The research, led by Xiomara Skrabal Ross of Canteen Australia and colleagues, tracked families in which a parent had been diagnosed with cancer within the previous twelve months. Participants were recruited through three Australian hospitals and three not-for-profit cancer organizations between May 2018 and December 2022. Each family completed quantitative questionnaires at two timepoints: once within twelve months of the diagnosis, and again six months later. The sample included 55 adolescents and young adults aged 12 to 24 years and 71 parents aged 32 to 62 years at baseline, both groups predominantly female. Of these, 31 young people and 52 parents completed both waves, allowing the researchers to chart how perceptions of family functioning changed over time. The team had also planned a third assessment one year after baseline, but high attrition left that dataset too small to analyze, a limitation the authors acknowledge candidly.

At the heart of the study is a deceptively simple question: what does it mean for a family to function well? The researchers defined family functioning as the family’s ability to deal with everyday life and cope effectively with problems and changes, and they measured it with the SCORE-15, a validated 15-item self-report instrument covering strengths and adaptability, disrupted communication, and feeling overwhelmed by difficulties. Crucially, higher scores on this scale indicate worse functioning, a detail that matters when interpreting the statistical results. The team also measured family resilience using the 54-item Family Resilience Assessment Scale, which probes domains such as family communication and problem-solving, social and economic resources, positive outlook, connectedness, spirituality, and the ability to make meaning of adversity. Psychological distress was captured with the Kessler-10, communication avoidance with the Family Avoidance of Communication About Cancer scale, unmet support needs of the young people with the Offspring Cancer Needs Instrument, and parental confidence in supporting children through cancer with the Help-Child subscale of the Cancer Self-Efficacy Scale.

The statistical approach was deliberately conservative. Separate multiple regression analyses were run for parents and for young people, controlling for age and gender, and only variables that correlated with family functioning at a threshold of p less than or equal to 0.01 were admitted into the models, keeping the number of predictors proportional to the sample size. Where more than one adolescent from the same family participated, one child was randomly selected to avoid the statistical distortion that would come from highly correlated sibling responses. The results at baseline were striking in their symmetry. For the young people, the regression model explained 62 percent of the variance in perceived family functioning; for parents, it explained 38 percent. In both groups, the same two variables emerged as significant predictors: greater family resilience and lower avoidance of communication about cancer were both associated with better family functioning within the first twelve months after diagnosis.

The numbers behind those associations are worth pausing on. Among the young people, the standardized coefficient for family resilience was β = −0.57, p < .001, and for communication avoidance β = 0.29, p = .04, with the negative sign for resilience simply reflecting the reverse scoring of the functioning scale. Among parents, the corresponding values were β = −0.21, p = .035 for resilience and β = 0.39, p < .001 for communication avoidance. In plain terms, families that talked openly about the cancer and possessed strong shared coping resources reported healthier dynamics, and this held true regardless of whether the perspective came from the parent or the child. Notably, individual psychological distress and parental self-efficacy, which correlated with functioning in the bivariate analyses, did not survive as independent predictors once resilience and communication were accounted for, suggesting that these broader family-level processes may absorb or channel the effects of individual emotional states.

Six months later, the picture shifted in an instructive way. At the second timepoint, twelve to eighteen months after diagnosis, the strongest predictor of family functioning for both groups was simply family functioning at baseline, with coefficients of β = 0.75 for the young people and β = 0.67 for the parents, both highly significant. In other words, family dynamics proved remarkably stable: families that were doing well early on continued to do well, and families that struggled early tended to keep struggling. For the young people, however, one additional factor carried independent weight. Baseline psychological distress predicted poorer perceived family functioning six months later, with β = 0.42, p = .001, even after controlling for prior functioning. This is the study’s most clinically consequential finding, because it identifies individual distress in adolescents and young adults as a sustained, forward-looking risk factor rather than a passing reaction to the crisis.

To visualize these trajectories, the researchers classified each participant using clinical cut-offs for the SCORE-15 established by Miller and colleagues, combined with a reliable change index of plus or minus nine points. Four trajectories were possible: stable high, stable low, improving, and deteriorating. The results were reassuring for the majority. Among parents, 78 percent showed stable high functioning and 16 percent stable low functioning, with only 4 percent deteriorating and 2 percent improving. Among the young people, 71 percent were stably high and 19 percent stably low, with 6 percent deteriorating and 3 percent improving. The dominant pattern, in which most families maintain healthy functioning through an aversive event with minimal lasting disruption, is precisely what resilience researchers call minimal-impact resilience, a concept drawn from the work of George Bonanno and colleagues on trajectories of adaptation after adversity.

Yet the minority trajectories carry the clinical urgency. Roughly one in five participants, between 16 and 19 percent, showed persistently low family functioning across both timepoints, and small additional fractions worsened over the study period. These families represent a clearly identifiable at-risk group for whom early intervention could be decisive. The authors argue that the stability of the trajectories itself constitutes an argument for acting early: because family functioning at baseline so strongly predicts functioning months later, the first year after diagnosis is the window in which assessment and support are most likely to alter long-term outcomes. Encouragingly, the study also found significant correlations between parents and their own children at baseline for family functioning, family resilience, and psychological distress, meaning that a clinician assessing one family member gains meaningful information about the others. Interestingly, communication avoidance did not correlate between generations, which the authors suggest may reflect differing communication needs within the same family system, with parents worrying about how to talk while young people urgently want information.

The implications reach beyond oncology wards. The findings align with a growing body of evidence that young people whose parents have cancer experience distress at levels substantially higher than their peers and report unmet needs concentrated in emotional support and family relationships. The study’s authors point to practical supports already available, such as peer programs and age-tailored counseling offered through Australian cancer not-for-profit organizations, and emphasize that identifying parent-patients in oncology settings and connecting their families to these resources can reduce distress in young people. Because distress in the young person appears to erode their perception of family wellbeing over time, treating the adolescent or young adult as a patient in their own right, rather than a bystander to a parent’s illness, may protect the entire family system.

The researchers are careful about the limits of their work. The sample was modest, particularly at follow-up, and skewed female and toward solid tumors, with breast cancer accounting for 31 of the 52 solid tumor cases, which constrains generalizability to other cancer types and to fathers and sons. The clinical cut-offs used to define trajectories were derived from adult data rather than adolescent-specific norms, and unmeasured variables such as illness severity and treatment type may also shape family functioning. The authors call for larger, more diverse samples with additional assessment points, and for qualitative research capturing the perspectives of both parents and young people across all four trajectory groups. Still, the core message stands with unusual clarity for a field often dominated by ambiguity: in the year after a parent’s cancer diagnosis, most families bend without breaking, the families that struggle tend to have been struggling from the start, and the twin levers of open communication and family resilience offer clinicians concrete, modifiable targets for helping households weather one of life’s hardest storms.

Subject of Research: Family functioning trajectories in parents with cancer and their adolescent and young adult children

Article Title: Correlates and trajectories of family functioning in parents with cancer and their adolescent and young adult children

Article References: Correlates and trajectories of family functioning in parents with cancer and their adolescent and young adult children. (n.d.). https://doi.org/10.1007/s00520-026-11241-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11241-5

Keywords: parental cancer, family functioning, family resilience, adolescents and young adults, communication avoidance, psychological distress, longitudinal study, psychosocial oncology, parenting self-efficacy, supportive care, Correlates, trajectories