Adolescents, cancer, and hospice.

The transition from childhood to adulthood represents a time of great physiologic and psychologic change. The adolescence period can be divided into early, middle, and late adolescence. The diagnosis of cancer and impending death during adolescence can add more stress and demands during this difficult period. The normal tasks of adolescence include separation from parents, development of abstract thinking, sexual awareness, and future orientation with goals for career and marriage. These tasks must be accomplished even in the face of severe illness. The physical changes brought about by cancer and its treatment may be the major concern for the adolescent patient. The prospect of death is met with denial and anger. Independence and therefore refusal of help is maintained until the younger adolescent can no longer care for himself. The older adolescent is more confident and may allow family closeness as death approaches. The uniqueness of the adolescent requires the knowledge and patience of health care providers. Hospice professionals who are trained to understand adolescents may be able to allow them to die with independence and dignity.