The impact of chemotherapy-induced nausea and vomiting on motherhood and family roles: A qualitative study among women with breast cancer

Abstract

Objective

To explore how women of reproductive age with breast cancer experience the impact of moderate-to-severe chemotherapy-induced nausea and vomiting (CINV) on motherhood and family roles.

Methods

A descriptive qualitative study was conducted using semi-structured interviews. Sixteen women of reproductive age with breast cancer who had experienced moderate-to-severe CINV during chemotherapy were recruited through purposive sampling with a maximum variation strategy. CINV severity was assessed with reference to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke's six-phase approach.

Results

Four themes were identified: (1) Triggered disruptions in mothering, describing how smell-triggered nausea and difficulties with physical closeness interrupted everyday mothering practices; (2) Visible challenges to maternal competence, reflecting mothers’ experiences when nausea and vomiting became visible to children and children responded to their distress; (3) Symptom-driven redistribution of mothering work, describing the temporary transfer of childcare responsibilities to spouses, parents, and parents-in-law during symptom episodes; and (4) Gaps between CINV management and mothering needs, highlighting limited mothering-related guidance and professional support during home-based symptom peaks.

Conclusions

Moderate-to-severe CINV may become intertwined with everyday mothering and family caregiving among women with breast cancer. The findings highlight the potential value of considering caregiving disruption and family-role needs alongside conventional symptom management and may inform the future development and evaluation of mother-sensitive, family-oriented supportive care.

Introduction

Breast cancer remains the most commonly diagnosed cancer among women worldwide, with approximately 2.3 million new cases and 665,000 deaths reported globally in 2022.¹ Although breast cancer is more common in middle-aged and older women, its burden among women of reproductive age has increased substantially; Global Burden of Disease 2021 estimates showed that incident cases among women aged 15–49 years rose from 256,715 in 1990 to 561,438 in 2021.² For many women in this age group, cancer treatment occurs during a life stage characterized by ongoing parenting, employment, and family responsibilities, making treatment-related symptoms potentially relevant not only to individual well-being but also to everyday caregiving and family life.^3,4

Motherhood is a multidimensional concept encompassing the social expectations, experiences, and meanings associated with being a mother, whereas mothering refers more specifically to the everyday practices through which children are cared for and relationships are maintained.⁵ These experiences and practices are shaped by social and cultural contexts rather than representing universal expectations of women. Within maternal-role theory, the maternal role encompasses caregiving responsibilities, behaviors, and the development of a maternal identity, while maternal competence refers to a mother's perceived ability and confidence in carrying out caregiving tasks and responding to her child's needs.^6,7 Family roles refer to the recurrent patterns through which family members fulfill family functions and allocate responsibilities, including childcare and related household responsibilities.⁸ Among women with breast cancer, existing research has shown that diagnosis and treatment may challenge maternal-role functioning, parenting confidence, parent–child communication, and the ability to meet children's physical and emotional needs.^3,9 Family relationships are also relevant because partners may assume additional practical and emotional responsibilities during treatment.⁴ In China, childcare is frequently organized across generations, with grandparents playing a substantial role in routine childrearing and parents negotiating caregiving responsibilities within extended family relationships.¹⁰ At the same time, contemporary parenting remains characterized by gendered divisions of care and intensive expectations of maternal involvement, which can place substantial practical and emotional responsibility on mothers.¹¹ These sociocultural features provide an important context for understanding motherhood and family caregiving among Chinese women undergoing cancer treatment.

Chemotherapy remains an important component of breast cancer treatment, and chemotherapy-induced nausea and vomiting (CINV) continues to be one of the most troublesome adverse effects despite advances in antiemetic prophylaxis and evidence-based guidelines.¹² CINV may occur during both acute and delayed phases, and delayed symptoms can remain substantial after patients return home.^13,14 Previous studies have also shown that clinicians may underestimate delayed CINV, highlighting potential gaps in the recognition of symptoms occurring outside hospital settings.¹⁴ Existing CINV research has largely focused on incidence, risk factors, antiemetic regimens, guideline adherence, symptom assessment, quality of life, and treatment adherence.^15,16 Qualitative studies have broadened this perspective by showing that CINV can disrupt eating, physical functioning, emotional well-being, social participation, and everyday life, and that patients may experience difficulties managing symptoms beyond hospital settings.17, 18, 19 However, this literature has generally emphasized patients’ experiences as individual symptom managers, with comparatively limited attention to the parenting, caregiving, and family contexts in which CINV is experienced.

Taken together, existing research has established that breast cancer and its treatment can affect mothers’ parenting experiences and family functioning, while the CINV literature has documented the persistence and everyday burden of nausea and vomiting. However, these two bodies of evidence remain insufficiently connected. In particular, limited evidence has examined how women with breast cancer experience CINV within the relational and caregiving contexts of motherhood, including everyday mothering practices, parent–child interactions, and family caregiving arrangements. This gap is especially relevant because CINV may extend beyond the clinical setting and into periods when women are managing symptoms within family life. Therefore, this study aimed to explore how women of reproductive age with breast cancer experience the impact of moderate-to-severe CINV on motherhood and family roles.

Methods

Design

A descriptive qualitative design was adopted to explore how women with breast cancer experienced the influence of CINV on motherhood and family roles. This design was considered appropriate because the study sought to obtain detailed accounts of participants’ experiences and the meanings they attributed to symptom-related changes in everyday family life, without imposing a predetermined theoretical framework.

The study was informed by an experiential and context-sensitive orientation, in which participants' accounts were treated as meaningful representations of their experiences while recognizing that these experiences were situated within particular clinical, relational, and sociocultural contexts. Reflexive thematic analysis was selected as the analytic approach because it enabled the identification and interpretation of patterned meanings across participants’ accounts while acknowledging the active and reflexive role of researchers in the analytic process. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ), which was used as a reporting guideline.²⁰

Setting and participants

The study was conducted in the oncology outpatient clinics, chemotherapy units, and post-chemotherapy follow-up services of Taiyuan Central Hospital, Taiyuan, Shanxi, China. Eligible participants were women who: (1) were aged 18–49 years; (2) had a diagnosis of breast cancer; (3) were currently receiving chemotherapy or had completed chemotherapy within the previous 6 months; (4) had experienced moderate-to-severe CINV; (5) had at least one child; and (6) were willing to participate. Women were excluded if they had severe cognitive impairment, were unable to communicate verbally, or were physically or emotionally unable to participate in an interview.

CINV severity was assessed by trained oncology nurses with reference to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0.²¹ Assessment considered participants' reports of nausea and vomiting, their effects on oral intake and daily functioning, the need for antiemetic medication or additional clinical management, and available nursing, medical, and follow-up records. Moderate-to-severe CINV was defined as Grade ≥ 2 nausea or vomiting. For women who were receiving chemotherapy at the time of recruitment, eligibility was determined using information from the current or recent chemotherapy period together with available clinical documentation. For women who had already completed chemotherapy, eligibility was confirmed retrospectively by combining participants’ recall of relevant CINV episodes with available nursing, medical, and post-chemotherapy follow-up records.

Sampling and recruitment

Purposive sampling with a maximum variation strategy was used to recruit participants.²² Maximum variation was sought in age, number and age of children, chemotherapy stage, and CINV experience. A sampling matrix was used during recruitment to monitor variation across these characteristics.

Potentially eligible women were identified continuously during the study period through chemotherapy records, discharge follow-up lists, nursing follow-up records, and routine post-chemotherapy follow-up services. Follow-up after chemotherapy was conducted according to patients’ clinical needs and could continue for several months after treatment completion. This ongoing follow-up process enabled the research team to identify eligible women not only during active chemotherapy but also after they had completed treatment. Information documented during routine follow-up, including reports of nausea and vomiting occurring outside the hospital setting, was used to support eligibility assessment. Although the timing of nausea and vomiting in relation to chemotherapy was documented in some clinical and follow-up records, acute and delayed CINV were not systematically classified as separate categories for all participants. Women who met the eligibility criteria were informed about the study by an oncology nurse and asked whether they were willing to be contacted by the research team. Those who agreed were subsequently contacted by the first author, who provided further information about the study and invited them to participate.

Sample-size rationale

Sample adequacy was guided by the principle of information power.²³ Recruitment and preliminary analysis proceeded concurrently, with consideration given to the specificity of the study aim, the specificity and variation of the sample, the richness of the interview dialogue, and the depth of the developing analysis. After 16 interviews, the research team judged that the dataset provided sufficient depth, richness, and variation to address the study aim, and recruitment was concluded.

Interview guide

A semi-structured interview guide was developed to explore how CINV affected women's maternal functioning during chemotherapy. Its development was informed by qualitative studies on CINV experiences and motherhood among women with breast cancer, particularly evidence concerning symptom-related disruption of everyday caregiving, maternal-role experiences, changes in family caregiving arrangements, and support needs.^17,24,25 The guide comprised eight core questions covering participants' recent CINV experiences, effects on everyday childcare activities, perceptions of maternal competence, children's responses to maternal illness, redistribution of caregiving responsibilities, family support, health care support, and unmet needs related to maintaining the maternal role. Each core question was accompanied by optional probes that were used flexibly according to participants' responses. The complete interview guide is provided in Supplementary File 1.

The guide was refined through team discussions and pilot interviews with two women receiving chemotherapy for breast cancer. The pilot interviews assessed question clarity, sensitivity, sequencing, and conversational flow. Based on participant feedback, lengthy questions were shortened, overlapping prompts were combined, and the sequence was adjusted to move from concrete CINV episodes and everyday caregiving experiences to broader maternal-role and support experiences. Probes were also added to explore activities that participants were able to maintain and experiences that varied across symptom episodes. Pilot interview data were not included in the final analysis.

Data collection

Data were collected through one-to-one semi-structured interviews between February and April 2026. After eligible participants agreed to be contacted by the research team, the first author provided detailed information about the study purpose, interview procedures, confidentiality, voluntary participation, and the right to withdraw at any time. Participants were given sufficient time to consider participation before providing written informed consent.

All interviews were conducted by the first author, who had training and prior experience in qualitative interviewing and was not involved in participants’ routine clinical care. The interview guide was used flexibly rather than as a fixed sequence. Participants were initially invited to describe concrete CINV episodes and their everyday experiences as mothers, after which probes were used to explore issues raised in their accounts. Women who had completed chemotherapy were asked to retrospectively recall relevant CINV episodes experienced during treatment and to describe how these episodes had affected their mothering and family life. The exact interval between each specific CINV episode described and the interview was not systematically recorded. Where participants reported little or no change in a particular maternal activity, the interviewer explored factors that enabled the activity to be maintained and whether this was consistent across symptom episodes. When both helpful and difficult aspects of an experience were described, both perspectives were explored.

Interview timing and format were arranged according to participants' physical condition, treatment schedule, and preference. Participants attending the hospital for symptom management or follow-up were interviewed face-to-face in a private consultation room in the oncology outpatient clinic or chemotherapy unit. Those who had returned home or preferred a remote interview were interviewed at an agreed time via WeChat voice call or telephone. Interviews lasted approximately 30–60 minutes and were audio-recorded with participants’ permission. Recordings were transcribed verbatim in Chinese by the first author within 24 hours and checked against the recordings for accuracy. Brief field notes were recorded following face-to-face interviews to document relevant contextual information and observable non-verbal expressions.

Data analysis

Data were analyzed using reflexive thematic analysis following Braun and Clarke's six-phase approach.²⁶ Analysis began with repeated reading of the transcripts to support familiarization and sustained engagement with the data. Initial codes were generated inductively and remained closely connected to participants' accounts of CINV, mothering practices, maternal-role experiences, and family roles. Codes and patterns were examined across transcripts, and related meanings were progressively developed into candidate themes.

Participants' treatment status and recall period were considered as contextual features during analysis. During transcript comparison and theme development, the researchers examined whether accounts from women who were still receiving chemotherapy differed in recurring ways from those of women who had completed treatment, and whether participants with longer recall periods described systematically different patterns of CINV-related mothering or family-role experiences. No recurring pattern was identified that clearly differentiated the thematic findings according to treatment status or recall period. This comparison was interpretive rather than a formal subgroup analysis, and the study was not designed to establish equivalence between treatment-status or recall-period groups. Participants’ accounts were therefore analyzed within the same dataset while treatment context was retained during interpretation.

Two researchers engaged with the transcripts and contributed to coding and interpretation. Coding was not undertaken to assess inter-coder reliability or establish coding agreement. Instead, developing codes, patterns, and candidate themes were discussed in analytic meetings to consider alternative interpretations, question assumptions, and refine theme boundaries and meanings. Differences in interpretation were treated as opportunities for reflexive discussion rather than discrepancies requiring consensus. Candidate themes were repeatedly reviewed against relevant coded extracts and the dataset as a whole before being refined, defined, and named.

Rigor and reflexivity

Rigor was supported through reflexive team discussion, maintenance of an audit trail, and continued attention to the relationship between researchers and the analytic process. The audit trail included field notes, coding records, and documentation of theme-development decisions. The corresponding author reviewed selected transcripts and contributed to theme development, while team discussions were used to consider alternative interpretations and refine the developing analysis. Throughout the study, the research team reflected on how their oncology nursing backgrounds and prior knowledge of chemotherapy-related symptoms might shape data collection and interpretation. All interviews and analyses were conducted in Chinese. Selected quotations were translated into English for reporting and checked against the original Chinese text by the research team to preserve their intended meaning.

Results

Characteristics of participants

A total of 20 eligible women were approached for participation. Four declined because of limited time or unwillingness to participate, resulting in a final sample of 16 women. Participants ranged in age from 27 to 45 years, and all were married with at least one child. The ages of the children ranged from infancy to adolescence. Participants included women currently undergoing chemotherapy as well as those within 6 months after chemotherapy completion, representing different chemotherapy cycles and treatment stages. Most participants were diagnosed with stage II-III breast cancer, while a small number had stage I disease. Participants also differed in employment status, family support, and childcare arrangements during treatment. At the time of interview, some women undertook primary caregiving responsibilities, whereas others mainly relied on spouses, parents, or parents-in-law for childcare support (Table 1).

Table 1.

Demographic and clinical characteristics of participants (N = 16).

Patient	Age (years)	Children	Employment status	Cancer stage	Chemotherapy stage	Primary childcare provider	Perceived family support
P01	29	1 child (2 y)	Sick leave	Stage II	Cycle 2	Spouse	Relatively sufficient
P02	34	2 children (4 y, 8 y)	Temporarily stopped working	Stage III	Cycle 5	Parents	Moderate
P03	41	1 child (13 y)	Employed	Stage II	3 months post-chemotherapy	Self	Relatively sufficient
P04	37	2 children (6 y, 10 y)	Sick leave	Stage III	Cycle 4	Spouse	Limited
P05	32	1 child (5 y)	Temporarily stopped working	Stage II	Cycle 3	Parents-in-law	Moderate
P06	45	2 children (15 y, 18 y)	Employed	Stage I	5 months post-chemotherapy	Self	Very sufficient
P07	28	1 child (1 y)	Sick leave	Stage II	Cycle 1	Mother	Relatively sufficient
P08	39	2 children (7 y, 11 y)	Temporarily stopped working	Stage III	Cycle 6	Spouse	Moderate
P09	35	1 child (9 y)	Employed	Stage II	2 months post-chemotherapy	Self	Relatively sufficient
P10	43	2 children (12 y, 16 y)	Employed	Stage I	6 months post-chemotherapy	Self	Very sufficient
P11	31	1 child (3 y)	Sick leave	Stage III	Cycle 4	Spouse	Moderate
P12	36	2 children (5 y, 9 y)	Temporarily stopped working	Stage II	Cycle 5	Parents	Relatively sufficient
P13	27	1 child (8 months)	Sick leave	Stage II	Cycle 2	Mother	Limited
P14	40	2 children (10 y, 14 y)	Employed	Stage III	4 months post-chemotherapy	Self	Moderate
P15	33	1 child (6 y)	Temporarily stopped working	Stage II	Cycle 3	Spouse	Relatively sufficient
P16	38	2 children (4 y, 12 y)	Sick leave	Stage III	Cycle 6	Parents-in-law	Moderate

Primary childcare provider refers to the person primarily responsible for childcare at the time of interview. Perceived family support was assessed through a single self-report item with four response options: limited, moderate, relatively sufficient, and very sufficient. These categories reflected participants' subjective appraisal of available family support and were not based on a standardized scale or researcher-assigned criteria.

Theme 1 triggered disruptions in mothering

Smell-triggered feeding disruption

Participants described cooking, preparing meals, feeding children, and accompanying children during meals as ordinary ways of caring for their families. However, after chemotherapy, these routine practices became closely associated with nausea. Smells from oil, meat, rice, milk, snacks, and even children's food could rapidly trigger retching or vomiting. For several participants, preparing food had previously represented attentiveness and maternal competence. When smell sensitivity made this impossible, they experienced a loss of one of the most familiar ways of “doing mothering.”

“The smell was the most obvious trigger, especially cooking oil. I used to enjoy cooking and felt that it was a way of caring for my family. But during chemotherapy, I felt nauseous as soon as I entered the kitchen. Even the smell of my child’s snacks, especially sweet ones, could make me feel sick.” (P09)

“Before chemotherapy, I always prepared meals for my child. But during treatment, I could not even enter the kitchen because of the smell.” (P11)

Withdrawal from physical closeness

CINV also disrupted mothering through physical closeness. Holding, comforting, feeding, sleeping beside, and playing with children were described as important forms of everyday maternal care. Among participants with young children, however, bodily proximity and movement could intensify nausea or the urge to vomit, making close contact difficult during symptom episodes. Some mothers wanted to respond when their children sought comfort or closeness, but during episodes of nausea, some described difficulty holding the child or remaining physically close. This temporary withdrawal was distressing because participants felt unable to provide the bodily reassurance they would normally offer. The tension between wanting to comfort the child and needing to retreat during episodes of nausea was experienced by some mothers as a challenge to their sense of maternal competence.

“My child was only one year old and depended on me so much. Bathing, feeding, and putting him to sleep were almost all done by me before. Now many things cannot be done. Especially holding him—when I feel nauseous, I do not even have the strength to hold him. Sometimes he reaches out to me, but I can only ask my mother to take him away. It feels terrible.” (P07)

“I felt like I was not being a proper mother because I could not even hold my child when she needed me.” (P15)

Theme 2 visible challenges to maternal competence

Losing composure before children

Participants described visible episodes of nausea and vomiting as particularly difficult when they occurred in front of their children. Several mothers tried to conceal vomiting by closing the bathroom or bedroom door or asking their children to stay away during symptom episodes. When children nevertheless witnessed or heard them vomiting, participants described feeling exposed and unable to maintain the composed and reassuring presence they usually tried to provide. Children's reactions, including fear, silence, or temporary withdrawal, further heightened mothers' distress. For some participants, the difficulty lay not only in experiencing vomiting itself, but also in realizing that their children were witnessing them during moments of visible physical distress, which challenged their sense of being capable and protective mothers. For some participants, concern about children witnessing repeated CINV episodes extended beyond the immediate symptom event. Mothers worried that repeated scenes of vomiting, retreating from close contact, or being unable to participate in usual caregiving might shape how their children remembered them during treatment. This concern further challenged their sense of being dependable and emotionally available mothers.

“I tried not to let my child see me vomiting. I would close the bathroom door and ask him to stay outside, but sometimes he still heard everything.” (P04)

“My child became very quiet after seeing me vomit. He did not come close to me for a while, which made me feel even worse.” (P11)

“I often worry about whether my child will remember this period. Whether he will remember that Mom always lay there, always vomited, and could not hold him. I do not want his memory of me to be like that, but I cannot change it.” (P13)

Receiving comfort from children

During episodes of severe nausea and vomiting, some participants described a temporary shift in the usual direction of care between themselves and their children. Mothers who usually saw themselves as providing comfort and reassurance described their children responding to visible symptom episodes by bringing water or tissues, helping them after vomiting, or becoming quieter and less demanding. Participants often interpreted these responses ambivalently. They felt touched by their children's concern, while also feeling distressed that their children had become attentive to their physical discomfort. Accounts from mothers of children at different ages suggested some variation in how children responded. Younger children were described as offering simple forms of practical comfort, whereas some older children became quieter and more observant of their mothers' condition. For some mothers, receiving care or increased attentiveness from their children during CINV episodes highlighted a temporary shift in their usual caregiving relationship and contributed to feelings of reduced maternal competence.

“She ran over and handed me a tissue, saying, ‘Mom, wipe your mouth.’ My hands were shaking so much that I could hardly hold it, so she squatted down and wiped the corner of my mouth for me. She was only six, and her movements were clumsy but very serious. At that moment I felt moved, but also very sad and useless.” (P15)

“The children would become quiet. My older daughter is 14 and already understands a lot. Once, after I vomited, she silently put warm water on the table. But she did not ask anything. I could feel that she was worried, but she did not know how to express it.” (P14)

Theme 3 symptom-driven redistribution of mothering work

Spouses absorbing symptom-disrupted routines

Participants described their spouses as taking on additional childcare and household responsibilities during periods when nausea and vomiting interfered with mothers' usual caregiving activities. This was particularly evident when food smells intensified nausea or when symptom episodes made it difficult for mothers to prepare meals, accompany their children, or participate in bedtime care. Spouses temporarily assumed tasks such as cooking, school pick-up, homework supervision, and caring for children during symptom peaks. For some participants, this redistribution provided reassurance that children's routines could continue; for others, it was accompanied by guilt as they saw their spouses combining paid work with increased childcare and support during CINV episodes.

“My husband used to mainly work and play with the child after coming home. Now everything is reversed. He has to work, care for the child, cook, clean, help me after I vomit, and take me to the hospital. I know he is tired, and I feel very sad when I see that.” (P11)

Parents and parents-in-law taking over hands-on care during symptom peaks

Participants described increased involvement of parents and parents-in-law when nausea and vomiting made hands-on childcare difficult, particularly among mothers of infants and younger children. During symptom peaks, these family members temporarily assumed activities such as feeding, bathing, preparing complementary foods, bedtime routines, and day-to-day supervision. Participants generally valued this support because it helped maintain children's routines and allowed them to step back from physically demanding caregiving during episodes of CINV. At the same time, some mothers described mixed feelings as they watched their children increasingly rely on grandparents for activities that they had previously undertaken themselves. For these participants, practical relief coexisted with sadness and a sense of reduced involvement in their maternal role during CINV episodes and chemotherapy treatment.

“Bathing the baby, putting him to sleep, preparing complementary food—most of these things are now done by my mother. I used to manage many small things at home, but now I cannot take care of them. Sometimes I feel as if I suddenly lost my original role.” (P13)

“Now my mother is the one taking care of almost everything for my child. I feel like I have gradually stepped back from my role as a mother.” (P06)

Theme 4 gaps between CINV management and mothering needs

Symptom-focused care without mothering guidance

Participants generally recognized that clinical care provided antiemetic medication and basic advice about diet, hydration, and symptom reporting. However, this support was experienced as primarily focused on symptom control. Some participants wanted additional practical guidance on how to manage mothering responsibilities during episodes of nausea and vomiting, including how to explain visible symptoms to children, maintain connection when direct caregiving was temporarily limited, and prepare for the transfer of childcare responsibilities during symptom peaks. Participants described a gap between being supported as patients with CINV and receiving guidance on how to manage the maternal and family-role consequences of these symptoms.

“Doctors always focus on whether I vomit or not, but no one tells me how to explain my illness to my child.” (P07)

Limited continuity during home-based symptom peaks

Several participants described nausea and vomiting as becoming particularly difficult after they returned home, especially during the first few days after chemotherapy and at night. These symptom episodes sometimes coincided with children's bedtime routines or night waking, making it difficult for mothers to manage their own discomfort while remaining available to their children. Participants also described professional support as less immediately accessible during these home-based periods and reported relying mainly on family members to manage symptoms and caregiving demands. For some mothers, this created a mismatch between when CINV-related difficulties were most disruptive to everyday mothering and when professional support was most readily available.

“After I got home, the vomiting became quite severe. I did not know who to ask, so I could only rely on my family to take care of me.” (P08)

“Night-time was the hardest. Sometimes the child would wake up, and I already could not sleep because of nausea. Together, it made me emotionally very fragile.” (P07)

“The second and third days after chemotherapy were the hardest after I returned home, but by then I was no longer in the hospital.” (P07)

Discussion

This study explored how women of reproductive age with breast cancer experienced moderate-to-severe CINV in relation to motherhood and family roles. The findings suggest that nausea and vomiting were experienced not only as distressing treatment-related symptoms, but also as episodes that became embedded in everyday mothering practices and family caregiving arrangements. CINV-related difficulties were particularly evident when food smells triggered nausea during meal preparation, when symptoms limited physical closeness with children, when vomiting became visible to children, and when childcare responsibilities had to be temporarily redistributed to spouses or grandparents. Participants also described difficulties during home-based symptom peaks, when nausea and vomiting coincided with caregiving demands and professional support was less immediately accessible. By identifying these symptom-specific and relational mechanisms, this study extends previous research on motherhood during breast cancer treatment beyond descriptions of broad treatment burden. At the same time, these experiences occurred within the wider context of cancer and chemotherapy; therefore, the findings should be understood as showing how CINV-related episodes intersected with mothering and family life rather than as evidence that CINV alone caused all reported disruptions.

Previous studies have shown that CINV is not merely a biomedical symptom, but a subjective and disruptive experience that can affect eating, physical functioning, emotional wellbeing, and daily life.^27,28 Delayed and intercycle symptoms may also become particularly burdensome after patients return home, when clinical monitoring and professional support are reduced.^15,29 In parallel, research involving young women with breast cancer has documented difficulties in maintaining everyday maternal responsibilities, meeting children's physical and emotional needs, and sustaining a sense of maternal role during treatment.^30,31 Building on these two bodies of literature, the present findings suggest that CINV-related disruption may acquire particular meaning when nausea and vomiting occur within activities through which mothers routinely enact care. Meal preparation and feeding, for example, may simultaneously represent ordinary caregiving practices and expose mothers to smell-related symptom triggers, while physical closeness with children may become difficult during episodes of nausea. The significance of these disruptions therefore extends beyond temporary functional limitation: symptom episodes may interfere with familiar practices through which participants understood themselves as responsive and involved mothers. In this sense, the contribution of the present study lies not simply in showing that CINV disrupts daily life, but in illustrating how symptom-related difficulties may become intertwined with the relational and embodied practices of everyday mothering.

Existing studies on motherhood and breast cancer have shown that women may experience difficulty sustaining everyday maternal roles while managing illness and treatment, particularly in relation to children's physical and emotional care and mothers' perceptions of their own maternal adequacy.^3,9 The present findings extend this literature by identifying a more specific relational mechanism through which CINV episodes may challenge maternal competence: nausea and vomiting were difficult to conceal and sometimes became directly visible or audible to children. When children witnessed vomiting or responded by becoming quiet, withdrawing, or offering comfort, participants described feeling exposed and less able to maintain the reassuring presence they usually tried to provide. The significance of these experiences may be understood partly in relation to socially and culturally shaped expectations of motherhood. Socially shaped ideals of intensive or “good” motherhood often position mothers as highly available and responsive caregivers who assume substantial responsibility for their children's physical and emotional needs.^32,33 Such expectations may make visible dependence or loss of composure especially difficult to reconcile with women's sense of maternal competence. From this perspective, participants' distress did not arise simply because children witnessed a physical symptom; visible CINV temporarily altered the usual direction of care, with children sometimes becoming observers or providers of comfort rather than solely recipients of maternal care. This interpretation is consistent with research showing that children often make sense of maternal cancer through visible and concrete changes in the family environment.³⁴ Thus, the relational significance of visible CINV lay in how symptom episodes intersected with participants' expectations of themselves as capable and reassuring mothers.

Studies of parental cancer have consistently shown that maternal illness can disrupt family routines and alter the distribution of caregiving responsibilities. Inhestern and Bergelt found that mothers with cancer and their partners reported practical changes in childcare and household duties, parental-role strain, maternal guilt, and increased responsibilities for fathers.³⁵ More recent qualitative research on family caregivers of women with breast cancer likewise suggests that relatives often assume additional practical and emotional responsibilities as cancer care increasingly extends into outpatient and home settings.³⁶ The present findings add to this literature by showing that episodes of nausea and vomiting could become specific occasions around which childcare responsibilities were temporarily reorganized, particularly when symptoms interfered with meal preparation, bedtime care, or other hands-on activities. The meaning of this redistribution was shaped by the family context in which it occurred. In China, grandparents are commonly involved in childcare and may share substantial caregiving responsibilities with parents, making intergenerational support an important resource within many families.³⁷ At the same time, contemporary intensive-mothering expectations and gendered divisions of parenting continue to place considerable practical and emotional responsibility on mothers.¹¹ Recent research on Chinese mothers, for example, has shown how unequal parenting responsibilities and intensive-mothering expectations can amplify mothers' emotional work and feelings such as guilt.¹¹ Against this background, participants' mixed responses to family support become more understandable: spouses and grandparents helped preserve children's routines and reduced mothers' immediate caregiving burden, yet the transfer of activities that participants associated with their own maternal role could also heighten feelings of reduced involvement or displacement. Thus, family support during CINV episodes functioned not simply as a practical substitute for unavailable labor, but as a relational reorganization of care whose emotional meaning was shaped by participants' expectations of themselves as mothers.

Current CINV care is guided by evidence-based antiemetic recommendations, including emetogenic risk assessment, prophylactic antiemetic regimens, and symptom-based management.¹² Nurse-led educational interventions have also shown potential to reduce CINV-related burden, but these approaches have largely emphasized symptom knowledge, self-management, and treatment adherence.³⁸ The present findings suggest an additional gap for mothers with dependent children: clinical support may address nausea and vomiting without fully addressing how symptom episodes interfere with childcare, mother–child interaction, and temporary family-role reorganization. This gap may be particularly relevant during home-based symptom peaks, when participants described nausea and vomiting as coinciding with caregiving demands while professional support was less immediately accessible. Thus, existing symptom-management and follow-up models may provide a useful foundation, but the findings indicate that future supportive-care approaches could be developed and evaluated to include mother-sensitive and family-oriented components alongside conventional CINV management.

Implications for practice

The findings suggest that CINV assessment for women with dependent children could extend beyond symptom severity to include the ways in which nausea and vomiting interfere with everyday caregiving and mother–child interaction. Alongside assessment of vomiting frequency, oral intake, and antiemetic use, clinicians could consider asking whether symptom episodes affect meal preparation, physical closeness with children, bedtime routines, mother–child communication, or the temporary redistribution of childcare responsibilities. The findings also identify several areas that may warrant consideration in the development and evaluation of mother-sensitive supportive care. Before chemotherapy, anticipatory guidance could help families identify likely periods of symptom burden, plan temporary childcare arrangements, reduce avoidable smell-related triggers, and consider ways of maintaining mother–child connection when direct caregiving is temporarily limited. Where appropriate, spouses, grandparents, or other family caregivers could be involved in such planning so that practical support is coordinated around the mother's needs and preferences rather than understood as replacing her maternal role. Brief, age-appropriate communication resources may also help mothers explain visible nausea and vomiting to children in ways that are understandable and reassuring. Because participants described nausea and vomiting as particularly difficult after returning home, targeted nurse-led or multidisciplinary follow-up during expected post-chemotherapy symptom peaks may also warrant evaluation. Such follow-up could assess not only symptom control but also caregiving disruption, emotional distress, and the adequacy of family support. Mothers experiencing persistent or severe symptoms, substantial role disruption, or psychological distress could then be considered for more intensive supportive care or referral where appropriate. These practice considerations require further evaluation before their effectiveness and feasibility can be established.

Limitations and further research

This study has several limitations. First, participants were recruited from a single clinical setting within an East Asian cultural context in which familism, intensive mothering expectations, and intergenerational childcare are salient. The findings therefore reflect a particular sociocultural and health care context and may not be directly transferable to settings with different family structures, caregiving arrangements, or expectations of motherhood. In addition, the relatively small purposive sample was appropriate for in-depth qualitative exploration but limits the breadth of perspectives represented. Detailed household and socioeconomic information, such as living arrangements, partner employment, and other indicators of caregiving resources, was not systematically collected and therefore could not be incorporated into the contextual interpretation of participants' family support and caregiving arrangements. Second, the study focused only on mothers' perspectives. Spouses, grandparents, and children were not directly interviewed; therefore, interpretations concerning family members' responses, caregiving redistribution, and children's reactions reflect mothers' perceptions rather than the perspectives of those family members themselves. Future family-based qualitative research could incorporate multiple family members to provide a more relational understanding of how CINV affects family roles and caregiving arrangements. Third, some participants retrospectively recalled CINV experienced during chemotherapy. The exact interval between specific CINV episodes and the interview, as well as acute versus delayed CINV classification, was not systematically recorded. These retrospective accounts may therefore have been affected by recall bias. Fourth, symptom attribution was inherently complex. Although the interviews focused specifically on nausea and vomiting episodes and the analysis prioritized experiences directly linked to CINV, participants' accounts were inevitably embedded within the broader context of breast cancer diagnosis, chemotherapy, fatigue, emotional distress, and other treatment-related effects. It is therefore not possible to completely isolate the effects of CINV from the overall burden of cancer and its treatment. The findings should consequently be interpreted as participants' accounts of how CINV-related episodes intersected with mothering and family life, rather than as evidence that CINV alone caused all of the reported disruptions. Fifth, some impact-focused wording in the interview guide may have encouraged fuller reporting of disruption or negative experiences, potentially introducing response bias.

Future research could use longitudinal, diary-based, or mixed-methods designs to examine mothering experiences across days with different levels of nausea and vomiting and to explore how CINV interacts with broader treatment-related functional impairment. Studies involving mothers and other family members across different cultural and clinical settings may also help clarify the symptom-specific and relational mechanisms identified in this study and inform the development and evaluation of mother-sensitive, family-oriented supportive interventions.

Conclusions

This study provides qualitative insight into how women of reproductive age with breast cancer experienced moderate-to-severe CINV in relation to motherhood and family life. The findings suggest that nausea and vomiting may become intertwined with everyday mothering through smell-triggered difficulties during meal preparation, limitations in physical closeness, visible symptom episodes in front of children, temporary redistribution of childcare responsibilities, and difficulties during home-based symptom peaks. These experiences occurred within the broader context of breast cancer and chemotherapy and should not be interpreted as effects of CINV in isolation. The findings highlight the potential value of considering caregiving disruption and family-role needs alongside conventional symptom management and may inform the future development and evaluation of mother-sensitive, family-oriented supportive care for women with dependent children.

CRediT authorship contribution statement

Xiaofang Song: Investigation, Conceptualization, Formal analysis, Data curation, Writing – original draft. Shaolong Chen: Project administration, Supervision, Writing – review and editing. Bin Liu: Conceptualization, Data curation, Writing – original draft. Hua Kang: Data curation, Investigation, Resources. Duan Zhang: Investigation, Resources. Zhuolin Li: Data curation, Investigation, Resources. All authors have read and approved the final manuscript.

Ethics statement

This study was reviewed and approved by the Biomedical Research Ethics Committee of Taiyuan Central Hospital (Approval No. KY2025062) and was conducted in accordance with the Declaration of Helsinki and its subsequent amendment. All participants provided written informed consent.

Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available because they contain qualitative interview material that could potentially compromise participant privacy and confidentiality.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this manuscript, the authors used ChatGPT (OpenAI) for language translation and English-language editing. The authors reviewed and revised all AI-assisted content and take full responsibility for the final content of the manuscript.

Funding

This study was supported by the Beijing Cancer Prevention and Treatment Research Association (Grant No. KY202502036). The funder had no role in the study design, data collection, analysis or interpretation, preparation of the manuscript, or the decision to submit the article for publication.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix. Supplementary materials

The following is the Supplementary data to this article: