner’s anticipated reaction to the diagnosis.
H3: Family concerns and patient stress
A patient’s expressed concerns about their family’s future, declared anxiety about their family, and perceptions of worsening finances or limited social contacts are correlated with the patient’s concerns.
H4: Acceptance of diagnosis and self-efficacy
A patient’s difficulty in believing the diagnosis and feeling a sense of injustice.
H5: Need for psychological support and emotional control
A patient’s opinion on the importance of psychological help to their spouse/partner and other adult family members is correlated with their own ability to resolve problems.
H6: Emotional expression and loneliness.
The act of a patient crying in the presence of family and their perception of providing adequate information to their spouse/partner are significantly related with their emotions, level of self- efficacy, and feeling of loneliness.

Material and methods

The main research was preceded by a pilot study involving 20 oncology patients to ensure the clarity of the questions included in the survey. There was no need to adjust the survey. A total of 200 questionnaires were distributed, and 190 completed questionnaires were returned. The main research was conducted between January 2020 and December 2022. The study included 185 questionnaires from individuals who correctly completed the survey packages. The remaining questionnaires were excluded due to incomplete responses.

Study group

One hundred eighty-five patients hospitalized at the Białystok Oncology Center in the Department of Gastrointestinal Tumor Surgery participated in the study. Patients whose clinical condition allowed for the completion of multiple questionnaires were included in the study; we did not take into account their family situation and other factors.
The inclusion criteria for patients included the diagnosis of cancer and their consent to participate in the study. Respondents were given questionnaires to complete after providing oral consent to participate, and a single interviewer distributed these. Participants were informed that the study was completely anonymous; participation was voluntary; it complied with the personal data protection law and related regulations; the collected information would be used solely for scientific purposes; results would only be presented in aggregate form; they could withdraw from the study at any time without consequences while filling out the questionnaires, and that participation in the survey was equivalent to the consent to complete the questionnaire. After completion, participants returned the questionnaires to a specially prepared container located at the Oncological Surgery Department of the Białystok Oncology Center.

Instruments

For the study, a diagnostic survey method was applied to make use of questionnaire techniques, including: a proprietary questionnaire consisting of  4 parts; family affluence scale (FAS) is an established measure used to estimate family wealth in the absence of direct income or wealth data [8]; life satisfaction scale (SWLS) by Dinner, measures global life satisfaction. Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness, that/which has been adapted in Poland by Juczyński, the reliability coefficient of the scale (Cronbach’s) is 0.81, and the stability coefficient of the scale – 0.86 [9]; social readjustment rating scale by Holmes and Rahe (SRRS) is a list of 43 stressful life events that can contribute to illness. The test works by accumulating a point score, which then provides an assessment of risk [10]. The perceived stress scale (PSS10) is widely considered the gold standard instrument for measuring stress perception. This self-report questionnaire is used to assess the degree to which a respondent finds their life circumstances to be unpredictable, uncontrollable, and/or overwhelming. The reliability coefficient of the scale (Cronbach’s) is 0.86. Reliability established based on a two-day test-retest is 0.90, whereas a four-week test-retest is 0.72. The coping inventory for stressful situations (CISS) is a psychological tool designed to assess how individuals cope with stress through three primary coping styles: task-oriented, emotion-oriented, and avoidance-oriented coping. The high internal consistency of individual scales (coefficients of 0.78–0.90) and satisfactory stability (correlation coefficients of 0.73–0.80) [11, 12] are notable. The Courtauld emotional control scale is a 21-item scale developed to assess the extent to which individuals report controlling anger, anxiety, and depressed mood. Cronbach’s : for anger control – 0.80; depression – 0.77; anxiety – 0.78; and total emotional control coefficient – 0.87 [9]. The generalized self-efficacy scale (GSES) is a self-report measure of self-efficacy. The general self-efficacy scale is correlated with emotion, optimism, and work satisfaction. Negative coefficients were found for depression, stress, health complaints, burnout, and anxiety. Reliability – Cronbach’s  is 0.85 [9]; social support scale by Kmiecik-Baran is designed to measure the perception of social support [13, 14]; De Jong Gierveld loneliness scale (DJGLS) is a valid and reliable measurement instrument for overall, emotional, and social loneliness, although its length has sometimes rendered it difficult to use in large surveys. The internal consistency coefficient, Cronbach’s , is high ( = 0.89), similar to the value of the average inter-item correlation (r = 0.42) and Loevinger’s homogeneity coefficient (H = 0.47) [15].

Data analysis

Statistical calculations were performed by means of Statistica 13.3 software. The analyzed variables were elaborated upon in terms of basic statistics (mean, median, standard deviation, minimum and maximum, lower and upper quartiles). For statistical analysis (to determine relationships between variables), Spearman’s non-parametric correlation analysis was used when at least one variable in the pair had a distribution that deviated from normality. A significance level of p < 0.05 was adopted for all statistical analyses.
Among the 185 patients hospitalized at the Białystok Oncology Center in the Department of Gastrointestinal Tumor Surgery, women constituted 62% of the study group, while men accounted for 38%. The average age of respondents was 59.2 ±1.96 years. The youngest respondent was 23 years old, while the oldest was 88. A significant majority of respondents (83 individuals, 45%) lived in towns with populations of up to 15,000 inhabitants, with only 18% (33 individuals) residing in rural areas. Most respondents scored low on the FAS scale, indicating low family material/financial resources (50% – 93 individuals). Only a small percentage of respondents reported high family affluence resources (8% – 15 individuals). The average score obtained by respondents was 4.3 ±1.97 points (min. 1 point, max. 8 points), indicating an average level of affluence resources. The most frequently occurring score was 4 points, obtained by 33 individuals.

Results

First symptoms and cancer diagnosis

Seventy-four percent of respondents independently recognized the first symptoms of the beginning of the cancer process. Spouses contributed to the detection of cancer in 11% of respondents, while it was detected incidentally in 8% of patients.
In the majority of cases (54%), patients personally informed their families about the diagnosed cancer. In 35% of cases, it was the doctor who informed the patient’s family about the diagnosis. A small percentage of respondents (11%) stated that their children informed the rest of the family about the cancer diagnosis. Half of the respondents indicated that the information provided to the family about the diagnosis was sufficient (50%). A small portion of respondents (38%) felt that the information was insufficient, while 12% had difficulty in declaring their opinion.

Therapy and prognosis

Forty-nine percent of patients personally informed their families about the planned therapy, while in 46% of cases, it was the doctor who conveyed that information. Just under a half of the respondents believed that the information provided to the family about the planned therapy was sufficient (48%). Those who felt otherwise constituted 39% of the group, and 13% were undecided on that matter.
Fifty-one percent of patients personally informed their families about the prognosis, while in 44% of cases, it was done through/by the doctor, and in 5% of cases – through/by their children. Just under a half of the respondents (48%) believed that the information provided to the family about the prognosis was sufficient. Forty-one percent of respondents felt that the information provided was not exhaustive and sufficient, while 11% had no opinion.

Care, attitudes towards cancer diagnosis

Most of the respondents (58%) stated that they primarily took care of themselves. The second most common caregivers were children (49%), followed by spouses (43%), sisters (34%), and brothers (21%). A small percentage of respondents (18%) identified friends as the individuals who provided the most of the care for them. The question allowed for selecting more than one correct answer, hence the values did not sum up to 100%.
According to the largest group of patients, their spouses/partners found it difficult to believe in the cancer diagnosis (41%), rejected the idea of cancer (35%), or took a stance of fighting for a better future for their children (30%). Anger towards fate/God was felt by 29% of respondents, while 26% felt a sense of injustice. Some patients also noted that their spouses/partners were indifferent to the treatment process (28%), and 7% had difficulty in providing a clear declaration. The question allowed for selecting more than one correct answer, hence the values did not sum up to 100%.
Patients were asked to indicate which statements from the survey corresponded to the behavior of their spouses/partners in the face of cancer. Most commonly, patients reported that their spouses/partners had to care for and protect them – 38%, and believed that it was difficult for them to manage household chores due to cancer – 35%. Twenty-two percent of respondents believed that their spouses/partners found it difficult to take care of children. Nineteen percent were convinced that their spouse brought a lot of good into their lives or redefined their world. Limitations in various aspects were observed by 18% of patients, and 17% felt they had to lower their expectations of their spouses/partners. Nineteen percent had difficulty in providing a clear declaration. The question allowed for selecting more than one correct answer, hence the values did not sum up to 100%.
According to the respondents, their spouses/partners, in the face of cancer, were most concerned about their health condition (28%), feared financial insecurity (26%), worried about what would happen to them after their loss (24%), or whether they would be able to take care of the children during their husband’s/wife’s illness (12%). Twenty-eight percent of respondents had difficulty providing a clear answer. The question allowed for selecting more than one correct answer, so the responses did not sum up to 100%. As far as children were concerned, respondents believed that due to cancer, they emotionally supported other family members (21%), but also felt anxiety (21%), sadness (20%), anxiety (15%), anger, or guilt (11% each). One percent did not provide a clear answer to that question.

Emotions experienced by the family

According to the respondents, the most common emotion experienced by spouses/partners of patients was sadness (30%), followed by anxiety (22%), the need for emotional support from other family members (19%), feelings of guilt (18%), worry (17%), and jealousy or anger (14% each). The question allowed for selecting more than one correct answer, so the values did not sum up to 100%.
The study participants believed that women were more concerned about the fate of their families compared to men (78% vs. 70%), and the age of the patients influenced this difference; the younger the patient, the more concerned they were about the fate of their family (p = 0.05).

Location/place of the therapy/therapy location

Treatment did not require spouses/partners to relocate to the location where therapy was conducted, according to 16.2% of rural residents, 39.2% of residents from towns with up to 15,000 inhabitants, and 44% of residents from cities with more than 15,000 inhabitants. On the other hand, 45.6% of rural residents, 28.3% of residents from towns with up to 15,000 inhabitants, and 26% of residents from cities with more than 15,000 inhabitants stated that cancer therapy required them to be present continuously at the treatment location. Periodic moves to the treatment location were required by 38.2% of rural residents, 32.1% of residents from towns with fewer than/up to 15,000 inhabitants, and 30% of residents from cities with more than 15,000 inhabitants. A significant (p < 0.001) relationship was found between the need for a family member to relocate to the treatment location and their current place of residence.

Family reactions to a cancer diagnosis

The largest group of patients, when asked about their spouses/partners’ reactions upon having received the diagnosis, indicated anxiety about their future life (60%), feelings of fear (51%), guilt (43%), helplessness (42%), denial (38%), repression of cancer information (36%), or withdrawal (32%). According to 30% of individuals, the news of the diagnosis did not evoke any emotions, and 34% were unable to give any definitive opinion. The question allowed for selecting more than one correct answer, hence the responses did not sum up to 100%. On the other hand, the largest group of respondents believed that their children either rejected the idea of their illness (31%) or had become accustomed to it (30%). According to 20% of children, they still could not believe in their illness. A small percentage of respondents (14%) stated that their children were angry at God for the situation. As many as 21% of respondents had difficulty in providing a clear response. The question allowed for selecting more than one correct answer, hence the results did not sum up to 100%.

Psychological, psychiatric support

Half of the respondents (50%) stated that psychological assistance was offered to their spouses/partners after the diagnosis of cancer. A different opinion was held by 43% of patients who said they were not offered such help, and 7% could not recall. The majority of patients indicated that when psychological help was offered, it was primarily suggested by the doctor (86%). In a small percentage of cases, a nurse suggested this (9%). On the other hand, a significant majority of respondents with children stated that in their opinion their children were not offered psychological help after the diagnosis of cancer (66%). That view was opposed by 33% of respondents, and 1% could not remember whether such an offer was made. If there was a perceived need for psychological assistance, the largest proportion of respondents said their children mostly took advantage of the help of a psychologist (27%) and relatives (7%). None of the respondents indicated that their children used psychiatric help or support groups.
The largest group of respondents (33%), when asked whether their spouses/partners required assistance outside the hospital, denied it. However, when such a need arose, the largest group of people sought help from their children (28%), relatives (25%), and from professionals; a smaller number of individuals sought help from a psychiatrist (15%), a psychologist (20%), and support groups (11%). The question allowed for selecting more than one correct answer, so the responses did not sum up to 100%. A significant relationship was found between the gender of the respondents and their spouses’ or partners’ use of assistance from relatives (p = 0.011). Details are presented in Table 1.
Most patients (42%) admitted crying frequently in the presence of their spouses/partners, 14% cried occasionally, and it never happened to 44% of the respondents. An equal percentage of respondents (45% each) stated that they both cried and did not cry in front of their children, while only 10% said it happened occasionally.

Financial status and job

Most respondents (47%) believed that their spouse/partner thought that cancer had worsened their family’s financial standing, while 43% denied it. According to most respondents (41.7% of women and 47.7% of men), their children believed that cancer did not worsen the family’s financial standing. Conversely, 49.6% of women and 40.6% of men stated that their children perceived the family’s financial standing as worse than before the cancer diagnosis, and 8.7% of women and 11.6% of men were unsure how to answer that question definitively. Significant relationships were found between the gender of the respondents and their perceptions of their children’s opinions regarding the deterioration of the family’s financial situation (p = 0.019). According to the majority of respondents, the cancer diagnosis did not require their spouses/partners to quit their jobs (53%). Periodic resignation from work was necessary for 18% of the surveyed spouses/partners, 8% had to take sick leave, and 21% permanently left their jobs. A significant (p < 0.001) relationship was found between spouses/partners resigning from work and the need to relocate them to the location where the patient’s treatment was conducted. As many as 77% of the respondents indicated that their children had to temporarily resign from their activities, including studies and/or work, due to their illness. That statement was denied by 23% of the patients. None of the respondents indicated that their children had permanently resigned from those activities.

Social contacts

Over half of the respondents (51%) believed that their illness did not worsen or limit their social contacts with their spouses/partners. A decrease in social interactions was noticed by 32% of respondents. Most respondents stated that their spouses/partners rarely attended any social gatherings outside the home (46%), while some reported that their spouses/partners never attended social gatherings (22%), and 4% mentioned they attended quite often. Difficulty in responding was reported by 28%. Statistical (p < 0.001) dependence/relationship was demonstrated between the frequency of social gatherings and the deterioration of social contacts, as well as between the resignation of spouses/partners from work and the limitation of family contacts (Table 2).
Respondents, in turn, stated that as a result of their illness, their children mostly participated in social gatherings outside the home relatively infrequently (45%). About one-third of respondents were unsure how to answer.

Attention towards children

Over half of the respondents (53%) expressed the opinion that their spouses/partners did not indicate any need for increased attention towards them. On the other hand, 29% of respondents stated that their children did not signal any need for increased attention from the patient after the diagnosis. Conversely, 27% disagreed, while a significant percentage (44%) could not recall if their children had such a need. A significant relationship was found between the respondents’ age and their opinion regarding the need for increased attention towards children (p = 0.008). Most respondents (56%) noticed that their children periodically signaled a need for increased attention from the healthy spouse/partner of the patient. A significant association was found between the phase of therapy the respondent was in and their opinion on whether the child needed increased attention from the healthy parent (p = 0.022). The results are presented in Table 3. The largest group of respondents believed that their children wanted to compensate for their illness in some way (26%), felt the need to protect them (23%), found it difficult to manage household chores (11%), and cared for sick parents (10%). A correlation was found between the treatment phase in which the respondents were and the attitudes they believed their children adopted (p = 0.05). The results are presented in Table 4.

Respondents’ perception of diagnosis and results in the SRRS, DJGLS scales

The evaluation of the correlation between the respondents’ sense of conveying the appropriate piece of information to their spouses/partners showed statistically significant dependencies/relationships between each piece of information conveyed regarding the diagnosis of the disease and the SRRS scale. In cases of doubt, a correlation was observed with the DJGLS scale. The results are presented in Table 5.

Respondents’ perception of their spouses’/partners’ reaction to the diagnosis and results in the SWLS, PSS10, DJGLS, and CECS scales

The assessment of the correlation between the respondents’ perception of their spouses’/partners’ expected reactions to the diagnosis revealed statistically significant dependencies/relationships between the feeling of indifference and the SWLS, PSS10, and DJGLS scales. Additionally, there were correlations between denial and the CESS scale. The results are presented in Table 6. The analysis revealed notable correlations between respondents’ perceptions of their partners’ emotional responses to illness and several psychological scales. Specifically, feelings of guilt were linked to the SWLS, while anxiety and sadness showed connections with the CISS. Additionally, anxiety, worry, anger, and emotional support were associated with the GSES, and emotional support was further related to both the DJGLS and the GSES. These results are detailed in Table 7. Respondents’ opinions regarding their family’s feelings about the diagnosis of cancer and results in the PSS10, CISS, SRRS, DJGLS, and courtauld emotional control scale (CECS) scales
The evaluation of correlations between respondents’ opinions regarding their family’s feelings upon hearing the diagnosis of cancer showed significant relationships: among adult family members – difficulty in believing in the diagnosis was correlated with the PSS10 scale; getting accustomed to the illness was correlated with the CISS scale and regarding children – the attitude of fighting for a better future was correlated with the SRRS scale and DJGLS scale; feelings of injustice were correlated with the CECS scale. The results are presented in Table 8.

Respondents’ opinions regarding the psychological help for their family

The assessment of correlations between respondents’ opinions regarding the offer of psychological help to their family showed statistically significant relationships, specifically concerning their spouses/partners and the CECS scale. The results are presented in Table 9. Respondents’ views on additional support to their families and results in the PSS10, SWLS, CESS, and CECS scales Analysis of the correlations between respondents’ views on providing additional support to their families outside the hospital revealed significant relationships. As far as adult family members were concerned, there was a correlation between the need for psychological help and the PSS10 scale. As far as children were concerned, there was a correlation between the belief that such a need did not exist and SWLS, CECS, and GSES.

Respondents’ crying, anxiety about family, financial status, work, social contacts, and the results in the tested scales

The evaluation of correlations between respondents’ crying in the presence of their family showed statistically significant relationships. As far as adult family members were concerned, there was a correlation between that behavior and CECS. As far as children were concerned, there was a correlation with SWLS. The results are presented in Table 10. The evaluation of the correlation between respondents’ opinions on anxiety about the family’s future due to their illness indicated statistically significant correlations exclusively in the case of adults, as far as the above is concerned, and the PSS10, CISS, and CECS scales. The results are presented in Table 11. The evaluation of correlations between respondents’ declared worry about their family did not show statistically significant relationships with the SWLS, SRRS, PSS10, CISS, CECS, GSES, and DJGLS scales. The results are presented in Table 12. The evaluation of correlations between respondents’ opinions regarding family members’ belief in worsening the financial status showed statistically significant relationships only among adults between the above and the results in the CECS scale. The results are shown in Table 13.
The assessment of correlations between respondents’ opinions regarding the necessity of family members to resign from work/study showed statistically significant relationships only among adults between the above and the results in the SWLS and GSES scales. The results are presented in Table 14. Correlations between respondents’ opinion on the necessity to resign from work/study by the family members and the tested scales are shown in Table 15, between the above and the results in the SWLS and CECS scales in Table 16.
Respondents’ opinions regarding their spouses’ or partners’ behavior in the face of their illness and the results in the SRRS, PSS10, CISS, and CECS scales.
The assessment of correlations between respondents’ opinions regarding their spouses’ or partners’ behavior in the face of their illness showed statistically significant relationships among adults. The social readjustment rating scale, PSS10, CISS, and CECS scales were used for adults, whereas the PSS10, CISS, and CSES scales were used for children. The results are presented in Table 17.
The assessment of correlations between respondents’ opinions regarding their family signaling the need for increased attention towards them showed statistically significant relationships only among adults, specifically between the above and the SWLS scale. The results are presented in Table 18.

Discussion

The illness, when it appears in a family, is not solely a problem affecting the individual who is sick, as all family members are involved in experiencing it. The paradigm of understanding the family in a systemic approach allows us to state that the illness (through circular causality) significantly influences not only the person who is ill but also all the family members, consequently leading to disturbances in the overall functioning of the family [16]. It is considered that the family’s reaction to illness is a multifactorial process, depending on factors such as the age of the ill person, the level of mutual acceptance among family members, the level of their cohesion, and the type of psychological resources the family possesses. Changes that occur after the diagnosis of an illness in one family member may take on an adaptive nature, promoting the therapeutic process and increasing the family’s integration, revealing new possibilities. Conversely, maladaptive changes may perpetuate dysfunctional and pathological patterns of interaction. Changes triggered by illness that disrupt family relationships also cause disturbances in their social environment, leading to dysfunction in a broader macrosystem [16].
One of the responsibilities of an oncologist is to conduct discussions with patients (and their families, with the patient’s consent) regarding the diagnosis of cancer, possible treatment options, and prognosis, which is considered one of the most challenging aspects of the medical field.
Most patients in the surveyed group personally conveyed information about the diagnosis of cancer (54%), planned therapy (49%), and prognosis (51%) to their families. In all of the discussed cases, the respondents believed that the information they provided to their families was sufficient.
Our research indicates that, according to respondents, family members are most often the primary caregivers (58%) for those who are ill. Children (49%) and spouses or partners (43%) are seen as the next most involved in providing care.
The cancer diagnosis is often initially perceived as a death sentence, even though early detection of cancer often leads to successful treatment. It triggers a strong emotional reaction. Feelings of anxiety, sadness, despair, helplessness, confusion, and often a sense of being misunderstood commonly arise [17–21]. The vast majority of the surveyed patients claimed to have independently recognized the initial symptoms of developing cancer.
One cannot forget that the moment when the family learns about a cancer diagnosis is highly stressful for them. On the one hand, they must remain calm, and on the other hand, they must face immense fear for the health/life of their family member. They are confronted with a new situation, a sort of chaos in their previous life, and its disintegration. They must mobilize themselves into action, plan new responsibilities for each family member, and reorganize their daily lives [20–30]. According to the opinion of the largest group of the surveyed patients, their spouses/partners found it difficult to believe in the diagnosed cancer (41%), rejected the idea of their illness (35%), or adopted an attitude of fighting for a better future for their children (30%).
When illness enters the family, healthy members are burdened with new tasks and often must acquire skills they were previously unfamiliar with [17–21]. In the current study, patients were also aware that their spouses/partners primarily feared financial insecurity (26%) and worried about what would happen to them after their loss (24%). Their children, on the other hand, expressed concerns about whether they would be able to take care of the sick parent (21%) and what would happen to them after the parent’s death (18%).
Unfortunately, depending on the stage of the disease, the type of therapy applied, and the patient’s condition, the symptoms of the disease may become increasingly noticeable. The patient’s appearance changes, and pain and fatigue appear and intensify. Family members caring for the patient may experience frustration and mood disorders [17–21]. There are publications indicating the need for psychotherapeutic assistance for families of patients [23–25].
Research by Trevino et al. [26] revealed that caregivers of cancer patients are at a significantly higher risk of developing mental health issues compared to the general population: they are over seven times more likely to experience an episode of depression and three times more likely to suffer from generalized anxiety disorder. Similar results were reported by Hu et al. [27]. Numerous studies have found [28–32] that spouses who are anticipating the potential loss of their partner experience mental health issues and increased rates of illness. Around 40% of caregivers suffer from anxiety, and over 80% experience symptoms of depression as a consequence of caring for a cancer patient. These findings align with our own results.
Current research literature does not provide clear statistics on how often or to what extent support is extended to families coping with cancer. Our findings reveal that in half of the cases, spouses of individuals with cancer were offered psychological support, most often provided by their doctors (86%). However, regarding children, most respondents (66%) indicated that their children did not receive any form of psychological support.
According to Rospęk [33], the challenge for therapists is the early identification of the family’s needs, as the well-being of patients and their families is closely intertwined (synergistic effect). The author emphasizes that family therapy provides an opportunity for respective family members to make informed decisions, which helps reduce their fear of the unknown associated with cancer in the family. Bernad et al. [34], in a study of 121 patients at the Greater Poland Oncology Center, found that 94% of those admitted experienced anxiety during their diagnosis and treatment. More than half of the participants reported intense anxiety while staying in the oncology hospital. That is particularly important because the social, informational, and emotional support provided by medical staff greatly helps patients overcome negative emotions associated with therapy.
Affluence, which may deteriorate in the case of cancer, is a very important aspect affecting the quality of life of cancer patients and the functioning of their families. The research conducted by Wrażeń et al. [35] has shown that half of the respondents undergoing therapy for breast cancer had their affluence deteriorated. Similar observations were noted among women treated for cervical cancer [36]. In our study, 47% of the respondents and their spouses/partners perceived that the financial situation had worsened.
Patients undergoing anticancer therapy [37, 38] experience disruptions in their quality of life, primarily in the emotional and social domains, as well as in role functioning.
According to research [37], a half of the children of patients with cancer experience emotional problems due to their parent’s illness. It is not uncommon for children to develop a deep fear regarding the possibility of their parent’s death. For children and adolescents, having a parent with cancer means the confrontation with very difficult emotions. Our study has confirmed that thesis, as the participants rated their level of worry about their children (on a scale 0–5) with an average score of 4.27 points.
Additionally, they notice changes in the appearance of the ill parent [1, 39, 40]. Research confirms that individuals with cancer-related issues observe those concerns. In their view, 21% of children worry about their ability to care for their ill parent, and 18% worry about what will happen to them after the parent’s death. About 27% of children need psychological help. According to patients, the most common emotions experienced by their children include anxiety, sadness, and fear. Concerning the parent’s health, 46% of the children surveyed worry about it, 23% want to protect them, and 26% seek to compensate for the illness in some way.
It is quite common that parents who are involved in therapy or rehabilitation activities often do not allocate enough time to their children. Being faced with the difficulties related to illness in the family, they often tend to push aside the problems of their child to the background [1, 36, 37]. Those observations have been confirmed in our study, where respondents indicated that in 56% of cases, their children signaled the need for periodic attention, and 18% indicated a need for constant increased attention from the healthy spouse/partner of the patient. This underscores the importance of parents spending more quality time together and showing greater interest and involvement in their children’s lives.
The cancer diagnosis of a parent triggers not only numerous negative reactions in a child, such as mood swings and changes in self-esteem, but may also lead to study difficulties, disruptions in social and interpersonal relationships, as well as somatic symptoms [41]. In the current study, patients reported that as many as 77% of their children had to periodically give up their activities, including studying and/or work. Additionally, a significant number of the children surveyed had to reduce their social gatherings outside the home substantially.
Quality of life is described as the individual’s perception of his/her position in life in the context of the culture and value systems in which he/she lives and in relation to one’s goals, expectations, standards, and concerns [42]. Assessing the quality of life in cancer patients is a significant component of holistic care. On the one hand, it allows for evaluating treatment outcomes beyond purely biological and objective indicators, but also incorporates the subjective opinions of the patients themselves [43]. In the present study, it has been found that the life satisfaction of cancer patients influenced their perception of specific family function-related issues. Those included their spouses/partners’ perceived indifference to the diagnosis, feelings of guilt from spouses/partners about the illness, lack of necessity for family members to seek external support services, crying in front of children by respondents, lack of necessity for spouses/partners to resign from work, reduced social contacts by children, and increased interest from family members directed towards them.

Study limitations

First, much of the data relied on self-reported perceptions, which may be subject to personal bias or inaccuracies in recollection, especially given the emotional burden of the disease. The cross-sectional nature of the research restricts the ability to establish causal relationships between variables such as affluence deterioration, emotional well-being, and family role changes. Furthermore, the study population may not be fully representative of all cancer patients, as differences in cultural background, socioeconomic status, or cancer type could influence experiences and perceptions in ways not captured here. There may also be underreporting of children’s psychological difficulties or unmet needs, as patient responses might not fully reflect the perspectives of other family members. Finally, the use of standardized instruments like the family affluence scale, while valuable, may not encompass the nuanced and dynamic realities faced by families navigating cancer diagnoses and treatment.

Conclusions

The surveyed patients believed that women in their families were more concerned about the family’s fate than men, and this perception was influenced by the age of the respondents, the level of perceived stress, the degree of emotional control, and the effectiveness of coping with difficult situations.
The degree of patients’ self-efficacy, their coping style with stress, and life satisfaction influenced their perception of selected problems in their family’s functioning related to their disease.

Disclosures

1. Institutional review board statement: The research has been approved by the Bioethics Commission of the Medical University of Białystok (APK.002.175.2020) and the Management of the  Białystok Oncology Center.
2. Assistance with the article: None.
3. Financial support and sponsorship: None.
4. Conflicts of interest: None.

References