Pathways linking benefit finding, fear of cancer recurrence, and family support to fertility concerns in women of reproductive age with malignant tumors: a cross-sectional study.

Background: Fertility concerns are common among women of reproductive age diagnosed with malignant tumors, and may be influenced by both individual factors-such as fear of cancer recurrence (FCR), benefit finding (a key aspect of cognitive adjustment that helps patients develop adaptive thinking and psychological resilience) and family support. While each of these factors has been linked to fertility-related distress, their combined effects and underlying mechanisms remain insufficiently understood. This study aimed to explore how individual characteristics, benefit finding, FCR, and family support influence fertility concerns, and to identify the psychosocial pathways through which these effects are mediated. Methods: A convenience sampling of women aged 20-49 years with gynecologic or breast malignancies was recruited from the Nanjing Women and Children's Healthcare Hospital between March 2022 and March 2023. Participants completed five instruments: a general information questionnaire and four validated scales-the Benefit Finding Scale (BFS), FCR Inventory, Family Support Self-Assessment Scale, and Reproductive Concerns After Cancer Scale. After excluding incomplete responses, 193 valid questionnaires (135 patients with gynecologic cancer and 58 with breast cancer) were analyzed. Correlations analysis, multiple linear regression, and structural equation modeling (SEM) were conducted to examine associations and identify direct and indirect pathways influencing fertility concerns. Results: The mean fertility concern score among participants was 51.82±15.13, indicating a moderately high level of reproductive anxiety. Multiple regression analysis showed that fewer children, lower benefit finding, and higher FCR were independent predictors of greater fertility concerns (P<0.001). Structural equation modeling revealed that both family support (β=-0.264, P<0.001) and benefit finding (β=-0.387, P<0.001) were significantly associated with lower FCR, while family support also positively influenced benefit finding (β=0.385, P<0.001). In turn, FCR was positively associated with fertility concerns (β=0.317; P<0.001), while benefit finding was negatively associated (β=-0.468; P<0.001). FCR partially mediated the relationship between benefit finding and fertility concerns, accounting for approximately 25% of the total effect. Conclusions: Fertility concerns are common and clinically significant among women of reproductive age with malignant tumors. This study identified benefit finding, FCR, and family support as key psychological factors shaping these concerns. FCR partially mediated the relationship between benefit finding and fertility anxiety, while family support indirectly reduced fertility concerns by enhancing benefit finding and lowering FCR. These findings highlight the need for integrated psychosocial and fertility-preserving strategies to support the reproductive and emotional well-being of young female cancer patients.