title: Childhood cancer: Impact on parents' marital dynamics.
abstract: OBJECTIVE
  To explore and analyze how marital relationships are affected by the crisis generated by the diagnosis and intensive regimens required in the treatment of children with cancer.
  
  
  METHODS
  A descriptive study with a qualitative data analysis was conducted. In-depth individual interviews were carried out with 18 married biological parents of children with cancer. Data was analyzed using an inductive content analysis.
  
  
  RESULTS
  The following themes represented the couples' experiences: (1) Abrupt changes after the child's diagnosis resulting in marital strain and need to focus on the present; (2) United but distant; (3) Exchanging roles; (4) Being parents all the time; (5) Focusing on the positive side of the experience; (6) Rescuing the marital relationship. The marital relationship of parents with a child/adolescent who has cancer may undergo either positive or negative changes, with intimacy and sexuality being negatively affected by the disease. Although the relationship may be more fragile after the illness, increased mutual commitment was observed in some couples.
  
  
  CONCLUSIONS
  Results indicate that health professionals should include parents as an important focus of their care. The establishment of solid bonds to enhance couples' communication is recommended as a way to provide anticipatory guidance to address the identified changes in marital relationships. The opportunities for dialog and partnership help couples to target their needs and recognize their strengths in order to mitigate the impact of a child's illness.
authors.affiliation: Faculdade de Ciências Médicas da Santa Casa de São Paulo- FCMSCSP, São Paulo, SP, Brazil; Interunit Nursing Doctoral Program, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil. Electronic address: fmachadosilv@gmail.com.
authors.forename: Fernanda Machado
authors.initials: FM
authors.lastname: Silva-Rodrigues
authors.affiliation: Interunit Nursing Doctoral Program, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Center for Nursing Research Development, Ribeirão Preto, SP, Brazil. Electronic address: raquelpan01@gmail.com.br.
authors.forename: Raquel
authors.initials: R
authors.lastname: Pan
authors.affiliation: University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: amandamps.to@gmail.com.
authors.forename: Amanda Mota
authors.initials: AM
authors.lastname: Pacciulio Sposito
authors.affiliation: University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Electronic address: willyanealvarenga@usp.br.
authors.forename: Willyane
authors.initials: W
authors.lastname: de Andrade Alvarenga
authors.affiliation: Maternal-Infant and Public Health Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, Brazil. Electronic address: lucila@eerp.usp.br.
authors.forename: Lucila Castanheira
authors.initials: LC
authors.lastname: Nascimento
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008393:Marriage; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy; D010290:Parents / Q000523:psychology*; D055815:Young Adult
keywords: Cancer; Child; Family relations; Pediatric nursing; Spouses