Tucked away in a meeting room in the back of the Abingdon YMCA, a group of children sat around a table, chatting and eating a quick dinner of chicken fingers, vegetables, fruit and a cookie for dessert.
When the plates were cleared, the children directed their attention to the front of the room.
"Why are we here today?" asked Patsy Astarita, a clinical oncology social worker.
"Because one of our people in our family has cancer," answered Ned Maxwell of Hickory. "And we want to learn more about what cancer is."
Ned was one of seven children, ages 6 to 15, who attended a session of CLIMB (Children's Lives Include Moments of Bravery), an initiative created by the Children's Treehouse Foundation, a psychosocial intervention program, to help children learn about and cope with cancer.
CLIMB was started because there was a lack of such programs to help children cope with a parent's cancer, said Peter van Dernoot, founder and chairman of the Denver-based foundation.
About 315,000 adults ages 25 to 54, will be diagnosed this year with an invasive cancer, and they have about 592,000 children, said van Dernoot, who created CLIMB in 2001.
Learning that a parent has cancer is staggering for these children, he said.
"These children need help," he said. "There is considerable evidence that shows that if these children don't receive ongoing emotional support, they will develop maladaptive behavior."
He also wants to dispel children's perceptions of cancer, he said.
"What gets to me is when a child comes to me and asks, 'Is it my fault that Mommy has cancer? Did she get it because I was so bad?' Or they ask, 'Can I catch cancer?'" van Dernoot said.
There are about 1,400 cancer hospitals In the United States, but only 50 to 60 emotional support programs for children, he said. More than 20 hospitals around the country offer the CLIMB program.
CLIMB is offered several times a year and is divided into six two-hour sessions that are designed to teach children about cancer and help them identify and express their feelings about it.
The format of each session includes dinner, a welcome and a warm-up activity during which the children use a letter to illustrate their feelings; a discussion about a feeling of the day, such as mad, confused or sad; a content activity such as an art project or a therapeutic play; and a closing activity in which the children talk about their feelings and what they learned in the session.
Skyler Parker said the program has made her feel better.
"During the first week, I learned that cancer is not a death sentence," said Skyler, 9, of Churchville. "I know I don't have to be scared when my grandma gets tired. I don't have to think she died because she's asleep on the couch in the living room."
Her sister, Karyn Crouse-Keithley, has learned to take their grandmother's cancer one day at a time, she said. The grandmother was scheduled to have surgery Thursday.
"Cancer is a little nerve-racking," said Karyn, 15, of Churchville. "Every day there is something else. I am starting to calm down a little bit about it because I understand it better now. It helps to be able to talk about it."
On a recent evening, the children expressed their feelings using a red letter A that was printed on a piece of 8 1/2 -by-11-inch paper. Their artwork included photos of sad and happy faces.
Their artwork isn't interpreted but rather is acknowledged, said Astarita, who heads Cancer LifeNet, a cancer support program for patients and their families at Upper Chesapeake Medical Center through which the children's program is offered.
When they finished, the children talked about the emotions they had depicted in their artwork, including fear, sadness and anger.
"When you have something hard to tell someone, it's best to just get it out," said Ned Maxwell, whose grandmother was diagnosed with breast cancer. "You can't keep it inside because they will know that you are keeping something from them."
Jacob Crisafulli, 8, and his brother Caleb, 6, of Edgewood have a grandfather with kidney cancer.
Jacob and Caleb attended the CLIMB program to get answers, he said.
"I want to know how they can make a cure for my grandfather," Jacob said.
"I want to know how they are going to get all the cancer out of my grandfather's body," Caleb said.
Later in the session, the children made paper masks, decorated with glitter, paint and other craft materials, to express their sadness.
Melita Maxwell, 67, of Bel Air helped the children with their mask project. The program is a good way to help children understand cancer, said Maxwell, the grandmother of Ned Maxwell, 7, and Anne Maxwell, 9.
Maxwell, who was diagnosed with breast cancer in the fall, volunteered to help with the program when it started. She watched as the children who attended the program bonded and coped with the disease.
"During the first week, the children look through a microscope to see what cells with cancer look like," said Maxwell, a former Baltimore County teacher. "When Ned saw that, he said, 'This is totally awesome.' It took away any fear that he had about cancer."
Her grandson agreed.
"When a family has someone who is sick, this is a place to see what the picture is," Ned said. "You can see how much pressure they've been through, how they feel and how I should feel."
The program also is helping the youngster learn what to do to help his grandmother.
"I don't know what to do for my grandma," Ned said. "I guess that's another reason why I am here."
While he was waiting for the other children to finish their masks, Ned expressed his anger toward cancer.
"If I could, I would punch cancer," he said. "Then I would take out a knife and stab it in the heart and kill it."