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Counseling, Support Areas of Urgent Need Among Mothers With Breast Cancer


Data are scarce on the impact that breast cancer among mothers has on their children and their emotional development due to parenting stress and maternal depression.

Image representing breast cancer | Image credit: vectorfusionart - stock.adobe.com

Image representing breast cancer | Image credit: vectorfusionart - stock.adobe.com

Experts are issuing a call to action for support and counseling services that cater to mothers living with breast cancer who suffer from depression and child-related parenting stress, following their analysis of breast cancer–related clinical factors potentially related to adverse childhood development. They found that parenting stress, not breast cancer–related factors, had a significant correlation with depression and child-related outcomes among these patients, according to their findings published in JAMA Network Open.

Female patients with diagnosed stage 0 to 3 breast cancer who were within 10 years of their diagnosis and who visited the Asan Medical Center in Seoul, South Korea, between June 2020 and April 2021 were included in this analysis. To gather demographic data, the investigators had all participants (N = 699; mean [SD] age, 39.6 [4.6 years]) complete the Center for Epidemiologic Studies Depression–Revised scale and basic questionnaires; those with children (n = 499) also completed the Korean Parenting Stress Index Short Form (K-PSI-SF), Child Behavior Checklist, Junior Temperament and Character Inventory, and Children’s Sleep Habits Questionnaire (CSHQ). The mean (SD) child age was 8.0 (2.7) years, and 490 of the parents gave birth before their diagnosis.

“For mothers with breast cancer, parenting can be challenging, especially during hospitalization or chemotherapy, which can place considerable psychological distress on these patients,” the study authors wrote. “To date, few studies have investigated the emotional problems of children of patients with breast cancer using relevant psychological and clinical scales. Moreover, research into the association of children’s emotional problems and depression with parenting stress of mothers with breast cancer is scarce.”

An elevated chance of depression was seen among the patients who were parents compared with the patients who did not have children (OR, 2.25; 95% CI, 1.01-5.05) and those receiving gonadotropin-releasing hormone treatment (GnRH) vs those who did not (OR, 1.68; 95% CI, 1.15-2.44). Additional risk factors for depression overall shown through univariable logistic regression analysis were age (OR, 0.95; 95% CI, 0.92-0.99), smoking history (OR, 4.50; 95% CI, 1.19-16.97), having a high school education level (OR, 1.74; 95% CI, 1.08-2.79), disease duration (OR, 0.82; 95% CI, 0.74-0.92), radiation treatment (OR, 0.72; 95% CI, 0.50-1.03), and GnRH receipt (OR, 1.75; 95% CI, 1.22-2.51).

Key Takeaways

  • Support and counseling services are a large unmet need among women with breast cancer who are also parents
  • Risk factors for depression among patients with breast cancer include smoking history, ultimate education level of high school, and radiation treatment
  • Stronger associations with parenting stress among patients with breast cancer are having children 6 years and older and being the sole primary caregiver

In contrast, there was an inverse association seen between disease duration and depression (OR, 0.85; 95% CI, 0.76-0.96).

Further, the patients with children had a higher risk of depression if their child had a physical illness (OR, 3.30; 95% CI, 1.29-8.42), their mother or other family members were primary caregivers (OR, 1.97; 95% CI, 1.16-3.32), and they received GnRH treatment (OR,1.93; 95% CI, 1.18-3.14). CSHQ–Sleep-Disordered Breathing score (OR, 1.78; 95% CI, 1.17-2.72) and total K-PSI-SF score (OR, 1.06; 95%CI, 1.04-1.07) also were associated with depression.

The patients without children were slightly younger, had a lower body mass index (BMI), were less likely to have diagnosed disease history, and were more likely to be college graduates and smokers:

  • Age: 37.3 (5.9) vs 40.5 (3.6) years (P < .001)
  • BMI: 22.3 (3.3) vs 22.9 (3.6) kg/m2 (P = .046)
  • Disease history: 32.5% vs 43.7% (P = .007)
  • College graduate: 91.5% vs 84.0% (P = .01)
  • Smoking history: 4.0% vs 0.2% (P < .001)

Significant differences were not seen between the parents and nonparents regarding disease duration, cancer stage, and BRCA sequence variation. However, breast-conserving surgery (69.5% vs 50.7%; P < .001) and radiation treatment (65.0% vs 54.3%; P = .005) were more common among the patients without children than those with children. Oophorectomy, chemotherapy, endocrine therapy, and GnRH treatment rates were similar between the parents and nonparents.

A stronger association was seen with parenting stress if children were 6 years and older (β = 3.09; 95% CI, 0.19-5.99), the parent was the sole primary caregiver (β = −3.43; 95% CI, −5.87 to −0.99), and the children exhibited anxiety/depression (β = 8.09; 95% CI, 3.34-12.83) or bedtime resistance (β = 0.57; 95% CI, 0.15-0.99).

Overall, there was a significant correlation between depression and parenting stress (β = 0.56; 95% CI, 0.45-0.66; P < .001).

Their findings indicate several notes of importance:

  • Parenting stress may not be associated with breast cancer.
  • Older maternal age and longer disease duration were linked to a lower risk of depression.
  • Age, temperament, emotional problems, and sleeping patterns had strong associations with parenting stress.
  • The children’s emotional development was not associated with maternal breast cancer diagnosis and treatment.
  • Maternal depression and parenting stress had a strong correlation.

“These findings underscored the susceptibility of mothers with breast cancer to both depression and parenting stress, regardless of disease duration, emphasizing the imperative for counseling and support tailored to this patient group,” the authors concluded. ”Furthermore, this research highlighted that emotional development of children whose mothers had breast cancer was not significantly different from reference values, which could offer solace to these patients amid the challenges they encounter during their illness.”


Shin Y, Kim H, Lee T, et al. Factors in parenting stress in young patients with breast cancer and implications for children’s emotional development: the PSYCHE Study. JAMA Netw Open. Published online November 28, 2023. doi:10.1001/jamanetworkopen.2023.44835

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