Some 80% of paediatric cancers are cured.¹ See? Not as bad as the charities would have you believe. Those black and white adverts of 3 year olds going head to head with the grim reaper are a bit misleading. Children have a much better success rate than adults and have fewer side effects, because their bodies are still growing.

Cancer in childhood is rare, but in fact 1 in 333 children will have had cancer by their 15th birthday.¹ And surprisingly, cancer is the leading cause of non-accidental death in kids. This daunting area of medicine—one of the largest specialties within paediatrics—is also one of the most colourful and well supported. I spent two weeks on a paediatric oncology ward and loved it. I met so many characters. Some even had celebrity status. Particular kids showed great resilience and I found them truly engaging.

I was initially scared by what I should say to the kids and their parents. You certainly cant say, “Youll be fine,” or, “Ooh, what a happy healthy baby.” No one ever knows what the outcome will be. Families have to live with constant uncertainty.

How did the staff support the families amid such instability? The nurses and doctors made it their top priority to listen. The families really appreciated the staff having time to discuss matters as concerns arose. This proved to me that you can support patients through listening, even when the outcome is dismal.

As a result, the ward was relaxed and calm. Children were often happy and the parents were able to enjoy the unexpected giggles and laughs. It is the most patient oriented environment I have ever experienced. Have you ever seen a pair of clowns do ward rounds twice a week? In fact, the ward was more oriented towards children than a lot of families are. I heard stories of parents thanking staff because supporting their child with cancer was an opportunity to refocus their lives on the most important part of family life.

Patients and their families were encouraged to hope. Happy proactive parents are hugely valuable to the child in spotting changes in their childrens condition and in giving support. Research has shown that fostering hope may protect parents from unhappiness and optimism can generate feelings of control.² By strengthening the parents positive expectations, you are hopefully encouraging a supportive family for the patient.

If parents are encouraged to be eternal optimists, however, their approach may not be appropriate to their childs own interests. In particular, evidence suggests that children do not get appropriate end of life treatment early enough.³ Parents understanding that their child has no realistic chance for cure lagged behind the oncologists specific documentation of this fact by more than three months. In this time, the child is less likely to receive appropriate hospice care, more likely to have uncomfortable cancer therapy, and the parents are less happy about care.⁴ This may be attributed to the doctors lack of clear communication or the parents lack of acceptance. Maybe fostering hope makes it difficult to accept any final decision. Whatever the reason, evidence suggests that children may receive less appropriate hospice care and a lower quality of life for this period of misunderstanding.

In fact, the child may well reach a more reconciled view not to carry on before the parents do. Since the childs quality of life is the most important priority, his or her opinion of treatment is crucial. This is really difficult. How do you tell whether a kid whines because you have not bribed him with a Happy Meal, or whether he or she has had enough of life altogether? This is where medicine becomes art; I have no answers for that.

And what happens if the hope for a cure has gone? Some people are still happy. Patients inevitably would have fatal recurrences, but still manage to lead a normal life. Some said they felt better after the uncertainty had gone. Even the sad bits can be happy. Happiness, relaxation, and realistic hope should be part of almost all treatments.