He XY, Huang Y, Qiao CP, Ma J, Han X, Fan XM, Chen Q. Fertility anxiety partially mediates depression and recurrence fear in reproductive-age cervical cancer patients: A cross-sectional study. World J Clin Oncol 2025; 16(9): 110031 [PMID: 41024840 DOI: 10.5306/wjco.v16.i9.110031]
Corresponding Author of This Article
Qin Chen, Chief Nurse, Department of Gynecological Oncology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, No. 123 Tianfei Lane, Mochou Road, Qinhuai District, Nanjing 210004, Jiangsu Province, China. qin@njmu.edu.cn
Research Domain of This Article
Womens Studies
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xin-Ying He, Cheng-Ping Qiao, Jiao Ma, Xue Han, Xue-Mei Fan, Qin Chen, Department of Gynecological Oncology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing 210004, Jiangsu Province, China
Ying Huang, Department of Obstetrics and Gynecology, Haian Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nantong 226600, Jiangsu Province, China
Co-first authors: Xin-Ying He and Ying Huang.
Author contributions: Huang Y conceived and designed the study; Han X performed the literature search; He XY and Han X acquired the data and drafted the manuscript; Chen Q assisted in revising the manuscript; Qiao CP, Chen Q and He XY wrote the original draft; Fan XM wrote, reviewed and edited the manuscript; Ma J ensured the authenticity of all the raw data. All authors have read and approved the final manuscript. He XY and Huang Y contributed equally to this work as co-first authors.
Supported by National Natural Science Foundation Youth Project, No. 72204123; and China Social Welfare Foundation- Nurse Care Fund, No. HLCXKT-20230130.
Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of the Maternity Hospital Affiliated to Nanjing Medical University (Nanjing Maternity and Child Health Hospital). The ethics acceptance number is 2022KY-135-02.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: The authors have no relevant financial or non-financial interests to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data is provided within the manuscript or supplementary information files. Deidentified data supporting this study’s findings are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qin Chen, Chief Nurse, Department of Gynecological Oncology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, No. 123 Tianfei Lane, Mochou Road, Qinhuai District, Nanjing 210004, Jiangsu Province, China. qin@njmu.edu.cn
Received: May 28, 2025 Revised: June 18, 2025 Accepted: July 31, 2025 Published online: September 24, 2025 Processing time: 118 Days and 16.1 Hours
Abstract
BACKGROUND
Cervical cancer survivors of childbearing age often face heightened reproductive anxiety due to the direct impact of the disease and its treatments on fertility. This anxiety may exacerbate psychological burdens, including depressive symptoms and fear of recurrence, significantly impacting quality of life.
AIM
To examine whether reproductive concerns partially mediate the relationship between depressive symptoms and fear of recurrence in cervical cancer patients of childbearing age.
METHODS
Utilizing a cross-sectional design with convenience sampling, 208 eligible cervical cancer patients (aged 18-45 years, stable condition, and aware of diagnosis) from three tertiary hospitals completed validated questionnaires: The Reproductive Concerns After Cancer Scale, Patient Health Questionnaire-9, and Fear of Cancer Recurrence Questionnaire. Structural equation modeling was used to assess the mediating role of reproductive concerns in the relationship between depression and fear of recurrence.
RESULTS
Reproductive concerns demonstrated significant positive correlations with depression (r = 0.477, P < 0.001) and fear of recurrence (r = 0.426, P < 0.001). Structural equation modeling analysis revealed that reproductive concerns acted as a significant partial mediator between depression and fear of recurrence. The indirect effect via reproductive concerns was significant (β_indirect = 0.152, P < 0.001), accounting for 28.1% of the total effect of depression on fear of recurrence.
CONCLUSION
Identified path reveals fertility anxiety links depression to recurrence fear. Targeted psych interventions for repro concerns may ease both in childbearing cervical cancer survivors.
Core Tip: This study establishes reproductive concerns as a significant partial mediator (accounting for 28.1% of the total effect, β-indirect = 0.152, P < 0.001) between depression and fear of recurrence in 208 childbearing-age cervical cancer patients, using validated scales (Patient Health Questionnaire-9, Reproductive Concerns After Cancer Scale, Fear of Cancer Recurrence Questionnaire) in a cross-sectional design. Strong correlations were observed (reproductive concerns with depression: r = 0.477; with fear of recurrence: r = 0.426), highlighting that depression amplifies fear of recurrence both directly (β-direct = 0.389) and indirectly via fertility-related distress. Given cervical cancer's direct impact on reproductive function and cultural childbearing expectations in populations like China, targeted oncofertility counseling and psychosocial interventions addressing reproductive concerns may concurrently alleviate depressive symptoms and recurrence fears, offering a dual-benefit strategy for survivorship care.
