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Background: Parents with cancer face elevated psychological distress, often exacerbated by parenting responsibilities. Affect-Focused Psychodynamic Therapy (AFPT) has shown efficacy in improving emotion regulation, psychological well-being and self-compassion, but its feasibility and preliminary effect in this population remains unexplored.

Objective: The aim of this study was to evaluate the feasibility, acceptability, safety, and preliminary effects on symptoms of depression and anxiety, of AFPT delivered via videoconferencing for parents with cancer.

Methods: The intervention consisted of 10 sessions of AFPT, specifically affect phobia therapy. Qualitative data were collected through post-intervention interviews and analysed using inductive content analysis. Quantitative data were collected through self-report questionnaires at pre-intervention, post-intervention, and at 6-month follow-up measuring symptoms of depression and anxiety (primary outcome), parenting concerns, emotion regulation, self-efficacy, adaptive affective functioning, closeness in the family and self-rated health. Quantitative data were analysed using dependent-samples t-tests, with Cohen's d for effect sizes, and McNemar tests.

Results: Fifteen mothers with cancer participated in the study. Results demonstrated efficient recruitment, acceptable study procedures, complete retention, and a relevant and beneficial intervention rated 8.4/10 in helpfulness. Moreover, findings showed significant reductions in symptoms of depression (Cohen's d = 1.29) and of anxiety (Cohen's d = 1.06) from pre- to post-intervention, maintained at 6-month follow-up, together with improvements in a majority of the secondary outcomes.

Conclusions: Videoconferencing AFPT appears feasible, acceptable, and safe to use for mothers with cancer, with promising preliminary effects in reducing psychological distress. These findings support further evaluation of the intervention to determine its efficacy in this population using a randomized controlled trial.

Early identification of postpartum depression and anxiety is critical for enabling timely preventive interventions. Although antenatal self-report measures are strong and widely used predictors of postpartum mental health outcomes, it remains unclear whether physiological markers such as heart rate variability (HRV) provide incremental predictive value beyond established psychological assessments, particularly when measured at different stages of pregnancy. This study investigated whether HRV indices, measured during early and late pregnancy, before and after a mild cognitive-emotional stressor, contribute incremental predictive information for postpartum depression and anxiety symptoms beyond established psychosocial and health predictors. Ninety-one pregnant women completed psychological assessments and HRV measurements before and after a mild cognitive-emotional stressor in both early and late pregnancy. Postpartum depression and anxiety symptoms were assessed using validated questionnaires. Random Forest models identified several HRV indices - particularly low-frequency/high-frequency ratio and indices reflecting parasympathetic activity- as meaningful predictors of postpartum outcomes, alongside established psychological factors. The models demonstrated high predictive accuracy, and model comparisons indicated that HRV measures provided a modest yet statistically reliable improvement, specifically reflected in reduced mean absolute error for depression and state anxiety. These findings suggest that HRV provides complementary physiological information beyond self-report measures, supporting its potential role in refining postpartum risk prediction - particularly in cases where self-report indicators alone may be ambiguous.

Background: Women with cancer tend to report higher levels of psychological distress than men with cancer. A deeper understanding of how modifiable psychological factors are related to psychological distress in mothers with cancer could inform targeted prevention strategies. The aim of this study was to investigate how the modifiable psychological factors; parenting concerns, self-efficacy, and emotion regulation strategies, are associated with symptoms of depression, anxiety, stress, and posttraumatic stress in mothers with cancer.

Methods: In 2023, 222 mothers with cancer, aged 25-60 years, with varying time since diagnosis were included in a longitudinal observational study. Data were collected at inclusion and one year later. Outcome measures were symptoms of depression, anxiety, stress, and PTSD, assessed using Depression, Anxiety and Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5) questionnaires. Sociodemographic and health-related variables were used as covariates and parenting concerns, self-efficacy, and emotion regulation strategies (cognitive reappraisal and expressive suppression) were used as explanatory variables in the hierarchical linear regression models.

Results: After controlling for sociodemographic and health-related variables, baseline symptom levels were the strongest predictors of symptoms of depression, anxiety, stress, and PTSD at one-year follow-up. With exception of parenting concerns in relation to depressive symptoms, modifiable psychological factors did not predict the outcomes after adjusting for the contribution of baseline symptoms.

Conclusions: Baseline symptom severity emerged as a strong predictor across all outcomes, as such early assessment of psychological symptoms may be particularly important for mothers with cancer. Future research should aim to diversify the study population to better capture differences in psychological symptoms across various cancer types, cancer stage, and age groups.

Purpose: Up to 40 % of parents of children with cancer experience relationship distress; a significantly higher proportion compared to the general population. Despite this elevated risk, there are few in-depth qualitative studies investigating relationship distress in the paediatric oncology context. Therefore, this study aimed to explore how parents of children with cancer experience relationship distress to thereby generate an in-depth understanding of the phenomenon.

Method: A sample of 25 parents (17 mothers, 8 fathers) who had experienced relationship distress related to their child's cancer participated in semi-structured interviews exploring relationship dynamics, communication, conflict management, and relational changes following the child's diagnosis. The interviews were audiorecorded, transcribed verbatim, and analysed using inductive content analysis.

Results: Three categories and nine subcategories were identified. In addition to these, one overarching theme emerged. The first category 'Pressure on the relationship', illustrated factors that placed strain on the couple relationship. The second category 'When unity fails' included parents' experiences of challenges in dealing with the situation together as a couple. The third category 'Fractured togetherness' highlighted relationship deterioration as a result of the cancer experience. The theme 'Fighting together, yet drifting apart' linked the categories by illustrating the process of experiencing joint hardships, of trying to manage these together, but ending up with a wounded relationship.

Conclusion: This study contributes with an in-depth understanding of relationship distress in parents of children with cancer. Thereby, it can contribute to the development of currently limited interventions to support parents' couple relationships in paediatric oncology care.

Background: There is a great need for non-estrogenic treatment of vulvovaginal atrophy (VVA) symptoms affecting sexual function and quality of life. Women with breast cancer on anti-estrogenic therapy are particularly vulnerable and in need of help. The primary aim of this proof-of-concept trial was to evaluate the efficacy of vaginal tamoxifen in reducing the most troublesome VVA symptom.

Methods: In this randomized, double blind, placebo-controlled study, 115 postmenopausal women, with or without breast cancer, were randomized to 20 mg vaginal tamoxifen once weekly or placebo (1:1). Follow-up after one and three-months of treatment, included self-reported VVA symptoms on the Endocrine Symptom Subscale of FACT-B, and gynecologic exams for VVA score and measurement of vaginal pH and endometrial thickness.

Findings: After three months, 37 (68.6 %) of women on vaginal tamoxifen reported their most troublesome VVA symptom to be mild or not present at all, whereas corresponding number in the placebo group was 5 (9.1 %), p < 0.001. Expressed as odds, women on vaginal tamoxifen were more likely to report no or minor symptoms after three-months, OR 21.76 (95 % CI 7.36 - 64.3). The improvement in self-reported outcomes was accompanied by improvements in VVA scores and vaginal pH, p <0.001.

Interpretation: This study has demonstrated that more than two-thirds of the women on vaginal tamoxifen improved in their most troublesome VVA symptom. This is likely due to a tamoxifen-induced estrogen agonistic effects in vagina in a low-estrogen environment. While findings are promising, further studies on improved vaginal administration and endometrial safety concerns are needed.

Introduction

A woman’s childbirth experience is multifaceted and has a great impact on not only the woman, but also the family’s health and well-being. Changes in childbirth experience over time have been evaluated with a variety of instruments, at different time points, and with inconsistent findings. In Sweden, the rating of birth experience is routinely collected after birth, but it is still unknown which time point is preferred from a clinical perspective. The primary aim was to investigate changes in childbirth experience over time from childbirth to 6 months postpartum, assessed by both a single and a multi-item instrument. A secondary aim was to test the correlation between these instruments.

Material and Methods

In a prospective cohort study, 320 women were recruited from two Swedish hospitals. Study participants completed a survey at the maternity ward after giving birth, and again three and 6 months postpartum, rating their overall childbirth experience on a single item 10-point numeric rating scale (NRS) and a multi-item instrument, the Childbirth Experience Questionnaire 2 (CEQ2), encompassing four known dimensions of childbirth: Perceived safety, Own capacity, Participation and Professional support. Changes in childbirth experience (NRS and CEQ2) over time were analyzed using the Friedman test. NRS ratings were analyzed in relation to CEQ2 dimensions with Spearman’s correlation.

Results

Overall childbirth experience rated using NRS did not change over time. The total CEQ2 score decreased significantly from childbirth to 6 months postpartum (p < 0.001). This change was driven by decreased scoring of the domains Participation and Professional support. The correlations between NRS and CEQ scores were consistent over time, with a moderate to weak correlation of NRS with Participation and Professional support.

Conclusions

Women perceive their birthing experience more negatively over time when assessed using the CEQ2 questionnaire, but this was not captured by a single-item question assessing overall childbirth experience.

Purpose:

In-depth exploration of how the couple relationship is affected by parental cancer in couples with dependent children.

Methods:

Semi-structured interviews were carried out with a convenience sample of 17 parents with cancer who were in a couple relationship and had children aged 18 years or younger. Data were analysed using qualitative content analysis.

Results:

The content analysis resulted in three categories representing areas in the couple relationship that had changed following the cancer diagnosis: Altered communication; Adapting to new roles; and A change in sex life, intimacy and fertility. The results illustrate a significant increase in the need for constructive communication when couples face a range of emotionally-charged topics that were made difficult to talk about due to the children being present. The results also showed that the experience of cancer had forced couples to adapt to new roles in their relationship, and in the family, in order to manage the complex practical issues of simultaneously being parents and dealing with cancer. Lastly, both physical and psychological aspects of cancer had affected the couples' sex life, intimacy and fertility including decreased sexual engagement and changed conditions impacting family planning.

Conclusions:

Results highlight the specific areas that are challenging for couples facing cancer who are parents of dependent children. Couples may need support to cope with these challenges due to the complexity of parenthood when managing cancer as a couple.

Background: Breast cancer is the most common cancer diagnosis among women in Sweden, and 20% of cases are women younger than 50 years. For many of these women, the diagnosis occurs during a period of active parenting, when they are responsible for the emotional and practical care of young children. This dual burden, coping with a life-threatening illness while maintaining a caregiving role, can lead to increased emotional strain, altered family dynamics and challenges in communication and support. The aim of this qualitative study was to explore the parenting experiences of women with breast cancer who have minor children, focusing on challenges, needs and interactions with the healthcare services

Methods: A self-selected sample of 131 mothers, living in Sweden, aged 25-60 years, who were diagnosed within the past five years participated. Participants were recruited via social media, patient organizations and oncology clinics. An online questionnaire was used to collect data between January and May 2023, which consisted of, among other things, sociodemographic information and an open-ended question about parenthood. The responses to the open-ended question were analysed using conventional content analysis.

Results: The analysis resulted in five categories: a significant impact on mothering and an increased emotional burden; challenges in communication within the family; a broad range of experiences of healthcare support from significantly lacking to positive experiences; the need for emotional and practical support from family, partners, relatives and school and the emotional and social impact on the children.

Conclusion: The findings highlight that there is a clear need for more accessible and structured support from the healthcare services to address the unique needs of mothers with breast cancer and their children, ensuring better communication, psychosocial care and practical assistance throughout the illness trajectory.

Background

When a parent is diagnosed with cancer, it often affects both family life and the couple relationship significantly. However, research on factors that influence relationship functioning over time in this population is limited.

Aims

To investigate the development of relationship functioning and factors associated with relationship functioning over a 1-year period among parents with cancer.

Methods

In this longitudinal study, 180 parents with cancer, aged 24–60 years, with dependent children completed online surveys at 2 time-points: at inclusion (T1) and 1 year later (T2). Data included self-reported sociodemographic, physical health and psychological factors, and relationship functioning. The outcome was relationship functioning at T2 assessed using 4 subscales (Dyadic cohesion, Dyadic satisfaction, Sensuality, and Sexuality) of the validated self-assessment scale Quality of Dyadic Relationship Scale-36 (QDR). Linear regression analyses were conducted to identify factors associated with the outcome.

Results

All aspects of relationship functioning statistically declined over time, except sexuality. After adjusting for multiple T1 factors, completion of cancer treatment predicted higher Dyadic cohesion; poor self-rated health predicted lower Dyadic satisfaction; higher age, being a mother and attachment-related anxiety predicted lower Sensuality; and lower age of youngest child, anxiety and attachment-related anxiety predicted lower Sexuality.

Conclusions

Cancer significantly impacts relationship functioning among parents with cancer who have dependent children, with significant declines in Dyadic cohesion, Dyadic satisfaction, and Sensuality over time. A number of sociodemographic, physical health and psychological factors were shown to predict lower relationship functioning. Addressing these factors may help identify and support parents with cancer who are at risk of, or who perceive, difficulties in their couple relationship.

BACKGROUND: Our microbiome is established during infancy, a time important for later health and long-term effects. Proton pump inhibitors and antibiotics are regularly prescribed during pregnancy. Both drugs cause microbiome disturbance and have been associated with increased cancer risk in adults, but effects of these drugs on the growing foetus and infant remain understudied.

AIM: The aim of this study is to study the association between prenatal and early life proton pump inhibitor and antibiotics exposure and the risk of childhood cancer.

METHODS: This study is a retrospective population-based cohort design, using registry data on all births (n = 722,372) in Sweden between 2006 and 2016, according to the STROBE checklist. For women who had multiple children in the timeframe of the study, only the first child during the time period was included in the cohort. Exposure was defined as either ≥ 1 proton pump inhibitor or antibiotics prescription during pregnancy, or during the first 2 years of life. Outcome was defined as cancer at any time during the follow-up or cancer after the age of 2 years for early life exposure. Multivariable Cox proportional hazard models were used to calculate hazard ratios.

RESULTS: In total, 1091 (0.2%) children were diagnosed with malignant cancer during the follow-up. Prenatal exposure to proton pump inhibitors and antibiotics were not associated with an increased risk of cancer. Regarding early life exposure, proton pump inhibitors were associated with an increased risk of cancer at age two or older (adjusted hazard ratio [aHR] 3.68, 95% confidence interval [CI] 2.24-6.06).

CONCLUSIONS: We did not find evidence that prenatal proton pump inhibitors and antibiotics were associated with overall childhood cancer. However, proton pump inhibitors during early life were associated with an increased risk of childhood cancer, but indication on drug use was not available and confounding by indication may be present.