**7.1 Parent and child**

Having a child diagnosed with cancer is one of the most severe stressors that parents could possibly ever experience; the threat of their child's death and feelings of helplessness converge as the entire family faces the uncontrollable enemy of cancer (Kazak, 1998; Patterson et al., 2004). The change of the A1 event criterion of PTSD in the *DSM-IV*  (American Psychiatric Association, 1994) to include "the diagnosis of a life threatening disease" as potentially traumatizing, expanded the range of traumatic effects to include the patient's interpersonal domain. Consequently, an individual's witnessing of or learning about a significant person [to him/her] being diagnosed with a terminal illness is now viewed as potentially traumatizing. Family members and loved ones torturously stand by as their beloved endures periods of devastating illness effects, physical and psycho-spiritual pain, or highly invasive treatments that produce debilitating fatigue---all of which may be followed by uncertain terminal illness and possible death. Family members typically are involved in making hard calls or decisions regarding the patient, which, in itself, is a potential independent risk factor for PTSD (Azoulay et al., 2004, 2005).

The psychological sequelae of childhood cancer in both the children and their parents are well documented, which consists of post-traumatic stress symptoms, anxiety, and depression (Kazak, 2005; Kazak et al., 2005). More specifically, the sequelae as to parental risk for affective and stress reactions range from 9% to 40% for the above disorders for a period of up to 3 years after the child's diagnosis (Kazak et al., 2004; Stoppelbein & Greening, 2007). Barakat and colleagues found that the parents of childhood cancer survivors showed significantly higher levels of post-traumatic stress symptoms (PTSS) than a comparison group of parents (1997). Similarly, Kazak found significant elevation in PTSD scores in parents of survivors in contrast to parents of never-ill children (Kazak et al., 1997). Indeed, the line of research exploring distress in relatives of cancer survivors indicate that the relatives are usually at least as distressed as the cancer survivors (especially mothers)---if not more so (e.g., Couper et al., 2006**;** Mosher & Danoff-Burg, 2004; Tuinmann et al., 2004). Kazak and colleagues (2004) found current PTSD prevalence for parents of adolescent survivors to be 13.7% for mothers and 9.6% for fathers. Lastly, an interesting finding in the literature demonstrating the parent-child relationship is that the ill child's psychological adjustment to his/her cancer diagnosis and treatment is highly correlated with the parents' adjustment to their child's diagnosis and treatment (Ljungman et al., 2003).
