The commentary, written by Peter Francis Raguindin, André Oscar von Bueren and Gisela Michel, lays out a technical argument about how an evidence gap compounds itself. The authors build on a 2025 scoping review by Olsavsky and colleagues that highlighted the need for more research on fathers of children with cancer, and they extend that recommendation into a four-part diagnosis. Limited inclusion of fathers, they contend, is not just an evidence gap; it also produces evidence that cannot be generalized to fathers, support strategies that are not tailored or appealing to them, and implementation research that fails to represent their experiences and perspectives.

The methodological roots of the problem are well documented. Studies of parents of children with chronic illness, including cancer, continue to enroll substantially fewer fathers than mothers, and the barriers are both logistical and cultural. Fathers often remain engaged in full-time employment and may therefore be less available during routine daily care, typically appearing only when important medical decisions are required. Even when they are present, fathers may prioritize spending their limited time with their child rather than participating in research activities. They also have fewer opportunities for direct contact with the researchers and healthcare professionals who recruit participants on the ward.

There is a subtler recruitment failure at work as well. Some families perceive that the mother’s response to a questionnaire already represents the family view, and researchers may unintentionally reinforce this pattern when study information is addressed broadly to parents but communication and follow-up are conducted primarily through mothers as the main point of contact. Across the literature, females are also more likely to participate in surveys than males. The result is a self-perpetuating cycle in which fathers are rarely invited directly, rarely respond, and rarely appear in the datasets that define what is known about family adjustment to childhood cancer.

The consequences for evidence quality are concrete. Because fathers are underrepresented in most surveys on families coping with childhood cancer, the psychosocial outcome of the childhood cancer experience remains largely unknown, or not generalizable, for fathers. Their experience has been documented by some qualitative studies, yet very few quantitative studies or surveys have systematically targeted fathers as a study population. As the authors note, the existing findings, although scientifically valid, cannot be generalized to fathers. A review of psychosocial interventions for families of children with cancer found that fathers experience severe distress and would benefit from psychological interventions, yet remain largely underrepresented in studies on distress management.

The gap extends into intervention design. A systematic review identified eleven psychosocial intervention programs for parents of children with cancer, built on cognitive-behavioral, systemic, and counselling models of change. Some programs were developed for and tested exclusively with mothers of newly diagnosed children. In other words, support for parents has, in practice, often meant support designed around and validated with mothers. The scientific basis of these programs is well justified, the authors acknowledge, but because fathers were not part of the development or testing, the effectiveness of such interventions may not be readily transferable to fathers.

Clinical trials follow the same pattern, and here the technical problem is one of statistical reporting. A 2025 systematic review and meta-analysis pooled trials of psychological interventions delivered to family members of pediatric cancer patients and found that these interventions improved resilience, with benefits sustained into the short to medium term. That is an encouraging result, but the analysis reported outcomes for family members as a single pooled category rather than separately for fathers and mothers, so it cannot tell whether the beneficial effect would be similar for fathers, who typically make up a small minority of trial samples. Newer randomized trials of technology-based psychological support for parents of children with cancer follow the same pattern, reporting a single combined parent outcome rather than breaking results out by father or mother status. Until fathers are adequately represented in clinical trials and their outcomes are analyzed and reported as a distinct group, evidence on the effectiveness of interventions specifically for fathers will remain limited.

Underlying all of this is an emotional dimension that remains underrecognized. Studies have shown that fathers suppress psychological distress because they believe they must be resilient for the child, the partner, and the family. While this emotional restraint may help fathers cope in the short term, it can also contribute to feelings of isolation and delayed emotional responses. After diagnosis, caregiving roles often divide, with mothers taking on more care tasks while fathers carry the financial responsibility, maintain employment, and remain present for medical decisions and the emotional needs of the ill child, other children, and their partner. Fathers may thus feel torn between multiple competing demands, and the forms of coping this produces, such as emotional suppression, work-based coping, difficulty asking for help, and feelings of inadequacy, are precisely the ones least visible in standard questionnaires.

The authors propose a set of concrete fixes. Future studies should be designed to include fathers from the beginning, with recruitment that identifies fathers directly rather than only through mothers. Study invitations should name fathers explicitly and explain why their perspective is needed, even when the mother has already participated. Researchers should offer flexible participation options, including shorter online surveys, telephone interviews, and short modular questionnaires, all of which have been suggested to increase participation. Recruitment should also occur through multiple points of contact, including clinics, registries, psychosocial teams, and parent organizations, to provide more opportunities for fathers to take part.

Measurement and analysis must change too. Studies should assess depression, anxiety, distress, fear of recurrence, work strain, couple relationship quality, social support, caregiving roles, and unmet needs, and should capture the less visible forms of coping and distress described above. Whenever possible, studies should include both parents and examine similarities and differences within families and between genders, clarifying how fathers’ and mothers’ distress interact, how roles are negotiated, and how support can be offered to fit individual preferences. The next step, the authors stress, is not to replace the focus on mothers but to complete the family picture by strengthening the evidence on fathers. Future work should generate estimates of the prevalence of fathers’ psychological distress, identify fathers at higher risk, and evaluate whether targeted or family-based interventions improve outcomes. Without these steps, fathers will remain visible in everyday family life but continue to be overlooked in both research evidence and clinical practice.

Subject of Research: The evidence gap caused by the underrepresentation of fathers in childhood cancer psychosocial research

Article Title: Closing the evidence gap: why childhood cancer research must include fathers

Article References: Raguindin, P. F., von Bueren, A. O., & Michel, G. (2026). Closing the evidence gap: why childhood cancer research must include fathers. Public Health Reviews, 47, Article 1610147. https://doi.org/10.3389/phrs.2026.1610147

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1610147

Keywords: childhood cancer, fathers, pediatric oncology, psychosocial interventions, family support, research methods, parental distress, clinical trials, mental health, public health, Closing, evidence