Motherhood with cancer: A qualitative interview study on burdens and support needs among mothers with gynecological tumors

Motherhood with cancer: A qualitative interview study on burdens and support needs among mothers with gynecological tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Motherhood with cancer: A qualitative interview study on burdens and support needs among mothers with gynecological tumors Theresa Engel, Pauline Faßler, Achim Wöckel, Elisabeth Jentschke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7904049/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Mothers diagnosed with gynecological tumors often experience substantial psychosocial strain. This study aimed to capture their specific needs and identify levers for targeted support by interdisciplinary healthcare professionals. Method Twenty-nine semistructured interviews with mothers who had a gynecological tumor, were receiving chemotherapy and/or radiotherapy, and were caring for minor children were conducted. The transcripts were analyzed via qualitative content analysis according to Kuckartz [ 1 ]. Results Six major themes emerged: experience of diagnosis; motherhood after diagnosis; impact on the mother–child relationship (MCR); communication and openness about the illness; social environment and support; and psycho-oncological care. Most women reported changes in the MCR—predominantly positive. At the same time, participants highlighted clear gaps in care, particularly regarding communication with their children and the social environment, as well as support with childcare and household management. Conclusions These findings emphasize the need to raise awareness among clinical staff of the unique psychosocial burdens faced by mothers with cancer. Such awareness may foster the development of targeted interventions that alleviate emotional distress and improve quality of life. breast cancer communication gynecological tumors mother–child relationship parenthood psycho-oncological intervention qualitative research quality of life semistructured interviews Background Gynecological tumors rank among the most common malignancies in women. According to the WHO’s Globocan Project (2022), four of the ten most common cancers in women belong to this group, accounting for a total of 40.4% (breast 25.0%, cervix uteri 7.2%, corpus uteri 4.6%, ovary 3.5%) [ 2 ]. Breast cancer therefore represents the most prevalent malignant disease among women. The prevalence of psychological distress and mental disorders in mothers with gynecological tumors is also high [ 3 ]. Beyond the challenge of coping with the disease itself, these women face complex family dynamics, particularly with respect to their children. Common concerns include the emotional and social development of their children, changes in the mother–child relationship (MCR), and difficulties communicating about the illness [ 4 ]. Many patients report that these topics receive insufficient attention in medical care. In recent years, research has gradually shifted its focus from the experiences of children (e.g., [ 5 ]) toward the well-being of parents, particularly mothers (e.g., [ 6 ]). Studies indicate that affected mothers often redefine their maternal role to remain present and supportive of their children despite the disease [ 7 ]. Protecting their children and maintaining stable routines are key priorities for parents in this situation [ 8 ]. However, communication about the illness is frequently perceived as distressing; many mothers vacillate between openness and the desire to shield their children [ 9 , 10 ]. Although professional support is considered essential, many mothers experience it as insufficient [ 11 ]. Consequently, several studies emphasize the need for culturally sensitive, family-oriented interventions [ 8 ]. Because cultural differences may limit the transferability of international findings, the present study examined the experiences of affected mothers in Germany. The objective of this study was to explore how radio- and/or chemotherapy affect the relationship between mothers with gynecological tumors and their children and to identify perceived needs and potential approaches for improving psychosocial care. Methods To gain an in-depth understanding of how mothers perceive the effects of cancer treatment on the MCR, an exploratory qualitative interview study was conducted between December 2018 and June 2022. Eligible participants were women diagnosed with gynecological tumors who were receiving chemotherapy and/or radiotherapy and had at least one minor child. Semistructured interviews were carried out and analyzed via qualitative content analysis according to Mayring, as modified by Kuckartz [ 1 ]. The study protocol was reviewed and approved by the Ethics Committee of the Medical Faculty of the responsible university (reference no. 183/18-me, August 11, 2021). Study population and data collection Potential participants were approached verbally by clinical staff in the oncological day clinic of the Department of Gynecology and/or during inpatient treatment. The inclusion criteria were as follows: (1) confirmed diagnosis of a gynecological tumor, (2) presence of at least one minor child at the time of diagnosis, and (3) receipt of radio- and/or chemotherapy. Patients were excluded if significant language barriers precluded an interview. All participants were fully informed about the study and provided written informed consent. Study information was distributed via flyers and explained verbally and in writing by the study team. Participation was voluntary, and no financial or other incentives were offered. The interviews were conducted in private rooms within the treating hospital. Recruitment and interviews were carried out by a doctoral candidate in human medicine (T.E.) as part of her dissertation, supervised by an experienced psycho-oncologist who led the overall project. The interviewer had no prior personal or professional relationship with any participant. A semistructured interview guide was developed on the basis of a literature review addressing the experiences of mothers with cancer. Five key themes were defined: (1) thoughts at the time of diagnosis, (2) impact on the MCR, (3) communication, (4) support from the social environment and psycho-oncological counseling and (5) reflections on motherhood. The guide ensured comparability across interviews while allowing adaptive follow-up questions. The complete guide is provided in Supplementary File 1 . All interviews were recorded via an MP3 device. The average duration was 17 minutes (SD = 8.4 minutes), ranging from 7–47 minutes. Following each interview, the participants completed a self-developed questionnaire capturing sociodemographic and clinical data, including age; marital status; education; employment; tumor type; date of diagnosis; therapy; psycho-oncological or psychotherapeutic care; and the number, age, and sex of the children. This instrument is provided in Supplementary File 2 . Data analysis The interviews were transcribed verbatim according to simplified transcription rules by Kuckartz [ 1 ] and anonymized. The transcripts are available in Supplementary File 3 . Data analysis followed Kuckartz’s structured approach to qualitative content analysis, characterized by systematic category development grounded in the material itself. Data collection continued until thematic saturation was reached; that is, no new categories emerged from subsequent interviews. Saturation was monitored throughout the analysis process. Coding was performed by the interviewer via f4 analysis software. Because of limited resources, an independent second coding could not be performed. In alignment with the research question, an initial set of deductive categories was derived from prior literature and the interview guide on the basis of existing theoretical concepts and defined independently of the data. After the first coding round, inductive categories were generated directly from the material. To ensure comprehensive coverage, a second round of coding was conducted, allowing multiple category assignments per segment. The final coding and synthesis were conducted via MAXQDA 2022 (VERBI GmbH). Six main thematic categories were identified: (1) experience of diagnosis, (2) motherhood after diagnosis, (3) mother–child relationship, (4) communication and openness, (5) social environment and support, and (6) psycho-oncological care. Results The study population consisted of 29 participants (all females) aged between 30 and 50 years (M = 40.7, SD = 4.8) who were receiving medical treatment for gynecological cancer. A detailed description of the sample can be found in Table 1 . Table 1 Sociodemographic and clinical characteristics of the study sample (N = 29) Variable n Age at diagnosis M = 40,7 SD = 4,8 30–39 years 11 40–49 years 17 50–59 years 1 Tumor type Breast cancer 26 Cervical cancer 2 Ovarian cancer 1 Type of therapy 1 Surgery 26 Chemotherapy 26 Radiotherapy 12 Other (e.g., immunotherapy, endocrine therapy) 10 Marital status Single 1 Married 24 Divorced 3 Widowed 1 Number of children 1 4 2 14 3 8 4 3 Employment before diagnosis Employed 27 Not employed 2 Received psycho-oncological support Yes 19 No 10 1 Multiple responses possible Table 2 provides an overview of the main categories and core themes that emerged from the analysis of the interviews. A detailed description of all categories is not provided here, as this would be too comprehensive. Instead, key content is discussed in greater detail and illustrated with representative quotes from participants. To ensure transparency of the analytic process, the full category system developed through qualitative content analysis—including all hierarchical levels—is available in Supplementary File 4 . Table 2 Categories and Core Themes Main Category Core Themes Illustrative Aspects Experience of the diagnosis Emotional reaction, coping strategies, side effects Shock, fear for children, optimism, need for empathy and information Illness in the context of motherhood Redefinition of maternal role, balancing illness and family Maintaining normalcy, concealing illness, guilt, new priorities, family cohesion Mother–child relationship Perceived changes in closeness or distance Closer emotional bond, empathy, occasional withdrawal by children Communication and openness Strategies for disclosure, challenges of hereditary cancer Openness vs. protection, age-appropriate communication, need for guidance Social environment and support Practical and emotional support, unmet needs Partner and family assistance, domestic help, school challenges Psycho-oncological care Utilization, barriers, and experiences Value of counseling, limited awareness, logistic barriers, peer support Experience of the diagnosis The first main category describes how the study participants experienced their cancer diagnosis. A large proportion of respondents (n = 19) reported being surprised and shocked by the diagnosis. Several women also mentioned that their immediate thoughts were about their children—particularly their wish to see them grow up and not leave them behind. In addition to the initial sense of being overwhelmed, some women reported adopting an optimistic attitude and developing a heightened awareness of their own needs. The participants also frequently discussed distressing symptoms during treatment, such as hair loss, nausea, and vomiting. A recurring point of criticism concerned the perceived lack of empathy and the insufficient communication of information by medical staff. “My doctor just said, ‘Start therapy,’ […] However, what that actually meant, what the chances of success were, and everything else—I didn’t truly get any initial information during that conversation.” (Pt. 11) Illness in the context of motherhood The next main category focused on motherhood after the diagnosis. When asked whether their attitudes toward motherhood had changed, 28 of the 29 participants responded in a way that allowed the answers to be categorized into “changed” and “unchanged.” Of these, 54% (n = 15) of the mothers indicated that their attitudes toward motherhood had not changed, whereas 46% (n = 13) reported a change in their attitudes. However, all the interviewed mothers stated that their role as a mother was affected by their cancer diagnosis. This included dealing with their uncertain future due to the illness. The participants described efforts to maintain a sense of normalcy by continuing to be a familiar point of reference for their children. This often involved concealing certain aspects of the illness for some time, such as hiding hair loss by wearing a wig or arranging for the children to stay with family or friends on chemotherapy days, to avoid showing physical and psychological limitations to their children. Nevertheless, the children experienced having a sick mother, which often placed a double burden on the mothers due to their own symptoms as well as concerns about the impact on their children. The participants repeatedly reported their children’s reactions to their hair loss, which varied widely. More than half of the patients reported everyday limitations attributable to cancer treatment. The generally reduced resilience often meant that mothers could not be fully available to their families and were unable to meet their children’s needs to the extent that they wished. This was frequently experienced as burdensome. “At times, I was almost just lying around, and I found that truly hard. I wasn’t even available to talk to the kids, which I always thought was important. I just did not have the headspace for them—I was preoccupied with myself.” (Pt. 12) Many participants concluded that fighting cancer was a family task. In addition, they often described stronger family cohesion and an increased sense of appreciation or gratitude toward their family. In particular, increased time spent together with partners and children was frequently mentioned. “It’s definitely more intense now. Like, yeah. You actually sit down, play games in the evening.” (Pt.22) “That was nice because it somewhat fulfilled my needs and, like I said, my husband was truly there a lot, and we just had a lot of time together as a family, which usually doesn’t happen.” (Pt. 13) Several mothers, particularly those with older children, reported that their children had become noticeably more independent since the time of diagnosis. They observed not only an increase in household skills such as cooking and doing laundry but also greater maturity in terms of school responsibilities and emotional support. Many participants reported having set new priorities in life, which initially included recognizing and expressing their own needs. “I don’t even know what my needs are. I’ve always just functioned and never truly thought about what my needs are. I’m still learning.” (Pt. 25) Several women distanced themselves from others’ expectations and placed less importance on a perfectly managed household. Aspects such as their children’s academic performance were also sometimes reassessed. “It doesn’t have to be, like, classically sweeping the street at 10 in the morning. No, I sweep when I have the time and feel like it […] You just do many things when you truly want to. In addition, you discover a bit more of the good things in life.” (Pt. 4) “Because I know that health is the most important thing, we don’t have big discussions about school, grades, or cleaning up rooms.” (Pt. 1) Mother‒Child Relationships The third main category includes the perceived impact of the cancer diagnosis on the MCR. In the interviews, 24 mothers described a change in their relationship with their child/children, whereas 13 women denied such a change. The number of mentions exceeds the number of 29 interviews because mothers with multiple children discussed each relationship separately, allowing multiple mentions. When mothers reported positive changes, the most frequently described change was an intensification of the MCR. Most women experienced understanding and solidarity from their children and felt that they had generally grown closer to them. Some reported sharing worries and fears or an increase in physical closeness (e.g., in the form of hugs or cuddling). “It has certainly become [...] emotionally closer or more emotionally open.” (Pt. 7) Some participants reported perceiving their children as more caring. “For example, my daughter loves to massage my head in the evenings. I enjoy it, I close my eyes, and she massages my head the whole time.” (Pt. 27) Negative changes in the MCR were mentioned much less frequently. Six mothers felt that their children distanced themselves from them after the diagnosis and that they had less access to their children. “I was in the hospital for two weeks, so mom wasn’t home for two weeks. Even though they visited me, she did not come close to me. You could tell the difference—that she wasn’t comfortable with it at two years old.” (Pt. 5) Among the participants who reported no change in the MCR, some described having always had a very close relationship with their children that was unaffected by the illness. One mother reported raising her children from birth at a certain distance so that she did not perceive any change in their relationship due to the illness: “I was actually glad I raised them the way I did—that they, well, don’t cling to me, so to speak. That they’re not that close to me.” (Pt. 8) Communication and openness in dealing with the illness The fourth main category focused on communication and openness regarding the illness, particularly in conversations with the children. The 15 mothers who reported discussing the diagnosis with their children found these conversations very challenging, and some wanted to delay the moment of disclosure. Various reasons were given for this, including the belief that children “have a right to an intact world” (Pt. 26) Which one does not want to shatter, that their own processing of the illness was not yet sufficient, and that the children’s reactions to the information were unpredictable. Several women noted feeling relieved after the conversation and were glad to have talked with their children. With respect to their communication strategies, more than two-thirds of the women reported openness as their chosen approach. The most common reason cited was to foster a greater understanding of the illness among their children. Many mothers also emphasized the importance of continuing to include their children in their lives—including the illness—and ensuring that future questions and conversations could take place. For Participant 20, involving her children was particularly important for alleviating their fears: “Because then the uncertainty is gone, and children can sense when something is wrong or being hidden. Therefore, I think it was a relief for them to know […] what is happening to us.” (Pt. 20) Most mothers also paid attention to adjusting the conversation to the child’s age. This included, among other things, avoiding overloading the children with too many details. The focus was usually less on the current state of illness and more on recovery. Additionally, many women (n = 12) avoided using the word “cancer” with their children, often because of its strong associations with suffering, death, and dying. Dealing with hereditary cancer posed a particular challenge. This was often accompanied by feelings of guilt and significant uncertainty. It was especially important for affected mothers that their daughters conscientiously attend gynecological screenings. One participant also mentioned heightened vigilance regarding breast cancer in relation to her son. In some cases, the genetic predisposition also created conflict potential, as one participant reported: “They then just casually threw it back at me and said, ‘Thanks a lot, Mom, right? Now you have breast cancer—hopefully, you did not pass it on to us.’ That was just teenage stuff, I think, but it was also somewhat justified.” (Pt. 8) When a genetic mutation was confirmed, the women often found themselves conflicted about when and how extensively to discuss it with their children. Many reported relying primarily on their intuition regarding these conversations and not feeling the need for assistance. When support was desired, mothers generally had to be proactive in seeking contacts and/or informational materials themselves. Most women reported wishing for more offers and support from medical staff in this regard. Social environment and Support The fifth main category addresses patients’ experiences with their social environment—including spouses, family, friends, acquaintances, and neighbors—and how they perceived the support they received. Among the 29 interviewed participants, 27 expressed satisfaction with support from their social environment. In families with older children who had increasing independence and the ability to help with daily tasks, less external support was generally necessary. The most frequently reported forms of assistance included caring for the children and help with household tasks, as well as emotional support and opportunities for conversation. Many participants described active support from their own parents in all areas. Fourteen women reported support from their partners, who were also confronted with a new reality following the diagnosis. A new division of labor was described. “He took over everything and truly had my back. However, you have to say, he was quite overwhelmed by it.” (Pt. 25) Overall, ten women reported being offered domestic help financed by health insurance. In many cases, such assistance was not needed because the partners took on the respective tasks. Although a clear majority stated that they were satisfied with the support received, five participants reported wishing for more assistance in some areas. The most common challenges mentioned related to logistics, such as taxi rides, dealing with authorities, social services, and childcare. The women emphasized the importance of not only receiving informational materials but also obtaining concrete help when needed. A few mothers reported challenges related to school and daycare. These included the perception that they sometimes encountered little understanding of their current life situation and its resulting consequences. Psycho-Oncological Care The sixth main category concerns psycho-oncological care. In the questionnaire, 19 women (66%) indicated that they had utilized psycho-oncological support. A portion of the participants (n = 11) reported that they did not and, thus far, did not have a need for further psycho-oncological therapy. Some respondents emphasized that the service represented an important addition to support from friends and family. “That it’s simply offered—you don’t have to accept it, but if you don’t have someone like, say, my nice colleague, then you can get someone with whom you can truly talk things through. Not just superficially, but someone who truly helps you on the inside.” (Pt. 8) Two interviewees recommended at least trying the offer. Four women described their ambivalence at the beginning of their illness, where they did not seek therapy because they were very focused on physical recovery but generally considered it to be helpful. Logistical challenges such as long travel distances (Pt. 13) were also mentioned, which in some cases made it impossible to attend psycho-oncological sessions. With respect to information and opportunities for psycho-oncological support, the patients expressed an understanding of the high workload of medical staff but wished for more proactive inquiries, especially from physicians. Many mothers reported that questions and uncertainties arose only as the illness progressed. They indicated that an initially provided leaflet was perceived as less helpful. Although screening procedures were established, many women felt that these procedures resulted in psycho-oncological support only if they actively requested it. Several women emphasized the importance of support services but also saw room for improvement. Some participants wished, for example, that psycho-oncological services would be more centrally placed (Pt. 7) or for greater involvement of children: “I could imagine something like a self-help group for children, or maybe a family event or meeting with others going through the same thing, because it kind of connects you. And I think it also gives that feeling that you’re not alone.” (Pt. 13) Twelve patients reported positive experiences with psycho-oncological therapy offers that had helped them. “[…] I found the care itself very good, that there was an option outside of the family to address things that you no longer want to discuss within the family, whether with your partner or your children. That was very good, and I was very grateful for the encouragement that such an option exists.” (Pt. 20) The patients often received new perspectives that allowed them to better assess their situation and draw consequences from it. Three women additionally emphasized that psychological processing takes time and is not complete at the end of treatment. Five participants reported negative experiences, primarily stating that they had expected more from the conversations and that their specific fears and current problems were often not addressed adequately. Five patients indicated that they had not found a suitable therapist because they could not build trust during the initial consultation. Several women also reported finding exchanges with other affected mothers very enriching. It helped them share experiences and benefit from the insights of others. “In rehab, it was actually nice to find out that others are going through the same thing—it was group therapy or sometimes individual—and just being able to exchange with others because there are so many emotions involved and to feel relief, knowing you’re not alone” (Pt. 13) Discussion The results of this study underscore that a cancer diagnosis represents a life-changing event for affected mothers, accompanied by significant uncertainty about their own future and, especially, that of their children. Most participants responded to this uncertainty by striving to maintain as much normalcy as possible in daily family life. The burdens identified in previous studies (e.g., [ 4 ], [ 6 ]), such as managing everyday life, particularly child-rearing, and communicating with children about the illness, were also reported by the participants in this study. Notably, the study participants clearly identified gaps in care for mothers with cancer—especially with respect to communication with their children and the social environment—as well as challenges related to childcare and household management. While these aspects are often mentioned in the literature, our study highlights the impact of the illness on the mother role and MCR in a concrete way that is directly evaluated by the women themselves. Unlike other qualitative studies (e.g., [ 8 ], [ 12 ]), which often rely on abstract conclusions [ 13 ], the semistructured interviews in our study allowed for an explicit and nuanced assessment of changes in the MCR. Remarkably, most mothers reported positive changes, suggesting potential resilience and new closeness despite the burdens. When describing deficiencies in care, a particular focus was placed on dealing with hereditary cancer, which was described as especially challenging. Some affected women experienced guilt over possibly passing on an increased cancer risk to their children, which is consistent with findings from previous studies [ 14 ]. They primarily wished for more support in communicating with their children in an age-appropriate manner. When such support was needed, many women had to actively seek it out themselves, including searching for information or contacts. This indicates a care gap that could be closed through proactive offers and better information provided by medical staff. For example, in Canada, “child life specialists” are integrated into adult oncology care to address the needs of children and provide counseling related to these needs [ 15 ]. With respect to psycho-oncological care, many participants initially reported no need for such support. It is important to note that need is usually assessed only at the start of treatment, although it may change over time. Delayed burdens—such as cancer-related fatigue syndrome, which may only emerge after treatment—can lead to a need for psycho-oncological counseling at a later stage. Logistical barriers to accessing psycho-oncological services were also mentioned, such as long travel distances, which pose a significant challenge for ill mothers with caregiving responsibilities, were also mentioned. Digital care formats, such as video therapy, could facilitate access and lower these barriers. Additionally, the lack of visibility of psycho-oncological services was discussed by participants, which could be improved through proactive engagement by medical and nursing staff. Finally, the participants’ statements underscore the importance of peer support and self-help groups. Several women described exchanges with other affected mothers as particularly enriching and helpful. This confirms the relevance of social support systems as a complementary resource to professional care. Low-threshold digital offerings, such as online self-help groups, could also be considered. Oncology professionals should increasingly point patients to existing support services to encourage their use. Currently, there are no established algorithms for oncological patient consultations that explicitly and straightforwardly assess the familial needs of female cancer patients [ 16 , 17 ]. The development and implementation of a family assessment tool as part of regular screening is recommended. Although the vast majority indicated satisfaction with the support they received, five participants reported wanting more assistance in certain areas. The most frequently mentioned issues were logistical challenges, such as transportation, dealing with bureaucratic regulations, and childcare. The women emphasized the importance of receiving not only informational materials but also concrete help when needed. In this study, requests for domestic helpers were rare, as partners often took over these tasks. While this may work for some time, studies show that partners often reach their limits in this role and feel overwhelmed, which can pose a risk to their mental health [ 18 ]. In this context, it could be helpful to establish routine counseling through social services combined with regular needs screening so that appropriate support options (e.g., household help) can be arranged on a case-by-case basis. Limitations The qualitative content analysis provides valuable insights into the living situations and experiences of mothers with cancer. However, the subjectivity of the findings must always be taken into account when analyzing interviews and interpreting data. The study population consisted of 29 patients from a university woman’s clinic who were recruited via leaflets, which introduces selection bias that should not be overlooked. It is likely that, owing to the necessity of an active participation request, there was already a preselection of study participants, and other affected women with different personality traits or family situations and thus different experiences did not participate. Participation was presumably less likely for mothers who were particularly burdened (e.g., due to diagnosis, family problems, or therapy side effects). As a result, our study provides insights into a specific care situation with significant regional limitations, and the results cannot be generalized to the overall care of mothers with cancer but primarily apply to comparable care settings in German-speaking regions. Although patients were selected according to inclusion criteria and anonymized afterwards, each woman represented a unique study participant. This is also a core limitation of qualitative content analyses, which allow only limited generalizability but provide strong reasons to expand research with complementary questions. Owing to its epidemiological distribution, the vast majority of patients suffered from breast cancer and were thus significantly more represented than other tumor types. Although an effort was made to depict a broad spectrum of gynecological tumors, the proportion of other tumor types was only 10%. It is evident that the cross-sectional data collected reflect only a current snapshot of the mothers’ perspectives and cannot fully capture the complexity of human relationships and emotions during the course of dealing with an illness such as cancer. Conclusions This study can help raise awareness among clinical staff about the specific psychosocial burdens faced by mothers with cancer and thereby reduce emotional strain. The women expressed a desire for low-threshold support that does not require them to actively organize or demand it over a long period of time. To meet the needs of affected mothers, digital and family-centered support services, including both informational materials and psycho-oncological counseling options as well as peer contact, should be developed. This should also involve a systematic assessment of the family situation and support needs in the oncological setting, ideally early and repeatedly during the course of treatment. For specific topics, such as communicating the diagnosis to children, easily accessible support services provided by psychosocial professionals integrated into oncology care teams should be quickly available. A multidisciplinary approach involving medical, nursing, psychological, and social service teams is essential for comprehensive patient care. Abbreviations MCR Mother‒child relationship Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the Ethics Committee of the Medical Faculty of the University of Würzburg, Germany (reference no. 183/18-me, August 11, 2021). Consent for publication Not applicable Availability of Data and Materials In the supplementary material, we provide the interview guideline used, as well as the questionnaire that was specifically developed for the present study and the interview transcripts generated in this study, originals all in German language. The related files contain the COREQ Checklist. Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors' contributions TE conducted and transcribed the interviews and evaluated the data by conducting qualitative content analysis. She was supervised by EJ and AW. 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Supplementary Files Supplementaryfile1InterveiwguidelineMCR.pdf Supplementaryfile2QuestionnaireMCR.pdf Supplementaryfile3TranscriptsMCR.pdf Supplementaryfile4DetailedCategorySystem.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 14 Nov, 2025 Editor invited by journal 21 Oct, 2025 Editor assigned by journal 20 Oct, 2025 Submission checks completed at journal 20 Oct, 2025 First submitted to journal 20 Oct, 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. We do this by developing innovative software and high quality services for the global research community. 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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-7904049","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549803267,"identity":"0b8cb62d-090b-46da-9268-ccd9b1256c21","order_by":0,"name":"Theresa Engel","email":"","orcid":"","institution":"University Hospital Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Theresa","middleName":"","lastName":"Engel","suffix":""},{"id":549803269,"identity":"e2ea5b4b-664e-4649-8e9e-5e0f7d68f4d5","order_by":1,"name":"Pauline Faßler","email":"","orcid":"","institution":"University Hospital 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14:06:48","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":222236,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile4DetailedCategorySystem.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7904049/v1/61aeb189ac3a8c64b61bf598.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Motherhood with cancer: A qualitative interview study on burdens and support needs among mothers with gynecological tumors","fulltext":[{"header":"Background","content":"\u003cp\u003eGynecological tumors rank among the most common malignancies in women. According to the WHO\u0026rsquo;s \u003cem\u003eGlobocan Project\u003c/em\u003e (2022), four of the ten most common cancers in women belong to this group, accounting for a total of 40.4% (breast 25.0%, cervix uteri 7.2%, corpus uteri 4.6%, ovary 3.5%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Breast cancer therefore represents the most prevalent malignant disease among women.\u003c/p\u003e\u003cp\u003eThe prevalence of psychological distress and mental disorders in mothers with gynecological tumors is also high [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Beyond the challenge of coping with the disease itself, these women face complex family dynamics, particularly with respect to their children. Common concerns include the emotional and social development of their children, changes in the mother\u0026ndash;child relationship (MCR), and difficulties communicating about the illness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Many patients report that these topics receive insufficient attention in medical care.\u003c/p\u003e\u003cp\u003eIn recent years, research has gradually shifted its focus from the experiences of children (e.g., [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]) toward the well-being of parents, particularly mothers (e.g., [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]). Studies indicate that affected mothers often redefine their maternal role to remain present and supportive of their children despite the disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Protecting their children and maintaining stable routines are key priorities for parents in this situation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, communication about the illness is frequently perceived as distressing; many mothers vacillate between openness and the desire to shield their children [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although professional support is considered essential, many mothers experience it as insufficient [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Consequently, several studies emphasize the need for culturally sensitive, family-oriented interventions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBecause cultural differences may limit the transferability of international findings, the present study examined the experiences of affected mothers in Germany. The objective of this study was to explore how radio- and/or chemotherapy affect the relationship between mothers with gynecological tumors and their children and to identify perceived needs and potential approaches for improving psychosocial care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo gain an in-depth understanding of how mothers perceive the effects of cancer treatment on the MCR, an exploratory qualitative interview study was conducted between December 2018 and June 2022. Eligible participants were women diagnosed with gynecological tumors who were receiving chemotherapy and/or radiotherapy and had at least one minor child. Semistructured interviews were carried out and analyzed via qualitative content analysis according to Mayring, as modified by Kuckartz [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Committee of the Medical Faculty of the responsible university (reference no. 183/18-me, August 11, 2021).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population and data collection\u003c/h2\u003e\u003cp\u003e Potential participants were approached verbally by clinical staff in the oncological day clinic of the Department of Gynecology and/or during inpatient treatment. The inclusion criteria were as follows:\u003c/p\u003e\u003cp\u003e(1) confirmed diagnosis of a gynecological tumor,\u003c/p\u003e\u003cp\u003e(2) presence of at least one minor child at the time of diagnosis, and\u003c/p\u003e\u003cp\u003e(3) receipt of radio- and/or chemotherapy.\u003c/p\u003e\u003cp\u003ePatients were excluded if significant language barriers precluded an interview.\u003c/p\u003e\u003cp\u003e All participants were fully informed about the study and provided written informed consent. Study information was distributed via flyers and explained verbally and in writing by the study team. Participation was voluntary, and no financial or other incentives were offered.\u003c/p\u003e\u003cp\u003eThe interviews were conducted in private rooms within the treating hospital. Recruitment and interviews were carried out by a doctoral candidate in human medicine (T.E.) as part of her dissertation, supervised by an experienced psycho-oncologist who led the overall project. The interviewer had no prior personal or professional relationship with any participant.\u003c/p\u003e\u003cp\u003eA semistructured interview guide was developed on the basis of a literature review addressing the experiences of mothers with cancer. Five key themes were defined: (1) thoughts at the time of diagnosis, (2) impact on the MCR, (3) communication, (4) support from the social environment and psycho-oncological counseling and (5) reflections on motherhood. The guide ensured comparability across interviews while allowing adaptive follow-up questions. The complete guide is provided in \u003cem\u003eSupplementary File 1\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eAll interviews were recorded via an MP3 device. The average duration was 17 minutes (SD\u0026thinsp;=\u0026thinsp;8.4 minutes), ranging from 7\u0026ndash;47 minutes. Following each interview, the participants completed a self-developed questionnaire capturing sociodemographic and clinical data, including age; marital status; education; employment; tumor type; date of diagnosis; therapy; psycho-oncological or psychotherapeutic care; and the number, age, and sex of the children. This instrument is provided in \u003cem\u003eSupplementary File 2\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe interviews were transcribed verbatim according to simplified transcription rules by Kuckartz [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and anonymized. The transcripts are available in \u003cem\u003eSupplementary File 3\u003c/em\u003e. Data analysis followed Kuckartz\u0026rsquo;s structured approach to qualitative content analysis, characterized by systematic category development grounded in the material itself.\u003c/p\u003e\u003cp\u003eData collection continued until thematic saturation was reached; that is, no new categories emerged from subsequent interviews. Saturation was monitored throughout the analysis process. Coding was performed by the interviewer via f4 analysis software. Because of limited resources, an independent second coding could not be performed.\u003c/p\u003e\u003cp\u003eIn alignment with the research question, an initial set of deductive categories was derived from prior literature and the interview guide on the basis of existing theoretical concepts and defined independently of the data. After the first coding round, inductive categories were generated directly from the material. To ensure comprehensive coverage, a second round of coding was conducted, allowing multiple category assignments per segment.\u003c/p\u003e\u003cp\u003eThe final coding and synthesis were conducted via \u003cem\u003eMAXQDA 2022\u003c/em\u003e (VERBI GmbH). Six main thematic categories were identified: (1) experience of diagnosis, (2) motherhood after diagnosis, (3) mother\u0026ndash;child relationship, (4) communication and openness, (5) social environment and support, and (6) psycho-oncological care.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study population consisted of 29 participants (all females) aged between 30 and 50 years (M\u0026thinsp;=\u0026thinsp;40.7, SD\u0026thinsp;=\u0026thinsp;4.8) who were receiving medical treatment for gynecological cancer. A detailed description of the sample can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and clinical characteristics of the study sample (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u0026thinsp;=\u0026thinsp;40,7 SD\u0026thinsp;=\u0026thinsp;4,8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTumor type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCervical cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOvarian cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of therapy\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (e.g., immunotherapy, endocrine therapy)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment before diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReceived psycho-oncological support\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eMultiple responses possible\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides an overview of the main categories and core themes that emerged from the analysis of the interviews. A detailed description of all categories is not provided here, as this would be too comprehensive. Instead, key content is discussed in greater detail and illustrated with representative quotes from participants. To ensure transparency of the analytic process, the full category system developed through qualitative content analysis\u0026mdash;including all hierarchical levels\u0026mdash;is available in \u003cem\u003eSupplementary File 4\u003c/em\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCategories and Core Themes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCore Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIllustrative Aspects\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperience of the diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional reaction, coping strategies, side effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eShock, fear for children, optimism, need for empathy and information\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIllness in the context of motherhood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRedefinition of maternal role, balancing illness and family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaintaining normalcy, concealing illness, guilt, new priorities, family cohesion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother\u0026ndash;child relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived changes in closeness or distance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCloser emotional bond, empathy, occasional withdrawal by children\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunication and openness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrategies for disclosure, challenges of hereditary cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOpenness vs. protection, age-appropriate communication, need for guidance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial environment and support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractical and emotional support, unmet needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePartner and family assistance, domestic help, school challenges\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsycho-oncological care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUtilization, barriers, and experiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eValue of counseling, limited awareness, logistic barriers, peer support\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eExperience of the diagnosis\u003c/h3\u003e\n\u003cp\u003eThe first main category describes how the study participants experienced their cancer diagnosis. A large proportion of respondents (n\u0026thinsp;=\u0026thinsp;19) reported being surprised and shocked by the diagnosis. Several women also mentioned that their immediate thoughts were about their children\u0026mdash;particularly their wish to see them grow up and not leave them behind. In addition to the initial sense of being overwhelmed, some women reported adopting an optimistic attitude and developing a heightened awareness of their own needs. The participants also frequently discussed distressing symptoms during treatment, such as hair loss, nausea, and vomiting. A recurring point of criticism concerned the perceived lack of empathy and the insufficient communication of information by medical staff.\u003c/p\u003e\u003cp\u003e\u0026ldquo;My doctor just said, \u0026lsquo;Start therapy,\u0026rsquo; [\u0026hellip;] However, what that actually meant, what the chances of success were, and everything else\u0026mdash;I didn\u0026rsquo;t truly get any initial information during that conversation.\u0026rdquo; (Pt. 11)\u003c/p\u003e\n\u003ch3\u003eIllness in the context of motherhood\u003c/h3\u003e\n\u003cp\u003eThe next main category focused on motherhood after the diagnosis. When asked whether their attitudes toward motherhood had changed, 28 of the 29 participants responded in a way that allowed the answers to be categorized into \u0026ldquo;changed\u0026rdquo; and \u0026ldquo;unchanged.\u0026rdquo; Of these, 54% (n\u0026thinsp;=\u0026thinsp;15) of the mothers indicated that their attitudes toward motherhood had not changed, whereas 46% (n\u0026thinsp;=\u0026thinsp;13) reported a change in their attitudes.\u003c/p\u003e\u003cp\u003eHowever, all the interviewed mothers stated that their role as a mother was affected by their cancer diagnosis. This included dealing with their uncertain future due to the illness. The participants described efforts to maintain a sense of normalcy by continuing to be a familiar point of reference for their children. This often involved concealing certain aspects of the illness for some time, such as hiding hair loss by wearing a wig or arranging for the children to stay with family or friends on chemotherapy days, to avoid showing physical and psychological limitations to their children.\u003c/p\u003e\u003cp\u003eNevertheless, the children experienced having a sick mother, which often placed a double burden on the mothers due to their own symptoms as well as concerns about the impact on their children. The participants repeatedly reported their children\u0026rsquo;s reactions to their hair loss, which varied widely.\u003c/p\u003e\u003cp\u003eMore than half of the patients reported everyday limitations attributable to cancer treatment. The generally reduced resilience often meant that mothers could not be fully available to their families and were unable to meet their children\u0026rsquo;s needs to the extent that they wished. This was frequently experienced as burdensome.\u003c/p\u003e\u003cp\u003e\u0026ldquo;At times, I was almost just lying around, and I found that truly hard. I wasn\u0026rsquo;t even available to talk to the kids, which I always thought was important. I just did not have the headspace for them\u0026mdash;I was preoccupied with myself.\u0026rdquo; (Pt. 12)\u003c/p\u003e\u003cp\u003eMany participants concluded that fighting cancer was a family task. In addition, they often described stronger family cohesion and an increased sense of appreciation or gratitude toward their family. In particular, increased time spent together with partners and children was frequently mentioned.\u003c/p\u003e\u003cp\u003e\u0026ldquo;It\u0026rsquo;s definitely more intense now. Like, yeah. You actually sit down, play games in the evening.\u0026rdquo; (Pt.22)\u003c/p\u003e\u003cp\u003e\u0026ldquo;That was nice because it somewhat fulfilled my needs and, like I said, my husband was truly there a lot, and we just had a lot of time together as a family, which usually doesn\u0026rsquo;t happen.\u0026rdquo; (Pt. 13)\u003c/p\u003e\u003cp\u003eSeveral mothers, particularly those with older children, reported that their children had become noticeably more independent since the time of diagnosis. They observed not only an increase in household skills such as cooking and doing laundry but also greater maturity in terms of school responsibilities and emotional support.\u003c/p\u003e\u003cp\u003eMany participants reported having set new priorities in life, which initially included recognizing and expressing their own needs.\u003c/p\u003e\u003cp\u003e\u0026ldquo;I don\u0026rsquo;t even know what my needs are. I\u0026rsquo;ve always just functioned and never truly thought about what my needs are. I\u0026rsquo;m still learning.\u0026rdquo; (Pt. 25)\u003c/p\u003e\u003cp\u003eSeveral women distanced themselves from others\u0026rsquo; expectations and placed less importance on a perfectly managed household. Aspects such as their children\u0026rsquo;s academic performance were also sometimes reassessed.\u003c/p\u003e\u003cp\u003e\u0026ldquo;It doesn\u0026rsquo;t have to be, like, classically sweeping the street at 10 in the morning. No, I sweep when I have the time and feel like it [\u0026hellip;] You just do many things when you truly want to. In addition, you discover a bit more of the good things in life.\u0026rdquo; (Pt. 4)\u003c/p\u003e\u003cp\u003e\u0026ldquo;Because I know that health is the most important thing, we don\u0026rsquo;t have big discussions about school, grades, or cleaning up rooms.\u0026rdquo; (Pt. 1)\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMother‒Child Relationships\u003c/h2\u003e\u003cp\u003eThe third main category includes the perceived impact of the cancer diagnosis on the MCR. In the interviews, 24 mothers described a change in their relationship with their child/children, whereas 13 women denied such a change. The number of mentions exceeds the number of 29 interviews because mothers with multiple children discussed each relationship separately, allowing multiple mentions.\u003c/p\u003e\u003cp\u003eWhen mothers reported positive changes, the most frequently described change was an intensification of the MCR. Most women experienced understanding and solidarity from their children and felt that they had generally grown closer to them. Some reported sharing worries and fears or an increase in physical closeness (e.g., in the form of hugs or cuddling).\u003c/p\u003e\u003cp\u003e\u0026ldquo;It has certainly become [...] emotionally closer or more emotionally open.\u0026rdquo; (Pt. 7)\u003c/p\u003e\u003cp\u003eSome participants reported perceiving their children as more caring.\u003c/p\u003e\u003cp\u003e\u0026ldquo;For example, my daughter loves to massage my head in the evenings. I enjoy it, I close my eyes, and she massages my head the whole time.\u0026rdquo; (Pt. 27)\u003c/p\u003e\u003cp\u003eNegative changes in the MCR were mentioned much less frequently. Six mothers felt that their children distanced themselves from them after the diagnosis and that they had less access to their children.\u003c/p\u003e\u003cp\u003e\u0026ldquo;I was in the hospital for two weeks, so mom wasn\u0026rsquo;t home for two weeks. Even though they visited me, she did not come close to me. You could tell the difference\u0026mdash;that she wasn\u0026rsquo;t comfortable with it at two years old.\u0026rdquo; (Pt. 5)\u003c/p\u003e\u003cp\u003eAmong the participants who reported no change in the MCR, some described having always had a very close relationship with their children that was unaffected by the illness. One mother reported raising her children from birth at a certain distance so that she did not perceive any change in their relationship due to the illness:\u003c/p\u003e\u003cp\u003e\u0026ldquo;I was actually glad I raised them the way I did\u0026mdash;that they, well, don\u0026rsquo;t cling to me, so to speak. That they\u0026rsquo;re not that close to me.\u0026rdquo; (Pt. 8)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCommunication and openness in dealing with the illness\u003c/h3\u003e\n\u003cp\u003eThe fourth main category focused on communication and openness regarding the illness, particularly in conversations with the children. The 15 mothers who reported discussing the diagnosis with their children found these conversations very challenging, and some wanted to delay the moment of disclosure. Various reasons were given for this, including the belief that children \u0026ldquo;have a right to an intact world\u0026rdquo; (Pt. 26) Which one does not want to shatter, that their own processing of the illness was not yet sufficient, and that the children\u0026rsquo;s reactions to the information were unpredictable. Several women noted feeling relieved after the conversation and were glad to have talked with their children.\u003c/p\u003e\u003cp\u003eWith respect to their communication strategies, more than two-thirds of the women reported openness as their chosen approach. The most common reason cited was to foster a greater understanding of the illness among their children. Many mothers also emphasized the importance of continuing to include their children in their lives\u0026mdash;including the illness\u0026mdash;and ensuring that future questions and conversations could take place. For Participant 20, involving her children was particularly important for alleviating their fears:\u003c/p\u003e\u003cp\u003e\u0026ldquo;Because then the uncertainty is gone, and children can sense when something is wrong or being hidden. Therefore, I think it was a relief for them to know [\u0026hellip;] what is happening to us.\u0026rdquo; (Pt. 20)\u003c/p\u003e\u003cp\u003eMost mothers also paid attention to adjusting the conversation to the child\u0026rsquo;s age. This included, among other things, avoiding overloading the children with too many details. The focus was usually less on the current state of illness and more on recovery. Additionally, many women (n\u0026thinsp;=\u0026thinsp;12) avoided using the word \u0026ldquo;cancer\u0026rdquo; with their children, often because of its strong associations with suffering, death, and dying.\u003c/p\u003e\u003cp\u003eDealing with hereditary cancer posed a particular challenge. This was often accompanied by feelings of guilt and significant uncertainty. It was especially important for affected mothers that their daughters conscientiously attend gynecological screenings. One participant also mentioned heightened vigilance regarding breast cancer in relation to her son. In some cases, the genetic predisposition also created conflict potential, as one participant reported:\u003c/p\u003e\u003cp\u003e\u0026ldquo;They then just casually threw it back at me and said, \u0026lsquo;Thanks a lot, Mom, right? Now you have breast cancer\u0026mdash;hopefully, you did not pass it on to us.\u0026rsquo; That was just teenage stuff, I think, but it was also somewhat justified.\u0026rdquo; (Pt. 8)\u003c/p\u003e\u003cp\u003eWhen a genetic mutation was confirmed, the women often found themselves conflicted about when and how extensively to discuss it with their children. Many reported relying primarily on their intuition regarding these conversations and not feeling the need for assistance. When support was desired, mothers generally had to be proactive in seeking contacts and/or informational materials themselves. Most women reported wishing for more offers and support from medical staff in this regard.\u003c/p\u003e\n\u003ch3\u003eSocial environment and Support\u003c/h3\u003e\n\u003cp\u003eThe fifth main category addresses patients\u0026rsquo; experiences with their social environment\u0026mdash;including spouses, family, friends, acquaintances, and neighbors\u0026mdash;and how they perceived the support they received.\u003c/p\u003e\u003cp\u003e Among the 29 interviewed participants, 27 expressed satisfaction with support from their social environment. In families with older children who had increasing independence and the ability to help with daily tasks, less external support was generally necessary. The most frequently reported forms of assistance included caring for the children and help with household tasks, as well as emotional support and opportunities for conversation. Many participants described active support from their own parents in all areas. Fourteen women reported support from their partners, who were also confronted with a new reality following the diagnosis. A new division of labor was described.\u003c/p\u003e\u003cp\u003e\u0026ldquo;He took over everything and truly had my back. However, you have to say, he was quite overwhelmed by it.\u0026rdquo; (Pt. 25)\u003c/p\u003e\u003cp\u003eOverall, ten women reported being offered domestic help financed by health insurance. In many cases, such assistance was not needed because the partners took on the respective tasks.\u003c/p\u003e\u003cp\u003eAlthough a clear majority stated that they were satisfied with the support received, five participants reported wishing for more assistance in some areas. The most common challenges mentioned related to logistics, such as taxi rides, dealing with authorities, social services, and childcare. The women emphasized the importance of not only receiving informational materials but also obtaining concrete help when needed.\u003c/p\u003e\u003cp\u003eA few mothers reported challenges related to school and daycare. These included the perception that they sometimes encountered little understanding of their current life situation and its resulting consequences.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePsycho-Oncological Care\u003c/h2\u003e\u003cp\u003eThe sixth main category concerns psycho-oncological care. In the questionnaire, 19 women (66%) indicated that they had utilized psycho-oncological support. A portion of the participants (n\u0026thinsp;=\u0026thinsp;11) reported that they did not and, thus far, did not have a need for further psycho-oncological therapy. Some respondents emphasized that the service represented an important addition to support from friends and family.\u003c/p\u003e\u003cp\u003e\u0026ldquo;That it\u0026rsquo;s simply offered\u0026mdash;you don\u0026rsquo;t have to accept it, but if you don\u0026rsquo;t have someone like, say, my nice colleague, then you can get someone with whom you can truly talk things through. Not just superficially, but someone who truly helps you on the inside.\u0026rdquo; (Pt. 8)\u003c/p\u003e\u003cp\u003eTwo interviewees recommended at least trying the offer. Four women described their ambivalence at the beginning of their illness, where they did not seek therapy because they were very focused on physical recovery but generally considered it to be helpful. Logistical challenges such as long travel distances (Pt. 13) were also mentioned, which in some cases made it impossible to attend psycho-oncological sessions.\u003c/p\u003e\u003cp\u003eWith respect to information and opportunities for psycho-oncological support, the patients expressed an understanding of the high workload of medical staff but wished for more proactive inquiries, especially from physicians. Many mothers reported that questions and uncertainties arose only as the illness progressed. They indicated that an initially provided leaflet was perceived as less helpful. Although screening procedures were established, many women felt that these procedures resulted in psycho-oncological support only if they actively requested it. Several women emphasized the importance of support services but also saw room for improvement. Some participants wished, for example, that psycho-oncological services would be more centrally placed (Pt. 7) or for greater involvement of children:\u003c/p\u003e\u003cp\u003e\u0026ldquo;I could imagine something like a self-help group for children, or maybe a family event or meeting with others going through the same thing, because it kind of connects you. And I think it also gives that feeling that you\u0026rsquo;re not alone.\u0026rdquo; (Pt. 13)\u003c/p\u003e\u003cp\u003eTwelve patients reported positive experiences with psycho-oncological therapy offers that had helped them.\u003c/p\u003e\u003cp\u003e \u0026ldquo;[\u0026hellip;] I found the care itself very good, that there was an option outside of the family to address things that you no longer want to discuss within the family, whether with your partner or your children. That was very good, and I was very grateful for the encouragement that such an option exists.\u0026rdquo; (Pt. 20)\u003c/p\u003e\u003cp\u003eThe patients often received new perspectives that allowed them to better assess their situation and draw consequences from it. Three women additionally emphasized that psychological processing takes time and is not complete at the end of treatment. Five participants reported negative experiences, primarily stating that they had expected more from the conversations and that their specific fears and current problems were often not addressed adequately.\u003c/p\u003e\u003cp\u003eFive patients indicated that they had not found a suitable therapist because they could not build trust during the initial consultation.\u003c/p\u003e\u003cp\u003eSeveral women also reported finding exchanges with other affected mothers very enriching. It helped them share experiences and benefit from the insights of others.\u003c/p\u003e\u003cp\u003e\u0026ldquo;In rehab, it was actually nice to find out that others are going through the same thing\u0026mdash;it was group therapy or sometimes individual\u0026mdash;and just being able to exchange with others because there are so many emotions involved and to feel relief, knowing you\u0026rsquo;re not alone\u0026rdquo; (Pt. 13)\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study underscore that a cancer diagnosis represents a life-changing event for affected mothers, accompanied by significant uncertainty about their own future and, especially, that of their children. Most participants responded to this uncertainty by striving to maintain as much normalcy as possible in daily family life. The burdens identified in previous studies (e.g., [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]), such as managing everyday life, particularly child-rearing, and communicating with children about the illness, were also reported by the participants in this study.\u003c/p\u003e\u003cp\u003eNotably, the study participants clearly identified gaps in care for mothers with cancer—especially with respect to communication with their children and the social environment—as well as challenges related to childcare and household management. While these aspects are often mentioned in the literature, our study highlights the impact of the illness on the mother role and MCR in a concrete way that is directly evaluated by the women themselves. Unlike other qualitative studies (e.g., [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]), which often rely on abstract conclusions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the semistructured interviews in our study allowed for an explicit and nuanced assessment of changes in the MCR. Remarkably, most mothers reported positive changes, suggesting potential resilience and new closeness despite the burdens.\u003c/p\u003e\u003cp\u003eWhen describing deficiencies in care, a particular focus was placed on dealing with hereditary cancer, which was described as especially challenging. Some affected women experienced guilt over possibly passing on an increased cancer risk to their children, which is consistent with findings from previous studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. They primarily wished for more support in communicating with their children in an age-appropriate manner. When such support was needed, many women had to actively seek it out themselves, including searching for information or contacts. This indicates a care gap that could be closed through proactive offers and better information provided by medical staff. For example, in Canada, “child life specialists” are integrated into adult oncology care to address the needs of children and provide counseling related to these needs [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWith respect to psycho-oncological care, many participants initially reported no need for such support. It is important to note that need is usually assessed only at the start of treatment, although it may change over time. Delayed burdens—such as cancer-related fatigue syndrome, which may only emerge after treatment—can lead to a need for psycho-oncological counseling at a later stage.\u003c/p\u003e\u003cp\u003eLogistical barriers to accessing psycho-oncological services were also mentioned, such as long travel distances, which pose a significant challenge for ill mothers with caregiving responsibilities, were also mentioned. Digital care formats, such as video therapy, could facilitate access and lower these barriers. Additionally, the lack of visibility of psycho-oncological services was discussed by participants, which could be improved through proactive engagement by medical and nursing staff.\u003c/p\u003e\u003cp\u003eFinally, the participants’ statements underscore the importance of peer support and self-help groups. Several women described exchanges with other affected mothers as particularly enriching and helpful. This confirms the relevance of social support systems as a complementary resource to professional care. Low-threshold digital offerings, such as online self-help groups, could also be considered. Oncology professionals should increasingly point patients to existing support services to encourage their use.\u003c/p\u003e\u003cp\u003eCurrently, there are no established algorithms for oncological patient consultations that explicitly and straightforwardly assess the familial needs of female cancer patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The development and implementation of a family assessment tool as part of regular screening is recommended.\u003c/p\u003e\u003cp\u003e Although the vast majority indicated satisfaction with the support they received, five participants reported wanting more assistance in certain areas. The most frequently mentioned issues were logistical challenges, such as transportation, dealing with bureaucratic regulations, and childcare. The women emphasized the importance of receiving not only informational materials but also concrete help when needed. In this study, requests for domestic helpers were rare, as partners often took over these tasks. While this may work for some time, studies show that partners often reach their limits in this role and feel overwhelmed, which can pose a risk to their mental health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In this context, it could be helpful to establish routine counseling through social services combined with regular needs screening so that appropriate support options (e.g., household help) can be arranged on a case-by-case basis.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe qualitative content analysis provides valuable insights into the living situations and experiences of mothers with cancer. However, the subjectivity of the findings must always be taken into account when analyzing interviews and interpreting data. The study population consisted of 29 patients from a university woman’s clinic who were recruited via leaflets, which introduces selection bias that should not be overlooked. It is likely that, owing to the necessity of an active participation request, there was already a preselection of study participants, and other affected women with different personality traits or family situations and thus different experiences did not participate. Participation was presumably less likely for mothers who were particularly burdened (e.g., due to diagnosis, family problems, or therapy side effects). As a result, our study provides insights into a specific care situation with significant regional limitations, and the results cannot be generalized to the overall care of mothers with cancer but primarily apply to comparable care settings in German-speaking regions.\u003c/p\u003e\u003cp\u003eAlthough patients were selected according to inclusion criteria and anonymized afterwards, each woman represented a unique study participant. This is also a core limitation of qualitative content analyses, which allow only limited generalizability but provide strong reasons to expand research with complementary questions. Owing to its epidemiological distribution, the vast majority of patients suffered from breast cancer and were thus significantly more represented than other tumor types. Although an effort was made to depict a broad spectrum of gynecological tumors, the proportion of other tumor types was only 10%. It is evident that the cross-sectional data collected reflect only a current snapshot of the mothers’ perspectives and cannot fully capture the complexity of human relationships and emotions during the course of dealing with an illness such as cancer.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study can help raise awareness among clinical staff about the specific psychosocial burdens faced by mothers with cancer and thereby reduce emotional strain. The women expressed a desire for low-threshold support that does not require them to actively organize or demand it over a long period of time. To meet the needs of affected mothers, digital and family-centered support services, including both informational materials and psycho-oncological counseling options as well as peer contact, should be developed. This should also involve a systematic assessment of the family situation and support needs in the oncological setting, ideally early and repeatedly during the course of treatment. For specific topics, such as communicating the diagnosis to children, easily accessible support services provided by psychosocial professionals integrated into oncology care teams should be quickly available. A multidisciplinary approach involving medical, nursing, psychological, and social service teams is essential for comprehensive patient care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMCR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mother‒child relationship\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Committee of the Medical Faculty of the University of Würzburg, Germany (reference no. 183/18-me, August 11, 2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Data and Materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the supplementary material, we provide the interview guideline used, as well as the questionnaire that was specifically developed for the present study and the interview transcripts generated in this study, originals all in German language.\u003c/p\u003e\n\u003cp\u003eThe related files contain the COREQ Checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTE conducted and transcribed the interviews and evaluated the data by conducting qualitative content analysis. She was supervised by EJ and AW. The manuscript for this article was written primarily by PF, on the basis of TE's doctoral thesis. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKuckartz U, R\u0026auml;diker S. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterst\u0026uuml;tzung. s.l.: Juventa Verlag GmbH; 2022. ISBN: 3779962314.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, Pi\u0026ntilde;eros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today (version 1.1). Lyon, France: International Agency for Research on Cancer; 2024 [accessed 2025 Aug 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gco.iarc.who.int/today\u003c/span\u003e\u003cspan address=\"https://gco.iarc.who.int/today\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFabian A, et al. Psychosocial distress in cancer patients undergoing radiotherapy: a prospective national cohort of 1042 patients in Germany. J Cancer Res Clin Oncol. 2023;149:9017\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTavares R, Brand\u0026atilde;o T, Matos PM. Mothers with breast cancer: A mixed-method systematic review on the impact on the parent\u0026ndash;child relationship. Psychooncology. 2017;27(5):367\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorris JN, Martini A, Preen D. The well-being of children impacted by a parent with cancer: an integrative review. Support Care Cancer. 2016 Apr.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarnes J, et al. Qualitative interview study of communication between parents and children about maternal breast cancer. BMJ (Clin Res Ed). 2000;321(7259):479\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArida JA, Bressler T, Moran S, D\u0026rsquo;Arpino S, Carr A, Hagan TL. Mothering with advanced ovarian cancer: You\u0026rsquo;ve got to find that little thing That\u0026rsquo;s going to make you strong. Cancer Nurs. 2019;42(4):E54\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavey MP, et al. African American Parents' Experiences Navigating Breast Cancer While Caring for Their Children. Qual Health Res. 2012;22(9):1260\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazzotti E, Serran\u0026ograve; F, Sebastiani C, Marchetti P. Mother-Child Relationship as Perceived by Breast Cancer Women. Psychology. 2012;3(12):1027\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang X, Gong N, Li N, Zhang Y, Du Q, Zou W et al. Why breast cancer patients avoid communicating disease-related information to their dependent children: A qualitative study. J Clin Nurs. 2022 Apr.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSinclair M, Schofield P, Turner J, Rauch P, Wakefield C, Mann GB et al. Maternal breast cancer and communicating with children: A qualitative exploration of what resources mothers want and what health professionals provide. Eur J Cancer Care. 2019;28(6).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRajagopal L, Liamputtong P, McBride KA. The Lived Experience of Australian Women Living with Breast Cancer: A Meta-Synthesis. Asian Pac J Cancer Prev. 2019;20(11):3233\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWright JD, et al. I Had to Make Them Feel at Ease: Narrative Accounts of How Women With Breast Cancer Navigate Social Support. Qual Health Res. 2021;31(8):1056\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu P, Ji Q, Liu X, Xu T, Wu Q, Wang Y, et al. I\u0026rsquo;m walking on eggshells: challenges faced by mothers with breast cancer in interacting with adolescent daughters. BMC Womens Health. 2022;22(1):385.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaneja S, Vanstone M, Lysecki DL, McKean H, Bainbridge D, Sussman J, Molinaro M. There\u0026rsquo;s so much more support we could have provided: Child life specialists\u0026rsquo; stories of the challenges working in adult oncology. Qual Health Res. 2024;34(11):1084\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJohannsen L, Frerichs W, Inhestern L, Bergelt C. Exploring the perspectives of cancer patients parenting minor children: a qualitative study on family-centered cancer care experiences. Patient Educ Couns. 2023;117:107989.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDencker A, Murray SA, Mason B, Rix BA, B\u0026oslash;ge P, Tj\u0026oslash;rnh\u0026oslash;j-Thomsen T. Disrupted biographies and balancing identities: A qualitative study of cancer patients\u0026rsquo; communication with healthcare professionals about dependent children. Eur J Cancer Care. 2019;28(2):e12991.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBorstelmann NA, Gray TF, Gelber S, et al. Psychosocial issues and quality of life of parenting partners of young women with breast cancer. Support Care Cancer. 2022;30:4265\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00520-022-06852-7\u003c/span\u003e\u003cspan address=\"10.1007/s00520-022-06852-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, communication, gynecological tumors, mother–child relationship, parenthood, psycho-oncological intervention, qualitative research, quality of life, semistructured interviews","lastPublishedDoi":"10.21203/rs.3.rs-7904049/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7904049/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMothers diagnosed with gynecological tumors often experience substantial psychosocial strain. This study aimed to capture their specific needs and identify levers for targeted support by interdisciplinary healthcare professionals.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eTwenty-nine semistructured interviews with mothers who had a gynecological tumor, were receiving chemotherapy and/or radiotherapy, and were caring for minor children were conducted. The transcripts were analyzed via qualitative content analysis according to Kuckartz [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSix major themes emerged: experience of diagnosis; motherhood after diagnosis; impact on the mother\u0026ndash;child relationship (MCR); communication and openness about the illness; social environment and support; and psycho-oncological care. Most women reported changes in the MCR\u0026mdash;predominantly positive. At the same time, participants highlighted clear gaps in care, particularly regarding communication with their children and the social environment, as well as support with childcare and household management.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings emphasize the need to raise awareness among clinical staff of the unique psychosocial burdens faced by mothers with cancer. Such awareness may foster the development of targeted interventions that alleviate emotional distress and improve quality of life.\u003c/p\u003e","manuscriptTitle":"Motherhood with cancer: A qualitative interview study on burdens and support needs among mothers with gynecological tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 15:26:07","doi":"10.21203/rs.3.rs-7904049/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-11-14T09:54:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-21T12:08:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-20T23:37:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-20T23:37:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-10-20T09:03:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d410a6c-125d-451e-9502-dda1ddebfaf1","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T15:26:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 15:26:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7904049","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7904049","identity":"rs-7904049","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}