Objective To examine symptom-level associations among cancer information overload (IO), asthenopia, depressive symptoms, and anxiety symptoms in patients with lung cancer and to compare model-based node-perturbation rankings with centrality rankings from a Gaussian graphical model (GGM). Methods In this cross-sectional study, 566 patients with lung cancer completed assessments of IO, asthenopia, anxiety, and depressive symptoms. A 25-node binary Ising model was estimated. Network Intervention Response Analysis (NIRA) was used to evaluate model-estimated changes in network sum scores after hypothetical node-specific threshold perturbations. A GGM based on the corresponding non-dichotomized variables was used as a sensitivity analysis, and network stability was evaluated using bootstrap procedures. Results The Ising network showed prominent conditional associations between IO4 (perceived impossibility) and PHQ-9 item 2 (sad mood), asthenopia and PHQ-9 item 3 (sleep problems), and IO1 (decision overload) and GAD-7 item 2 (uncontrollable worry). Under the hypothetical alleviating perturbation, perturbing “Sad mood” produced the largest estimated decrease in the network sum score, from an unperturbed baseline of 12.71 to 10.85. Under the hypothetical aggravating perturbation, perturbing “Trouble relaxing” produced the largest estimated increase, from an unperturbed baseline of 12.74 to 14.63. In the GGM, information skepticism and sleep problems were among the most central nodes. The Ising and GGM absolute edge-weight patterns showed broad correspondence (Mantel r = 0.8385, P < 0.001), although asthenopia was operationalized differently across models. Conclusions This cross-sectional study characterized model-estimated associations among IO, asthenopia, depressive symptoms, and anxiety symptoms in patients with lung cancer. The perturbation findings are hypothesis-generating and identify candidate symptoms for future prospective testing; they do not establish clinical effectiveness, therapeutic benefit, or causal effects.
Objective To examine sociodemographic, clinical, and support-related factors associated with parenting concerns among Japanese parents with cancer raising children aged <18 years. Methods This secondary analysis used data from a cross-sectional web survey previously conducted to validate the Japanese Parenting Concerns Questionnaire (PCQ). Invitations were sent to 2,852 members of a Japanese online patient support network, and 174 parents responded. PCQ analyses were restricted to 157 participants who selected Married in the survey marital-status variable. The PCQ total score was the primary outcome, and three subscales were exploratory outcomes. Multiple linear regression analyses used a post hoc parsimonious model and an expanded forced-entry sensitivity model. Results Participants had a median age of 45 years, and 145 (83%) reported female sex. In the parsimonious total-score model, higher PCQ scores were associated with female sex (B = 5.33, 95% CI 1.03-9.64), uterine/ovarian cancer (B = 6.19, 95% CI 1.00-11.38), chemotherapy (B = 3.54, 95% CI 0.11-6.96), a self-reported past/current psychiatric history (B = 5.46, 95% CI 2.43-8.49), and reported wanting practical support with parenting (B = 5.74, 95% CI 1.98-9.49). In the expanded model, the associations with uterine/ovarian cancer, chemotherapy, self-reported past/current psychiatric history, and reported wanting practical support with parenting remained, whereas the female-sex association was attenuated (P = 0.076). Subscale findings were exploratory and several were model-dependent. Conclusions Despite the limited single-network sample and low response rate, this study found that parenting concerns were associated with several self-reported characteristics and preferences for parenting support. However, these exploratory cross-sectional findings do not establish causal relationships or provide sufficient evidence to justify clinical targeting. Further confirmation in larger and more representative samples is needed.
Objective This study aimed to explore self-care practices and support needs among outpatients with lung cancer experiencing breathlessness, with attention to family caregivers’ perspectives. Methods This qualitative descriptive study used semistructured interviews with 13 outpatients with lung cancer experiencing breathlessness and 8 family caregivers, who were purposively recruited from respiratory outpatient clinics at two institutions. The 21 participants were interviewed in 15 sessions: seven patient-only, two family caregiver-only, and six joint patient–family caregiver sessions. Patient interviews were the primary data source, while family caregiver interviews were used as supplementary data rather than for dyadic comparison. Data were analyzed using qualitative content analysis based on Krippendorff’s approach. Results Patients’ self-care practices included encouraging oneself through successful coping experiences, monitoring and understanding breathlessness, using social support in daily life, performing direct care to relieve breathlessness, adjusting activity patterns to prevent or manage breathlessness, and preserving psychological stability. Their support needs included practical support for managing breathlessness, positive goal-setting that supports treatment continuation, a desire for breathlessness-related distress to be understood, coordination of support systems for home care, and explanations and advice for understanding breathlessness. Supplementary family caregiver data described the care they provided to patients, as well as their own needs for explanations, symptom-assessment guidance, and consultation and support resources. Conclusions Outpatients with lung cancer practiced multidimensional self-care to manage breathlessness in daily life. These findings may inform family-inclusive outpatient breathlessness support that builds on patients’ self-care practices, recognizes the care provided by family caregivers, and addresses family caregivers’ own support needs.
Objective To identify, appraise, and synthesize the best available evidence on complete decongestive therapy (CDT) for people with breast cancer-related lymphedema (BCRL). Methods Using an evidence-based healthcare pyramid approach, we searched bibliographic databases, guideline and professional organization websites, and clinical decision support sources from inception to October 1, 2025. Eligibility was defined using the PIPOST framework. Methodological quality was independently appraised by three reviewers for guidelines and by two reviewers for other evidence types using evidence-type-specific appraisal tools. Two reviewers extracted and synthesized the evidence. Evidence levels were assigned using the JBI 2014 system, and recommendation grades were determined through expert-panel assessment of feasibility, appropriateness, meaningfulness, and effectiveness. Results Thirty-one evidence sources were included, comprising clinical decision support sources, guidelines, evidence summaries, systematic reviews, and expert consensus documents. Thirty-seven evidence statements were synthesized across three domains: implementation principles, the intensive treatment phase, and the maintenance treatment phase. Nineteen statements (51.4%) were supported by Level 1 evidence, and 25 (67.6%) received Grade A recommendations. Conclusions This evidence summary provides an evidence-informed framework for CDT across the intensive and maintenance phases, with explicit attention to transition planning and self-management. The evidence is stronger for several core interventions than for implementation strategies and long-term self-management. Further high-quality primary and implementation research is needed.
Objective:Fertility intention among breast cancer survivors of childbearing age is influenced by clinical, personal, and social considerations. Therefore, multidimensional assessment is essential across treatment and survivorship. Although the Fertility Intention Scale (FIS) assesses fertility intention in women with breast cancer, no validated Korean version is currently available. This study aimed to translate and culturally adapt the FIS into Korean and evaluate its validity and reliability. Methods:This validation study was conducted in two phases. The first phase involved translation and cultural adaptation of the FIS, including forward translation, expert panel review, back-translation, pre-testing, cognitive interviews, and linguistic refinement. The second phase evaluated psychometric properties using secondary data from 203 women aged 18-45 years with breast cancer. Construct validity was assessed using confirmatory factor analysis (CFA), known-group validity, and convergent validity. Reliability was evaluated using Cronbach's α and a 2-week test-retest analysis. Results:The CFA indicated an overall acceptable, though marginal, model fit. Known-group validity was confirmed, as women planning pregnancy scored significantly higher on the Korean FIS (K-FIS) than those not planning pregnancy (t = 6.09, P < 0.001). Convergent validity was partially supported by a significant correlation between the K-FIS "social support" factor and perceived social support (r = 0.31, P < 0.001). Cronbach's α for the total scale was 0.93, and the intraclass correlation coefficient was 0.798. Conclusions:The K-FIS showed generally acceptable preliminary evidence of reliability and validity for assessing fertility intention among Korean women with breast cancer. It may support tailored fertility interventions and counseling in oncology nursing practice.
Objective To describe online health information-seeking behavior during the preoperative period among patients with pancreatic tumors scheduled for pancreatectomy and caregivers in China, and to identify implications for structured information support. Methods This qualitative descriptive study was conducted from October to December 2025 in the pancreatic surgery department of a tertiary cancer center in Shanghai, China. Maximum-variation sampling was used to recruit 20 participants (8 patients and 12 caregivers), who were interviewed individually rather than as matched dyads. Individual semistructured interviews were audio-recorded, transcribed, and analyzed using directed content analysis. The Technology Acceptance Model served as a sensitizing framework while allowing themes beyond the model to emerge. Results Six themes were identified: (1) platform differentiation and complementary use; (2) structural barriers to accessing online health information; (3) use of online information to address cognitive, emotional, and practical needs; (4) credibility appraisal and verification strategies; (5) individual and contextual influences on information seeking; and (6) expectations for institution-led online information services. Ten participants reported intermittent large language model use, mainly to interpret examination reports. Caregivers more often described leading multiplatform searches, although group-level comparisons could not assess within-family interactions. Conclusions Patients and caregivers used multiple platforms to address preoperative information needs but encountered fragmented content, limited personalization, and credibility concerns. Structured, plain-language support led by healthcare institutions and oncology nurses may help patients and caregivers evaluate online information and obtain individualized clinical guidance.
Objective:To develop a brief, clinician-administered Chinese-language Breakthrough Cancer Pain Assessment (BCPA) instrument and evaluate its content validity, inter-rater reliability, and ability to detect change in selected rescue medication-related items. Methods:The 11-item BCPA was developed from literature review, clinical input, and three Delphi rounds with 14 experts. Inter-rater reliability was evaluated through independent physician and nurse interviews with 30 participants with cancer and breakthrough cancer pain (BTcP). In an exploratory observational phase, selected BCPA responses were compared in 77 participants before and 7 days after routine-care initiation of fentanyl buccal soluble film. Results:In the third Delphi round, all items had an item-level content validity index of 1.00 and the scale-level content validity index based on universal agreement (S-CVI/UA) was 1.00. Kappa coefficients for categorical items ranged from 0.507 to 0.888, and intraclass correlation coefficient [ICC(2,1)] values for numerical items ranged from 0.836 to 0.979. The proportion reporting pain relief within 15 minutes increased from 33.8% to 66.2% (matched-pairs odds ratio, 4.57; 95% CI, 2.02-10.35; P < 0.001). Mean satisfaction with the effectiveness of rescue medication increased from 5.96 to 7.60, and perceived improvement in sleep and mood increased from 6.01 to 7.40 (both P < 0.001). Conclusions:The Chinese-language BCPA showed preliminary content validity and inter-rater reliability. Selected rescue medication-related items detected pre/post changes in an uncontrolled observational sample. Further evaluation of response processes, criterion-related validity, cross-cultural validity, and responsiveness is required before routine clinical implementation.
Objective:Cognitive problems may be associated with role functioning in adolescent and young adult (AYA) cancer survivors. This study aimed to characterize the prevalence and phenotypes of cognitive complaints and examine their associations with role functioning limitations in Chinese AYA cancer survivors. Methods:This multicenter cross-sectional study included AYA cancer survivors (diagnosed at 15-39 years). The participants' cognitive complaints were collected using the Childhood Cancer Survivor Study-Neurocognitive Questionnaire (CCSS-NCQ). Role functioning in family, leisure, and work/school was assessed using the Life Functioning Questionnaire. Patterns of cognitive complaints across the four CCSS-NCQ domains were determined using latent class analysis (LCA). Multivariable logistic regression was used to investigate the association between phenotypes of cognitive complaints and role functioning limitations, adjusting for clinically relevant factors. Results:Overall, 421 AYA cancer survivors (female: 59.6%, mean age: 31.51 ± 8.35 years) were recruited. With reference to age- and sex-adjusted reference scores derived from community controls, survivors reported cognitive complaints in task efficiency (23.5%), emotional regulation (24.7%), organization (20.2%), and memory (18.1%). The LCA identified three phenotypes of cognitive complaints (Class 1: no/mild complaints; Class 2: complaints in higher-order thinking; Class 3: complaints in global cognition). Compared with the "no/mild complaints" class, the "complaints in global cognition" class had higher odds of role functioning limitations in duties at work/school (OR = 5.43; 95% CI: 1.87-15.83) and duties at home (OR = 7.81; 95% CI: 3.49-17.48). Conclusions:These findings suggest that phenotyping cognitive complaints may help characterize patterns of role functioning limitations in AYA cancer survivors.
Objective This study aimed to investigate the interrelations among depressive symptoms, anxiety symptoms, decision-related factors, and health behaviors in prostate cancer survivors using a symptom network approach. Methods A cross-sectional study was conducted among 251 prostate cancer survivors experiencing urinary incontinence at a tertiary hospital in China between October 2025 and February 2026. Participants completed interviewer-administered questionnaires assessing depression, anxiety, shared decision making, decisional conflict, loneliness, urinary incontinence, and exercise adherence. Scale-level and symptom-level networks were estimated using Gaussian graphical models with graphical LASSO regularization and EBIC model selection. Centrality, predictability, and network stability were examined using bootstrap procedures. Results At the scale level, anxiety and depression emerged as the most central nodes, forming a tightly connected psychological cluster with loneliness. Shared decision making was strongly associated with decisional conflict (partial r = 0.68); and urinary incontinence was moderately associated with exercise adherence (partial r = 0.43) and weakly associated with anxiety and depression. At the symptom level, suicidal ideation and low energy were the most central depressive symptoms, while difficulty controlling worry occupied a central position in the anxiety network. Conclusions Depression and anxiety occupy central positions within integrated psychosocial and clinical networks in patients with prostate cancer. Identifying these core nodes underscores their importance for clinical monitoring and comprehensive symptom assessment. Longitudinal investigations are required to clarify their potential role in managing broader psychological distress, treatment-related symptoms, and health behaviors.
Objective:School re-entry after a cancer-related interruption may involve academic, social, emotional, and health-related adjustment. Evidence from school personnel remains limited. This study explored school personnel's perspectives on school re-entry among children and adolescents undergoing or having completed childhood cancer treatment. Methods:This qualitative descriptive study was conducted in Türkiye with 12 school personnel recruited through purposive maximum-variation and snowball sampling: eight teachers, two school administrators, one school counselor, and one school nurse. Data were collected through online semi-structured interviews between April 2025 and January 2026 and analyzed using a team-based inductive thematic analysis informed by Braun and Clarke's six phases. Results:Three analytic domains encompassing eight themes were identified: academic and health-related adjustment; social and emotional reintegration; and school-side support needs and coordination gaps. Participants described school absence as involving academic disruption, weakened belonging, peer-related vulnerability, and a need for individualized adjustment. Support was often dependent on individual initiative, with limited school-useable health information, unclear role boundaries, and insufficient coordination. Conclusions:School personnel described school re-entry as a gradual, individualized process requiring coordinated communication, planning, and follow-up. The school-side needs identified may inform future interdisciplinary models linking children and families, schools, and health care teams. Pediatric oncology nurses may contribute to communication and planning; however, role-specific recommendations require direct investigation with nurses, children, and families.
Objective To synthesize publicly available guidance on communicating with children about a parent’s cancer from official national cancer organization websites. Methods We conducted a qualitative document analysis of eligible webpages and PDF resources identified through systematic Google and within-site searches. Thirteen resources from 13 countries were analyzed using the READ (Ready, Extract, Analyze, Distil) approach and conventional content analysis.. Results Six themes described why, when, and how to communicate; who should be involved; what information should be discussed; and how emotional support could be provided. The resources generally favored honest, developmentally appropriate communication, preparation for treatment-related and daily-life changes, and involvement of trusted family members and professionals when needed.. Conclusions The study provides a structured thematic synthesis of publicly available guidance rather than a validated communication framework. All included resources were from Europe, North America, or Oceania, which limits transferability to other sociocultural settings. Further research should culturally adapt and empirically evaluate these strategies across disease stages, child developmental stages, and family structures.
Objective To describe changes in symptom communities and contemporaneous symptom network structure across four postoperative time points in patients with oral squamous cell carcinoma (OSCC) undergoing flap reconstruction. Methods This prospective longitudinal study included 251 participants with complete data. Symptoms were assessed on postoperative days 1 (T1), 3 (T2), 7 (T3), and 30 (T4) using the Chinese version of the MD Anderson Symptom Inventory-Head and Neck Module. Gaussian graphical models with EBICglasso regularization were estimated separately at each time point. Symptom communities were identified using principal component analysis (PCA), with exploratory graph analysis (EGA) performed as a sensitivity analysis. Node strength and bridge strength were summarized. Paired Network Comparison Tests with 2,000 permutations compared networks across time points; global-strength comparisons were Bonferroni-adjusted. Results In the PCA solution, three, three, four, and five symptom communities were identified at T1, T2, T3, and T4, respectively; the sensitivity analysis yielded four, three, three, and six communities, indicating methodological sensitivity. Choking cough, somnolence, problems with mucus, and vomiting had the highest node strength at T1, T2, T3, and T4, respectively. Problems with mucus had the highest bridge strength at T1 and T2, lack of appetite at T3, and distress at T4. Global strength differed between T2 and T3 and between T2 and T4 after Bonferroni correction. Conclusions These descriptive, hypothesis-generating findings provide a complementary view of postoperative symptom interrelationships and may support stage-specific symptom assessment. They do not establish causal mechanisms or validated intervention targets.
Objective:To investigate the status of anticipatory grief, psychological resilience, family resilience, and parental pain catastrophizing about the child's pain in parents of children with cancer, and to identify factors associated with anticipatory grief. The study also explored the potential mediating role of parental pain catastrophizing about the child's pain in the relationship between psychological resilience and anticipatory grief, as well as the moderating role of family resilience. Methods:A total of 236 parents of children with cancer were recruited from four Grade A tertiary hospitals in China between November 2024 and April 2025. The participants were assessed using the Anticipatory Grief Scale (AGS), Connor-Davidson Resilience Scale (CD-RISC), Family Resilience Scale (FRS), and Pain Catastrophizing Scale (PCS). Results:The parents of pediatric cancer patients reported a mean AGS score of 76.74 (standard deviation [SD] = 16.92). Multiple linear regression showed that educational level, psychological resilience, family resilience, and pain catastrophizing were significantly associated with anticipatory grief, explaining 63.5% of the variance. Parental pain catastrophizing about the child's pain partially mediated the relationship between psychological resilience and anticipatory grief (indirect effect: B = -0.125, 95% confidence interval [CI]: [-0.182,-0.070]). Furthermore, family resilience moderated the pathway from psychological resilience to pain catastrophizing, with a significant psychological resilience × family resilience interaction (B = -0.319, P < 0.001). The index of moderated mediation was also significant (index = -0.061, 95% CI: [-0.102, -0.026]). Conclusions:Anticipatory grief in parents of children with cancer was directly associated with psychological resilience and indirectly associated with parental pain catastrophizing about the child's pain. Family resilience moderated the relationship between psychological resilience and pain catastrophizing, suggesting that higher family resilience may strengthen the protective association of psychological resilience against pain catastrophizing. These findings suggest that strengthening the protective function of family resilience may inform future supportive interventions and provide potential targets for clinical support aimed at alleviating anticipatory grief in parents and promoting overall family adjustment.
Objective:This study aimed to explore the psychosocial and behavioral experiences of children undergoing cancer treatment, as well as their perceived identity-related changes, including changes in roles, social relationships, and self-perception. Methods:This phenomenologically informed qualitative study used thematic analysis. Purposive sampling was used to recruit 12 children diagnosed with brain tumors or leukemia from pediatric oncology units at three medical centers in northern Taiwan. Data were collected through in-depth, face-to-face semi-structured interviews. Each interview lasted 30-40 minutes and was conducted in a private setting. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's six-phase thematic analysis within a phenomenological orientation. Results:Four interrelated themes were identified: (1) psychological turmoil, characterized by fear, anxiety, and emotional distress; (2) changes in social interactions and identity-related experiences, including social isolation, peer disconnection, changes in family roles, and shifts in self-perception; (3) disruption of normalcy, involving interruptions in schooling, adjustments to learning, and reduced participation in usual daily activities; and (4) behavioral coping and responses, including overt expressions of distress and more implicit coping strategies such as withdrawal. Conclusions:Understanding these multifaceted experiences provides important insights for family-centered care. Health care professionals should remain attentive to children's psychosocial and behavioral experiences and actively listen to their voices to better understand perceived changes in self-perception, social roles, and identity-related experiences during the cancer trajectory. Tailored supportive interventions may help promote social engagement, preserve a sense of normalcy, and support a positive self-perception throughout cancer treatment.
Objective:This study aimed to develop and preliminarily validate the Exercise Fit Tool (EFT), a patient-reported self-assessment tool for adolescents undergoing cancer treatment in Hong Kong. Methods:A convenience sample of 158 adolescents aged 13-18 years who were undergoing cancer treatment and could communicate in Cantonese and read Chinese was recruited in Hong Kong. Instrument development followed the procedures recommended in AMEE Guide No. 87. Candidate items were generated from a literature review and focus groups with adolescents and healthcare professionals, refined by an expert panel, assessed for content validity, and revised through cognitive interviews. Pilot testing was conducted in 158 adolescents. Convergent validity was examined using pain scores and forced expiratory volume in 1 second (FEV1, % predicted), and criterion-related validity was evaluated by comparing EFT scores with physiotherapists' ratings. Test-retest reliability was assessed in 50 participants, and principal component analysis with Varimax rotation was performed. Results:The final 10-item EFT demonstrated satisfactory content validity, with I-CVIs ranging from 0.86 to 1.00, and good internal consistency (Cronbach's alpha = 0.92). The 2-week test-retest ICC was 0.82 (P < 0.001). EFT scores were negatively correlated with pain scores and positively correlated with FEV1 (% predicted), supporting convergent validity. The Kaiser-Meyer-Olkin measure was 0.87, and Bartlett's test of sphericity was significant (P < 0.001). Principal component analysis identified a two-component solution: cancer- and treatment-related influences on physical activity (7 items; Cronbach's alpha = 0.96; 55.7% of the rotated variance) and perceived physical activity exertion (3 items; Cronbach's alpha = 0.74; 20.6% of the rotated variance). Primary component loadings ranged from 0.74 to 0.93, and communalities ranged from 0.55 to 0.91. The two components explained 76.3% of the total variance. Conclusions:The EFT demonstrated preliminary evidence of validity and reliability for adolescents undergoing cancer treatment in Hong Kong. Further evaluation of its latent structure and implementation in independent samples is required before wider clinical use.
Objective: To investigate factors associated with help-seeking for urinary symptoms among Chinese patients with bladder cancer. Methods: A qualitative descriptive research design was employed, involving semi-structured interviews with patients diagnosed with bladder cancer. Content analysis was used to analyze the data. Results: A total of 19 patients were interviewed . Four key themes were identified: (1) Factors influencing initial symptom appraisal, with three subthemes: attribution of urinary symptoms to non-threatening causes, lack of awareness of hematuria as a cancer sign, andillusion of self-healing caused by painless and intermittent symptoms; (2) Factors sustaining inaction, with three subthemes: masculine endurance, prioritizing social roles, age-related fatalism; (3) Factors converting inaction into action, with three subthemes: symptom persistence or worsening, social support, authoritative advice; (4) Factors that serve as sociocultural and contextual moderators, with four subthemes: financial constraints, festival taboos, the digital divide in healthcare, the warning effect of others’ illness experiences. Conclusions: Help-seeking behavior among Chinese patients with bladder cancer is influenced by gaps in symptom awareness and appraisal, cultural-psychological barriers, and contextual moderators. Targeted interventions could focus on enhancing risk awareness of hematuria, addressing endurance norms and age-related fatalism, strengthening family and social support, and bridging the digital divide, with the aim of supporting timely help-seeking.
Objective: To develop a stage-based post-discharge homecare journey map for patients with colorectal cancer living with a permanent stoma, integrating patient-caregiver dynamics to inform digitally supported nursing interventions. Methods: A qualitative study was conducted using semi-structured interviews with 15 patients aged 18-59 years, 6 informal caregivers, and 4 stoma nurses. Patient diaries and photo-elicitation were used as supplementary data sources. Data were analyzed using a framework approach informed by the Chronic Care Model and the Theoretical Domains Framework. Two rounds of Delphi consultation with 8 multidisciplinary experts were undertaken to refine the structure and content of the journey map. Results: Five sequential phases of the post-discharge homecare journey were identified: Home Transition, Early Adaptation, Late Adjustment, Chronic Challenge, and Stabilization. Across phases, participants described fluctuating emotional responses, strong bidirectional influences between patients and caregivers, variable engagement with digital resources, and discrepancies between perceived and actual self-management capacity. Key critical events-such as stoma leakage, concerns about public exposure, and caregiver-patient conflict-frequently triggered setbacks in recovery and reduced self-care confidence. Conclusions: The proposed journey map provides a structured, stage-based framework for understanding post-discharge homecare experiences. It offers a conceptual foundation for developing personalized, digitally supported nursing interventions that address emotional needs, dyadic interactions, and disparities in health and digital literacy.
Objective:This study investigated the relationship between reproductive concerns and fertility intentions among reproductive-age Chinese women with breast cancer, examining the mediating roles of fertility information needs, perceived social support, and marital intimacy. Methods:A cross-sectional study was conducted from April 2025 to September 2025 among 463 married reproductive-age women with breast cancer. Participants completed validated questionnaires assessing fertility intentions, reproductive concerns, fertility information needs, perceived social support, and marital intimacy. Structural equation modeling was employed to test a parallel multiple mediation model, with place of residence and number of children included as covariates. Results:The mean fertility intention score was 42.77 ± 5.49. Reproductive concerns demonstrated a significant negative direct effect on fertility intentions (β = -0.278, 95% CI [-0.353, -0.179]), accounting for 58.4% of the total effect. All three hypothesized mediators showed significant indirect effects: perceived social support (β = -0.089, 95% CI [-0.133, -0.050], 18.7% of total effect), marital intimacy (β = -0.077, 95% CI [-0.119, -0.042], 16.2% of total effect), and fertility information needs (β = -0.032, 95% CI [-0.060, -0.011], 6.7% of total effect). The total indirect effect through all three mediators was significant (β = -0.198, 95% CI [-0.268, -0.128]), accounting for 41.6% of the total effect. Conclusions:Reproductive concerns were associated with lower fertility intention, partly through their associations with lower fertility information needs, perceived social support, and marital intimacy. Health care providers should provide proactive, needs-responsive fertility counseling, strengthen social support, and promote couple-centered communication to support informed reproductive decision-making.
