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Cancer remains a major global public health challenge. According to the GLOBOCAN 2022 estimates, nearly 20 million new cancer cases occurred worldwide in 2022, with China representing one of the countries with a high cancer burden (). At the same time, the incidence of early-onset cancer has increased markedly over recent decades, meaning that more patients are diagnosed during life stages characterized by active work, partnership, and parenting responsibilities (). For patients raising dependent children, cancer is therefore not only an individual health crisis but also a family event. Population-based evidence suggests that a considerable number of patients with cancer have minor or dependent children, and earlier estimates from the United States indicated that approximately 1.5 million cancer survivors were raising minor children, with 2.85 million children living with a parent affected by cancer ().

Parenting concerns refer to the worries and distress experienced by patients with cancer regarding the impact of their illness on their children and their ability to fulfill parenting responsibilities (; ). These concerns may involve practical caregiving, emotional availability, communication about diagnosis and prognosis, children’s psychological adjustment, future care arrangements, and the parenting capacity of a spouse or co-parent (; ). Evidence indicates that parenting concerns are associated with psychological distress and may influence patients’ quality of life, family functioning, and even treatment-related decision-making (; ; ). From a family-centered care perspective, these concerns should not be regarded as private family issues alone, but as clinically relevant supportive care needs that require recognition within oncology care (). In Chinese and other East Asian contexts, cultural expectations around family responsibility, child protection, and interdependence may further shape how patients interpret their parental role and communicate illness-related information to children ().

Despite the clinical significance of parenting concerns, the needs of patients with cancer who are parents remain insufficiently addressed in routine oncology practice. Recent qualitative and mixed-methods studies have shown that many parents want guidance on how to talk with their children, maintain family normality, and balance treatment demands with parenting responsibilities. However, healthcare professionals do not always proactively identify or respond to these family-specific concerns (). Interventions focusing on parent-child illness communication and family support are emerging, but the evidence base remains limited, and effective, feasible, and culturally adaptable approaches have not yet been fully established ().

Existing reviews have contributed important knowledge by summarizing the experiences of parents with cancer, the impact of parental cancer on children, and the broader challenges of parenting during cancer (Matuszczak-Swigon and Bakiera, 2021). However, three gaps remain. First, previous syntheses have mainly described parenting difficulties and support needs, whereas the processes through which cancer-related disruption threatens parental identity, generates layered concerns about children, and activates protective parenting have not been sufficiently theorized. Second, the cultural and family-centered meanings of parenting concerns, particularly evidence from Chinese-language studies and East Asian family contexts, have not been explicitly integrated. Third, the implications of these experiences for tailored assessment, parent-child communication guidance, and family-level psychosocial support remain insufficiently specified. Therefore, this qualitative meta-synthesis aimed to integrate Chinese and English qualitative studies on parenting concerns among patients with cancer and to develop an interpretive understanding of how these concerns are experienced, constructed, and managed within cancer-affected families. The findings may inform the identification of high-need families and the development of family-centered, developmentally appropriate supportive care.

Meta-synthesis is one of the most commonly used methods in systematic reviews of qualitative research. It enables the aggregation of qualitative data in a specific field to gain an in-depth understanding and interpretation of the essence of a phenomenon, forming new explanations, accumulating knowledge, and developing new theories (). This study utilized meta-synthesis not to simply summarize the original qualitative studies, but rather as an “interpretive integration” of parenting concerns from the perspective of cancer patients. This method facilitates a more comprehensive and in-depth understanding of cancer patients’ views, experiences, and coping strategies regarding parenting issues. This review employed the integration analysis framework of “Thematic Synthesis” (), which is based on the critical realist philosophy by Thomas and Harden. This framework is effective for addressing questions concerning people’s views and experiences (; ). We conducted iterative meta-data analysis, involving continuous discussion and abstraction, to generate new perspectives and insights regarding the experiences of parenting concerns among cancer patients. This study was conducted in accordance with the reporting guideline “Enhancing Transparency in Reporting the Synthesis of Qualitative Research: ENTREQ” ().

All retrieved records were imported into EndNote X9 software (Thomson Reuters, Philadelphia, PA, USA) for management and duplicate removal. Then, two researchers with evidence-based experience (Yuchen Jiao and Bing Wu) independently screened titles and abstracts according to the inclusion and exclusion criteria (). Following this, two researchers further reviewed the full texts to determine the final included studies. During the study selection process, all discrepancies were resolved through weekly research team meetings involving all authors and frequent communication, ultimately reaching consensus.

The quality of the included studies was assessed using the JBI Critical Appraisal Checklist for Qualitative Research (). This checklist comprises 10 items assessing methodological congruity, data collection, data analysis, interpretation of findings, representation of participants and their voices, researcher positioning and influence, ethical considerations, and the link between data analysis and conclusions. Two researchers independently appraised all included studies. Disagreements were discussed and resolved through consensus; when necessary, the full research team was consulted. To enhance transparency, item-level appraisal results were reported to show the methodological strengths and limitations of the included studies. No study was excluded solely on the basis of the quality appraisal results, because all included studies met the eligibility criteria, addressed the review question, and contributed relevant qualitative data to the synthesis. Methodological limitations identified during appraisal, particularly incomplete reporting of researcher reflexivity or researcher influence, were considered when interpreting the findings and assessing the credibility of the synthesis.

To facilitate qualitative synthesis, one researcher extracted data from the included studies using a standardized extraction form, and another researcher checked the extracted information for accuracy and completeness. Extracted information included first author, publication year, country or region, participant characteristics, cancer type and disease context, study aim, qualitative design, data collection method, data analysis method, phenomenon of interest, and main findings or themes. Thematic synthesis was conducted following the approach proposed by Thomas and Harden (). First, findings and relevant participant quotations from the primary studies were coded line by line. Second, similar codes were compared, grouped, and organized into descriptive themes. Third, through repeated comparison, discussion, and abstraction, analytical themes were developed to move beyond a descriptive summary of primary studies. NVivo software was used to assist the coding and organization of qualitative data.

To enhance interpretive rigor, two researchers independently coded the data and then compared coding results. Differences were discussed in regular team meetings until consensus was reached. During synthesis, we repeatedly returned to the original studies to ensure that the analytical themes were grounded in the primary data while also providing a higher-level interpretation of parenting concerns among cancer patients. The quality appraisal results were considered during interpretation, especially when findings were primarily supported by studies with incomplete methodological reporting.

Researcher reflexivity was considered throughout the review process. The review team included researchers with backgrounds in oncology nursing, palliative care, psychosocial care, evidence-based practice, and qualitative research. These professional backgrounds facilitated sensitivity to the clinical and family-centered meanings of parenting concerns, but they may also have shaped our attention to supportive care needs and family adaptation. To reduce the influence of pre-existing assumptions, several strategies were used. First, screening, quality appraisal, coding, and theme development were conducted by at least two researchers independently. Second, researchers kept analytic notes during coding and synthesis to record emerging interpretations, uncertainties, and potential assumptions. Third, disagreements were discussed in regular team meetings, and alternative interpretations were considered before final themes were agreed upon. Fourth, the team repeatedly checked the analytical themes against the original studies to ensure that the synthesis remained grounded in the primary qualitative evidence. These procedures were used to strengthen reflexivity, transparency, and credibility in the synthesis process.

A total of 4,328 articles were identified through database searches, and 6 articles were identified through other sources. After removing 1,490 duplicate documents, 2,844 articles remained. After reading the titles and abstracts of the remaining 2,844 articles, 2,790 articles were excluded. Then, we read the full texts of 54 articles, 17 were excluded for the following reasons: research designs did not meet the criteria (such as non-qualitative studies, secondary literature reviews, etc.); study populations did not meet the criteria (such as including pregnant women); and research topics or final findings did not meet the criteria (i.e., articles not focusing on the parenting concerns experienced by cancer parents with minor children, but rather other thematic studies). In the final review, 37 studies (3 Chinese literature and 34 English literature) met the inclusion criteria and were included in the quality assessment ().

shows an overview of the characteristics of included studies. All included studies were published between 2000 and 2025, with 43.2% published in the last 5 years ( N = 16). Studies were mainly conducted in the United States ( N = 12) and China ( N = 7). The included studies explored the experiences of cancer patients raising children from various aspects, such as disclosing cancer diagnosis to children, navigating parent-caregiver role conflicts and ethical issues, challenges in patient-child interactions, and the support needs of patients in raising their children. The sample sizes of the 37 included studies ranged from 6 to 224 cancer patients, with different studies having varying criteria on the age of children and the time of diagnosis. Various qualitative designs were adopted in the included studies. The most commonly used qualitative method was the phenomenological approach ( N = 9), followed by the focus group method ( N = 6), grounded theory research ( N = 5), descriptive qualitative research ( N = 3). One study termed its research report an “interpretive qualitative study”, and 13 studies did not specify their research design. Semi-structured interviews were the most common method for data collection. In terms of data analysis, content analysis ( N = 11), topic analysis ( N = 5), Colaizzi analysis ( N = 4), and grounded theory analysis ( N = 3) were used. 10 studies only described data analysis or coding steps. There were four studies that conducted data analysis or coding under the guidance of a theoretical framework. Regarding methodological quality, all 37 studies were appraised using the JBI Critical Appraisal Checklist for Qualitative Research, and the item-level appraisal results are presented in . Overall, most studies demonstrated methodological congruity among research objectives, qualitative methods, data collection, data analysis, and interpretation of findings, and participants’ voices were generally adequately represented. The most common methodological limitation was incomplete reporting of researcher positioning and the influence of the researcher on the research process. These limitations were considered when interpreting the synthesis findings.

The meta-synthesis generated three themes and 11 subthemes that explain how parenting concerns develop and are managed in cancer-affected families. Across studies, cancer diagnosis and treatment undermined parents’ everyday caregiving capacity and threatened their ability to remain a “good parent”, which generated layered concerns about children’s present well-being, future security, and possible hereditary risks. At the same time, parenting concerns also activated relational resources, as parents attempted to protect children, maintain emotional connection and family normality, and reconstruct meaning through love, responsibility, and family growth. Nevertheless, these adaptive efforts were often self-initiated and insufficiently supported, highlighting the need for family-centered and developmentally tailored care. summarizes this interpretive model. Theme 1: disrupted parental identity and layered threat appraisal under cancer-related uncertainty

This theme describes how cancer disrupted patients’ sense of themselves as parents and generated layered threat appraisals about children and the family’s future. Across the included studies, parents did not interpret cancer-related functional decline, hospitalization, and treatment burden merely as practical caregiving difficulties. Rather, these changes were understood as threats to parental presence, caregiving capacity, emotional availability, and the moral identity of being a “good parent”. As illness uncertainty persisted, threat appraisal expanded from current parenting disruption to children’s future security, possible parent-child separation, the continuity of family life, and potential hereditary risks to children’s health. Thus, parenting concern originated in the conflict between the patient role and the parental role, but more deeply reflected cancer parents’ multi-layered worries about children’s current well-being, future development, and intergenerational health risks. Disrupted parental presence and caregiving capacity

The core of the parental role is to nurture, care for, accompany, guide, and emotionally support children. However, cancer imposed time, physical, and emotional constraints that created persistent conflict between being a patient and being a parent. Surgery, chemotherapy, radiotherapy, fatigue, pain, immune vulnerability, hospitalization, and medical appointments limited parents’ ability to provide daily care, supervise schoolwork, accompany children, participate in school or social activities, and maintain familiar family routines (; ; ; ; ; ; ). Several studies illustrated how the ill body directly interrupted ordinary parenting. After surgery, some mothers could not hug their children and even had to ask children to approach gently (). Because of swelling in the hands and declining strength, some parents could no longer drive children as before (). Caregiving disruption was particularly salient when children were young, when the patient had previously been the primary caregiver, or when the family lacked alternative support. For example, one mother with colorectal cancer was unable to care for her infant during cancer-related pain crises and had to rely on her adolescent son to prepare formula and feed his younger sibling at night ().

Importantly, changes in parental presence were not always experienced in a single negative direction. Studies of fathers with cancer showed that illness could also prompt some men to shift their life focus from work toward family. When their physical condition improved, some fathers participated more in housework and parent-child companionship and viewed this renewed family involvement as an opportunity to re-adapt to fatherhood (). This finding suggests that cancer has a complex influence on parental roles: it disrupts prior caregiving capacity and family order, but may also prompt some patients to reinterpret and re-practice parenthood (). Moral distress and guilt over failing to be a “good parent”

When cancer prevented parents from being responsible, emotionally available, and protective in the way they expected of themselves, many experienced guilt, shame, self-blame, and moral distress. Some parents described themselves as inadequate or as having failed their children because illness prevented them from providing companionship, patience, financial security, emotional availability, or continuous care (; ; ; ; ). This moral distress was intensified by the asymmetry between parents’ intentions and capacities. Parents still wanted to protect children, maintain family stability, and provide a normal childhood, but their bodies, treatment demands, and emotional burden made this difficult. Some children showed separation anxiety, fear, silence, or behavioral changes after parents left home for treatment or were absent for extended periods. Parents often interpreted these changes as evidence that they had not sufficiently protected or accompanied their children, which deepened their self-blame and helplessness (; ). At the same time, one study reported that some parents sought a better caregiving environment or even foster-parent arrangements for children, which partly relieved their guilt and helped them preserve a sense of moral responsibility in parenting ().

This internal conflict around being a “good parent” was shaped by gender. Mothers often worried about being irreplaceable in daily care and emotional caregiving, whereas fathers sometimes struggled with the loss of provider identity and with cultural expectations that men should remain strong, independent, and self-sufficient (; ). Anticipated loss, child vulnerability, and future insecurity This subtheme concerns parents’ future-oriented threat appraisal. Cancer is a severe illness associated with recurrence, progression, and death. Parents worried that their children might not receive adequate care, emotional protection, financial resources, or parental guidance in the future (; ; ; ; ; ; ). These worries were especially strong among patients with advanced disease, single parents, parents of young children, and those who believed that their parental role could not be replaced (; ; ; ). One participant described the fear of leaving a young child without a mother, emphasizing that a child who loses a mother can never truly find another one ().

Parents’ concerns about children’s vulnerability involved both immediate emotional reactions and long-term developmental consequences. Studies reported that children, after learning about parental illness, could show anxiety, withdrawal, sadness, anger, academic difficulties, somatic complaints, behavioral changes, or excessive responsibility-taking (; ; ; ; ; ; ; ). Parents often struggled to distinguish whether children’s emotional and behavioral changes reflected ordinary adolescence or distress caused by parental cancer. This uncertainty increased parents’ helplessness and intensified their need for professional guidance. Therefore, anticipated loss was not limited to fear of death; it also involved fear that cancer would disturb children’s trust, development, emotional security, and future family structure (; ). Hereditary and embodied anxieties about children’s health Some cancers have clear or perceived hereditary tendencies. In studies involving breast cancer and other cancers with known or suspected familial risk, parents worried that children might inherit susceptibility to cancer or later encounter similar illness trajectories (; ; ; ). This concern linked the parent’s diseased body to the child’s imagined future body. Some parents experienced guilt because cancer seemed to threaten children not only emotionally but also biologically.

Hereditary anxiety was closely tied to information needs. Parents wanted accurate and individualized guidance about genetic risk, screening, prevention, and how to discuss risk with children without creating unnecessary fear (; ; ). For parents of daughters, particularly in breast cancer contexts, this concern sometimes shaped health education, monitoring behaviors, and communication about future screening (; ). The synthesis indicates that hereditary anxiety expands the conceptual scope of parenting concerns: children are not only vulnerable family members who may be affected by parental illness, but also imagined future patients whose health risks may be connected to the parent’s diagnosis. Theme 2: protective parenting and family adaptation as relational resources

This theme reveals the protective parenting practices and family adaptation processes mobilized by cancer parents after identity disruption and threat appraisal. Parenting concern was not expressed solely as distress, guilt, or helplessness; it could also activate relational resources within parents and families. The included studies showed that children and parental love often became important sources of treatment persistence, meaning reconstruction, and adaptation to the new identity of being a parent with cancer. Parents also constantly balanced child protection and emotional connection, using selective communication, family routines, and ordinary daily life to reduce the impact of illness on children’s lives and psychological state. Meanwhile, some families demonstrated increased responsibility, maturity, gratitude, and cohesion while facing illness together. Love and parental responsibility as sources of endurance and meaning

Across the included studies, children were frequently described as a central reason for cancer parents to continue treatment, endure suffering, and remain engaged in life (; ; ; ; ; ; ). Parents drew strength from love, responsibility, and the desire to witness their children’s growth. One participant stated, ‘I felt I was obligated to recover again. I had to fight against my own suffering’ (). For many mothers, strong attachment to children and maternal responsibility compelled them to endure the suffering caused by disease. Conversely, children also provided female patients with security, motivation to continue treatment, and energy for daily living, thereby reducing the psychological consumption caused by cancer-related stress and adverse events (; ). Thus, parenting concern contained a paradox: the same bond that intensified fear and guilt also provided meaning, motivation, and emotional energy. Contact with children, photographs, telephone calls, play, daily caregiving, and shared small moments could all serve as emotional replenishment (; ). These experiences helped parents reconstruct meaning during illness and resist being defined only as patients. Protecting children while preserving emotional connection

Parents used multiple protective strategies to reduce children’s distress while trying to preserve intimacy. Some concealed information, delayed disclosure, softened explanations, or avoided showing bodily vulnerability; others chose open communication, honest preparation, or shared discussion about uncertainty and death (; , ; ; ; ; ). These strategies varied according to children’s age, maturity, family communication patterns, disease stage, and cultural expectations about protecting children from suffering. For example, one father explained that he did not want his children to see him in pain and therefore invited them to the hospital only when he felt relatively well, because he wanted to protect the image of fatherhood (). These apparently opposite strategies can both be understood as forms of protective parenting. Parents who concealed information often aimed to prevent fear, preserve childhood normality, or maintain an image of parental strength (; ). Parents who disclosed information often aimed to maintain trust, reduce confusion, and prepare children for change (; ). However, both groups faced the same dilemma: cancer parents often did not know how to manage cancer-related information that might overwhelm children while still protecting them. Many therefore hoped for professional guidance regarding timing, wording, and developmentally appropriate communication (, ; ; ).

Maintaining normality to preserve family stability and parental role continuity Another protective strategy was the attempt to maintain ordinary family life. Parents tried to preserve routines, keep children engaged in school and leisure activities, spend time with children when physically able, and adapt activities according to changing energy levels (; ; ; ; ; ). Maintaining normality helped parents preserve continuity in the parental role and reassured children that family life had not been completely replaced by illness. Behind the effort to maintain normality was also a process in which cancer patients reconsidered their parental role and actively adjusted to the new identity of being a parent with cancer. This difficult and challenging experience sometimes promoted positive changes and helped patients become more reflective parents. For example, some parents shifted from physically demanding activities to quieter interactions, relied on partners or relatives for practical tasks, and focused on emotionally meaningful moments (). For fathers in some studies, illness created unexpected opportunities to spend more time at home and renegotiate the fathering role (; ; ). One participant stated, ‘I think the cancer made me into a father. Until then (before becoming ill), I really didn’t have that sort of awareness, you know?’ ().

Reframing illness into maturity, responsibility, and family growth Some parents and families reframed the cancer experience as an opportunity for learning, responsibility, gratitude, and family growth (; ; ; ; ; ; ; ). By explaining disease causes, treatment processes, and health risks to children, patients guided children to pay attention to health, develop healthier lifestyles, and learn how to face crisis and uncertainty. In families affected by breast cancer or other cancers with hereditary risk, parents were especially likely to transform their illness experience into health reminders and life education for children. One mother reported telling her son why she became ill, encouraging him to exercise more, remain happy, and avoid unhealthy habits ().