Fertility preservation counselling in women with cancer: knowledge, preferences, and unmet needs from a cross-sectional survey.

Background: Fertility preservation (FP) is a critical survivorship issue for young women with cancer, yet gaps persist between guidelines and clinical practice. This study assesses knowledge, attitudes, and unmet needs among women referred for specialist counseling. Methods: An observational cross-sectional survey was conducted (November 2022 - June 2026) among women referred to a single tertiary oncofertility center in Rome. A Delphi-informed online questionnaire was completed before the clinical visit. Descriptive statistics and exploratory multivariable logistic regression examined post-diagnosis intention. Results: Among 284 women invited to participate, 260 completed the survey (response rate, 91.5%); 240 patients with a confirmed cancer diagnosis were included in the final analysis (median age, 32 years). Overall, 69.6% were interested in FP, and 94.2% recognized that gonadotoxic treatments could impair fertility. While 89.6% had heard of FP, only half received this information from healthcare professionals, and 24.2% knew of no specific options. Over half reported concerns regarding treatment delay, safety, effectiveness, and cost. Before diagnosis, 73.7% planned to have children; post-diagnosis, positive intention remained common, while those previously without intentions shifted toward uncertainty. In the 188-case model, pre-diagnosis intention showed the strongest association (OR 11.64, 95% CI 4.45-30.48). Given limited model performance (pseudo-R²=0.19), estimates warrant caution. Conclusions: In this single-center referred cohort, informational gaps and uncertainty remained despite high awareness. Findings confirm and contextualize prior evidence in an Italian tertiary setting and may inform similar referral pathways, but require validation in broader populations.