A cancer diagnosis during pregnancy represents an enormous mental challenge for patients and their partners, who respond differently psychologically to this event. The authors of a prospective study published in Frontiers in Psychology explain this after enrolling patients from the International Network on Cancer, Infertility and Pregnancy in Netherlands, Belgium, Italy, and the US.

“The pregnancy itself is intrinsically a stressful life event, which induces emotional fluctuations at the hormonal level and is generally accompanied by uncertainty about the transition to parenthood,” wrote the study authors led by Evangeline A. Huis in ’t Veld of the Antoni van Leeuwenhoek-Netherlands Cancer Institute in Amsterdam, Netherlands, the lead author of the paper. The researchers emphasize that the added burden of a cancer diagnosis can further exacerbate this vulnerability. Specifically, in their research, Huis in ’t Veld and colleagues focused not only on patients but also on their partners, analyzing the perspectives and self-reported coping strategies for both.

Reactions to the Diagnosis

The analysis involved 220 women with a cancer diagnosis during pregnancy at a median gestational age of 17 weeks. The patients and 189 partners completed two study-specific questionnaires, the Cancer and Pregnancy Questionnaire, developed by the same research group, and the shortened version of the Cognitive Emotion Regulation Questionnaire. Results clearly showed that patients and partners experience different emotional burdens and concerns.

Patients reported significantly greater worry than partners about the unborn child’s health, the implications of the disease and its treatment, and concerns about pregnancy and delivery. Coping strategies also differed: Women more frequently used both adaptive strategies, such as positive reappraisal and positive refocusing, and dysfunctional strategies, such as rumination and self-blame, outlining a complex and ambivalent psychological response.

“From these data comes a fundamental message: Care must not be limited to strictly medical aspects through collaboration among the oncologist, gynecologist, midwife, and neonatologist but should include the psychologist-psychotherapist, an expert in psycho-oncology, into the care team to manage the emotional distress of both parents,” Maria Calanni Macchio, psychologist-psychotherapist and psycho-oncologist, counselor for the Italian Society of Psycho-Oncology (SIPO), Sicily Section, and member of the SIPO Young Committee, told Univadis Italy, part of the Medscape Professional Network. These observations align with Huis in ’t Veld and colleagues’ recommendation in the article that “given the significant emotional burden, it may be helpful to include a psychologist in the multidisciplinary care team from the outset.”

Faces of Coping

Commenting on the differing coping strategies — a kind of two-faced reaction among patients — Calanni Macchio explains that this reflects the extreme complexity of the situation. It can be interpreted on one hand as a form of protection for personal well-being and that of the fetus, through more adaptive and functional strategies of emotional regulation and cognitive coping, and on the other hand as fear of childbirth (tokophobia).

“Several studies show that despite a strong desire wish to become mothers, anxiety and fear — both of labor pain and of the physical and psychological changes that result — lead about 20% of women worldwide to avoid a first or second pregnancy,” she told Univadis Italy. In the specific case of a cancer diagnosis during pregnancy, the enactment of dysfunctional strategies stems from high levels of rumination and guilt that emerge from the sense of responsibility toward the unborn child and from uncertainty linked to the disease: which therapeutic path to take, the most appropriate timing for treatment, secondary complications, and treatment side effects. “This indicates that although patients are very proactive in trying to respond, the severity of the event inevitably exposes them to maladaptive tendencies that require specific professional intervention,” she added.

Support for the Couple

To help expectant mothers and their partners in these very difficult moments, the study authors suggest using screening tools and structured conversations that take into account personal factors such as maternal age and gestational age at diagnosis. Above all, they recommend guaranteeing personalized care for both patients and their partners so that their specific needs are addressed. “Actively involving partners turns them from mere spectators into informed therapeutic allies, without neglecting their own emotional experience or reinforcing a conspiracy of silence. Also, we should remember that today’s fathers have not always had adequate parental role models,” Calanni Macchio said.

Regarding the Italian context, the expert explained that despite centers of excellence, systematic implementation of this model presents significant challenges throughout the country. “In practical terms, the advice to patients is to request psychological support immediately, not to wait until the distress becomes unbearable,” she said, stressing the importance of promoting open communication within the couple and relying on centers with specific experience in the cancer-pregnancy setting. “Talking openly about one’s fears helps balance the coping strategies of both partners.” The psychological impact is not incidental but structural to the treatment process, and making psycho-oncology a permanent part of the multidisciplinary team is not optional but an essential component of quality care.

Calanni Macchio declared having no conflicts of interest.

This story was translated from Univadis Italy.