Received: 11 February 2019 Revised: 23 April 2019 Accepted: 27 May 2019

DOI: 10.1002/pon.5138

PAPER

Parenting in the face of serious illness: Childhood cancer

survivors remember different rearing behavior than the general
population

Mareike Ernst1 | Elmar Brähler1 | Eva M. Klein1 | Claus Jünger2 | Philipp S. Wild2,3,4 |

Jörg Faber5 | Astrid Schneider6 | Manfred E. Beutel1

1
Department of Psychosomatic Medicine and
Psychotherapy, University Medical Center of Abstract
the Johannes Gutenberg‐University Mainz,
Objective: A child's cancer diagnosis and treatment affect the whole family. While
Mainz, Germany
2 it has been recognized that parents are an important resource for their children, little
Preventive Cardiology and Preventive
Medicine, Center for Cardiology, University is known about the specifics of parenting in the face of serious illness.
Medical Center of the Johannes Gutenberg‐
University Mainz, Mainz, Germany Methods: We used the Recalled Parental Rearing Behavior Questionnaire in a
3
Center for Thrombosis and Hemostasis register‐based cohort of adult childhood cancer survivors (CCS) (N = 951) and a rep-
(CTH), University Medical Center of the
resentative population sample of the same age range (N = 2042). The questionnaire
Johannes Gutenberg‐University Mainz, Mainz,
Germany assesses behavior of mothers and fathers with three scales (emotional warmth,
4
German Center for Cardiovascular Research rejection/punishment, and control/overprotection) by querying the (former) child.
(DZHK), Mainz, Germany
5
We compared the two groups using general linear models. With a hierarchical linear
Department of Pediatric
Hematology/Oncology/Hemostaseology, regression analysis, we tested associations of recalled rearing behavior with
Center for Pediatric and Adolescent Medicine, disease‐ and treatment‐related factors.
University Medical Center of the Johannes
Gutenberg‐University Mainz, Mainz, Germany Results: Compared with the general population, CCS remembered both parents as
6
Institute for Medical Biostatistics, emotionally warmer, more overprotective, and less punishing/rejecting and less ambi-
Epidemiology and Informatics, University
Medical Center of the Johannes Gutenberg‐
tious. The regression analysis showed that having received radiotherapy (β = 0.092;
University Mainz, Mainz, Germany P = .009) and chemotherapy (β = 0.077; P = .027) was positively related to memories

Correspondence
Mareike Ernst, Department of Psychosomatic
Medicine and Psychotherapy, University
Medical Center Johannes Gutenberg,
University Mainz, Untere Zahlbacher Str. 8,
55131 Mainz, Germany.
Email: mareike.ernst@unimedizin‐mainz.de
Funding information
Federal Ministry of Education and Research,
Grant/Award Number: BMBF01EO1503; Ger-
man Cancer Aid, Grant/Award Number:
70112165; German Research Foundation,
Grant/Award Numbers: FA1038/2‐1&2,
SP1381/2‐1&2 and WI3881/2‐1&2
of maternal emotional warmth.
Conclusions: CCS remembered parenting styles which are generally deemed more
positive. The extent of recalled control and overprotection deviated from the popula-
tion in different directions, suggesting that parenting in childhood cancer entails
more complex adaptations than being affectionate and giving comfort. The results
suggest an adaptation of parental behavior to particularly challenging treatments.
They highlight potential vulnerability and resilience factors, some of which were
sex‐dependent.
K E Y W OR D S
adaptation, cancer, childhood cancer survivors, family relations, oncology, parenting, pediatric,
survivorship

Psycho‐Oncology. 2019;28:1663–1670. wileyonlinelibrary.com/journal/pon © 2019 John Wiley & Sons, Ltd. 1663
1664
1 | I N T RO D U CT I O N
After a diagnosis of childhood cancer, families go through processes of
disruption and adaptation. Although medical advances have signifi-
cantly increased survival rates,1 meeting the demands of complex
treatment protocols, managing side and late effects, and uncertainty
about the course of treatment exert considerable strains on patients,
2-4
siblings, and parents. Parents act as stewards of their children
regarding care decisions while they struggle to meet other responsibil-
ities at home and at work.5-7
Thus, parent‐child relationships can be affected by childhood
cancer in different ways: For instance, the wish to avoid negative
8
emotions and phantasies (eg, that their child might not survive ) can
limit parents' capacity to attend to children's emotional needs in a
well‐attuned way. During separations because of hospital treatments,
children might even feel they have lost the relationship with their par-
ents.9 On the other hand, parents who wish to protect their children
as best they can might also undermine the children's needs for auton-
omy and individual development. This was indicated by quantitative
and qualitative studies 10-12
which reported higher levels of overpro-
tection and concern among parents of children with cancer, irrespec-
tive of treatment status. These behaviors include, eg, the limitation
of the child's free‐time activities such as playing outside. Shortly after
treatment, children and parents alike identified overprotection as a
source of family conflict. 13
On the other hand, parents have placed
fewer demands on children with cancer, spoiled them, and favored
them over siblings.10,13,14 This behavior was especially pronounced
in the first year after diagnosis. 10
Parents have also reported deeper
bonds with the acutely afflicted child, 15 9
especially mothers.
To date, only few research endeavors have investigated different
facets of parenting in the context of cancer in a systematic way by
questioning survivors with an established questionnaire: The Recalled
Parental Rearing Behavior Questionnaire reliably assesses the (former)
child's mental representations of paternal and maternal emotional
warmth, rejection/punishment, and control/overprotection.16,17 Using
this questionnaire, a recent Korean study found relations of recalled
emotional warmth and quality of life in adolescents affected by leuke-
mia.18
Further, compared with age‐matched controls, young adult
long‐term cancer survivors were found to remember both their
parents as emotionally warmer and their mothers as less rejecting. 19
Surprisingly, this investigation reported no differences between can-
cer survivors and controls concerning the control/overprotection
scale, contrasting reports of the predominantly qualitative studies
which had investigated these aspects separately and attested to
higher levels of overprotective parental behavior.10 Thus, there might
be differences between the families' reports a short time after the
acute treatment phase and retrospective survivor reports. However,
the respective scale of the questionnaire also contains aspects of
performance/success motivation which was previously diminished
among cancer survivors' parents.14 Hence, there is a need to investi-
gate these subjective experiences separated from each other to clarify
which types of behavior were perceived as more or less present by
long‐term survivors.
ERNST ET AL.
We aim to build upon the research discussed above by quantita-
tively examining parental behavior within a large sample of long‐term
CCS using the Recalled Parental Rearing Behavior Questionnaire,
examining the control/overprotection scale as a whole and as
separate items, comparing CCS with a representative sample from
the population, investigating sex differences, and exploring whether
disease‐related variables are linked to rearing behavior.
2 | METHODS
2.1 | Participants
The German Childhood Cancer Registry (GCCR) systematically docu-
ments former patients treated for childhood cancer residing in
Germany.20 To comprehensively assess their physical and psychoso-
cial health status, they were invited to take part in the projects Cardiac
and Vascular Late Sequelae in Long‐Term Survivors of Childhood
Cancer (CVSS; clinicaltrials.gov‐nr. NCT02181049) and its add‐on
Psycho‐Social Long‐Term Effects, Health Behavior and Prevention
Among Long‐Term Survivors of Cancer in Childhood and Adolescence
(PSYNA). CCS eligible for participation were diagnosed with a neopla-
sia according to the International Classification of Childhood Cancer
(ICCC3) between the years 1980 and 1990 when they were less than
15 years old and had been treated at 1 of the 34 participating pediatric
cancer centers. Survivors of Hodgkin lymphoma and a small propor-
tion of former nephroblastoma patients were not considered as they
took part in other investigations. Of 2894 invited CCS, 1002 took part
in the study's examinations carried out between October 2013 and
February 2016. After excluding 51 CCS due to subsequent malignant
neoplasms, the final sample consisted of 951 individuals. The largest
diagnosis groups were leukemias (43.5%), CNS tumors (12.8%), and
lymphomas (9.9%).21 CVSS/PSYNA is carried out in accordance with
the ethics standards of the institutional research committee (approved
by ethics review committee of Rhineland‐Palatinate Chamber of
Physicians, nr. 837.453.13(9138‐F)) and with the Declaration of
Helsinki. All participants gave written informed consent for study
participation and data retrieval.
A representative community sample from the German population
was surveyed by the Berlin‐based independent institute USUMA
(independent service for surveys, methods, and analyses). Participants
were selected via random‐route procedure.22 Previous research used
information from the Federal Statistical Office to attest to the sam-
ple's representativity for the German residential population.17 All
5036 participants took part voluntarily. They were informed about
data usage and data protection in agreement with the Helsinki
Declaration. The study was approved according to the ethical guide-
lines of the German Professional Institutions for Social Research.
2.2 | Assessment and measurements
At the study center in Mainz, CVSS/PSYNA participants completed a
standardized 5.5‐hour examination program including cardiovascular
ERNST ET AL.
and clinical phenotyping, self‐administered questionnaires, and a
computer‐assisted personal interview (CAPI).21,23
CCS and the representative sample completed the German ultra-
short screening version of the Recalled Parental Rearing Behavior
Questionnaire.16 It was derived from the Swedish scale Egna Minnen
av Barndoms Uppfostran (EMBU; my memories of upbringing). Previ-
ous studies using the short version have attested to its satisfactory
to good psychometric properties and measurement invariance with
respect to sex and age.17,24 The selected items had previously shown
the highest factor loadings and had a high, positive correlation
with the total value. Its subscales had relevant associations with
relationship status, resilience, and depression and anxiety symptoms
17,24,25
in representative samples from the German population and
26
with resilience in a clinical Korean sample.
The scale consists of 12 items (3 dimensions with 2 questions per
parent) referring to parenting style and behavior: “Did your
mother/father comfort you when you were sad?” and “Was your
mother/father able to smooch with you?” assessing emotional
warmth, “Did your mother/father spur you to become the best?” (in
the following called ambition) and “Do you think that your
mother's/father's anxiety that something might happen to you was
exaggerated?” (in the following called overprotection), assessing
control/overprotection, “Have you been punished hard by your
mother/father, even for trifles (small offenses)?” and “Did it happen
that your mother/father gave you corporal punishment without rea-
son?”, and assessing rejection/punishment. Participants judge the
respective frequency of occurrence on a Likert scale ranging from
0 = no, never to 3 = yes, always. In the present study, reliability esti-
mates of the scales were ω = 0.82 (emotional warmth), ω = 0.76
(rejection/punishment), and ω = 0.71 (control/overprotection).
2.3 | Statistical analysis
The representative sample's age (initial age range 14‐92 years) was
aligned to CCS by excluding younger (<23 years) and older (>48 years)
participants. This reduced the initial sample of 5036 participants to
2042. To robustly compare means, we conducted a general linear
model (GLM). We modeled group (CCS vs population) and sex as fixed
effects and age as a covariate. Criterion variables were the three
dimensions per parent (emotional warmth, rejection/punishment, and
control/overprotection). Items of the control/overprotection scale
were investigated separately to offer more insight into the inconclu-
19
sive results of previous research. As this resulted in three GLMs
investigating the dependent variable(s) control/overprotection (per
parent), for these analyses, the threshold for P values considered sig-
nificant was lowered to P = .017 (in all other instances, it was
P = .05). To investigate the relevance of disease‐related characteris-
tics, we tested them as factors in separate hierarchical linear
regression models (one per each scale of the Recalled Parental
Rearing Behavior Questionnaire and one per item of the control/
overprotection scale). Hierarchical linear regression allows for testing
whether the introduction of new predictors adds to the explanation
1665
of the dependent variable's variance in a statistically significant way
after accounting for all other variables. We did this separately for
maternal and paternal rearing behavior. Missing values were not
imputed and are reported in the table legends. Sensitivity analysis
was performed using the calculator provided by Soper.27 As we are
not aware of comparable investigations, we tested the sample size
required to observe a small effect ( f 2 = 0.02) on recalled rearing
behavior taking all five predictors of the final model into account,
yielding a minimum number of 91 participants. Regression models
were checked for multicollinearity using the variance inflation factor
(VIF). No observed VIF was larger than 4 (10 being the critical thresh-
old28), indicating no concerning levels of multicollinearity. Effect sizes
(d) and regression coefficients are interpreted after Cohen.29 P values
correspond to two‐tailed tests. Statistical analyses were performed
using SPSS 23 for Windows.
3 | RESULTS
3.1 | Sample description
Table 1 gives an overview of the CCS' and the population sample's
demographic characteristics and mean values for the different facets
of parental rearing behavior. The most common treatment exposure
among CCS was the combination of radiotherapy and chemotherapy.
The population sample was less likely to have a high level of educa-
tion. This was true for men (d = 0.47) and women (d = 0.42). Cancer
survivors were less likely to be married (men: d = 0.26; women:
d = 0.50) (see Table SS1 for univariate comparisons).
3.2 | Comparison of the two samples' recalled
parental rearing behavior
We observed consistent, but small group effects (Table 2): CCS
recalled their fathers and mother as emotionally warmer and less
rejecting/punishing. Regarding the control/overprotection scale,
group affiliation had no impact on the maternal sum score; the
paternal sum score was lower in CCS. The single items were differ-
ently affected by group affiliation: Maternal and paternal ambition
was reported as weaker by CCS, and overprotection as more
pronounced. Age effects pertained to emotional warmth and
control/overprotection (sum score and ambition item): Older
participants remembered their parents as less warm, and less
controlling/overprotecting, in particular as less ambitious. There were
also effects of the participants' sex: Women remembered mothers and
fathers as emotionally warmer. Women also remembered mothers as
more rejecting, whereas men remembered fathers as more rejecting.
There was one interaction effect between group and sex: Male CCS
reported fathers as less rejecting than men of the general population.
This effect was not present in women. There were different effects of
sex regarding the separate items of the control/overprotection scale.
Men remembered both parents as more ambitious than female
1666 ERNST ET AL.

TABLE 1 Demographic, disease‐, and treatment‐related information and recalled rearing behavior

Childhood Cancer Survivors Population Sample

Women Women
All N = 951 Men N = 526 N = 425 All N = 2042 Men N = 880 N = 1162

M SD M SD M SD M SD M SD M SD

Age 34.05 5.56 34.50 5.50 33.48 5.58 36.50 7.26 36.40 7.52 36.59 7.05
Age at diagnosis 6.14 4.28 6.56 4.32 5.63 4.18
Parental rearing behavior
Emotional warmth (mother)b 3.92 1.45 3.77 1.33 4.12 1.58 3.46 1.42 3.30 1.38 3.58 1.44
Emotional warmth (father)b 3.05 1.61 2.82 1.52 3.35 1.66 2.42 1.57 2.15 1.48 2.61 1.61
b
Rejection/punishment (mother) 0.34 0.73 0.31 0.63 0.38 0.83 0.47 0.89 0.42 0.80 0.51 0.94
b
Rejection/punishment (father) 0.37 0.76 0.37 0.72 0.36 0.82 0.65 1.03 0.76 1.09 0.56 0.97
Control/overprotection (mother)b 1.57 1.34 1.59 1.30 1.54 1.39 1.61 1.30 1.59 1.25 1.64 1.34
c
Overprotection 1.07 0.99 1.06 0.94 1.10 1.05 0.87 0.85 0.83 0.83 0.91 0.87
Ambitionc 0.50 0.75 0.54 0.77 0.45 0.71 0.74 0.81 0.76 0.78 0.73 0.83
b
Control/overprotection (father) 1.15 1.15 1.16 1.11 1.14 1.19 1.32 1.17 1.38 1.16 1.28 1.18
c
Overprotection 0.65 0.77 0.61 0.73 0.70 0.81 0.52 0.68 0.46 0.65 0.57 0.71
Ambitionc 0.50 0.75 0.54 0.76 0.44 0.73 0.80 0.84 0.91 0.86 0.71 0.82

n % n % n % n % n % n %

Demographics
High educationa 390 41.01 223 42.4 167 39.3 406 19.89 183 20.8 223 19.2
Married 354 37.23 200 38.0 154 36.2 1,188 58.18 453 51.5 735 64.8
Treatment‐related variables
Chemotherapy and radiation 444 46.7 248 47.1 196 46.1
Chemotherapy only 325 34.2 179 34.0 146 34.4
Radiation only 27 2.8 17 3.2 10 2.4
None of the two 74 7.8 41 7.8 33 7.8

Note. Missing values: marital status: 1 female CCS, educational level: 2 female CCS.
a
German Abitur/equivalent qualification ranked 4 in the European Qualifications Framework (EQF), required for postsecondary education at universities.
b
Range 0‐6.
c
Range 0‐3.

participants. However, women reported their fathers as more
overprotective than men.
3.3 | Relations of disease characteristics and rearing
behavior
We conducted hierarchical linear regressions to test whether disease‐
related characteristics (age at diagnosis, chemotherapy, and radiation)
were related to recalled parental rearing behavior (Table 3). Only the
regression models with the dependent variables maternal warmth
(final model: R2 = 0.053, F (5, 820) = 10.236, P < .001) and paternal
warmth (final model: R2 = 0.036, F (2, 785) = 6.978, P < .001)
explained statistically relevant proportions of variation in recalled rear-
ing behavior. This suggests that the predictors were not related to
recalled rejection/punishment and control/overprotection. Female
sex was positively associated with recalled emotional warmth of both
parents, corroborating the results of the previously reported GLM.
Disease‐related variables associated with maternal warmth were che-
motherapy and radiotherapy: Participants who had undergone these
treatments remembered their mothers as emotionally warmer. Female
sex was also positively related to the recalled paternal warmth.
However, neither age at diagnoses nor therapy variables added
predictive power to the model.
4 | DISCUSSION
Drawing from a large, register‐based sample of long‐term CCS and a
representative sample from the community, the present study con-
firmed differences between CCS and the general population in
recalled rearing behavior using a validated questionnaire. The results
speak to an adaptation of parents' rearing behavior to the special,
taxing situation of caring for a child afflicted by a serious illness. Our
ERNST ET AL. 1667

TABLE 2 Results of the general linear models on parental rearing results corroborate previous research showing that CCS recalled both
behavior their parents as emotionally warmer and less rejecting.19 They are in

Maternal Paternal line with other surveys and interviews of CCS9,15 and mirror parents'
statements about what they perceive as helpful parenting styles in
F P η2 F P η2
the face of childhood cancer.30
Emotional warmth
We add to previous research by showing that the subjective mem-
Sex 28.169 <.001 0.009 58.124 <.001 0.020 ories of ambition and overprotection were affected in different ways.
Group 60.173 <.001 0.020 103.236 <.001 0.034 Ours is the first study using the EMBU in a large CCS sample with this
Age 25.578 <.001 0.009 15.397 <.001 0.005 approach. However, as CCS remembered less maternal ambition and
Sex × group 0.143 .706 0.000 0.122 .727 0.000 more maternal overprotection than the general population, the single

Rejection/punishment items' mean scores might cancel each other out when calculating the
sum score. With regard to maternal control/overprotection, this was
Sex 6.448 .011 0.002 6.886 .009 0.002
the case in our investigation. Concerning this scale's sum score, there
Group 10.238 .001 0.003 52.139 <.001 0.018
were no differences between CCS and the general population,
Age 3.772 .052 0.001 3.260 .071 0.001
mirroring results reported by Lehmann, Hagedoorn.19
Sex × group 0.132 .716 0.000 6.305 .012 0.002 Regarding fathers' control/overprotection, however, the whole
Control/overprotection sum score differed between CCS and the population. This finding con-
Sex 0.011 .917 0.000 1.915 .167 0.001 trasts previous research19 using a longer version of the same question-
Group 1.500 .221 0.001 17.826 <.001 0.006 naire. Thus, possible differences might be attributed to the different
Age 5.883 .015 0.002 9.548 .002 0.003 questionnaire version or sample characteristics (such as older age at

Sex × group 1.235 .267 0.000 0.470 .493 0.000

diagnosis, younger current age, or other nationality/sociocultural
environment).
Control (separately)
Further, we provide evidence that disease‐related variables, ie,
Sex 3.929 .048 0.001 23.855 <.001 0.008
radiotherapy and chemotherapy, are associated with recalled rearing
Group 66.991 <.001 0.022 104.317 <.001 0.034
behavior, ie, emotional warmth. Possibly, the most taxing treatment
Age 8.579 .003 0.003 11.342 .001 0.004 protocols gave rise to especially caring and loving parental behavior.
Sex × group 1.467 .226 0.000 1.801 .180 0.001 They might also have led to more situations in which the respective
Ambition (separately) parental behavior could be displayed. Thus, the findings suggest a
Sex 2.189 .139 0.001 11.124 .001 0.004 way in which parents might have tried to ameliorate their children's
Group 30.045 <.001 0.010 21.028 <.001 0.007 situation. The connection of therapy variables and emotional warmth
was only found for memories of maternal behavior, perhaps because
Age 1.064 .302 0.000 1.640 .200 0.001
mothers were more likely to be the ones staying at home/hospital
Sex × group 0.467 .494 0.000 0.119 .730 0.000
tending to the child whereas fathers were more likely to act as bread-
Note. Sex: men = 0, women = 1. Group: CCS = 0, population = 1. winners, although gender role behavior might slowly be changing.31,32

TABLE 3 Hierarchical regression analyses of recalled emotional warmth in childhood cancer survivors

Maternal Warmth Paternal Warmth

Final β B 95% CI B Final P ΔR2 R2 Final β B 95% CI B Final P ΔR2 R2

Block 1 0.043*** 0.041 0.039*** 0.037

Sex 0.094 0.285 0.089/0.481 .001 0.136 0.444 0.220/0.667 <.001
Age −0.094 −0.047 −0.065/−0.029 <.001 −0.102 −0.039 −0.060/−0.019 <.001
Block 2 0.004 0.044 0.000 0.036
Age at diagnosis −0.113 −0.040 −0.080/0.001 .057 −0.038 −0.014 −0.061/0.033 .554
Block 3 0.011** 0.053 0.003 0.036
Chemotherapy 0.077 0.339 −0.039/0.639 .027 0.049 0.239 −0.102/0.580 .169
Radiation 0.092 0.267 0.067/0.468 .009 0.032 0.102 −0.127/0.331 .381

Note. Sex: men = 0, women = 1. Chemotherapy: no = 0, yes = 1. Radiation: no = 0, yes = 1. Values for B and 95% CI B are taken from the model in which the
respective predictor was introduced.
1668
Similarly, differences between men and women regarding ambitious
and overprotective behavior might be traced back to gendered expec-
tations of a child's individual capacities and vulnerabilities. Along these
lines, the experiences of childhood cancer survivors today might be
different—on the one hand because of improved survival rates1 and
on the other hand due to more liberal parenting styles.33
Lastly, the results caution against a reductionist categorization of
recalled parental rearing behavior as “positive” or “negative”: On the
one hand, emotional warmth has been implicated as a powerful pro-
tective force, fostering resilience and adaptation. However, in combi-
nation with fearful overprotection, and more forgiving parenting
behavior, CCS might encounter conflicts in navigating developmental
tasks.34 More longitudinal research is needed which links variables of
the context of the experience of childhood cancer to well‐being later
in life in a meaningful way to test the clinical relevance of the small
group differences observed in the present study. The aim should be
to advance the understanding of resilience factors, to detect those
CCS who are at risk for unfavorable outcomes, and to offer
adequate interventions to pediatric cancer patients, survivors, and
their families.
4.1 | Clinical implications
The present results suggest that parenting in the context of childhood
cancer is more complex than just giving solace as cancer modulated
other parental behaviors as well. This finding can be helpful in guiding
supportive care efforts during and after treatment. There is abundant
evidence that parental behavior has far‐reaching mental health conse-
quences, so it should also be explored in the context of childhood can-
cer survivors' long‐term adaptation and coping. Especially discussing
experiences of parents' overprotective behaviors could give insight
into survivors' individual struggles and decisions revolving around
autonomy. Along these lines, more research is needed to link parent-
ing styles with long‐term survivors' quality of life and other relevant
lived outcomes.
Importantly, changes in parental behavior can indicate a way in
which parents' troubles affect the child. Bearing in mind the high levels
of psychological distress among parents caring for childhood cancer
patients, especially those undergoing intensive treatments,3,35 not
every parent might be able to offer their child the needed emotional
support. For example, depressed mothers have previously shown less
36
sensitivity towards their children and less observant caregiving.
Routine screening and targeted interventions should be available in
order to detect and alleviate parents' distress. Ultimately, this will also
benefit pediatric cancer patients or long‐term survivors (who previ-
ously showed increased susceptibility towards mental distress37).
4.2 | Study limitations
Limitations pertain to the limited information available regarding pre-
vious treatment, the brevity of the Recalled Parental Rearing Behavior
Questionnaire (ie, that overprotection/ambition were assessed using
ERNST ET AL.
one item each) and to the specificity of our CCS sample. Due to the
long follow‐up times in our study, its results might not reflect the
experiences of childhood cancer patients with shorter survival times.
Furthermore, they might not reflect the experiences of those long‐
term cancer survivors who did not respond to the study invitation.
The absence of data assessed at the time of cancer diagnosis and
treatment is another limitation. Retrospectively assessing parental
rearing behavior by querying the former child entails a number of
caveats. Most likely, these internal conceptions have been shaped by
recurring experiences throughout development. As they depend on
the individual's subjective appraisal, they might be influenced by mood
or recent events. However, memories of parenting styles have shown
to be stable across mood changes.38,39 Lastly, a limitation is the
absence of data on the family constellation, eg, growing up in a one‐
parent household or experiencing a divorce/separation.
5 | CO NC LUSIO NS
The present study details particularities of parenting as recalled by
survivors of childhood cancer. It expands previous research by using
a quantitative approach to compare a large sample of adult long‐term
survivors with a representative population sample. CCS remembered
more affectionate parenting than participants from the general popu-
lation. They also remembered more overprotection and less ambition.
Our results speak to an adaptation of parents' rearing behavior in the
face of an extremely taxing situation and shine a light on powerful
predictors of vulnerability and resilience over the life span.
ACKNOWLEDGEMENTS
We thank all former childhood cancer patients who underwent clinical
examination for this study, all participating and supporting medical
centers, the study centers of the GPOH, the staff of the GHS,
and the staff of the treatment data retrieval team. The CVSS is
funded by the German Research Foundation (DFG) (SP1381/2‐1&2,
FA1038/2‐1&2, WI3881/2‐1&2). PSYNA is funded by the German
Cancer Aid (DKH) (70112165). P.S. Wild is funded by the Federal
Ministry of Education and Research (BMBF01EO1503).
CONFLIC T OF INT E RE ST
None. This work is part of the dissertation of the first author.
DATA AVAILABILITY STATEMENT
The written informed consent of the study participants is not suitable
for public access to the data, and this concept was not approved by
the local data protection officer and ethics committee. Access to data
at the local database in accordance with the ethics vote is offered
upon request at any time. Interested researchers make their requests
to the principal investigators of the CVSS/PSYNA study (philipp.
wild@unimedizin‐mainz.de).
ERNST ET AL.
ORCID
Mareike Ernst https://orcid.org/0000-0003-4952-9717
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SUPPORTING INFORMATION
Additional supporting information may be found online in the
Supporting Information section at the end of the article.
ERNST ET AL.
How to cite this article: Ernst M, Brähler E, Klein EM, et al.
Parenting in the face of serious illness: Childhood cancer
survivors remember different rearing behavior than the
general population. Psycho‐Oncology. 2019;28:1663–1670.
https://doi.org/10.1002/pon.5138
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