Cancer diagnosed during pregnancy: a qualitative study of women’s psychosocial experiences during treatment and survivorship

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While clinical aspects are well studied, the psychosocial impact on survivorship remains underexplored. This study examined the lived experiences of women diagnosed during pregnancy, focusing on emotional, psychological, and practical challenges from diagnosis through survivorship. Methods: A qualitative study was conducted using interview data from 20 women in the UK diagnosed with cancer during pregnancy. Participants were recruited via Mummy’s Star, a charity supporting individuals affected by cancer in pregnancy. Interviews were thematically analysed using template analysis, focusing on decision-making, psychosocial burden, and support needs. Results: Six interrelated themes were identified: (1) Managing cancer with uncertainty , women reported distress due to delayed investigations and treatment adjustments during pregnancy; (2) Ethical decision-making , emotionally charged choices around treatment, birth, and feeding were made with limited or conflicting information; (3) Balancing cancer and its treatment with pregnancy and family life , early parenting was disrupted; (4) Work disruption and financial strain , treatment-related costs and lost income caused hardship; (5) Emotional impact of diagnosis and treatment; including lasting psychological effects; and (6) Coping and support , guilt, fear of recurrence, and unmet support needs persisted post-treatment. Conclusions: Women diagnosed with cancer in pregnancy face profound, long-term emotional and financial challenges. Fragmented care and inadequate support exacerbate these difficulties. Integrated multidisciplinary care is essential to improving survivorship. Cancer survivorship Pregnancy-associated cancer Psychosocial support Qualitative research Decision-making Figures Figure 1 Introduction Globally, an increasing number of women are diagnosed with cancer during pregnancy, a trend likely influenced by delayed parenthood in developed economies and the increased use of prenatal testing for foetal chromosomal abnormalities [ 1 , 2 ]. While a growing body of research has examined the epidemiology and clinical management of cancer during pregnancy [ 3 – 6 ], including oncological, maternal, and infant outcomes, relatively little attention has been given to the psychosocial impact of receiving a cancer diagnosis and navigating treatment and survivorship, alongside new parenthood, during this uniquely vulnerable time [ 7 , 8 ]. The experience of cancer during pregnancy presents profound psychological and emotional challenges. Women often report high levels of distress, anxiety, and isolation, exacerbated by the uncertainty surrounding treatment decisions, concerns about foetal health, and the perceived lack of appropriate support networks[ 9 – 13 ]. Additionally these women frequently struggle to find peer support groups that feel relevant to their experiences and consequently endure isolation during treatment, and healthcare professionals (HCPs), despite their best efforts, may lack the experience or confidence to provide tailored psychosocial care[ 7 ] [ 14 ] International research indicates that the psychological burden of a pregnancy-associated cancer diagnosis extends well beyond childbirth, with implications for long-term survivorship, maternal identity, and family dynamics [ 9 ]. However, there remains a significant gap in understanding these experiences, particularly within the context of universal healthcare systems such as the UK’s National Health Service (NHS) [ 8 ] where access to psychosocial care in survivorship is managed by primary care. Our recent UK-based qualitative study [ 15 ] examined women’s pathways to cancer diagnosis during pregnancy, revealing that symptoms were frequently misattributed to pregnancy-related changes, both by the women themselves and the HCPs they consulted. As a result, many women faced delays in diagnosis, requiring repeated visits to primary care before receiving specialist referrals. While the study focused on diagnostic pathways, participants also shared detailed accounts of their treatment experiences and survivorship concerns, underscoring the need for further exploration of these important phases. Given the limited research on the post-diagnostic journey of women with pregnancy-associated cancer, we conducted this analysis as part of the pre-planned objective of qualitative interview study[ 15 ]. The aim was to explore the psychosocial trajectory of women following their cancer diagnosis, throughout pregnancy and postpartum, including their experiences of treatment, support, decision-making, and survivorship. By understanding these experiences, we can better inform service provision, improve patient-centred care, and identify priorities for future research and practice. Method Design, procedures and sample recruitment This study involved analysis of qualitative interview data collected to explore the experiences of 20 women who received a cancer diagnosis during or soon after pregnancy. Full methodological details of the study are reported elsewhere[ 15 ]. In summary, participants were recruited via Mummy's Star, a charity dedicated to supporting women and families affected by cancer during pregnancy or within the first year postpartum. A study advertisement was shared on the charity's online forum to facilitate recruitment. Women were eligible to participate if they resided in the UK and had received a cancer diagnosis during pregnancy (or had sought help during pregnancy but formal diagnosis was made post-partum) within the four years preceding recruitment, starting from January 2018. Women were excluded if they were diagnosed before January 2018, were currently pregnant at the time of the study, or were less than three months postpartum. Sampling and data collection were guided by the principle of information power (guided by data depth, relevance, and richness) [ 16 ]. Interviews were conducted online via Zoom between January and May 2022 by an experienced female social psychologist (AM), who was also a new mother with an academic interest in cancer inequalities. Interviews followed a semi-structured format guided by an interview schedule, allowing participants to share narrative accounts of their experiences. Interviews lasted between 36 and 66 minutes, were digitally recorded, and transcribed verbatim. Prior to the interviews, AM gained informed consent and collected demographic, cancer, and maternal history data. This pre-interview engagement helped familiarize participants with the researcher and ensured they understood the study's purpose. Participants received reimbursement of £25 for their time. The conception of this study was developed informed by an open academic, practice and public community engagement workshop held at the University of Surrey to identify priorities for psychosocial research around cancer and pregnancy with discussions and recommendation captured live by an artist (Supplement 1 ). Patient and public involvement was integral to the study design, with two women who had lived experience of cancer during pregnancy contributing to the development of the study materials, including the participant information sheet and interview topic guide[ 15 ]. Ethical approval was obtained from the University of Surrey Ethics Committee (FHMS 20–21 199 EGA). Analysis We employed template analysis[ 17 , 18 ]. This structured form of thematic analysis is widely used in qualitative psychology research, particularly when a priori themes have been established through prior analysis [ 17 ]. The analytical process began with data familiarisation, followed by preliminary coding to identify key themes. An initial coding template was developed iteratively and refined as additional data were analysed. Once finalised, this template was systematically applied to all transcripts using NVivo[ 19 ] ensuring a structured yet flexible analytical approach. Template analysis balances inductive and deductive approaches[ 18 ] and accommodates various epistemological perspectives. For this study, we adopted a realist perspective [ 17 ], focusing on women's experiences from diagnosis through treatment and into survivorship. Our research team included members with expertise in psychology, nursing and midwifery. The analysis began with JS (midwife) conducting an initial review of the dataset. The coding template was developed based on four key sources: Prior knowledge of challenges faced by women diagnosed with cancer during pregnancy. A scoping review and gap analysis [ 8 ]. Findings from the study on pathways to diagnosis [ 15 ]. Preliminary analysis of a subset of five transcripts (conducted by JH, JA, and JS), selected to represent diverse cancer types and diagnostic timings (during pregnancy and postpartum). The initial template was applied across the dataset by two authors (JS and JH independently) and performed well, and final refinements were made to thematic categories descriptors to reflect the emerging themes (JH and JA). This iterative approach ensured the analysis remained responsive to the dataset while maintaining a structured framework for interpretation. Results Sample characteristics Full details of the sample are described elsewhere[ 15 ]. The sample comprised 20 women, aged between 27 and 45 years (median age 35.5 years) ( Supplement Tables 2 and 3 ). Their age at diagnosis ranged from 26 to 44 years (median 33.5 years). Most were married or cohabiting (N = 17, 85%). Fourteen (70%) were diagnosed during the COVID-19 pandemic, with the remaining being diagnosed before it. Seventeen participants (85%) received their diagnosis while pregnant, ranging from 5 to 35 weeks of pregnancy, while three (15%) were diagnosed 6–16 weeks postpartum after initially seeking help for symptoms during pregnancy. Ten participants (50%) gave birth at full term (i.e., > 37 weeks gestation). The remaining 10 gave birth preterm (following induction or C-section) after their cancer diagnosis (all between 33 to 36 weeks). Two-thirds were diagnosed with breast cancer (N = 13, 65%). Four women were diagnosed with advanced disease (20%). Themes Participants shared their experiences in a sequential fashion, meticulously recounting their pathway from treatment, childbirth, and the aftermath, following the cancer diagnosis. Their narratives were replete with intricate descriptions and the analysis produced six inter-related psychosocial themes, sometimes spanning the antenatal and postnatal phases (Fig. 1 , Supplement 5 ). Managing cancer with constrained choices: the weight of uncertainty Many women experienced the strain of facing limited diagnostic and treatment options during pregnancy. The inability to undergo standard investigations, staging and treatment often led to delays or altered care, leaving some with unanswered questions and heightening women’s fears about disease progression: That’s the other thing, you are then being told all the things you can’t have. So, I couldn’t have the bone scan, I couldn’t have Herceptin, there was quite a lot of things they can’t do when you are pregnant. That’s always a bit of a worry […] because it was quite an aggressive cancer […] they wanted me to have the longer cycles of chemo […] Some people have, is it 9 or 8 cycles? I had 12 cycles because they wanted to be quite aggressive, and they weren’t going to be able to fit all the chemo in before they wanted the baby to be born. (P4, Breast Cancer) Feelings of uncertainty and possible decisional regret were protracted for women who later discovered their disease was more advanced than initially expected: I was diagnosed when I was 16 weeks, […] I didn’t realise some women have chemo and diagnostics while they are pregnant. But they just didn’t want to do that with me because they diagnosed via a biopsy. They said no treatment. They said, “We are just going to let the baby grow”. […] But had they known how widespread it was, because it really was very widespread and that’s why they had to take off the whole breast, maybe if they knew the full extent, I might have been offered treatment. But I’ll never know that. (P3 Breast cancer) These uncertainties sometimes had profound long-term consequences, particularly when a delayed diagnosis was associated with advanced disease. One woman with bowel cancer, whose symptoms were initially misattributed to pregnancy, was not diagnosed until her third trimester. By then, the priority had to be managing a bowel obstruction, and standard investigations and cancer staging had to be postponed until after delivery. During survivorship, [infant] reflected on the impact of delayed diagnosis: By the time they took the tumour out […], and then they scanned me […] because they could now do a proper scan, because the baby wasn’t in there anymore, we found out that it had gone to my liver. [pause] Whether it was already going to go to my liver or not, you don’t really know. But if I had been diagnosed earlier in the pregnancy, I guess I could have had some… I know a girl who was in a similar situation, but she got diagnosed much earlier in her pregnancy. They sort of said to her, ‘You can either have an abortion, or you can try and have your chemo during your pregnancy,’ and she had the chemo. So, I know that it is possible to have chemo during pregnancy. I probably would have done that. Then, that may have meant that the cancer would at least have been just contained in the colon and then wouldn’t have gone to my liver. It has now gone to my liver and my lungs. I have had two recurrences. The liver twice, I have had two liver ops, and then one lung operation. I have had a major operation every year since I got diagnosed. […] I think [chemotherapy] would have helped my long-term prognosis. (P10 Bowel Cancer) Ethical decision-making processes For many women, navigating treatment decisions during pregnancy was emotionally taxing. When they believed they had a choice, they faced the burden of weighing whether to proceed with investigations or treatments or to delay them, while balancing their own health, the well-being of their unborn child, and, in some cases, the needs of their existing children. One woman described the turmoil of deciding whether to proceed with surgery despite possible risks to her unborn child: I had this real emotional rollercoaster […] Because obviously there is a risk of miscarriage during surgery under general anaesthetic, I had this real emotional rollercoaster of well if I don’t go ahead [I’d] … wait another seven, eight, possibly nine months […] I came to the conclusion of [name of child] is already here, [name of child] already knows me, I’m already [name of child] mummy, and obviously baby didn’t at the time, so I just kind of had to try and break that emotional attachment to try and be pragmatic in making that decision (P5 Thyroid cancer) Similarly, others described the immense difficulty of weighing their survival against their baby’s well-being: I guess it was a toss-up between the baby and yourself […] and certainly in my case, there was that period of months where you are kind of weighing it up, the priorities of his (baby’s) life and my life (P15 Bowel cancer) For some, the emotional weight of these decisions was compounded by the need to advocate for themselves in conversations with healthcare professionals, particularly when they felt their preferences were not being fully acknowledged. Some women found themselves needing to assert their preferences against healthcare professionals' recommendations: It was just a feeling within me, when I got to 35 weeks, I just had this really strong feeling and I said […] I’ve done everything […] I’m continually in this hospital having scans. I’m glad [infant]’s grown to a good size. The obstetrician was quite reluctant, but then […] [the obstetrician] agreed […] So I was induced […] emotionally I felt like… I think it had got to a point where I’d known of this [cancer] in me for however many months, four months, and I just wanted to get on with the treatment because all I cared about was being there and trying to have some of my maternity leave to just enjoy my daughter […] And I didn’t want my cancer to spread any more than it already had either […] it was a relief to have her. It was a real strain carrying her in my pregnancy and all that was going back and forth in my mind. (P3 Breast cancer) Many actively sought information to support their decisions, yet some struggled with guilt and decisional regret: I was able to get some of the information about the risks with things like early labour, stillbirth rates. I remember discussing all that, but for quite a long time it was “what am I doing?” I just felt so guilty […] my need for a child was such that I was prepared to put this baby through […] all this chemo, and who knows what the outcome of her would be, just because I felt quite selfish, what effect could this have on her? (P4 Breast Cancer) For some, the absence of information and not being offered choices by clinicians reinforced a sense of lost agency. One woman had to independently research reconstruction options, as she had not been informed about them: I had the option whether I wanted to go ahead or not, but I didn’t have any options in terms of what I’m having… I chose to have the implant put in which I’d already done my research and asked for, but it wasn’t an option that was given to me, I’d sort of looked into that and requested it. (P11, Breast Cancer) Beyond treatment, some women felt disempowered in other aspects of their care, such as infant feeding: They basically said you can’t [breastfeed]. So yes, that was very sad for me because I loved breastfeeding […] And in all honesty, that was the thing I found hardest in the whole diagnosis. I could sit and I could talk to anyone about it and the only thing that ever made me cry was that I wouldn’t be able to breastfeed my second baby, because it was so important to me to be able to do that […] when the bottle making machine turned up at the door I burst into tears and stuff like that. It was very strangely the hardest thing I found about the whole experience […] (P14 Breast cancer) This same woman, however, was able to negotiate with her oncology team, demonstrating how persistence sometimes influenced clinical decisions: I think because I kept breaking down into tears anytime anyone talked about breastfeeding, or every time I brought up breastfeeding. I think my team realised how important it was to me and my oncologist tried to give me as long as possible afterwards. So, [the oncologist] initially maybe said two weeks, which I thought was just a joke because by two it’s just that’s no time at all, is it? Then [the oncologist] kind of said maybe two to three weeks and then I kept negotiating with [the oncologist] a little bit more and, yes, I think I ended up being able to breastfeed for four weeks (P14 Breast cancer). Balancing cancer and its treatment with pregnancy and family life A common theme was the ongoing challenge of managing the dual demands of cancer care and motherhood, often with lasting physical and emotional consequences. The transition into motherhood, typically a time of bonding and recovery, was disrupted by the necessity of prioritising cancer treatment. The relentless juggling act of balancing medical appointments, treatment side effects, postnatal recovery, and childcare often left women physically and emotionally drained. The enduring impact of these experiences shaped not only their recovery but also their ongoing journey as both cancer survivors and mothers. Women described how the relentless frequency of appointments, treatments, and monitoring left little room for rest, recovery or a sense of normality. The demands of cancer care felt particularly overwhelming when combined with pregnancy, a new baby, and the ongoing responsibilities of existing children: I found it really exhausting because I was still trying to look after my other two children, do things like the school run. I found it exhausting and sometimes really overwhelming because the amount of appointments I’d have. Some days I might be seeing my haematologist one day at one hospital in (one location), the next day at a different hospital in (another location) for a scan, I used to have scans every two weeks, then I might be seeing the midwife the next day, then I might be going to my GP’s the day after that to have my pre chemo bloods done and then I might be, on the Friday, going and having the chemo. And it was just exhausting (P1 Hodgkin’s Lymphoma) Logistical challenges were amplified for a woman needing to manage the specific requirements of thyroid treatment: “[Due to radiotherapy] I would have had to stay away from home for another four days, so I had the issue of logistics of where would I stay… the friends that I do have all have young children as well, so that was another real mental headache” (P5, Thyroid) These logistical and emotional challenges did not end with childbirth. For many, treatment extended into or commenced in the postpartum period, compounding the sense of exhaustion and overwhelm. “ There was a lot going on at all times. It was really quite difficult to manage. I don’t think I actually […] missed any appointments, […] but it would have very easily been done […] sometimes it was just so overwhelming, the amount of appointments ” (P14, Breast) The simultaneous challenges of cancer and pregnancy compounded the usual fatigue associated with both experiences. Women described an overwhelming sense of exhaustion, which extended into their postpartum recovery as they juggled motherhood and ongoing treatment. So then after I had [daughter] I had a week off and then started back on chemotherapy again for another nine weeks, so that was quite gruelling. [laughs] (P13 Breast Cancer ) The need to prioritise cancer treatment over new motherhood often meant that women were unable to fully experience early bonding moments with their babies. For some, the transition from pregnancy to intensive cancer treatment was abrupt, leaving little time to recover physically or emotionally. I felt like when people talk about the baby bubble and you get to spend those first few weeks just at home and cuddling and having a nice time, breastfeeding, just being close and bonding with your baby, especially the very first time that I had to get up and leave the house and go for chemotherapy, it was just heart-breaking. Yes, I just felt like it was a very abrupt end to almost… It almost felt like it was like, right, well that’s that then, that’s finished. (P14 Breast cancer) For some, the necessity of immediate treatment further complicated birth and recovery experiences, disrupting their ability to care for their newborns: Then, when the baby came, we were just happy that [infant] is okay, and then [infant] goes to NICU [due to planned pre-term delivery at the same time as her surgery]… Going up to visit the baby was really hard, because I had to be taken in a wheelchair by someone else. I couldn’t get there myself. I was finding it hard to express milk. I wasn’t really eating much, so the milk wasn’t really coming. I was just worried that I wasn’t going to visit enough, and everyone would think I was an awful mother, because I was never up there. All the other mums would sit by their incubator all day, but I would go there for about ten minutes, and I just couldn’t sit there anymore, because I was so ill. (P10 Bowel Cancer) The intersection of cancer treatment and pregnancy often resulted in medical complications that intensified the already demanding experience. Some women experienced unexpected surgical complications, further prolonging their recovery: When I had gone to the hospital to be induced, they told me that they would know about my history but they didn’t know [laughs], ... My wound was leaking. I thought it was just breast milk from the other breast, but it was actually my wound was leaking, so they did get a consultant to come and check just to make sure it was okay and I think it was just some excess fluid or something with the pressure of labour (P9 Breast cancer) For one woman, a Caesarean-section led to additional complications that significantly impacted recovery and mobility, adding yet another layer of difficulty to an already overwhelming situation: When they did the C-section, …they also cut my bladder, and I got a wound infection from the C-section So, I had lots of complications […] on top of everything else. I had a catheter for six weeks […] while my bladder healed. It was a complete nightmare. A nightmare month in hospital […] The bladder injury […] just complicated things loads because it just added another thing to the list of things that were already bad. It made me much less mobile, and it added much more hospital appointments and […] scans […] I had urine coming out of my C-section scar, pouring out of me. Then they let us both out […]I was at home for about a week, and then I went back [in for] the tumour surgery. (P10 bowel cancer) Work disruption and financial strain As the women were of working age, many described the strain of managing cancer, pregnancy and work simultaneously. Cancer often disrupted women’s plans to work during pregnancy or return to work after maternity leave, forcing difficult choices about priorities and capacity: I couldn’t cope with work. I didn’t have the mental headspace for being pregnant, having cancer and working. I obviously have done being pregnant and working. I think I could have done cancer and working to the point… but I couldn’t do them all…Keeping a track of what the doctors were saying, medicine, where to be, appointments. Even when it got to the point in your chemo journey where you are maybe getting a bit more regular, starting to feel a bit more better [sic], and some people were trying to do a day or two of work around that. I was six months pregnant at that point and I was just like I’m not doing work as well. (P4 Breast Cancer) These disruptions to employment were often accompanied by significant financial strain particularly as frequent appointments, travel, and unpaid leave compounded existing expenses: It has a big financial implication […] you’re having to travel a lot to these appointments […] things like petrol (gas), diesel, and then having to pay to park at the hospital as well […] Because you are at higher risk from the cancer, you then need to see your obstetrician, midwife, whoever, more often, so you are at hospital more, so you are paying quite a lot of money to be in a car park and obviously I didn’t work then, I was off sick from work […] You’ve got enough to worry about without having to worry about money. Sometimes I had to borrow money from my mum to put petrol in my car to go to my hospital appointments. I didn’t have any money. (P1 Hodgkin’s Lymphoma) These financial challenges could be compounded for those who already had children: I just needed some support. I did need a babysitter […] if […] you have a toddler and you have a baby but because of your circumstance you can’t physically look after them. We got out a loan and we spent loads of money on childcare because I couldn’t look after them sometimes. That was really difficult and we’ve only just paid it off three years later. (P3 Breast Cancer) Some had partners who were able to take time off work to support them and handle family responsibilities. Nevertheless, this could result in greater financial strain: Obviously with my partner not being able to work because he was looking after me and the baby and then me not working and my maternity pay obviously runs out [talking about receiving free counselling]. I don’t think I would have sought that sort of help if I’d had to pay for I […] I would have thought but there’s so much I need to [buy] look after my daughter, the money should really go to that (P16 breast cancer) In response to these challenges, some women turned to cancer charities for practical support and financial guidance: I have been in contact with [charity named], but that was more helping out with finances, if you are ill and you can’t work. I had lots of weird things to do with my maternity pay and not being able to work. I went and saw someone who helps you apply for what benefits you can get, and what to do, and stuff like that. That was good […] help with life, benefits, things like that (P10 bowel cancer) Emotional impact of diagnosis and treatment The immediate aftermath of diagnosis was often marked by overwhelming feelings of threat, fear, and emotional paralysis: I was just in shock […] I just felt so locked in. I didn’t do anything. All I remember of that period is sitting in the beanbag chair watching telly, nothing else, in this empty room (P7 breast cancer, secondary cancer lungs and lymph nodes) However, for some the magnitude of these feelings were delayed as they initially attempted to cope by continuing their regular routines: When I was told, “You’ve got cancer,” […] it didn’t sink in, and I wanted to know that my baby would be safe, that was my main concern really, and I was just in absolute shock to be honest with you, and it took quite a long time. I put on this brave face and I think it was like a few weeks after, I just couldn’t stop crying and I had to call my husband. I parked outside his work and he just said, “I did think you were taking it very well”. And I just don’t think it had sunk in because I was looking after my son. I was working four days a week, I was carrying a baby, busy times. And this was just completely out of the blue, unexpected […] I was devastated, confused […] and searching for answers. (P3 breast cancer) As the shock of diagnosis gave way to daily realities, many women described navigating intense emotional contradictions of joy and fear, hope and despair, often within the same moment. The same women described regaining emotional control by compartmentalising these contradictory thoughts and emotions: It’s a completely conflicting stage of your life; you should be happy, and people want to congratulate you. And actually, at work I decided not to tell anyone except my immediate teams. There were three people that knew and everyone else just kept saying, “Oh you must be so excited,” and I was, but in the back of my mind I knew the diagnosis and it was a real battle in my mind. I don’t really know, looking back, how I kept all those feelings under control […] It was a real rollercoaster of emotions […] and as we did with my son, we opted to find out the sex of the baby and I was overjoyed it was a girl because that’s what we wanted, one of each, so that helped me feel more connected and gave me that real drive to just keep going and keep going. (P3 Breast cancer) Many accounts detailed efforts to retain a sense of normality during a disrupted antenatal and postnatal period, highlighting the emotional toll of guilt and social withdrawal: For the first couple of weeks, it was a nice positive thing, like having a baby and it was something to look forward to and then you start (more investigations) […] got the CT scan and then it was back to all about the cancer. Then you are starting treatment. I feel like I pushed myself so much to still do things, like still make sure I was doing my fair share with [son], even probably when I shouldn’t have, I should have just been taking my time. But I feel like I did keep pushing myself. I think there was a lot of guilt there. I sometimes I couldn’t look after him, I couldn’t look after both my kids and that was quite hard, I was relying on my mum and dad a lot and my husband and I felt like a bad mum […] It’s hard because you know it’s not your fault, but you still feel that guilt. Some days I just wanted to hide in my room and just hide under the duvet and not come out. I did [laughs]. But yes. It was hard. (P9 breast cancer) Women also showed concern about the emotional impact of their cancer their partners and extended family members, frequently experiencing guilt for the distress caused to their loved ones: Massive fear…… So how are we going to tell family? Guilt that I was bringing it on the family as a whole, which I know is utterly ridiculous, but at the time I did feel really guilty that, at a time when it should have been a time of joy for the family in having my daughter – [infant] is the first grandchild on both sides – so going from the joy of having a [n] week-old baby to having lockdown, where we didn’t know whether grandparents would be able to see her, to not only having that but then the cancer diagnosis. I felt really guilty that I was adding more stress and worry to everybody’s plates, not just ours. (P18 Breast Cancer) Some women found themselves supporting their partners and families while simultaneously managing their own adjustment. One woman, experiencing a recurrence, adopted a problem-focused approach: [My Partner] was really upset, crying, and I just turned round and said, “We’ve done this. We can do it again”. I just said [to her partner], “Right, tell me what we need to do, and we’ll take each week as it comes”. (P16 Breast Cancer with bone metastases) Coping, adjustment and support Many described how cancer had permanently changed them, leading to long-term psychosocial adjustment challenges years later: I used to be quite outgoing, quite a social person. I’m finding it really difficult to go out now, quite anxious about seeing people, definitely lacking in confidence in myself, not just appearance but everything. (P9 Breast Cancer) I read something recently that said being diagnosed with cancer is like having a gun placed to the back of your head. It’s always there, you know it’s always there and sometimes you just feel it a bit more […] it’s just learning to live with it always being there […] I find I need to manage one day at a time, one week at a time. (P4 Breast Cancer) For some diagnosed during COVID-19 restrictions, lingering frustrations about care experiences later exacerbated their fears of recurrence: I’m angry with myself […] and I’m angry with them that it took so long […] With my birth as well, I was angry that they didn’t know about my situation and they didn’t have the compassion for my husband to [due to Covid …] stay with me. (P9 Breast Cancer) Women described varied experiences with support, ranging from deep isolation to resilience fostered by social networks: It was frustrating because I’d found the [names support group] very helpful, but you only get to go to that once. It’s run every year but once you’ve been once that’s it […] I always felt very alone and very isolated. That didn’t help my mental health. I had a massive crash mentally afterwards because just, well, everything got on top, I suppose. (P4 Breast Cancer) Specialist psychological support was often seen as more beneficial later in their survivorship journey, rather than during treatment: I’ve not found counselling very helpful, to be honest. […] At that time, it wasn’t as easy to talk about it when you are going through the throes of treatment […] I’m considering therapy now […] but just I think maybe because all the dust has settled you start to really appreciate all the complexities of what you are feeling. But during (treatment) […] I don’t think I had the headspace for it and the counselling […] I think I was just too busy just surviving it. (P15 Bowel Cancer) Some sought professional help for their mental health, while others recognised the importance of self-care and maintaining well-being during survivorship: I did go for counselling after my active treatment finished, just because I was aware that I had been through a lot […] I knew that I needed to make sure I was alright emotionally and mentally […] I needed to make sure I had time to reflect and accept what had happened to me as well […] I know that at certain times I might need to go back into that […] just to make sure I’m keeping myself well mentally as well as physically. (P18 Breast Cancer) Discussion This study provides important contributions to the research into the complex experiences of women navigating cancer survivorship when the diagnosis coincided with pregnancy. Although fortunately an uncommon diagnosis, incidence is increasing, and so it is important that cancer professionals are aware of the issues faced by these women and families in survivorship[ 14 , 20 ] in order to support shared decision-making about treatment [ 21 ] and to provide support at the time when it is needed. Our findings highlight the tension between autonomy and constraint in decision-making, where women’s choices about treatments, investigations, and parenting decisions such as breastfeeding were frequently shaped or limited by external factors related to their cancer. While some women were able to negotiate aspects of their care, others felt their options were restricted or imposed, contributing to feelings of uncertainty, guilt, and powerlessness. These high-stakes decisions, sometimes made contrary to medical advice or in the absence of clear guidance, placed considerable emotional strain on women already managing the dual challenges of cancer and pregnancy. This aligns with the wider literature on decisional regret in oncology, which shows that constrained or unsupported decision-making is associated with lasting psychological distress, including anxiety, guilt and reduced quality of life[ 22 , 23 ]. Decisional regret is particularly pronounced when patients feel they have received insufficient information or were pressured into choices that conflicted with their personal values[ 24 ]. Similarly, in the context of maternity and early motherhood, emerging research suggests that when women’s decisions during pregnancy and childbirth are constrained by external factors, this can contribute to sense of lost autonomy and subsequent regrets[ 25 ]. Our findings suggest that for pregnant women with cancer, these dynamics may be further amplified by the simultaneous need to consider foetal well-being, compounding the emotional complexity of care decisions and increasing potential for long-term psychological impact. Studies have also reported that many women feel overwhelmed by the need to balance cancer treatment with pregnancy-related concerns, contributing to emotional distress, guilt, and confusion about how to prioritise care[ 7 , 8 , 26 – 28 ]. Similar to our study, previous work has shown that the care of these women may be fragmented across multiple specialties with variable communication, contributing to feelings of being unsupported or misunderstood by their healthcare teams[ 20 , 29 ]. The emotional disruption reported by the women, with psychological stress emerging as a key theme in their journey, are consistent with those of other qualitative studies on cancer and pregnancy, which have similarly highlighted the emotional and psychological challenges faced by women in this context[ 7 , 8 , 13 , 30 ]. Our findings aligns with the "burden of treatment" theory, which describes the workload imposed on patients by healthcare systems and their capacity to manage that burden [ 31 ]. In our study, this burden was compounded by the unique challenge of navigating two life-changing events simultaneously: cancer and pregnancy. For many, this duality created not only competing demands; managing intensive medical care, adapting to the pregnancy, and in many cases, continuing caregiving and work responsibilities[ 32 , 33 ], but also conditions of cumulative stress that may be experienced as traumatic. Several women described being in survival mode, focused on simply getting through the experience day by day. In this context, the act of enduring, rather than reflecting, became the priority. This response is consistent with trauma theory[ 34 , 35 ], which recognises how chronic threat, uncertainty, and loss of control can lead to psychological trauma, even in the absence of a single acute event. The cumulative impact of delayed emotional response, sustained stress, and role overload may explain the longer-term adjustment difficulties some women described in survivorship and suggests the potential value of adopting a trauma-informed approach[ 35 , 36 ] to post-treatment care. Such an approach emphasises safety, empowerment, and understanding of trauma’s impact on physical and emotional wellbeing[ 37 , 38 ] and may help address unmet psychological needs in this population[ 8 , 39 ]. This warrants further research. Financial precarity emerged as a consistent concern in our study, reflecting findings from the cancer survivorship research [ 40 – 42 ] and maternity and early motherhood literature [ 43 ]. This financial strain is particularly concerning given its established association with poorer mental health outcomes[ 44 ]. However, the economic impact of cancer during pregnancy remains under-researched but it is likely that being diagnosed with cancer during pregnancy worsens this. Women of childbearing age are often in the early or mid-stages of building their careers, and a diagnosis of cancer during this life phase may have lasting consequences for income, job security, and long-term career progression. The economic burden of undergoing cancer treatment while pregnant, including costs associated with frequent hospital visits, treatment-related expenses, and the potential loss of earnings due to reduced capacity to work likely compounds the overall challenges of managing pregnancy associated cancer. In our study, these pressures were a recurrent theme, pointing to a significant gap in the literature around how best to support women with cancer during pregnancy, particularly in terms of financial guidance, workplace rights, and reintegration into employment following treatment. Maternal guilt[ 45 ], previously described in the context of high-risk pregnancies[ 46 ], was also intensified in the context of cancer and may be an issue that cancer clinicians working with these women are unaware of. Concerns about the health of their baby, their ability to manage treatment, ability to care and live up to their own expectations for existing children or their maternal role contributed to deep, long-lasting feelings of guilt. These emotional challenges can be traumatising and may have a lasting impact on women’s psychological well-being, potentially shaping their long-term adjustment and recovery[ 46 ]. Our findings emphasise the need for integrated psychological support, as many women actively sought out personalised care, often finding it difficult to find appropriate resources. Routine access to counselling and emotional support should be considered an essential component of care for women with PAC, given the profound and enduring psychological effects reported by participants in our study and others [ 2 , 5 , 13 , 47 ]. However, the timing and format of such support warrant careful consideration. As our findings and existing literature suggest, women are often in “survival mode” during diagnosis, treatment, and early motherhood; emotionally overwhelmed and focused on immediate tasks. In this context, some may lack the capacity or headspace to benefit from psychological interventions when they are offered in the immediate post-natal/treatment period. Furthermore, our study resonates with the broader body of research on maternal guilt and shame[ 45 , 48 ]. Studies on women facing high-risk pregnancies[ 49 ], including those with cancer, consistently report feelings of guilt related to their health, treatment choices, and maternal role. Our study further demonstrated that in the context of PAC, this guilt is compounded by concerns about the potential impact of cancer treatment on the foetus and the difficulty of managing both the emotional and physical demands of pregnancy alongside cancer treatment. Our findings are consistent with those of other studies on cancer and pregnancy, which have similarly highlighted a sense of isolation and uncertainty[ 28 , 50 , 51 ], as these women struggle to make decisions about their health and the health of their unborn child. Rather than a one-size-fits-all approach, psychological support should be trauma informed, flexible, ongoing, and tailored to individual readiness. Some women may benefit most from support in the later stages of survivorship, once the initial intensity of treatment and caregiving has eased and emotional processing becomes more feasible. Integrated, long-term support pathways could help ensure that women are not only offered care but are also able to access it at a time that aligns with their emotional recovery trajectory[ 51 , 52 ]. This also requires more coordinated services and greater recognition of the significant effort involved in navigating two clinical specialties, oncology and maternity, that often operate in silos. Limitations and Strengths This study has some limitations. The sample size was relatively small and self-selecting, which may limit the transferability of the findings. However, given the aim of the study, the shared experience of participants (cancer diagnosis during or shortly after pregnancy), and the richness of data generated, our sample size was considered sufficient to support in-depth qualitative analysis based on the principle of information power[ 16 ]. Additionally, the study relied on retrospective accounts of participants’ experiences, which may be subject to recall bias. However, this was countered by the detailed description participants provided, including dates of diagnosis and other significant events. While the lack of cultural diversity in the sample may limit the applicability of findings to broader populations, the study did include geographic diversity across the UK and captured a range of experiences. There was also diversity in the quality of care received, some women were dissatisfied with their oncologist or obstetrician, while others reported positive experiences and felt well supported. Furthermore, the cross-sectional nature of the study limits our ability to qualitatively examine long-term psychological outcomes or the evolution of women's experiences over time. Despite these limitations, the strengths of this study lie in its novel contributions to understanding the psychological, emotional, and financial burdens faced by women with PAC, an underexplored area in existing literature. By focusing on participants lived experiences, this study provides valuable insights that can inform future research and guide improvements in healthcare delivery for this population. Conclusion and Recommendations This study illuminates the significant emotional, psychological, and financial challenges faced by women with PAC, often exacerbated by fragmented care pathways. Healthcare systems need to prioritise the integration of multidisciplinary care teams that address not only the medical aspects of treatment but also the psychological, financial, and social dimensions of these women’s experiences. Preliminary implications for survivors and families are summarised in Supplement 5. Future research should explore long-term psychological outcomes for women with PAC and investigate interventions to improve care integration and support services. Enhancing survivorship care for women with PAC is crucial for improving their quality of life both during and after treatment. Declarations Implications for Cancer Survivors Structured psychosocial interventions and long-term support are needed. Research should address care integration and financial impacts to better support affected families. Competing interests: The authors have declared no competing interests. Author Contribution Jenny Harris: Conceptualization; Methodology; Formal analysis; Writing - Original draft; Writing – review & editing; Supervision; Funding acquisition. Afrodita Marcu: Conceptualization; Methodology; Data collection; Supervision; Writing – review & editing; Supervision; Funding acquisition. Faith Gibson: Conceptualization; Methodology; Writing – review & editing; Funding acquisition. Emma Ream: Conceptualization; Methodology; Writing – review & editing; Funding acquisition. Karen Poole: Conceptualization; Methodology; Writing – review & editing; Funding acquisition. Jane Stewart: Formal analysis; Writing - Original draft.Jenny Harris: Conceptualization; Methodology; Formal analysis; Writing – review & editing; Supervision; Funding acquisition. Acknowledgement We are grateful to the charity Mummy’s Star and in particular its CEO, Pete Wallroth, for supporting this research and facilitating access to study participants. We would like to thank Lisa Whittaker, Shakardokht Jafari and Laura Pearson for their invaluable involvement as patient representatives, and all the women who participated and shared their experiences in the interviews. Funding: This research was supported by an internal grant from the School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey. Faith Gibson is supported in part by the Great Ormond Street National Institute for Health and Care Research (NIHR) Biomedical Research Centre. Jo Armes receives funding from the NIHR Applied Research Collaboration Kent, Surrey, Sussex (grant number: NIHR200179). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Data Availability The research data are not shared because they contain sensitive and potentially identifying information. References Ma, K.K., et al., Cancer and pregnancy: national trends . American Journal of Perinatology, 2022. 39(02): p. 144–153. Maggen, C., et al., Pregnancy and cancer: the INCIP project . Current oncology reports, 2020. 22: p. 1–10. Amant, F., et al., Management of cancer in pregnancy . Best Practice & Research Clinical Obstetrics & Gynaecology, 2015. 29(5): p. 741–753. Peccatori, F.A., et al., Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up . Annals of oncology, 2013. 24: p. vi160-vi170. Amant, F., et al., Breast cancer in pregnancy: recommendations of an international consensus meeting . European journal of cancer, 2010. 46(18): p. 3158–3168. 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Siersma, and A.D. Guassora, Sample size in qualitative interview studies: guided by information power . Qualitative health research, 2016. 26(13): p. 1753–1760. Brooks, J., et al., The utility of template analysis in qualitative psychology research . Qualitative research in psychology, 2015. 12(2): p. 202–222. King, N., Doing template analysis. Qualitative organizational research: Core methods and current challenges, 2012. 426: p. 426–450. QSR-International-Pty-Ltd., NVivo. 12 2020. Stafford, L., et al., Cancer during pregnancy: A qualitative study of healthcare experiences of Australian women . European Journal of Cancer Care, 2021: p. e13425. Hori, R. and S. Suzuki, Shared Decision-Making Support Process for Healthcare Professionals for Pregnant Cancer Patients and Their Families . Asia-Pacific Journal of Oncology Nursing, 2021. 8(3): p. 304–313. Becerra Pérez, M.M., et al., Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review . Med Decis Making, 2016. 36(6): p. 777–90. Kao, Y.-L., et al., The relationship between decision regret, quality of life, and mindfulness in early-stage breast cancer survivors . The Breast, 2025. 81: p. 104435. Liu, J., et al., Decision Regret About Treatment Amongst Women With Early Breast Cancer: An Integrative Review. Journal of Advanced Nursing. n/a(n/a). Yuill, C., et al., Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research . BMC pregnancy and childbirth, 2020. 20: p. 1–21. Gomes, J.S., I.C.P.V.d. Sand, and N.M.O. Girardon-Perlini, Cancer during pregnancy: from the diagnosis to the repercussions on the family experience of maternity. Revista da Escola de Enfermagem da USP, 2021. 55. Facchin, F., et al., “ Lights and Shadows”: An Interpretative Phenomenological Analysis of the Lived Experience of Being Diagnosed With Breast Cancer During Pregnancy . Frontiers in psychology, 2021. 12: p. 1066. Kozu, M., M. Masujima, and T. Majima, Experience of Japanese pregnant women with cancer in decision-making regarding cancer treatment and obstetric care . Japan Journal of Nursing Science, 2020. 17(2): p. e12300. Hammarberg, K., et al., Health care experiences among women diagnosed with gestational breast cancer . European Journal of Cancer Care, 2018. 27(2): p. e12682. Ferrari, F., et al., Psychological issues and construction of the mother-child relationship in women with cancer during pregnancy: a perspective on current and future directions . BMC psychology, 2018. 6(1): p. 1–4. May, C.R., et al., Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness . BMC Health Services Research, 2014. 14(1): p. 281. Fisher, C. and M. O'Connor, "Motherhood" in the context of living with breast cancer . Cancer Nurs, 2012. 35(2): p. 157–63. Mackenzie, C.R., 'It is hard for mums to put themselves first': how mothers diagnosed with breast cancer manage the sociological boundaries between paid work, family and caring for the self . Soc Sci Med, 2014. 117: p. 96–106. Marks, C., et al., Articulating the trauma-informed theory of individual health behavior . Stress and Health, 2022. 38(1): p. 154–162. Treatment, C.f.S.A., Trauma-informed care: A sociocultural perspective. Substance Abuse and Mental Health Services Administration (Ed.), Trauma-Informed Care in Behavioral Health Services, 2014: p. 3–33. Davidson, C.A., K. Kennedy, and K.T. Jackson, Trauma-Informed Approaches in the Context of Cancer Care in Canada and the United States: A Scoping Review . Trauma, Violence, & Abuse, 2023. 24(5): p. 2983–2996. Sperlich, M., et al., Integrating Trauma-Informed Care Into Maternity Care Practice: Conceptual and Practical Issues . Journal of Midwifery & Women's Health, 2017. 62(6): p. 661–672. Machtinger, E.L., et al., From Treatment to Healing: The Promise of Trauma-Informed Primary Care . Women's Health Issues, 2015. 25(3): p. 193–197. Harrison, P., Psychosocial Impact of a Cancer Diagnosis During Pregnancy . Nursing for Women's Health, 2013. 17(5): p. 437–442. Altice, C.K., et al., Financial hardships experienced by cancer survivors: a systematic review . Journal of the National Cancer Institute, 2017. 109(2): p. djw205. Zheng, Z., et al., Medical financial hardship among cancer survivors in the United States . Cancer, 2019. 125(10): p. 1737–1747. Warner, E.L., et al., Cancer survivors’ financial hardship and their caregivers’ employment: results from a statewide survey . Journal of Cancer Survivorship, 2023. 17(3): p. 738–747. Taylor, K., et al., Financial Hardship Among Pregnant and Postpartum Women in the United States, 2013 to 2018 . JAMA Network Open, 2021. 4(10): p. e2132103-e2132103. Katz, J., et al., Material Hardship and Mental Health Symptoms Among a Predominantly Low Income Sample of Pregnant Women Seeking Prenatal Care . Maternal and Child Health Journal, 2018. 22(9): p. 1360–1367. Liss, M., H.H. Schiffrin, and K.M. Rizzo, Maternal guilt and shame: The role of self-discrepancy and fear of negative evaluation . Journal of child and family studies, 2013. 22: p. 1112–1119. Dawson, A.J., et al., Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis . BMJ open, 2018. 8(9): p. e022755. Schwab, R., K. Anic, and A. Hasenburg, Cancer and Pregnancy: A Comprehensive Review. Cancers, 2021. 13(12): p. 3048. Law, N.K., P.L. Hall, and A. Cheshire, Common negative thoughts in early motherhood and their relationship to guilt, shame and depression . Journal of Child and Family Studies, 2021. 30(8): p. 1831–1845. Isaacs, N.Z. and M.G. Andipatin, A systematic review regarding women’s emotional and psychological experiences of high-risk pregnancies . BMC Psychology, 2020. 8(1): p. 45. Stafford, L., et al., Isolation experienced by women with gestational cancer: could peer support and tailored information be the answer? Supportive Care in Cancer, 2021. Armitage, L., et al., “ I didn’t really fit into any boxes”: understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum—a mixed-method systematic review . Journal of Cancer Survivorship, 2024. Steel, J.L., et al., Patient, family caregiver, and economic outcomes of an integrated screening and novel stepped collaborative care intervention in the oncology setting in the USA (CARES): a randomised, parallel, phase 3 trial . Lancet, 2024. 403(10434): p. 1351–1361. Additional Declarations No competing interests reported. Supplementary Files Supplements02.07.25.pdf Supplementnotforreview02.07.25.docx Cite Share Download PDF Status: Published Journal Publication published 23 Apr, 2026 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 08 Dec, 2025 Reviews received at journal 08 Dec, 2025 Reviewers agreed at journal 21 Nov, 2025 Reviewers agreed at journal 09 Sep, 2025 Reviewers invited by journal 16 Aug, 2025 Editor assigned by journal 16 Aug, 2025 Submission checks completed at journal 09 Jul, 2025 First submitted to journal 03 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7040036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":481845157,"identity":"0fc0b29a-68a5-41ba-a39a-f0c607e608fd","order_by":0,"name":"Jenny 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07:59:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":520652,"visible":true,"origin":"","legend":"","description":"","filename":"Supplements02.07.25.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7040036/v1/769b1c44af43c889bd94c807.pdf"},{"id":86308712,"identity":"72fff37c-5303-444b-8a5f-7658efef8fdc","added_by":"auto","created_at":"2025-07-09 07:51:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21902,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementnotforreview02.07.25.docx","url":"https://assets-eu.researchsquare.com/files/rs-7040036/v1/6e27c61b2e18dc810ed5ca37.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cancer diagnosed during pregnancy: a qualitative study of women’s psychosocial experiences during treatment and survivorship","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, an increasing number of women are diagnosed with cancer during pregnancy, a trend likely influenced by delayed parenthood in developed economies and the increased use of prenatal testing for foetal chromosomal abnormalities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While a growing body of research has examined the epidemiology and clinical management of cancer during pregnancy [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], including oncological, maternal, and infant outcomes, relatively little attention has been given to the psychosocial impact of receiving a cancer diagnosis and navigating treatment and survivorship, alongside new parenthood, during this uniquely vulnerable time [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe experience of cancer during pregnancy presents profound psychological and emotional challenges. Women often report high levels of distress, anxiety, and isolation, exacerbated by the uncertainty surrounding treatment decisions, concerns about foetal health, and the perceived lack of appropriate support networks[\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally these women frequently struggle to find peer support groups that feel relevant to their experiences and consequently endure isolation during treatment, and healthcare professionals (HCPs), despite their best efforts, may lack the experience or confidence to provide tailored psychosocial care[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eInternational research indicates that the psychological burden of a pregnancy-associated cancer diagnosis extends well beyond childbirth, with implications for long-term survivorship, maternal identity, and family dynamics [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, there remains a significant gap in understanding these experiences, particularly within the context of universal healthcare systems such as the UK’s National Health Service (NHS) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] where access to psychosocial care in survivorship is managed by primary care.\u003c/p\u003e\u003cp\u003eOur recent UK-based qualitative study [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] examined women’s pathways to cancer diagnosis during pregnancy, revealing that symptoms were frequently misattributed to pregnancy-related changes, both by the women themselves and the HCPs they consulted. As a result, many women faced delays in diagnosis, requiring repeated visits to primary care before receiving specialist referrals. While the study focused on diagnostic pathways, participants also shared detailed accounts of their treatment experiences and survivorship concerns, underscoring the need for further exploration of these important phases.\u003c/p\u003e\u003cp\u003eGiven the limited research on the post-diagnostic journey of women with pregnancy-associated cancer, we conducted this analysis as part of the pre-planned objective of qualitative interview study[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The aim was to explore the psychosocial trajectory of women following their cancer diagnosis, throughout pregnancy and postpartum, including their experiences of treatment, support, decision-making, and survivorship. By understanding these experiences, we can better inform service provision, improve patient-centred care, and identify priorities for future research and practice.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cb\u003eDesign, procedures and sample recruitment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study involved analysis of qualitative interview data collected to explore the experiences of 20 women who received a cancer diagnosis during or soon after pregnancy. Full methodological details of the study are reported elsewhere[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In summary, participants were recruited via Mummy's Star, a charity dedicated to supporting women and families affected by cancer during pregnancy or within the first year postpartum. A study advertisement was shared on the charity's online forum to facilitate recruitment.\u003c/p\u003e\u003cp\u003eWomen were eligible to participate if they resided in the UK and had received a cancer diagnosis during pregnancy (or had sought help during pregnancy but formal diagnosis was made post-partum) within the four years preceding recruitment, starting from January 2018. Women were excluded if they were diagnosed before January 2018, were currently pregnant at the time of the study, or were less than three months postpartum. Sampling and data collection were guided by the principle of \u003cem\u003einformation power\u003c/em\u003e (guided by data depth, relevance, and richness) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInterviews were conducted online via Zoom between January and May 2022 by an experienced female social psychologist (AM), who was also a new mother with an academic interest in cancer inequalities. Interviews followed a semi-structured format guided by an interview schedule, allowing participants to share narrative accounts of their experiences. Interviews lasted between 36 and 66 minutes, were digitally recorded, and transcribed verbatim.\u003c/p\u003e\u003cp\u003ePrior to the interviews, AM gained informed consent and collected demographic, cancer, and maternal history data. This pre-interview engagement helped familiarize participants with the researcher and ensured they understood the study's purpose. Participants received reimbursement of £25 for their time.\u003c/p\u003e\u003cp\u003eThe conception of this study was developed informed by an open academic, practice and public community engagement workshop held at the University of Surrey to identify priorities for psychosocial research around cancer and pregnancy with discussions and recommendation captured live by an artist \u003cb\u003e(Supplement 1\u003c/b\u003e). Patient and public involvement was integral to the study design, with two women who had lived experience of cancer during pregnancy contributing to the development of the study materials, including the participant information sheet and interview topic guide[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Ethical approval was obtained from the University of Surrey Ethics Committee (FHMS 20–21 199 EGA).\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe employed template analysis[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This structured form of thematic analysis is widely used in qualitative psychology research, particularly when a priori themes have been established through prior analysis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe analytical process began with data familiarisation, followed by preliminary coding to identify key themes. An initial coding template was developed iteratively and refined as additional data were analysed. Once finalised, this template was systematically applied to all transcripts using NVivo[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] ensuring a structured yet flexible analytical approach.\u003c/p\u003e\u003cp\u003eTemplate analysis balances inductive and deductive approaches[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and accommodates various epistemological perspectives. For this study, we adopted a realist perspective [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], focusing on women's experiences from diagnosis through treatment and into survivorship. Our research team included members with expertise in psychology, nursing and midwifery. The analysis began with JS (midwife) conducting an initial review of the dataset. The coding template was developed based on four key sources:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePrior knowledge of challenges faced by women diagnosed with cancer during pregnancy.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eA scoping review and gap analysis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFindings from the study on pathways to diagnosis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePreliminary analysis of a subset of five transcripts (conducted by JH, JA, and JS), selected to represent diverse cancer types and diagnostic timings (during pregnancy and postpartum).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe initial template was applied across the dataset by two authors (JS and JH independently) and performed well, and final refinements were made to thematic categories descriptors to reflect the emerging themes (JH and JA). This iterative approach ensured the analysis remained responsive to the dataset while maintaining a structured framework for interpretation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSample characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFull details of the sample are described elsewhere[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The sample comprised 20 women, aged between 27 and 45 years (median age 35.5 years) (\u003cb\u003eSupplement Tables\u0026nbsp;2 and 3\u003c/b\u003e). Their age at diagnosis ranged from 26 to 44 years (median 33.5 years). Most were married or cohabiting (N\u0026thinsp;=\u0026thinsp;17, 85%). Fourteen (70%) were diagnosed during the COVID-19 pandemic, with the remaining being diagnosed before it. Seventeen participants (85%) received their diagnosis while pregnant, ranging from 5 to 35 weeks of pregnancy, while three (15%) were diagnosed 6\u0026ndash;16 weeks postpartum after initially seeking help for symptoms during pregnancy. Ten participants (50%) gave birth at full term (i.e., \u0026gt;\u0026thinsp;37 weeks gestation). The remaining 10 gave birth preterm (following induction or C-section) after their cancer diagnosis (all between 33 to 36 weeks). Two-thirds were diagnosed with breast cancer (N\u0026thinsp;=\u0026thinsp;13, 65%). Four women were diagnosed with advanced disease (20%).\u003c/p\u003e\u003cp\u003e\u003cb\u003eThemes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants shared their experiences in a sequential fashion, meticulously recounting their pathway from treatment, childbirth, and the aftermath, following the cancer diagnosis. Their narratives were replete with intricate descriptions and the analysis produced six inter-related psychosocial themes, sometimes spanning the antenatal and postnatal phases (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cb\u003eSupplement 5\u003c/b\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eManaging cancer with constrained choices: the weight of uncertainty\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMany women experienced the strain of facing limited diagnostic and treatment options during pregnancy. The inability to undergo standard investigations, staging and treatment often led to delays or altered care, leaving some with unanswered questions and heightening women\u0026rsquo;s fears about disease progression:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThat\u0026rsquo;s the other thing, you are then being told all the things you can\u0026rsquo;t have. So, I couldn\u0026rsquo;t have the bone scan, I couldn\u0026rsquo;t have Herceptin, there was quite a lot of things they can\u0026rsquo;t do when you are pregnant. That\u0026rsquo;s always a bit of a worry [\u0026hellip;] because it was quite an aggressive cancer [\u0026hellip;] they wanted me to have the longer cycles of chemo [\u0026hellip;] Some people have, is it 9 or 8 cycles? I had 12 cycles because they wanted to be quite aggressive, and they weren\u0026rsquo;t going to be able to fit all the chemo in before they wanted the baby to be born.\u003c/em\u003e (P4, Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFeelings of uncertainty and possible decisional regret were protracted for women who later discovered their disease was more advanced than initially expected:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI was diagnosed when I was 16 weeks, [\u0026hellip;] I didn\u0026rsquo;t realise some women have chemo and diagnostics while they are pregnant. But they just didn\u0026rsquo;t want to do that with me because they diagnosed via a biopsy. They said no treatment. They said, \u0026ldquo;We are just going to let the baby grow\u0026rdquo;. [\u0026hellip;] But had they known how widespread it was, because it really was very widespread and that\u0026rsquo;s why they had to take off the whole breast, maybe if they knew the full extent, I might have been offered treatment. But I\u0026rsquo;ll never know that.\u003c/em\u003e (P3 Breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese uncertainties sometimes had profound long-term consequences, particularly when a delayed diagnosis was associated with advanced disease. One woman with bowel cancer, whose symptoms were initially misattributed to pregnancy, was not diagnosed until her third trimester. By then, the priority had to be managing a bowel obstruction, and standard investigations and cancer staging had to be postponed until after delivery. During survivorship, [infant] reflected on the impact of delayed diagnosis:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eBy the time they took the tumour out [\u0026hellip;], and then they scanned me [\u0026hellip;] because they could now do a proper scan, because the baby wasn\u0026rsquo;t in there anymore, we found out that it had gone to my liver. [pause] Whether it was already going to go to my liver or not, you don\u0026rsquo;t really know. But if I had been diagnosed earlier in the pregnancy, I guess I could have had some\u0026hellip; I know a girl who was in a similar situation, but she got diagnosed much earlier in her pregnancy. They sort of said to her, \u0026lsquo;You can either have an abortion, or you can try and have your chemo during your pregnancy,\u0026rsquo; and she had the chemo. So, I know that it is possible to have chemo during pregnancy. I probably would have done that. Then, that may have meant that the cancer would at least have been just contained in the colon and then wouldn\u0026rsquo;t have gone to my liver. It has now gone to my liver and my lungs. I have had two recurrences. The liver twice, I have had two liver ops, and then one lung operation. I have had a major operation every year since I got diagnosed. [\u0026hellip;] I think [chemotherapy] would have helped my long-term prognosis.\u003c/em\u003e (P10 Bowel Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical decision-making processes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor many women, navigating treatment decisions during pregnancy was emotionally taxing. When they believed they had a choice, they faced the burden of weighing whether to proceed with investigations or treatments or to delay them, while balancing their own health, the well-being of their unborn child, and, in some cases, the needs of their existing children.\u003c/p\u003e\u003cp\u003eOne woman described the turmoil of deciding whether to proceed with surgery despite possible risks to her unborn child:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI had this real emotional rollercoaster [\u0026hellip;] Because obviously there is a risk of miscarriage during surgery under general anaesthetic, I had this real emotional rollercoaster of well if I don\u0026rsquo;t go ahead [I\u0026rsquo;d] \u0026hellip; wait another seven, eight, possibly nine months [\u0026hellip;] I came to the conclusion of [name of child] is already here, [name of child] already knows me, I\u0026rsquo;m already [name of child] mummy, and obviously baby didn\u0026rsquo;t at the time, so I just kind of had to try and break that emotional attachment to try and be pragmatic in making that decision\u003c/em\u003e (P5 Thyroid cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSimilarly, others described the immense difficulty of weighing their survival against their baby\u0026rsquo;s well-being:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI guess it was a toss-up between the baby and yourself [\u0026hellip;] and certainly in my case, there was that period of months where you are kind of weighing it up, the priorities of his (baby\u0026rsquo;s) life and my life\u003c/em\u003e (P15 Bowel cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some, the emotional weight of these decisions was compounded by the need to advocate for themselves in conversations with healthcare professionals, particularly when they felt their preferences were not being fully acknowledged.\u003c/p\u003e\u003cp\u003eSome women found themselves needing to assert their preferences against healthcare professionals' recommendations:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIt was just a feeling within me, when I got to 35 weeks, I just had this really strong feeling and I said [\u0026hellip;] I\u0026rsquo;ve done everything [\u0026hellip;] I\u0026rsquo;m continually in this hospital having scans. I\u0026rsquo;m glad [infant]\u0026rsquo;s grown to a good size. The obstetrician was quite reluctant, but then [\u0026hellip;] [the obstetrician] agreed [\u0026hellip;] So I was induced [\u0026hellip;] emotionally I felt like\u0026hellip; I think it had got to a point where I\u0026rsquo;d known of this [cancer] in me for however many months, four months, and I just wanted to get on with the treatment because all I cared about was being there and trying to have some of my maternity leave to just enjoy my daughter [\u0026hellip;] And I didn\u0026rsquo;t want my cancer to spread any more than it already had either [\u0026hellip;] it was a relief to have her. It was a real strain carrying her in my pregnancy and all that was going back and forth in my mind. (P3 Breast cancer)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMany actively sought information to support their decisions, yet some struggled with guilt and decisional regret:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI was able to get some of the information about the risks with things like early labour, stillbirth rates. I remember discussing all that, but for quite a long time it was \u0026ldquo;what am I doing?\u0026rdquo; I just felt so guilty [\u0026hellip;] my need for a child was such that I was prepared to put this baby through [\u0026hellip;] all this chemo, and who knows what the outcome of her would be, just because I felt quite selfish, what effect could this have on her?\u003c/em\u003e (P4 Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some, the absence of information and not being offered choices by clinicians reinforced a sense of lost agency. One woman had to independently research reconstruction options, as she had not been informed about them:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI had the option whether I wanted to go ahead or not, but I didn\u0026rsquo;t have any options in terms of what I\u0026rsquo;m having\u0026hellip; I chose to have the implant put in which I\u0026rsquo;d already done my research and asked for, but it wasn\u0026rsquo;t an option that was given to me, I\u0026rsquo;d sort of looked into that and requested it.\u003c/em\u003e (P11, Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBeyond treatment, some women felt disempowered in other aspects of their care, such as infant feeding:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThey basically said you can\u0026rsquo;t\u003c/em\u003e [breastfeed]. \u003cem\u003eSo yes, that was very sad for me because I loved breastfeeding [\u0026hellip;] And in all honesty, that was the thing I found hardest in the whole diagnosis. I could sit and I could talk to anyone about it and the only thing that ever made me cry was that I wouldn\u0026rsquo;t be able to breastfeed my second baby, because it was so important to me to be able to do that [\u0026hellip;] when the bottle making machine turned up at the door I burst into tears and stuff like that. It was very strangely the hardest thing I found about the whole experience [\u0026hellip;]\u003c/em\u003e (P14 Breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis same woman, however, was able to negotiate with her oncology team, demonstrating how persistence sometimes influenced clinical decisions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI think because I kept breaking down into tears anytime anyone talked about breastfeeding, or every time I brought up breastfeeding. I think my team realised how important it was to me and my oncologist tried to give me as long as possible afterwards. So, [the oncologist] initially maybe said two weeks, which I thought was just a joke because by two it\u0026rsquo;s just that\u0026rsquo;s no time at all, is it? Then [the oncologist] kind of said maybe two to three weeks and then I kept negotiating with [the oncologist] a little bit more and, yes, I think I ended up being able to breastfeed for four weeks\u003c/em\u003e (P14 Breast cancer).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBalancing cancer and its treatment with pregnancy and family life\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA common theme was the ongoing challenge of managing the dual demands of cancer care and motherhood, often with lasting physical and emotional consequences. The transition into motherhood, typically a time of bonding and recovery, was disrupted by the necessity of prioritising cancer treatment. The relentless juggling act of balancing medical appointments, treatment side effects, postnatal recovery, and childcare often left women physically and emotionally drained. The enduring impact of these experiences shaped not only their recovery but also their ongoing journey as both cancer survivors and mothers.\u003c/p\u003e\u003cp\u003eWomen described how the relentless frequency of appointments, treatments, and monitoring left little room for rest, recovery or a sense of normality. The demands of cancer care felt particularly overwhelming when combined with pregnancy, a new baby, and the ongoing responsibilities of existing children:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI found it really exhausting because I was still trying to look after my other two children, do things like the school run. I found it exhausting and sometimes really overwhelming because the amount of appointments I\u0026rsquo;d have. Some days I might be seeing my haematologist one day at one hospital in (one location), the next day at a different hospital in (another location) for a scan, I used to have scans every two weeks, then I might be seeing the midwife the next day, then I might be going to my GP\u0026rsquo;s the day after that to have my pre chemo bloods done and then I might be, on the Friday, going and having the chemo. And it was just exhausting\u003c/em\u003e (P1 Hodgkin\u0026rsquo;s Lymphoma)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLogistical challenges were amplified for a woman needing to manage the specific requirements of thyroid treatment:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;[Due to radiotherapy] I would have had to stay away from home for another four days, so I had the issue of logistics of where would I stay\u0026hellip; the friends that I do have all have young children as well, so that was another real mental headache\u0026rdquo;\u003c/em\u003e (P5, Thyroid)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese logistical and emotional challenges did not end with childbirth. For many, treatment extended into or commenced in the postpartum period, compounding the sense of exhaustion and overwhelm.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eThere was a lot going on at all times. It was really quite difficult to manage. I don\u0026rsquo;t think I actually [\u0026hellip;] missed any appointments, [\u0026hellip;] but it would have very easily been done [\u0026hellip;] sometimes it was just so overwhelming, the amount of appointments\u003c/em\u003e\u0026rdquo; (P14, Breast)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe simultaneous challenges of cancer and pregnancy compounded the usual fatigue associated with both experiences. Women described an overwhelming sense of exhaustion, which extended into their postpartum recovery as they juggled motherhood and ongoing treatment.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eSo then after I had [daughter] I had a week off and then started back on chemotherapy again for another nine weeks, so that was quite gruelling. [laughs]\u003c/em\u003e (P13 Breast Cancer\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe need to prioritise cancer treatment over new motherhood often meant that women were unable to fully experience early bonding moments with their babies. For some, the transition from pregnancy to intensive cancer treatment was abrupt, leaving little time to recover physically or emotionally.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI felt like when people talk about the baby bubble and you get to spend those first few weeks just at home and cuddling and having a nice time, breastfeeding, just being close and bonding with your baby, especially the very first time that I had to get up and leave the house and go for chemotherapy, it was just heart-breaking. Yes, I just felt like it was a very abrupt end to almost\u0026hellip; It almost felt like it was like, right, well that\u0026rsquo;s that then, that\u0026rsquo;s finished.\u003c/em\u003e (P14 Breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some, the necessity of immediate treatment further complicated birth and recovery experiences, disrupting their ability to care for their newborns:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThen, when the baby came, we were just happy that [infant] is okay, and then [infant] goes to NICU [due to planned pre-term delivery at the same time as her surgery]\u0026hellip;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eGoing up to visit the baby was really hard, because I had to be taken in a wheelchair by someone else. I couldn\u0026rsquo;t get there myself. I was finding it hard to express milk. I wasn\u0026rsquo;t really eating much, so the milk wasn\u0026rsquo;t really coming.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI was just worried that I wasn\u0026rsquo;t going to visit enough, and everyone would think I was an awful mother, because I was never up there. All the other mums would sit by their incubator all day, but I would go there for about ten minutes, and I just couldn\u0026rsquo;t sit there anymore, because I was so ill.\u003c/em\u003e (P10 Bowel Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe intersection of cancer treatment and pregnancy often resulted in medical complications that intensified the already demanding experience. Some women experienced unexpected surgical complications, further prolonging their recovery:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eWhen I had gone to the hospital to be induced, they told me that they would know about my history but they didn\u0026rsquo;t know [laughs], ... My wound was leaking. I thought it was just breast milk from the other breast, but it was actually my wound was leaking, so they did get a consultant to come and check just to make sure it was okay and I think it was just some excess fluid or something with the pressure of labour\u003c/em\u003e (P9 Breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor one woman, a Caesarean-section led to additional complications that significantly impacted recovery and mobility, adding yet another layer of difficulty to an already overwhelming situation:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eWhen they did the C-section, \u0026hellip;they also cut my bladder, and I got a wound infection from the C-section So, I had lots of complications [\u0026hellip;] on top of everything else. I had a catheter for six weeks [\u0026hellip;] while my bladder healed. It was a complete nightmare. A nightmare month in hospital [\u0026hellip;]\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe bladder injury [\u0026hellip;] just complicated things loads because it just added another thing to the list of things that were already bad. It made me much less mobile, and it added much more hospital appointments and [\u0026hellip;] scans [\u0026hellip;] I had urine coming out of my C-section scar, pouring out of me. Then they let us both out [\u0026hellip;]I was at home for about a week, and then I went back\u003c/em\u003e [in for] \u003cem\u003ethe tumour surgery.\u003c/em\u003e (P10 bowel cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eWork disruption and financial strain\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs the women were of working age, many described the strain of managing cancer, pregnancy and work simultaneously. Cancer often disrupted women\u0026rsquo;s plans to work during pregnancy or return to work after maternity leave, forcing difficult choices about priorities and capacity:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI couldn\u0026rsquo;t cope with work. I didn\u0026rsquo;t have the mental headspace for being pregnant, having cancer and working. I obviously have done being pregnant and working. I think I could have done cancer and working to the point\u0026hellip; but I couldn\u0026rsquo;t do them all\u0026hellip;Keeping a track of what the doctors were saying, medicine, where to be, appointments. Even when it got to the point in your chemo journey where you are maybe getting a bit more regular, starting to feel a bit more better [sic], and some people were trying to do a day or two of work around that. I was six months pregnant at that point and I was just like I\u0026rsquo;m not doing work as well. (P4 Breast Cancer)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese disruptions to employment were often accompanied by significant financial strain particularly as frequent appointments, travel, and unpaid leave compounded existing expenses:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIt has a big financial implication [\u0026hellip;] you\u0026rsquo;re having to travel a lot to these appointments [\u0026hellip;] things like petrol (gas), diesel, and then having to pay to park at the hospital as well [\u0026hellip;] Because you are at higher risk from the cancer, you then need to see your obstetrician, midwife, whoever, more often, so you are at hospital more, so you are paying quite a lot of money to be in a car park and obviously I didn\u0026rsquo;t work then, I was off sick from work [\u0026hellip;] You\u0026rsquo;ve got enough to worry about without having to worry about money. Sometimes I had to borrow money from my mum to put petrol in my car to go to my hospital appointments. I didn\u0026rsquo;t have any money.\u003c/em\u003e (P1 Hodgkin\u0026rsquo;s Lymphoma)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThese financial challenges could be compounded for those who already had children:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI just needed some support. I did need a babysitter [\u0026hellip;] if [\u0026hellip;] you have a toddler and you have a baby but because of your circumstance you can\u0026rsquo;t physically look after them. We got out a loan and we spent loads of money on childcare because I couldn\u0026rsquo;t look after them sometimes. That was really difficult and we\u0026rsquo;ve only just paid it off three years later.\u003c/em\u003e (P3 Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome had partners who were able to take time off work to support them and handle family responsibilities. Nevertheless, this could result in greater financial strain:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eObviously with my partner not being able to work because he was looking after me and the baby and then me not working and my maternity pay obviously runs out [talking about receiving free counselling]. I don\u0026rsquo;t think I would have sought that sort of help if I\u0026rsquo;d had to pay for I [\u0026hellip;] I would have thought but there\u0026rsquo;s so much I need to [buy] look after my daughter, the money should really go to that\u003c/em\u003e (P16 breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn response to these challenges, some women turned to cancer charities for practical support and financial guidance:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI have been in contact with [charity named], but that was more helping out with finances, if you are ill and you can\u0026rsquo;t work. I had lots of weird things to do with my maternity pay and not being able to work. I went and saw someone who helps you apply for what benefits you can get, and what to do, and stuff like that. That was good [\u0026hellip;] help with life, benefits, things like that\u003c/em\u003e (P10 bowel cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEmotional impact of diagnosis and treatment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe immediate aftermath of diagnosis was often marked by overwhelming feelings of threat, fear, and emotional paralysis:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI was just in shock [\u0026hellip;] I just felt so locked in. I didn\u0026rsquo;t do anything. All I remember of that period is sitting in the beanbag chair watching telly, nothing else, in this empty room\u003c/em\u003e (P7 breast cancer, secondary cancer lungs and lymph nodes)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHowever, for some the magnitude of these feelings were delayed as they initially attempted to cope by continuing their regular routines:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eWhen I was told, \u0026ldquo;You\u0026rsquo;ve got cancer,\u0026rdquo; [\u0026hellip;] it didn\u0026rsquo;t sink in, and I wanted to know that my baby would be safe, that was my main concern really, and I was just in absolute shock to be honest with you, and it took quite a long time. I put on this brave face and I think it was like a few weeks after, I just couldn\u0026rsquo;t stop crying and I had to call my husband. I parked outside his work and he just said, \u0026ldquo;I did think you were taking it very well\u0026rdquo;. And I just don\u0026rsquo;t think it had sunk in because I was looking after my son. I was working four days a week, I was carrying a baby, busy times. And this was just completely out of the blue, unexpected [\u0026hellip;] I was devastated, confused [\u0026hellip;] and searching for answers.\u003c/em\u003e (P3 breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs the shock of diagnosis gave way to daily realities, many women described navigating intense emotional contradictions of joy and fear, hope and despair, often within the same moment. The same women described regaining emotional control by compartmentalising these contradictory thoughts and emotions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIt\u0026rsquo;s a completely conflicting stage of your life; you should be happy, and people want to congratulate you. And actually, at work I decided not to tell anyone except my immediate teams. There were three people that knew and everyone else just kept saying, \u0026ldquo;Oh you must be so excited,\u0026rdquo; and I was, but in the back of my mind I knew the diagnosis and it was a real battle in my mind.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI don\u0026rsquo;t really know, looking back, how I kept all those feelings under control [\u0026hellip;] It was a real rollercoaster of emotions [\u0026hellip;] and as we did with my son, we opted to find out the sex of the baby and I was overjoyed it was a girl because that\u0026rsquo;s what we wanted, one of each, so that helped me feel more connected and gave me that real drive to just keep going and keep going.\u003c/em\u003e (P3 Breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMany accounts detailed efforts to retain a sense of normality during a disrupted antenatal and postnatal period, highlighting the emotional toll of guilt and social withdrawal:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eFor the first couple of weeks, it was a nice positive thing, like having a baby and it was something to look forward to and then you start (more investigations) [\u0026hellip;] got the CT scan and then it was back to all about the cancer. Then you are starting treatment. I feel like I pushed myself so much to still do things, like still make sure I was doing my fair share with [son], even probably when I shouldn\u0026rsquo;t have, I should have just been taking my time. But I feel like I did keep pushing myself. I think there was a lot of guilt there.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eI sometimes I couldn\u0026rsquo;t look after him, I couldn\u0026rsquo;t look after both my kids and that was quite hard, I was relying on my mum and dad a lot and my husband and I felt like a bad mum [\u0026hellip;] It\u0026rsquo;s hard because you know it\u0026rsquo;s not your fault, but you still feel that guilt. Some days I just wanted to hide in my room and just hide under the duvet and not come out. I did [laughs]. But yes. It was hard.\u003c/em\u003e (P9 breast cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWomen also showed concern about the emotional impact of their cancer their partners and extended family members, frequently experiencing guilt for the distress caused to their loved ones:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eMassive fear\u0026hellip;\u0026hellip; So how are we going to tell family? Guilt that I was bringing it on the family as a whole, which I know is utterly ridiculous, but at the time I did feel really guilty that, at a time when it should have been a time of joy for the family in having my daughter \u0026ndash; [infant] is the first grandchild on both sides \u0026ndash; so going from the joy of having a [n] week-old baby to having lockdown, where we didn\u0026rsquo;t know whether grandparents would be able to see her, to not only having that but then the cancer diagnosis. I felt really guilty that I was adding more stress and worry to everybody\u0026rsquo;s plates, not just ours.\u003c/em\u003e (P18 Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome women found themselves supporting their partners and families while simultaneously managing their own adjustment. One woman, experiencing a recurrence, adopted a problem-focused approach:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e[My Partner] \u003cem\u003ewas really upset, crying, and I just turned round and said, \u0026ldquo;We\u0026rsquo;ve done this. We can do it again\u0026rdquo;. I just said [to her partner], \u0026ldquo;Right, tell me what we need to do, and we\u0026rsquo;ll take each week as it comes\u0026rdquo;.\u003c/em\u003e (P16 Breast Cancer with bone metastases)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCoping, adjustment and support\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMany described how cancer had permanently changed them, leading to long-term psychosocial adjustment challenges years later:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI used to be quite outgoing, quite a social person. I\u0026rsquo;m finding it really difficult to go out now, quite anxious about seeing people, definitely lacking in confidence in myself, not just appearance but everything.\u003c/em\u003e (P9 Breast Cancer)\u003c/p\u003e\u003cp\u003e\u003cem\u003eI read something recently that said being diagnosed with cancer is like having a gun placed to the back of your head. It\u0026rsquo;s always there, you know it\u0026rsquo;s always there and sometimes you just feel it a bit more [\u0026hellip;] it\u0026rsquo;s just learning to live with it always being there [\u0026hellip;] I find I need to manage one day at a time, one week at a time. (P4 Breast Cancer)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some diagnosed during COVID-19 restrictions, lingering frustrations about care experiences later exacerbated their fears of recurrence:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI\u0026rsquo;m angry with myself [\u0026hellip;] and I\u0026rsquo;m angry with them that it took so long [\u0026hellip;] With my birth as well, I was angry that they didn\u0026rsquo;t know about my situation and they didn\u0026rsquo;t have the compassion for my husband to [due to Covid \u0026hellip;] stay with me.\u003c/em\u003e (P9 Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWomen described varied experiences with support, ranging from deep isolation to resilience fostered by social networks:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIt was frustrating because I\u0026rsquo;d found the [names support group] very helpful, but you only get to go to that once. It\u0026rsquo;s run every year but once you\u0026rsquo;ve been once that\u0026rsquo;s it [\u0026hellip;] I always felt very alone and very isolated. That didn\u0026rsquo;t help my mental health. I had a massive crash mentally afterwards because just, well, everything got on top, I suppose.\u003c/em\u003e (P4 Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSpecialist psychological support was often seen as more beneficial later in their survivorship journey, rather than during treatment:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI\u0026rsquo;ve not found counselling very helpful, to be honest. [\u0026hellip;] At that time, it wasn\u0026rsquo;t as easy to talk about it when you are going through the throes of treatment [\u0026hellip;] I\u0026rsquo;m considering therapy now [\u0026hellip;] but just I think maybe because all the dust has settled you start to really appreciate all the complexities of what you are feeling. But during (treatment) [\u0026hellip;] I don\u0026rsquo;t think I had the headspace for it and the counselling [\u0026hellip;] I think I was just too busy just surviving it.\u003c/em\u003e (P15 Bowel Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome sought professional help for their mental health, while others recognised the importance of self-care and maintaining well-being during survivorship:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI did go for counselling after my active treatment finished, just because I was aware that I had been through a lot [\u0026hellip;] I knew that I needed to make sure I was alright emotionally and mentally [\u0026hellip;] I needed to make sure I had time to reflect and accept what had happened to me as well [\u0026hellip;] I know that at certain times I might need to go back into that [\u0026hellip;] just to make sure I\u0026rsquo;m keeping myself well mentally as well as physically.\u003c/em\u003e (P18 Breast Cancer)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides important contributions to the research into the complex experiences of women navigating cancer survivorship when the diagnosis coincided with pregnancy. Although fortunately an uncommon diagnosis, incidence is increasing, and so it is important that cancer professionals are aware of the issues faced by these women and families in survivorship[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] in order to support shared decision-making about treatment [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and to provide support at the time when it is needed.\u003c/p\u003e\u003cp\u003eOur findings highlight the tension between autonomy and constraint in decision-making, where women’s choices about treatments, investigations, and parenting decisions such as breastfeeding were frequently shaped or limited by external factors related to their cancer. While some women were able to negotiate aspects of their care, others felt their options were restricted or imposed, contributing to feelings of uncertainty, guilt, and powerlessness. These high-stakes decisions, sometimes made contrary to medical advice or in the absence of clear guidance, placed considerable emotional strain on women already managing the dual challenges of cancer and pregnancy.\u003c/p\u003e\u003cp\u003eThis aligns with the wider literature on decisional regret in oncology, which shows that constrained or unsupported decision-making is associated with lasting psychological distress, including anxiety, guilt and reduced quality of life[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Decisional regret is particularly pronounced when patients feel they have received insufficient information or were pressured into choices that conflicted with their personal values[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, in the context of maternity and early motherhood, emerging research suggests that when women’s decisions during pregnancy and childbirth are constrained by external factors, this can contribute to sense of lost autonomy and subsequent regrets[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur findings suggest that for pregnant women with cancer, these dynamics may be further amplified by the simultaneous need to consider foetal well-being, compounding the emotional complexity of care decisions and increasing potential for long-term psychological impact.\u003c/p\u003e\u003cp\u003eStudies have also reported that many women feel overwhelmed by the need to balance cancer treatment with pregnancy-related concerns, contributing to emotional distress, guilt, and confusion about how to prioritise care[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e–\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similar to our study, previous work has shown that the care of these women may be fragmented across multiple specialties with variable communication, contributing to feelings of being unsupported or misunderstood by their healthcare teams[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe emotional disruption reported by the women, with psychological stress emerging as a key theme in their journey, are consistent with those of other qualitative studies on cancer and pregnancy, which have similarly highlighted the emotional and psychological challenges faced by women in this context[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur findings aligns with the \"burden of treatment\" theory, which describes the workload imposed on patients by healthcare systems and their capacity to manage that burden [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In our study, this burden was compounded by the unique challenge of navigating two life-changing events simultaneously: cancer and pregnancy. For many, this duality created not only competing demands; managing intensive medical care, adapting to the pregnancy, and in many cases, continuing caregiving and work responsibilities[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], but also conditions of cumulative stress that may be experienced as traumatic. Several women described being in survival mode, focused on simply getting through the experience day by day. In this context, the act of enduring, rather than reflecting, became the priority. This response is consistent with trauma theory[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], which recognises how chronic threat, uncertainty, and loss of control can lead to psychological trauma, even in the absence of a single acute event. The cumulative impact of delayed emotional response, sustained stress, and role overload may explain the longer-term adjustment difficulties some women described in survivorship and suggests the potential value of adopting a trauma-informed approach[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] to post-treatment care. Such an approach emphasises safety, empowerment, and understanding of trauma’s impact on physical and emotional wellbeing[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and may help address unmet psychological needs in this population[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This warrants further research.\u003c/p\u003e\u003cp\u003eFinancial precarity emerged as a consistent concern in our study, reflecting findings from the cancer survivorship research [\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e–\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and maternity and early motherhood literature [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. This financial strain is particularly concerning given its established association with poorer mental health outcomes[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. However, the economic impact of cancer during pregnancy remains under-researched but it is likely that being diagnosed with cancer during pregnancy worsens this.\u003c/p\u003e\u003cp\u003eWomen of childbearing age are often in the early or mid-stages of building their careers, and a diagnosis of cancer during this life phase may have lasting consequences for income, job security, and long-term career progression. The economic burden of undergoing cancer treatment while pregnant, including costs associated with frequent hospital visits, treatment-related expenses, and the potential loss of earnings due to reduced capacity to work likely compounds the overall challenges of managing pregnancy associated cancer.\u003c/p\u003e\u003cp\u003eIn our study, these pressures were a recurrent theme, pointing to a significant gap in the literature around how best to support women with cancer during pregnancy, particularly in terms of financial guidance, workplace rights, and reintegration into employment following treatment.\u003c/p\u003e\u003cp\u003eMaternal guilt[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], previously described in the context of high-risk pregnancies[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], was also intensified in the context of cancer and may be an issue that cancer clinicians working with these women are unaware of. Concerns about the health of their baby, their ability to manage treatment, ability to care and live up to their own expectations for existing children or their maternal role contributed to deep, long-lasting feelings of guilt. These emotional challenges can be traumatising and may have a lasting impact on women’s psychological well-being, potentially shaping their long-term adjustment and recovery[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Our findings emphasise the need for integrated psychological support, as many women actively sought out personalised care, often finding it difficult to find appropriate resources.\u003c/p\u003e\u003cp\u003eRoutine access to counselling and emotional support should be considered an essential component of care for women with PAC, given the profound and enduring psychological effects reported by participants in our study and others [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. However, the timing and format of such support warrant careful consideration. As our findings and existing literature suggest, women are often in “survival mode” during diagnosis, treatment, and early motherhood; emotionally overwhelmed and focused on immediate tasks. In this context, some may lack the capacity or headspace to benefit from psychological interventions when they are offered in the immediate post-natal/treatment period.\u003c/p\u003e\u003cp\u003eFurthermore, our study resonates with the broader body of research on maternal guilt and shame[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Studies on women facing high-risk pregnancies[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], including those with cancer, consistently report feelings of guilt related to their health, treatment choices, and maternal role. Our study further demonstrated that in the context of PAC, this guilt is compounded by concerns about the potential impact of cancer treatment on the foetus and the difficulty of managing both the emotional and physical demands of pregnancy alongside cancer treatment. Our findings are consistent with those of other studies on cancer and pregnancy, which have similarly highlighted a sense of isolation and uncertainty[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], as these women struggle to make decisions about their health and the health of their unborn child.\u003c/p\u003e\u003cp\u003eRather than a one-size-fits-all approach, psychological support should be trauma informed, flexible, ongoing, and tailored to individual readiness. Some women may benefit most from support in the later stages of survivorship, once the initial intensity of treatment and caregiving has eased and emotional processing becomes more feasible. Integrated, long-term support pathways could help ensure that women are not only offered care but are also able to access it at a time that aligns with their emotional recovery trajectory[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. This also requires more coordinated services and greater recognition of the significant effort involved in navigating two clinical specialties, oncology and maternity, that often operate in silos.\u003c/p\u003e"},{"header":"Limitations and Strengths","content":"\u003cp\u003eThis study has some limitations. The sample size was relatively small and self-selecting, which may limit the transferability of the findings. However, given the aim of the study, the shared experience of participants (cancer diagnosis during or shortly after pregnancy), and the richness of data generated, our sample size was considered sufficient to support in-depth qualitative analysis based on the principle of information power[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, the study relied on retrospective accounts of participants’ experiences, which may be subject to recall bias. However, this was countered by the detailed description participants provided, including dates of diagnosis and other significant events. While the lack of cultural diversity in the sample may limit the applicability of findings to broader populations, the study did include geographic diversity across the UK and captured a range of experiences. There was also diversity in the quality of care received, some women were dissatisfied with their oncologist or obstetrician, while others reported positive experiences and felt well supported. Furthermore, the cross-sectional nature of the study limits our ability to qualitatively examine long-term psychological outcomes or the evolution of women's experiences over time.\u003c/p\u003e\u003cp\u003eDespite these limitations, the strengths of this study lie in its novel contributions to understanding the psychological, emotional, and financial burdens faced by women with PAC, an underexplored area in existing literature. By focusing on participants lived experiences, this study provides valuable insights that can inform future research and guide improvements in healthcare delivery for this population.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eThis study illuminates the significant emotional, psychological, and financial challenges faced by women with PAC, often exacerbated by fragmented care pathways. Healthcare systems need to prioritise the integration of multidisciplinary care teams that address not only the medical aspects of treatment but also the psychological, financial, and social dimensions of these women’s experiences. Preliminary implications for survivors and families are summarised in Supplement 5. Future research should explore long-term psychological outcomes for women with PAC and investigate interventions to improve care integration and support services. Enhancing survivorship care for women with PAC is crucial for improving their quality of life both during and after treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eImplications for Cancer Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStructured psychosocial interventions and long-term support are needed. Research should address care integration and financial impacts to better support affected families.\u003c/p\u003e\n\u003ch2\u003eCompeting interests:\u003c/h2\u003e\n\u003cp\u003eThe authors have declared no competing interests.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eJenny Harris: Conceptualization; Methodology; Formal analysis; Writing - Original draft; Writing \u0026ndash; review \u0026amp; editing; Supervision; Funding acquisition. Afrodita Marcu: Conceptualization; Methodology; Data collection; Supervision; Writing \u0026ndash; review \u0026amp; editing; Supervision; Funding acquisition. Faith Gibson: Conceptualization; Methodology; Writing \u0026ndash; review \u0026amp; editing; Funding acquisition. Emma Ream: Conceptualization; Methodology; Writing \u0026ndash; review \u0026amp; editing; Funding acquisition. Karen Poole: Conceptualization; Methodology; Writing \u0026ndash; review \u0026amp; editing; Funding acquisition. Jane Stewart: Formal analysis; Writing - Original draft.Jenny Harris: Conceptualization; Methodology; Formal analysis; Writing \u0026ndash; review \u0026amp; editing; Supervision; Funding acquisition.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe are grateful to the charity Mummy\u0026rsquo;s Star and in particular its CEO, Pete Wallroth, for supporting this research and facilitating access to study participants. We would like to thank Lisa Whittaker, Shakardokht Jafari and Laura Pearson for their invaluable involvement as patient representatives, and all the women who participated and shared their experiences in the interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp; This research was supported by an internal grant from the School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey. Faith Gibson is supported in part by the Great Ormond Street National Institute for Health and Care Research (NIHR) Biomedical Research Centre. Jo Armes receives funding from the NIHR Applied Research Collaboration Kent, Surrey, Sussex (grant number: NIHR200179). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe research data are not shared because they contain sensitive and potentially identifying information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMa, K.K., et al., \u003cem\u003eCancer and pregnancy: national trends\u003c/em\u003e. American Journal of Perinatology, 2022. 39(02): p. 144\u0026ndash;153.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaggen, C., et al., \u003cem\u003ePregnancy and cancer: the INCIP project\u003c/em\u003e. Current oncology reports, 2020. 22: p. 1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmant, F., et al., \u003cem\u003eManagement of cancer in pregnancy\u003c/em\u003e. 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Journal of Cancer Survivorship, 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteel, J.L., et al., \u003cem\u003ePatient, family caregiver, and economic outcomes of an integrated screening and novel stepped collaborative care intervention in the oncology setting in the USA (CARES): a randomised, parallel, phase 3 trial\u003c/em\u003e. Lancet, 2024. 403(10434): p. 1351\u0026ndash;1361.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Cancer survivorship, Pregnancy-associated cancer, Psychosocial support, Qualitative research, Decision-making","lastPublishedDoi":"10.21203/rs.3.rs-7040036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7040036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003ePurpose:\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eCancer diagnosed during pregnancy presents unique challenges, requiring women to navigate treatment alongside pregnancy and early parenthood. While clinical aspects are well studied, the psychosocial impact on survivorship remains underexplored. This study examined the lived experiences of women diagnosed during pregnancy, focusing on emotional, psychological, and practical challenges from diagnosis through survivorship.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods:\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eA qualitative study was conducted using interview data from 20 women in the UK diagnosed with cancer during pregnancy. Participants were recruited via Mummy’s Star, a charity supporting individuals affected by cancer in pregnancy. Interviews were thematically analysed using template analysis, focusing on decision-making, psychosocial burden, and support needs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults:\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eSix interrelated themes were identified: (1) \u003cem\u003eManaging cancer with uncertainty\u003c/em\u003e, women reported distress due to delayed investigations and treatment adjustments during pregnancy; (2) \u003cem\u003eEthical decision-making\u003c/em\u003e, emotionally charged choices around treatment, birth, and feeding were made with limited or conflicting information; (3) \u003cem\u003eBalancing cancer and its treatment with pregnancy and family life\u003c/em\u003e, early parenting was disrupted; (4) \u003cem\u003eWork disruption and financial strain\u003c/em\u003e, treatment-related costs and lost income caused hardship; (5) \u003cem\u003eEmotional impact of \u003c/em\u003ediagnosis and treatment; including lasting psychological effects; and (6) \u003cem\u003eCoping and support\u003c/em\u003e, \u0026nbsp;guilt, fear of recurrence, and unmet support needs persisted post-treatment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions:\u003c/em\u003e\u003cstrong\u003e \u003c/strong\u003eWomen diagnosed with cancer in pregnancy face profound, long-term emotional and financial challenges. Fragmented care and inadequate support exacerbate these difficulties. Integrated multidisciplinary care is essential to improving survivorship.\u003c/p\u003e","manuscriptTitle":"Cancer diagnosed during pregnancy: a qualitative study of women’s psychosocial experiences during treatment and survivorship","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-09 07:51:54","doi":"10.21203/rs.3.rs-7040036/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-09T03:52:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T09:55:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312452674918169957743172939690323579382","date":"2025-11-21T10:22:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155800004257924207874525460664916382155","date":"2025-09-09T19:51:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-16T12:18:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-16T12:15:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-09T22:09:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-07-03T16:07:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e902d96c-c8ec-4bae-90f4-4d15e1403eda","owner":[],"postedDate":"July 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:08:53+00:00","versionOfRecord":{"articleIdentity":"rs-7040036","link":"https://doi.org/10.1007/s00520-026-10645-7","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2026-04-23 15:58:16","publishedOnDateReadable":"April 23rd, 2026"},"versionCreatedAt":"2025-07-09 07:51:54","video":"","vorDoi":"10.1007/s00520-026-10645-7","vorDoiUrl":"https://doi.org/10.1007/s00520-026-10645-7","workflowStages":[]},"version":"v1","identity":"rs-7040036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7040036","identity":"rs-7040036","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}