Specific challenges faced by women when diagnosed with cancer

Gender-based differences in psychological distress following cancer diagnosis and treatment are widely reported in the international literature. A Canadian study of patients diagnosed with non-metastatic renal cell carcinoma found that women experience higher levels of anxiety and distress than men at several timepoints in their cancer journey, including at diagnosis, biopsy, and surgical treatment (Ajaj et al., Reference Ajaj, Cáceres, Berlin, Wallis, Chandrasekar, Klaassen, Ahmad, Leao, Finelli, Fleshner and Goldberg2020). A study of gastrointestinal cancer patients in China found that a greater proportion of females (52.8%) than males (35.9%) had clinically significant psychological distress (Cheng et al., Reference Cheng, Xie, Duan, Li, She, Lu and Chen2024).

A German study of over 21,000 patients with all cancer types classified patients into five distress cluster groups: ‘minimally distressed’, ‘highly distressed’, ‘mainly physically distressed’, ‘mainly psychologically distressed’, and ‘mainly socially distressed’ (Herschbach et al., Reference Herschbach, Britzelmeir, Dinkel, Giesler, Herkommer, Nest, Pichler, Reichelt, Tanzer-Küntzer, Weis and Marten-Mittag2020). Men were over-represented in the ‘minimally distressed’ cluster, and women were over-represented in the ‘highly distressed’ and ‘mainly psychologically distressed’ clusters. These findings confirm that females experience higher levels of distress relating to cancer diagnosis and treatment than men.

In the Irish context, we recently published a study which explored the experience of cancer patients attending for oncological treatment in the largest national cancer centre in the country (Carter et al., Reference Carter, Collier, Plunkett, Beirne and Kelly2025). We confirmed gender disparities in the psychological experience of Irish cancer patients during diagnosis and treatment, with women reporting more extreme distress than males. In our study, almost half of females who participated (46.4%) reported ‘extreme’ distress at cancer diagnosis compared to 17.8% of males. Consistent with the international literature, our results confirm that gender differences exist among Irish cancer patients, with women experiencing increased levels of ‘extreme’ distress compared to men.

These findings have both therapeutic and – possibly – prognostic significance. Some studies have shown that patients with higher levels of distress and psychiatric symptomatology demostrate poorer treatment adherence and lower satisfaction with their oncological care providers (Arrieta et al., Reference Arrieta, Angulo, Núñez-Valencia, Dorantes-Gallareta, Macedo, Martínez-López, Alvarado, Corona-Cruz and Oñate-Ocaña2013, Meggiolaro et al., Reference Meggiolaro, Berardi, Andritsch, Nanni, Sirgo, Samorì, Farkas, Ruffili, Carruso, Belle, Linares, de Padova and Grassi2016). This finding may go some way towards explaining the somewhat controversial conclusion that lower levels of psychological distress and fatigue were associated with longer disease-free and overall survival in a study of primary breast cancer patients, after controlling for multiple biological variables, not including treatment adherence (Groenvold et al., Reference Groenvold, Petersen, Idler, Bjorner, Fayers and Mouridsen2007). While a recently published systematic review of the link between psychological distress and survival in solid tumour patients suggested that there may indeed be a correlation between psychological distress, survival, and other disease related outcomes, the authors identify that the studies reviewed had a moderate to high level of bias and that more research was needed to confirm if such a relationship exists (Roche et al., Reference Roche, Cooper, Armstrong and King2023). More robust studies clarifying this issue would be welcome.

The increased levels of psychological distress experienced by female cancer patients are likely multifaceted and complex, incorporating biological, emotional, psychological, societal, and economical dimensions. Women appear to express distress differently to men, as reflected by differing rates of mental disorders among men and women: women display increased rates of depression, anxiety, and eating disorders compared to men, while men have increased likelihoods of substance use and conduct disorders (Boyd et al., Reference Boyd, Van de Velde, Vilagut, de Graaf, O’Neill, Florescu, Alonso and Kovess-Masfety2015; European Institute for Gender Equality 2021). Overall, the Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4 showed that one in five (20.2%) adults in England has a common mental health condition, with the overall prevalence higher in women (24.2%) than men (15.4%) (Liubertiene et al., Reference Liubertiene, Sloman, Morris, Bhavsar, Clark, Das-Munshi, Jenkins, McManus, Oram, Wessely, Morris, Hill, Brugha and McManus2025).

In addition, background risk factors for mental distress differ significantly between women and men. For example, findings from one European survey of violence against women, show that over one-quarter (26%) of women surveyed in Ireland experience physical and/or sexual violence by a partner or non-partner since the age of 15 years (European Union Agency for Fundamental Rights, 2015). This indicates a high level of pre-existing adverse life experiences among women which might predispose them to increased rates of psychological distress following the additional challenge of a cancer diagnosis.

There are also socioeconomic factors which might play a role in the relationship between cancer and psychological distress, especially among women. There are particular norms and gender roles assigned to women in society which might be relevant. For example, as is the case elsewhere, women in Ireland are more likely than men to assume informal care roles, with 61% of informal carers identified as females (Central Statistics Office, 2025). A gender-pay gap also persists in Ireland and is widening, with 2024 figures estimating that men are paid 1.78% more than females for the same role, an increase of 0.2% from 2023 (National Shared Services Office, 2024).

Taken together, the impact of previous adverse life experiences, carer roles, financial inequity, and a range of other factors might increase the likelihood of psychological distress among women who are diagnosed with cancer. More specifically, the increased caring responsibility placed on women and their financial challenges might become more prominent when a woman is diagnosed with cancer and she finds herself unable to fulfil her usual caring roles and other responsibilities. It is also relevant that some of those carer roles can involve caring for, and supporting, other family members with cancer.

Gender based differences exist in terms of preference for therapeutic intervention. There is evidence that accommodating patient treatment preferences is associated with fewer treatment dropouts and improved treatment outcomes, thereby indicating that a gender-specific approach to psychological treatment may result in enhanced patient outcomes (Swift et al., Reference Swift, Callahan, Cooper and Parkin2018). The literature has shown that women are more likely than men to prefer psychological over pharmacological treatment (McHugh et al., Reference McHugh, Whitton, Peckham, Welge and Otto2013), a female therapist (Liddon et al., Reference Liddon, Kingerlee and Barry2018), and three times more likely to use an information-based helpline (Manning and Quigley Reference Manning and Quigley2002).

Ireland’s current provisions for mental health and psycho-oncological care for women with cancer

In Sharing the Vision: A Mental Health Policy for Everyone, the Department of Health set clear goals to ‘ensure that mental health priorities and services are gender-sensitive and that women’s mental health is specifically and sufficiently addressed in the implementation of policy’ (Department of Health, 2020). As part of this initiative, a Women’s Health Taskforce was established and, as a result of the findings of this taskforce, the Women’s Health Action Plan 2024–2025: Phase 2: An Evolution in Women’s Health was published in 2024 (Department of Health, 2024). Ireland thus became one of the first countries worldwide to develop a specific women’s health action plan, which has been informed by women for women. This aims to revolutionise the management of women’s health in Ireland, incorporating both mental health and physical health, including cancer care.

In terms of mental health, a 2022 report on Embedding Women’s Mental Health in Sharing the Vision emphasises the need for gender awareness so ‘that women experience an inclusive, supportive and effective mental health service that meets their needs’ (Department of Health, 2022) This policy commits to providing ‘a gender-aware approach to the delivery and accessibility of all care’; ‘a trauma-aware approach by all staff who contribute to the service’; and ‘the systematic collection and analysis of data on gender, ethnicity, disability and other risk factors for marginalisation of women’ (p. 6). The policy makes specific recommendations for ‘integrated models of care for women’, combining physical and mental health (p. 16). In addition, the recently published Sharing the Vision: Implementation Plan 2025–2027 sets out specific recommendations for implementation, including development and rollout of ‘a toolkit for embedding women’s mental health in policy implementation’ (Health Service Executive, 2025).

In relation to cancer, the National Cancer Strategy aims to develop services nationally for cancer patients and their families. This strategy seeks to develop psycho-oncology services nationally to address ‘the psychological responses of patients to cancer at all stages of the disease (and that of their families and carer); and the psychological, behavioural, and social factors that may influence the disease process’ (Department of Health, 2017) (p. 93). The National Cancer Control Programme Model of Care for Psycho-Oncology, which was launched in 2020, also aims ‘to provide a framework to support the way psychosocial care is delivered to patients with cancer and their families [and] promote psychological wellbeing and improve access to psychological services at both acute hospital and community level’ (Greally et al., Reference Greally, Love and Mullen2020, p. 6).

The current model of care for psycho-oncology in Ireland operates via a hub and spoke model, aiming to provide psychosocial care for cancer patients and their families. This model of care is an example of integration of physical and mental health care for patients. It aims to provide multidisciplinary care to cancer patients on a stepped approach based on the level of clinical distress experienced by each individual.

Other countries have addressed this issue in different ways, but definitive evidence about the benefits of any given approach is not yet available. In Germany, for example, a new form of care called nFC-isPO (integrated, cross-sectoral psycho-oncology/integrierte, sektorenübergreifende Psycho-Onkologie) is currently being developed, implemented, and studied (Kusch et al., Reference Kusch, Labouvie, Schiewer, Talalaev, Cwik and Bussmann2022). This approach seeks to advance the goals of Germany’s National Cancer Plan by making psycho-oncological care available to all cancer patients according to their individual needs. The German programme involves structured, legally binding cooperation between different professional groupings and/or institutions in both medical and non-medical care. This approach bears certain similarities to Ireland’s model of care, but it is too early in Germany’s initiative to be certain about medium-term and long-term outcomes.

Conclusions: bridging the gap between need and care provision

The number of women who will be directly or indirectly affected by cancer is increasing, with an estimated 11,282 women diagnosed with invasive cancer each year in Ireland (National Cancer Registry, 2024). There is a large body of international evidence that women affected by cancer experience greater psychological distress than men, and this has been replicated in the Irish context (Carter et al., Reference Carter, Collier, Plunkett, Beirne and Kelly2025). It is essential that relevant services are developed in line with patient experience and evidence-based need. In Ireland, the current Model of Care for Psycho-Oncology could usefully place greater emphasis on gender-specific care provisions which recognise the increased psychological needs of women with cancer.

In recent decades, Ireland has made significant, albeit limited, progress in recognising the physical and mental healthcare needs of women and developing gender-informed policies in certain areas. In the area of perinatal mental health, there are now integrated mental health teams within physical healthcare settings. While there is further progress to be made in this area, the number of full-time staff working in perinatal mental health increased from five in 2017 to close to 100 in 2023 (Duffy et al., Reference Duffy, Hinds and Cooney2023). Positive change is therefore possible, even if it is sometimes challenging to achieve.

To make this happen more broadly, it is essential that relevant policies are implemented fully so as to reduce and eliminate disparities in access to care. As identified in Embedding Women’s Mental Health in Sharing the Vision, there is a particular need for improved understanding of women’s experiences of mental healthcare (Department of Health, 2022). Hopefully, this will be addressed through the policy’s aim of collecting and analysing data on gender and other risk factors for marginalisation of women. Improved understanding of gender-based treatment choices within the Irish context is needed in order to shape services in line with patient preference and acceptibility.

Further work is needed to enhance our knowledge of gender-specific cancer experiences in both national and international contexts, especially in relation to psychological distress and mental health. Future research could usefully incorporate evolving understandings of gender, given that most existing literature uses a somewhat limited binary framework for gender.

The next iteration of Ireland’s Model of Care for Psycho-Oncology could also place greater emphasis on the physical health of people with major mental illness who develop cancer in the context of higher than usual risk factors (e.g., smoking), poor pre-existing physical health, issues with accessing screening, therapeutic complexities (owing to treatment combinations and psychiatry medications), and possible worse prognosis (owing to later diagnosis, among other potential disadvantages). Shared management with primary care would likely optimise screening practices, facilitate earlier intervention, and improve cancer outcomes in this population.

This paper focused on psychological and social factors in psycho-oncology care. Other factors are also relevant and merit further attention, including biological factors that are specific to females such as the impact of cancer treatment on female reproductive hormones (e.g., surgical menopause, complexities with use of hormone replacement therapy) and implications for fertility. Further work could also look in greater depth at the possible impact of cancer treatment on female identity, particularly where mastectomy or hysterectomy/oophorectomy are required.

Given that Ireland’s National Cancer Strategy will be reviewed and revised as it comes to its end in 2026, there is an opportunity to address the particular challenges faced by women with cancer, including their increased levels of psychological distress. A more tailored, gender-informed approach could be taken when reviewing the strategy to ensure the provision of gender-aware psycho-oncological care for all women and men as they navigate their cancer journeys.