Introduction

Breast cancer is the most prevalent cancer among women worldwide, and its incidence continues to rise globally, with more than 2 million new cases reported in 2022. China has experienced one of the fastest-growing breast cancer incidence rates, recording nearly 300,000 new cases in 2022, which accounted for approximately 29% of all female cancer incidence nationally1. About 22.4% of cancer patients are diagnosed between the ages of 20 and 55, among whom 22% face the dual challenge of raising children while coping with cancer2,3. With an increasing number of young and middle-aged women being diagnosed with cancer, many of whom have minor children at the time of diagnosis, taking on the dual role of ‘mother’ and ‘patient’4. Numerous studies have documented that breast cancer patients in this situation experience varying degrees of parenting concerns during treatment5,6,7. Parenting concern refers to the stressful emotions experienced by cancer patients who are parents, arising from concerns about the impact of illness and possible death on their children8,9, including anxiety about being unable to fulfill parenting responsibilities and potential disruption to family life10. Breast cancer patients with minor children often make more aggressive treatment decisions (e.g., opting for bilateral mastectomy) to prolong their lives to ensure they can continue parenting responsibilities. This decision can decrease quality of life and negatively impact child development and family stability9,11. Therefore, exploring parenting concerns among young and middle-aged breast cancer patients is essential for enhancing mental health, optimizing nursing service, improving family coping mechanisms, and fostering resilience.

The majority of breast cancer patients experience conflicting roles and struggle to balance treatment, side effect management, and parental responsibilities12. Numerous studies13,14,15,16 indicate that mild to moderate levels of parenting concerns are common among breast cancer patients during treatment. Longitudinal studies have indicated that patients reporting higher levels of parenting concerns at baseline experience more severe psychological distress and communication difficulties17, demonstrate a gradual decline in parenting ability over time, and report increasing frustration in caring for their children18. Several studies support the effectiveness of parent-targeted interventions in improving parenting concerns, parenting efficacy, and family quality of life19,20,21. Helping patients balance the roles of “patient” and “mother” improves treatment adherence and exerts a lasting positive impact on children’s development22.

Research indicates that breast cancer patients tend to report lower levels of parenting anxiety if they are older, have fewer minor children, and have older youngest children7,23,24,25. Strong couple relationships and family support are inversely associated with parenting concerns5. Patients diagnosed with advanced or metastatic cancer are more likely to experience heightened worry about the impact of death on their children and develop parenting-related frustration due to physical limitations and fatigue26,27. Additionally, juggling full-time work alongside parenting obligations, coupled with concerns about the financial burden on the family, can exacerbate patients’ parenting stress28. Conversely, sharing caregiving responsibilities can alleviate parenting concerns among breast cancer patients24.

Women’s heightened concern for health and emotional expression, combined with body image changes resulting from breast cancer, may contribute to stronger negative perceptions of the disease29. Mothers with cancer experiencing distress often report inadequate support and perceive parenting as challenging. These negative states compromise parenting capacity and heighten parenting-related anxiety30. Adopting a positive confrontational approach towards the disease mitigates worries stemming from anxiety and guilt in everyday parenting, whereas avoidance and resignation coping styles undermine parenting role fulfillment and increase parental anxiety regarding their capacity to meet responsibilities31,32. For women with breast cancer raising minor children, coping ability is reflected not only in their assessment of parenting stress, but more critically, in whether this assessment translates into parenting self-efficacy3. Coping strategies and illness perceptions interact complexly. For instance, high confrontation may be protective for patients with low illness threat perceptions but ineffective or even detrimental for those perceiving their illness as overwhelmingly catastrophic. Standard regression models struggle to detect these nuanced interactions. A person-centered latent profile analysis directly addresses this gap by revealing how these factors synergistically cluster within individuals to form discrete, clinically meaningful subgroups with unique concern profiles. Social or peer support positively influences parenting confidence in this population33. Failure of mothers with cancer to disclose illness information to their children can lead to children’s misconceptions about maternal health, potentially exacerbating internalizing problems34. In such instances, family support becomes particularly important. Understanding and support among family members can be fostered through enhanced family communication and collaborative discussion35. Variable-centered approaches cannot distinguish these clinically distinct profiles, potentially obscuring subgroup-specific risk mechanisms and intervention targets. This limitation underscores the necessity of a person-centered approach to identify naturally occurring, qualitatively different patterns of parenting concerns.

This study is guided by the multifactorial theory of psychological stress proposed by Chinese scholar Prof. Jiang Qianjin36. The theory proposes that stressors influence individuals via mediating factors (e.g., cognition, coping, social support, and personality traits), triggering stress responses that ultimately compromise physical and mental health. A breast cancer diagnosis constitutes a significant negative life stressor. We mapped study variables onto theoretical mediators as follows: illness perception reflects cognitive appraisal, medical coping modes represent coping styles, social networks capture social support, and personality type combined with key demographic/clinical factors represent personal and contextual resources. This study hypothesizes that parenting concerns develop in patients under this stressor, modulated by general demographic, clinical factors, illness perception, medical coping modes, and social support.

In summary, existing research primarily focuses on the prevalence, influencing factors, and interventions for parenting concerns. Parenting concerns encompass multiple dimensions, such as the practical and emotional impact on children, and concerns about the co-parent. These dimensions may be prioritized differently across diverse populations. Previous studies, employing a variable-centered approach and treating patients as a homogeneous group, have explored the current status and influencing factors, but lack analysis of differences in parenting concern levels considering patient group heterogeneity. The present study utilized latent profile analysis to provide a new perspective on the heterogeneity of parenting concern profiles among young and middle-aged breast cancer patients.

Materials and methods

Aims

This study aimed to explore the different latent categories of parenting concerns and their influencing factors in young and middle-aged breast cancer patients using potential profile analysis.

Design

A cross-sectional descriptive study design was employed, adhering to the STROBE reporting guidelines37.

Participants

Between May 2024 and May 2025, breast cancer patients were recruited via convenience sampling from the breast surgery, oncology chemotherapy, oncology radiotherapy, and minimally invasive oncology departments of one tertiary general hospital in Jinan, Shandong Province, East China. Inclusion criteria were: (a) female patients aged 18–59 years; (b) cytologically or histopathologically confirmed breast cancer diagnosis; (c) raising at least one physically and psychologically healthy minor child (< 18 years); (d) aware of their disease status; (e) normal hearing, reading, speech, and writing abilities; (f) provided informed consent voluntarily. Exclusion criteria were: (a) concomitant life-threatening diseases; (b) diagnosed mental disorders (e.g., severe depression, schizophrenia); (c) inability to self-care.

Sample size

Sample size was calculated using the formula for cross-sectional studies: N = (Zα/2 σ/δ)2, where α = 0.05, thus Zα/2 = 1.96, σ = 2.56 points, and setting the tolerance error δ = 0.256 points (less than 20% of the estimated standard deviation)38. This yielded a minimum sample size of 385. Additionally, latent profile analysis typically requires a sample size of approximately 50039. A review of previous studies using latent profile analysis found a sample mean of 48140. The final sample size was 490 in this study.

Data collection

All investigators received standardized training. The investigator explained the purpose and significance of the study to those who met the inclusion and exclusion criteria. After obtaining consent, the participants were provided with a standardized paper questionnaire for completion in the ward. The questionnaires were completed by the participants themselves. The questionnaires were collected and verified immediately. Missing items were identified and noted on the spot, and the participants’ status was preliminarily assessed. Participants could supplement missing items either in person within 2 h or by phone within 24 h.

Instruments

General information questionnaire

This questionnaire, designed by the research team based on a systematic literature review, included highly relevant variables: (a) Socio-demographic information: age, residence, personality type, marital status, education level, work status, per capita monthly household income, medical insurance, number of minor children, age of the youngest minor child, primary caregivers for minor children. (b) Disease-related characteristics: disease stage, recurrence or metastasis, type of surgery, receipt of radiation/chemotherapy, and presence of comorbid chronic diseases. Standardized response options were used for all items. The questionnaire underwent expert team review and revision to ensure comprehensiveness, feasibility, and scientific rigor.

Parenting concerns questionnaire (PCQ)

PCQ, originally developed by Muriel et al.41 and translated into Chinese by Tingting Kang et al.42, assessed parenting concerns among cancer patients. It comprises 3 dimensions: worry about the practical impact of cancer on the child, worry about the emotional impact of cancer on the child, and worry about co-parenting, totaling 15 items. If the patient lacked a spouse or the child had no other parent, the corresponding item in the third dimension was omitted. The dimension score was calculated as the average of the remaining items. Responses are rated on a Likert 5-point scale (1 = “not worried” to 5 = “extremely worried”). Higher total scores indicate greater worry. The Chinese version demonstrated good reliability (Cronbach’s α = 0.85) and test-retest reliability (r = 0.917). In this study, the Cronbach’s α coefficient was 0.853.

Medical coping modes questionnaire (MCMQ)

MCMQ, developed by Feifel et al.43, originally contained 19 items. It assesses coping strategies in response to illness. The Chinese version was revised by Shen Xiaohong and Jiang Qianjin44 and validated among Chinese chronic disease patients. The revised Chinese version consists of 20 items across three dimensions: “confrontation”, “avoidance”, and “resignation”. Higher dimension scores indicate a greater tendency towards that coping style. In this study, Cronbach’s α coefficients were 0.849 (confrontation), 0.838 (avoidance), and 0.866 (resignation).

Brief illness perception questionnaire (BIPQ)

BIPQ, developed by Broadbent et al.45 based on the Illness Perception Questionnaire (IPQ), contains 3 dimensions and 8 core items, plus 1 open-ended question (excluded from statistical analysis in this study). Items are rated on a Likert 0–10 scale. Items 3, 4, and 7 are reverse-scored; others are positively scored. The total score ranges from 0 to 80, with higher scores indicating stronger negative illness perceptions and greater perceived threat. Total scores are categorized: <16 (mild), 16–31 (mild-moderate), 32–47 (moderate), 48–64 (moderate-severe), > 64 (severe). The Cronbach’s α coefficient in this study was 0.792.

Lubben social network scale 6 (LSNS-6)

LSNS-646 is a simplified version of the 1988 Social Network Scale. It contains 6 items across two dimensions (family network and friend network), assessing an individual’s relationships with family and friends. Total scores range from 0 to 30; higher scores indicate stronger social networks. A total score < 12 indicates a deficient social network; scores < 6 for either the family or friend subscale indicate deficiency in that specific network. Chang Qingsong et al.47 translated and validated the scale, reporting content validity indices of 0.84–0.96 and a Cronbach’s α coefficient of 0.83. In this study, the Cronbach’s α coefficient was 0.766.

Ethical considerations

Ethical approval was granted by the Ethics Committee of Shandong First Medical University (Approval No.: R202507030441). All procedures were conducted in accordance with the Declaration of Helsinki and relevant ethical guidelines. All participants provided written informed consent after receiving a full explanation of the study’s purpose, content, and process. Anonymity was maintained throughout data collection and analysis to ensure confidentiality.

Data analysis

Data were analyzed using SPSS 26.0 and Mplus 8.3, with the level of statistical significance set at P < 0.05 for two-sided tests. Frequencies and percentages (%) were used to describe the count data, and mean ± standard deviation to describe the measure data. The Chi-square test was used to compare the distributions of categorical variables across the latent profiles of parenting concerns. One-way analysis of variance (ANOVA) was used to assess differences in continuous variables across these profiles. Before conducting ANOVA, assumptions of homoscedasticity and normality were evaluated.

Based on the principles of latent profile modeling, the 15-item scores of the Parenting Concerns Questionnaire were used as an exogenous variable to explore the latent categories of parenting concerns in young and middle-aged breast cancer patients48. The number of latent categories was incrementally increased from K = 1, and the model with the smallest values of Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and Corrected Bayesian Information Criterion (aBIC) was prioritized based on information theoretic criteria. The category increment validity was verified by likelihood ratio test, requiring significant (p < 0.05) results from the Lo- Mendell- Rubin test (LMR) and Bootstrap likelihood ratio test (BLRT). Entropy was required to be ≥ 0.80. At the same level of fit, preference was given to models with fewer categories and greater theoretical explanatory power, and to ensure that the minimum category proportion was > 5% to maintain statistical validity39,49.

Multinomial logistic regression analyses were used to explore the factors influencing the different latent categories of parenting concerns. Using the potential category of parenting concerns as the dependent variable, demographic characteristics, disease-related variables, disease perception, medical coping modes, and social support variables that were statistically significant in the univariate analysis were included in the model.

Results

Common method bias assessment

As data were derived from patient self-report questionnaires with numerous items, common method bias was assessed using Harman’s single-factor test. All entries were simultaneously placed into an unrotated exploratory factor analysis, which showed that 14 factors with eigenroots > 1 were extracted. The variance explained for the common factors was 25.652% (below the 40% threshold), indicating no significant common method bias.

Participant characteristics

A total of 509 questionnaires were distributed; 490 valid questionnaires were returned, yielding a response rate of 96.27%. The mean parenting concerns score was 42.19 (SD = ± 12.06). The mean age of the participants was 41.27 (SD = ± 4.87), and 93.7% were married with a spouse. The general information characteristics of the participants are shown in the following table (Table 1).

Table 1 General characteristics and univariate analysis of latent categories of parenting concerns in young and middle-aged breast cancer patients (N = 490).
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Latent profile analysis

Models ranging from K = 1 to K = 5 were fitted using the 15 PCQ item scores as indicators (Table 2). Entropy values for all models exceeded 0.8, and BLRT results were significant (p < 0.05). The model with K = 3 demonstrated the highest entropy (0.957), and both LMR and BLRT were significant (p < 0.05) (Table 2). The average posterior probabilities for class membership indicated high classification accuracy, with diagonal values exceeding 0.97 (Table 3)50. Our decision was driven by three key factors: the model’s higher entropy (indicating better classification), a significant LMR test favoring it over the 2-class model, and a non-significant LMR arguing against a 4-class model. Additionally, the 3-class model offered greater theoretical clarity and interpretability, and all latent classes were sufficiently large (each > 5% of the sample), ensuring statistical stability.

Based on the three-class model, the characteristic profile plot is presented (Fig. 1). Category 1 (223 cases, 45.5%) exhibited lower scores on dimensions D1 (Practical impact on children) and D2 (Emotional impact on children) compared to other categories, while scores on D3 (Concerns about co-parenting) were higher than in C2. Thus, this class was labeled “low concern/concerns about children’s fathers group”. Category 2 (120 cases, 24.5%) showed moderate overall parenting concerns, characterized by significantly lower D3 dimension scores than the other classes, and was named “moderate concern/concerns about children group”. Category 3 (147 cases, 30.0%) displayed high scores across all dimensions and was labeled “high concern group” (Table 4).

Table 2 Latent categories of parenting concerns in young and middle-aged breast cancer patients.
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Table 3 Average membership probability for each potential category.
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Fig. 1
Fig. 1The alternative text for this image may have been generated using AI.
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Distribution of characteristics of three latent profiles of parenting concerns in young and middle-aged breast cancer patients.

Table 4 Comparison of parenting concern dimension scores across different latent categories.
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One-way ANOVA for continuous variables

ANOVA revealed significant differences between the three latent categories of: Brief Illness Perception Questionnaire (F = 101.599, p < 0.001), MCMQ dimensions “confrontation” (F = 77.312, p < 0.001), “avoidance” (F = 91.238, p < 0.001), “resignation” (F = 89.757, p < 0.001), and LSNS-6 dimensions “family network” (F = 33.018, p < 0.001) and “friend network” (F = 32.247, p < 0.001) (Table 5).

Table 5 Descriptive statistics for indicator variables across three latent categories.
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Predictors of latent profile membership

The chi-square test revealed significant differences in the distribution of the following variables among the three latent categories: personality type (χ² = 36.403, p < 0.001), marital status (χ² = 19.776, p < 0.001), education level (χ² = 19.436, p < 0.01), work status (χ² = 9.550, p < 0.01), per capita monthly household income (χ² = 64.629, p < 0.001), medical insurance (χ² = 14.741, p = 0.022), primary caregivers for minor children (χ² = 10.343, p = 0.006), disease stage (χ² = 41.526, p < 0.001), recurrence or metastasis (χ² = 27.203, p < 0.001), type of surgery (χ² = 43.747, p < 0.001), and receipt of radiotherapy or chemotherapy (χ² = 9.739, p = 0.008) (Table 2).

Variables showing statistical significance in univariate analyses were included in the multinomial logistic regression model, with “C1: low concern/concerns about children’s fathers group” as the reference group. Compared to patients with a per capita monthly household income > 5000 RMB, those with incomes ≤ 3000 RMB or 3001–5000 RMB were significantly more likely to belong to C2 (OR = 15.435, 95% CI = 6.378–37.357; OR = 4.599, 95% CI = 2.180–9.701, respectively). Patients with an education level of high school and below were significantly more likely to belong to C2 compared to those with college education or higher (OR = 2.011, 95% CI = 1.041–3.885). Employed patients were significantly more likely to belong to C3 compared to unemployed patients (OR = 2.827, 95% CI = 1.259–6.347). Patients covered by resident medical insurance were significantly more likely to belong to C3 compared to those with employee medical insurance (OR = 3.057, 95% CI = 1.193–7.835). Compared to patients who underwent breast-conserving surgery, those who had non-breast-conserving surgery or no surgery were significantly more likely to belong to C3 (OR = 6.905, 95% CI = 2.389–19.959; OR = 2.202, 95% CI = 1.033–4.693, respectively). Patients who were the primary caregivers for their minor children exhibited a significantly lower probability of assignment to C2 compared to those relying on others for care (OR = 0.426, 95% CI = 0.225–0.807) (Table 6).

Higher BIPQ scores (indicating more negative illness perceptions) were associated with a significantly increased likelihood of assignment to class C2 or C3 (OR = 1.088, 95% CI = 1.042–1.135; OR = 1.079, 95% CI = 1.031–1.128, respectively). Patients with higher scores on the “Confrontation” coping dimension were significantly less likely to belong to C3 (OR = 0.380, 95% CI = 0.207–0.699). Higher “family network” scores were associated with a significantly lower likelihood of belonging to C3 (OR = 0.680, 95% CI = 0.466–0.992). Higher “friend network” scores were associated with a significantly lower likelihood of belonging to C2 (OR = 0.681, 95% CI = 0.468–0.993) (Table 6).

Table 6 Multinomial logistic regression analysis of latent categories.
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Discussion

This study identified three distinct latent categories of parenting concerns among young and middle-aged breast cancer patients: the low concern/concerns about children’s fathers group(C1), the moderate concern/concerns about children group(C2), and the high concern group(C3). The study confirms that parenting concerns are influenced by multiple factors, including socioeconomic status, employment status, surgical types, illness perceptions, coping modes, and social support. By adopting a person-centered approach, this study reveals population heterogeneity in parenting concerns among breast cancer patients, thus providing empirical support for stratified psychological interventions.

Patients in C3 exhibited high scores across all dimensions: practical impact on children (D1), emotional impact on children (D2), and concerns about co-parenting (D3). Parenting concerns in breast cancer patients may partially stem from insufficient communication51. Evidence suggests that some female patients exhibit strong psychological reactions soon after diagnosis52, whereby their focus on diagnosis and treatment may lead to neglect of family communication, potentially resulting in excessive worry about the disease’s impact on their children and the children’s understanding of the illness53. Furthermore, the vast majority of parents with cancer express a desire to understand how their child is coping and require support to address their child’s feelings54. Patients in C2 demonstrated greater concern regarding the illness’s impact on their child’s practical and emotional well-being (D1, D2), alongside relatively low concerns about spousal support (D3), suggesting variations in family support network dynamics55. Spouses are the most important source of emotional and practical support for patients, and increasing partner satisfaction can help to alleviate patients’ psychological anxiety56,57. Emotional trajectories of patients and spouses may synchronize over time, and they are susceptible to common stressors (e.g., the cancer treatment trajectory)58. Patients in C1 had the lowest scores on D1 and D2. Despite breast cancer posing a significant threat to maternal roles, many mothers report personal growth, and their children provide a sense of purpose and value for life59. Studies indicate that raising minor children can instill patients with sustained motivation and meaning in confronting cancer, yielding positive psychological and behavioral effects60. However, patients in C1 scored significantly higher on the D3 dimension than those in C2, indicating substantial concern about their partner’s ability to independently assume parenting responsibilities and provide emotional and practical support.

Young and middle-aged breast cancer patients with lower medical insurance coverage (e.g., resident insurance), work status, and those undergoing non-breast-conserving or no surgery were more likely to belong to the high concern group (C3). Compared to employee insurance, rural and urban resident insurance offers relatively limited coverage, resulting in out-of-pocket payments averaging 16% higher61. The combined costs of disease treatment and child-rearing create substantial financial pressure, prompting some patients to return to work post-treatment62. However, increased work hours may reduce parent-child interaction time, while post-treatment functional limitations can impair work capacity. These multiple role conflicts likely exacerbate parenting concerns63,64. Studies report that approximately 31%–67% of breast cancer survivors encounter body image distress during treatment65. Such distress is more pronounced following mastectomy (especially without reconstruction) compared to breast-conserving surgery, potentially fueling mothers’ worries about their impact on their children and undermining parenting confidence66,67,68,69. Patients with metastatic breast cancer often receive systemic therapy as first-line treatment, with surgery delayed or omitted. Although this strategy may delay progression, these non-operated patients face a greater tumor burden and significantly shorter overall survival70. Consequently, mothers’ concerns about disease uncertainty and mortality may lead to diminished self-perceived parenting efficacy and significantly higher parenting concerns compared to surgical patients71.

Young and middle-aged breast cancer patients with a high school education or less and a per capita monthly household income ≤ 5000 RMB were more likely to belong to the moderate concern/concerns about children group (C2). Patients with lower education levels may possess less knowledge and fewer resources to navigate their caregiving roles, exhibit lower awareness of psychological distress, have reduced help-seeking rates, and consequently face greater parenting challenges72. The tendency for patients raising minor children to select more expensive treatment options underscores a significant correlation between parenting anxiety and income level73. Greater financial resources provide enhanced security, and higher-income families typically demonstrate greater stress resilience, aiding in managing the dual challenges of illness and parenting74,75.

Young and middle-aged breast cancer patients with minor children who were the primary caregivers for their minor children, utilized positive coping modes (confrontation), held less negative illness perceptions, and reported higher social support, were more likely to belong to the low concern/concerns about children’s father group (C1). Research indicates that patients with insufficient awareness of breast cancer symptoms and those who thought the disease lasted longer were more likely to regard it as uncontrollable and having serious consequences76. Negative illness perceptions can lead mothers to feel inadequate in meeting their children’s needs, adversely affecting parenting29,77,78. However, patients adopting a “confrontation” strategy actively engage with the disease, reflect on potential positive aspects, and initiate family communication and parent-child interactions79. By confronting reality, patients gain a better understanding of their condition, enabling positive adjustments that reduce parenting stress and enhance family well-being80. Social support serves as a protective factor for mental health, and diverse social networks offer crucial resources when maternal roles and social functioning are compromised5,81. Breast cancer patients report reduced parenting abilities due to physical limitations, struggle to fulfill responsibilities, and actively seek diverse support forms11. Support sources include family, friends, healthcare services, and community resources82. Family support, particularly from husbands and children, is paramount, bolstering resilience and hope83. Despite available resources, patients often encounter difficulties accessing adequate practical support, which is significantly associated with high maternal anxiety84,85. Parenting stress intensifies when patients lack a trusted adult to assume childcare responsibilities in the event of serious illness or anticipated death86.

For C3 patients, interventions should incorporate couples’ co-parenting training or spousal counseling modules to facilitate positive partner role adaptation, establish multi-level complementary family support networks, and implement holistic family interventions involving patients, spouses, and children. Clinicians can develop a “Co-Parenting Competency Checklist” to evaluate a partner’s confidence in managing children’s emotional needs, coordinating medical schedules, and handling school communications. Identified gaps should then be addressed through targeted training sessions. These approaches aim to enhance family resilience and well-being in coping with breast cancer. The demand for family-oriented support peaks during active treatment; thus, psychosocial support systems should be tailored to group characteristics and sustained throughout the illness trajectory82. For C2 patients, interventions should help mothers understand and respond to their children’s coping mechanisms, challenging negative assumptions about children’s responses. Psychoeducational components should clarify emotional boundaries between parental and child illness perceptions and assist parents in implementing strategies to mitigate intergenerational emotional transmission51. To address this, clinicians can offer C2 patients resources that depict typical child responses to parental illness, thereby normalizing behaviors like temporary regression. Providing models for age-appropriate dialogues about cancer can further alleviate mothers’ fear of misspeaking, enhancing their communication self-efficacy. For C1 patients, interventions should build upon their existing parenting efficacy. For couples sharing parenting responsibilities, recognizing the overall relational context is vital for resolving cancer-related parenting concerns. Couples should be coached in using validation and acceptance techniques during discussions to enhance satisfaction and effectiveness in family communication11. For couples in C1, a feasible strategy is to integrate a brief, structured consultation into routine follow-up care. This session would provide anticipatory guidance on potential future challenges and affirm the couple’s existing effective co-parenting strategies. This low-intensity, preventive approach aims to mitigate the risk that their identified concerns about the co-parent (D3) escalate over time.

This study has several limitations. First, the cross-sectional design precluded assessment of dynamic changes in parenting concerns across treatment stages. Future longitudinal studies are recommended to track the trajectories. Second, there were regional limitations in conducting convenience sampling in only one tertiary hospital. This sampling approach may introduce selection bias, likely over-representing patients with better healthcare access or health literacy. Caution is warranted when generalizing our findings to all young and middle-aged breast cancer patients. Future studies should target rural community hospitals and cancer centers serving ethnic minorities to validate whether the three-profile structure remains consistent across healthcare settings with varying resource levels. Finally, reliance on patient self-assessment questionnaires may introduce potential subjective bias. It is recommended that multiple data sources be integrated for triangulation to enhance the reliability of the results.

Conclusion

In this study, we used latent profile analysis to identify three latent categories of parenting concerns among young and middle-aged breast cancer patients: the low concern/concerns about children’s father group, the moderate concern/concerns about children group, and the high concern group. The study found that per capita monthly household income, education level, work status, medical insurance, type of surgery, primary caregivers for minor children, perception of illness, medical coping modes (confrontation), and social support were influential factors in the three latent categories of parenting concerns.