Reproductive concerns and awareness of oncofertility preservation among female cancer patients: implications for sustainability.

The cross‑sectional study design was carried out from March to the end of August 2024 at the gynecological oncology unit in collaboration with the assisted reproductive technology unit at Woman Health Hospital, Assiut University, Egypt. This hospital is a large university teaching hospital that receives patients from all over Upper Egypt. A purposive sample of twenty women between the ages of 16 and 40 years who had been recently diagnosed with early-stage cancer and had not yet begun treatment and were either attending or had been transferred to the gynecological oncology unit, who received fertility consultations through the hospital’s Oncofertility Program, who consented to be involved in the study, and who were willing to participate in a 30-minute in-person interview were chosen. Owing to the exploratory nature of this cross-sectional study and the narrowly defined eligibility criteria, a formal a priori power calculation was not performed. The sample size therefore reflects a purposive recruitment of all eligible women attending the gynecological oncology unit during the study period. This study excluded women who had received fertility-threatening cancer treatment, had a secondary cancer, had a recurrence or remission of their cancer, had no ovaries or uterus, had bilateral ovarian cancer, were morbidly obese (body mass index (BMI) ≥ 40), had a preexisting mental illness, or were incapable of providing informed consent. Eligibility criteria limited participation to women recently diagnosed with early-stage cancer prior to treatment initiation, a stage at which fertility preservation awareness is most relevant. Patients diagnosed with gestational trophoblastic disease were included because, at the time of diagnosis and referral for fertility counseling, they face fertility-related concerns and decision-making processes comparable to those experienced by other women with newly diagnosed malignancies. The focus of the study was on reproductive awareness, concerns, and intentions rather than disease-specific treatment outcomes. Additionally, recruitment within a culturally conservative context affected participation in in-person interviews. Although these considerations restricted the number of participants, they ensured the inclusion of a clinically appropriate and contextually relevant population. Consequently, the findings contribute targeted insights into reproductive concerns and oncofertility awareness within the studied setting rather than aiming for wide generalizability. Data collection was performed via a structured interview questionnaire. It includes five tools. The first tool is the patient assessment tool. A structured patient assessment tool was developed by the researchers for this study on the basis of a literature review. It was split into four parts: Part I, comprising personal and general traits such as age, occupation, residence, marital status, level of education, family income, height/cm, weight/kg and BMI. Part II: obstetrical/labor characteristics of the woman, such as the number of pregnancies, last pregnancy complications, number of children, last delivery or abortion/years, and type of last delivery, are included. Part III included 8 questions concerning the reproductive history of the women. The last part IV covered cancer-related data, such as cancer type/localization, stage of cancer, thoughts of pregnancy and wanted to preserve fertility. The second tool is the Infertility Knowledge Questionnaire (IKQ), which was created by Huang et al. (2019) with assistance from Taiwan’s Ministry of Science and Technology [ 11 ]. It was used to examine how well-informed cancer patients were about infertility. There were eleven items on the scale overall, split across two subdomains: two items in the first category evaluated general knowledge about infertility, whereas nine items in the second domain evaluated knowledge about cancer and its treatments. Each item’s response was categorized as either “yes/correct” = 1 or “no/incorrect/do not know” = 0. The total ratings varied from 0 to 11 points, with higher scores indicating a greater understanding of infertility. Each domain’s knowledge level and overall knowledge were put into three categories: poor knowledge (> 5.5 or less than 50% of the maximum potential score), fair knowledge (5.5–7, or 50–65% of the maximum possible score), and good knowledge (< 7 or more than 65% of the maximum possible score). Five cancer patients examined facial validity, while five experts analyzed content validity. For relevance and importance, the IKQ’s content validity index across expert evaluations was 0.96 and 0.95, respectively. Using Cronbach’s α coefficient, the internal consistency of the IKQ scale was determined to be 0.84. The third tool is the Reproductive Concerns after Cancer (RCAC) scale, originally developed by Gorman et al. (2019), which measures the reproductive problems of female cancer patients [ 12 – 14 ]. Partner disclosure, child health, personal health, acceptance, and the possibility of fertility and pregnancy are among its six dimensions, with a total of eighteen components. The ratings for items 13, 14, and 15 were reverse-scored, with a score of one for “strongly agree” and a score of five for “strongly disagree.” Each item was graded from 1 for “strongly disagree” to 5 for “strongly agree.” Higher scores indicate greater levels of worry. A significant degree of reproductive concern in a particular region was indicated by a mean value of ≥ 4 in that dimension. The sum of the scores for each of the six dimensions is the overall score. With a Cronbach’s alpha of 0.89, the RCAC scale has shown strong validity and reliability. The fourth tool is the fertility intention scale (FIS), developed by Li et al. (2018), which is used to gauge cancer survivors’ intentions to become parents [ 15 – 17 ]. The FIS consists of 15 items that address four areas: happiness, social support, disease prevention, and pregnancy risk. The perceptions of the women regarding the safety and burden of pregnancy were determined to be the realm of pregnancy risk. As a result, patients were more willing to become pregnant when their chances of becoming pregnant were reduced (higher domain scores). The disease control domain evaluated how patients perceived the risk of illness and cancer. Perceived potential help from others and sentiments about being able to raise the next generation were measured by social support and happiness. A five-point Likert scale is used to score each item’s response. A higher fertility intention is indicated by a higher overall fertility intention score (sum of the 15 items). For the FIS (15 items), the Cronbach’s alpha was 0.88. Four factors that explained approximately 68.72% of the variation were found when factor analysis was performed to assess the scale’s construct validity. The fifth tool was the Decisional Conflict Scale (DCS), developed by O’Connor (1995) [ 18 – 20 ]. It has 16 items that address three domains: external pressure or support, uncertainty and effective decision-making, and clarity and informed values. Every item was given a rating between 0 and 4 on a five-point Likert scale. The score was determined by multiplying the product by 25 and then averaging the sum of the points for each individual component. As a result, the scores fall between 0 and 100. Higher decisional conflict is indicated by a higher score. The scale’s Cronbach’s alpha was calculated and found to be 0.93. The structured interview questionnaire was developed by the researchers on the basis of a comprehensive review of the literature and relevant clinical guidelines. Standardized and previously validated instruments were used to assess infertility knowledge, reproductive concerns, fertility intention, and decisional conflict. The content validity of the developed and selected tools was evaluated by a panel of experts in gynecologic oncology, assisted reproductive technology, and nursing. Cultural adaptation was considered throughout the tool development and data collection process. The questionnaire was administered via simple and culturally appropriate language to ensure understanding among women with varying educational backgrounds. Careful attention was given to the wording of fertility-related questions to ensure cultural sensitivity and participant comfort within the study setting. A pilot study was conducted on 10% of the sample to assess the clarity, feasibility, and applicability of the tools. As no modifications were needed, the participants involved in the pilot study were included in the final sample. To ensure data reliability, all interviews were conducted by the same trained researcher following a standardized interview protocol. Prior training was undertaken to ensure consistency in question delivery, interpretation, and recording of responses. The interviews were conducted face-to-face in a private setting to increase confidentiality, participant comfort, and consistency of data collection. The Woman’s Health Hospital Oncology Board and the Faculty of Nursing Ethics Committee at Assiut University approved the study (Approval No. 11120240760). Data collection took place from March to August 2024. After tool development and validation by three specialists in gynecologic oncology, ART medicine, and nursing, a pilot study involving 10% of the sample was conducted to assess clarity and feasibility; as no modifications were needed, these participants were included in the final sample. Eligible patients attending the gynecological oncology unit after fertility consultation were approached through referrals from oncologists, breast surgeons, and fertility specialists. The researcher explained the study, confirmed eligibility, and obtained informed consent, emphasizing voluntary participation and the right to withdraw at any time. For participants younger than 18 years of age, written informed consent was obtained from a parent or legal guardian in addition to assent from the participant herself. Individual face-to-face interviews were conducted in a private room to ensure confidentiality and lasted 30–45 min. Culturally sensitive language was used, particularly when discussing reproductive intentions and fertility preservation, in accordance with the local sociocultural context of Upper Egypt. Psychological comfort was prioritized during the interviews, and support was offered when the participants expressed emotional distress related to fertility or future parenthood. During the interview, the researcher collected personal, reproductive, obstetrical, and cancer-related data, followed by an assessment of infertility knowledge, reproductive concerns, fertility intentions, and decisional conflict. For women who expressed a desire for fertility preservation, the researcher provided education about available procedures and coordinated with fertility specialists, maintaining follow-up throughout the process. The Statistical Package for the Social Sciences (SPSS), version 27.0 (IBM Corp., Somers, New York, USA), was used for statistical analysis. Frequencies were used to describe categorical variables, whereas means ± standard deviations were used to describe continuous variables. Bivariable analyses were performed via Student’s t‑test for normally distributed continuous variables and the Mann–Whitney test for nonnormally distributed variables. The chi‑square test or Fisher’s exact test was applied, as appropriate, to examine associations between categorical variables. Associations between infertility knowledge, reproductive concerns, fertility intention, decisional conflict, and personal and obstetrical characteristics were examined via Spearman’s rho correlation coefficients because of the ordinal nature of several variables and the small sample size. Correlation coefficients were interpreted as measures of effect size. Logistic regression analysis was performed on an exploratory basis to identify variables influencing correct responses. Confidence intervals were not routinely reported given the exploratory nature of the analyses and limited sample size; however, exact p‑values were consistently presented. A p‑value of less than 0.05 was considered statistically significant.

Table ( 1 ) illustrates the personal and general attributes of the women under study and reports that nearly half of them ( n = 9) were aged 20–30 years, with a mean ± SD of 24.9 ± 7.5. More than half of them lived in rural areas. With respect to the level of education, nearly half of the women were illiterate or read and write. With respect to socioeconomic level, more than half of the studied women had inadequate incomes, and more than two-thirds of them were housewives. Half of them [ 10 ] were married, and those with a BMI greater than two-thirds [ 16 ] were overweight. Table 1 Personal and general characteristics of the studied women ( n =20) Variables Frequency or mean ±SD Age/years  Less than 20 7  20-30 9  30-40 4  Mean ± SD 24.9±7.5 Occupation  Housewife 18  Employed 2 Residence  Urban 7  Rural 13 Marital status  Single 10  Married 10 Level of education  Illiterate or read &write 9  Secondary education 7  University education 4 Family income  Inadequate 13  Adequate 7 Height/cm  Mean ± SD 155.7±5.9  Weight/kg  Mean ± SD 70.7±15.3 BMI  Mean ± SD 29.2±5.95  Normal weight 3  Overweight 16  Under weight 1 Personal and general characteristics of the studied women ( n =20) Table ( 2 ) presents the obstetrical/labor characteristics of the studied women and shows that more than half of the women [ 12 ] had not previously been pregnant and that more than two-thirds of the women [ 18 ] had no children. Table 2 Obstetrical/labor characteristics of the studied women ( n =20) Variables Frequency Number of pregnancies (including miscarriages or abortions)  0 12  1 6  2-4 2 Last pregnancy complications  No 2  Abortion 6  Number of children  0 18  ≥ 1 2 Last delivery or abortion/years            2-3 4  4-10 4 Type of last delivery  Normal 1  Cesarean section 1 Obstetrical/labor characteristics of the studied women ( n =20) Table ( 3 ) shows the reproductive history of the studied women and reveals that more than half of the women [ 13 ] experienced severe pain. Additionally, more than half of them [ 11 ] had a history of pelvic surgery, and half of them [ 10 ] had a menstrual cycle shorter than twenty-one days when they did not utilize contraceptives. Nearly one quarter of them [ 4 ] were suffering from endometriosis, and nearly half of them [ 9 ] had a history of pelvic inflammatory disease. Table 3 Reproductive history of the studied women ( n =20) Variables Frequency Suffering from severe period pains  Yes 13  No 7 History of pelvic surgery  Yes 11  No 9 The menstrual cycle can be erratic. The period frequently arrives more than five days early or later than anticipated. (When not utilizing contraceptives)  Yes 16  No 4 The menstrual cycle is shorter than twenty-one days. (When not utilizing contraceptives)  Yes 10  No 10 The menstrual cycle lasts longer than thirty-five days. (When not utilizing contraceptives)  Yes 10  No 10 Suffering from endometriosis  Yes 4  No/Not sure 16 History of pelvic inflammatory disease (PID)  Yes 9  No/Not sure 11 History of amenorrhea (When not utilizing contraceptives)  Yes 9  No/Not sure 11 Reproductive history of the studied women ( n =20) Table ( 4 ) Cancer-related data, thoughts of pregnancy and desires to perform fertility preservation for the studied women. More than one quarter of them [ 6 ] had lymphoma, half of them [ 10 ] were at the 2nd stage of cancer, and nearly all of the studied women [ 19 ] had thoughts of pregnancy and wanted to preserve their fertility. Table 4 Cancer-related data, thoughts about pregnancy and the desire to preserve the fertility of the studied women ( n =20) Variables Frequency Cancer type/localization  Breast cancer 2  Cervical cancer 1  Endometrial 1  Ovarian 3  Gestational trophoblastic disease 3  Leukemia 2  Lymphoma 6  Brain tumor 1  Osteosarcoma 1 Stage of cancer  0 2  1 8  2 10 Thoughts of pregnancy  Yes 19  No 1 Performing fertility preservation  Yes 19  No 1 Cancer-related data, thoughts about pregnancy and the desire to preserve the fertility of the studied women ( n =20) Table ( 5 ): Infertility knowledge among the studied women; nearly three quarters [ 14 ] reported poor knowledge. Table 5 Infertility knowledge among the studied women ( n =20) Variables  Frequency or mean ±SD Level of infertility knowledge  Poor knowledge 14  Fair knowledge 4  Good knowledge 2 Infertility Knowledge score  General infertility knowledge .800 ±.89  Cancer/treatment‐specific knowledge 3.30 ±2.75  Total of infertility knowledge score 4.1±3.3 Infertility knowledge among the studied women ( n =20) Table ( 6 ): Revealing reproductive worries following cancer, fertility intentions and conflicts over decisions among the studied women. With respect to the degree of reproductive issues following cancer and the level of fertility intention, nearly all the studied women [ 19 ] had high reproductive concern and high fertility intention; with respect to the level of decisional conflict, three quarters [ 15 ] had low decisional conflict. Table 6 Reproductive concerns, fertility intentions and decisional conflicts among the studied women ( n =20) Variables  Frequency or mean ±SD Level of reproductive concerns after cancer  High reproductive concern 19  Moderate reproductive concern 1  Low reproductive concern 0  Total of reproductive concerns score 68.1±10.7 Level of fertility intention  High fertility intention 19  Moderate fertility intention 1  Low fertility intention 0 Fertility Intention  Pregnancy risk 24.1±2.7  Disease control 16.6±2.7  Social support 11.2±2.3  Happiness 8.6±1.5  Total of fertility intention score 60.5±7.6 Level of decisional Conflict  Low decisional Conflict 15  High decisional Conflict 5  Total of decisional Conflict score 27.65±.12.5 Reproductive concerns, fertility intentions and decisional conflicts among the studied women ( n =20) Table ( 7 ): Correlations among infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women, which revealed highly significant differences between the levels of education and infertility knowledge and positive associations, including between education level and infertility knowledge, as well as between fertility intentions and reproductive concerns (r = 0.587, p = 0.006). Additional associations were noted between selected obstetrical variables and reproductive concerns or infertility knowledge. Table 7 Correlations between infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women Spearman's rho correlation Variables Infertility knowledge Reproductive concerns Fertility Intention Decisional conflict Age r. value 0.438 0.520 0.280 -0.097 P . value 0.054 0.019 * 0.232 0.683 Occupation r. value -0.263 -0.131 0.291 0.291 P . value 0.263 0.583 0.214 0.214 Residence r. value 0.101 -0.027 -0.046 0.192 P . value 0.672 0.909 0.848 0.418 Marital status r. value 0.377 0.558 0.366 -0.139 P . value 0.102 0.011 * 0.112 0.558 Level of education r. value 0.721 0.032 0.461 -0.108 P . value <0.001** 0.892 0.041 * 0.649 Family income r. value 0.266 0.247 0.421 -0.119 P . value 0.256 0.294 0.065 0.618 Pregnancy history r. value 0.381 0.505 0.296 -0.099 P . value 0.098 0.023 * 0.205 0.679 Having children r. value 0.482 0.247 0.087 -0.029 P . value 0.031* 0.294 0.715 0.903 Pregnancy complications r. value 0.492 0.450 0.326 -0.046 P . value 0.028 * 0.047 * 0.161 0.847 Thoughts of pregnancy r. value 0.342 0.240 0.340 -0.020 P . value 0.140 0.308 0.142 0.933 Infertility knowledge r. value --- 0.369 0.432 -0.317 P . value --- 0.109 0.057 0.173 Reproductive concerns r. value 0.369 --- 0.587 -0.359 P . value 0.109 --- 0.006 ** 0.120 Fertility intention r. value 0.432 0.587 --- -0.133 P . value 0.057 0.006 ** --- 0.577 Decisional conflict r. value -0.317 -0.359 -0.133 --- P . value 0.173 0.120 0.577 --- *Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed) Correlations between infertility knowledge, reproductive concerns, fertility intentions, decisional conflicts, and personal and obstetrical characteristics of the studied women Spearman's rho correlation *Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed)

This study concludes that young female cancer patients demonstrate high levels of reproductive concern and strong fertility intentions despite having limited awareness of infertility and fertility preservation options. These findings highlight a clear gap between patients’ reproductive priorities and their understanding of the potential impact of cancer treatment on future fertility. On the basis of these findings, health care providers are encouraged to integrate fertility-related counseling into routine oncology care, particularly at the time of diagnosis, and to utilize culturally sensitive educational materials. At a broader level, efforts to reduce financial and structural barriers to fertility preservation may help improve equitable access to oncofertility services in resource-limited settings. Future research should build on this work through larger-scale and multicenter studies to increase generalizability. Longitudinal designs may help clarify changes in fertility concerns and awareness over time, whereas intervention-based studies could evaluate the effectiveness of structured educational and counseling programs tailored to culturally sensitive contexts. This study has several limitations that should be considered when the findings are interpreted. The relatively small sample size and the use of purposive sampling may limit the generalizability of the results. In addition, the cross‑sectional design precludes causal inferences regarding the relationships between infertility knowledge, reproductive concerns, fertility intention, and decisional conflict. Data were collected through self‑reported face‑to‑face interviews, which may be subject to recall bias and social desirability bias, particularly when sensitive fertility‑related issues are discussed. All participants had already received fertility counseling prior to enrollment, which may have contributed to higher infertility knowledge scores and lower levels of decisional conflict than patients who had not received counseling. This introduces potential selection bias and limits the generalizability of the findings to counseling‑naïve populations. Moreover, participants’ responses regarding fertility intentions and decisional conflict may have been influenced by the presence of the researcher or accompanying family members during interviews. In addition, certain items within the infertility knowledge questionnaire reflect commonly held educational perceptions regarding assisted reproductive technologies rather than up‑to‑date clinical live‑birth statistics, which should be considered when interpreting knowledge scores. Furthermore, important potential confounders, such as participants’ psychological state, coping strategies, and available social or emotional support systems, were not formally assessed and may have influenced their perceptions and responses. Another important limitation relates to the marked heterogeneity of cancer types included in this study. The sample comprised both solid tumors and hematological malignancies, which differ substantially in treatment protocols, gonadotoxic risk, and the available time window for fertility preservation. Given the small sample size, pooling these heterogeneous diagnoses limits disease‑specific analysis and reduces the clinical interpretability of the findings. Several context‑related factors also affected the study. Financial constraints and the high cost of fertility preservation procedures represented significant barriers for many participants. Additionally, cultural norms, late cancer diagnosis, urgency to initiate treatment, and family involvement in decision‑making may have influenced fertility‑related discussions and participants’ ability to openly express reproductive preferences, particularly among unmarried women. Finally, the specific fertility preservation methods chosen or recommended for participants were not systematically recorded, which limited further analysis of method‑specific decision‑making and its variation by marital status.

The current study sought to determine how well-informed female cancer patients were about reproductive issues related to oncofertility preservation. The findings showed that nearly three‑quarters of the participants had limited infertility knowledge. This aligns with the results of McClam et al. (2024), who reported that most breast cancer patients lacked adequate understanding of oncofertility and expressed a need for clearer information regarding fertility preservation options and the reproductive effects of cancer treatment [ 5 ]. Similar results were reported by Alsaif (2023), who highlighted the limited awareness among women in the Saudi population, further influenced by cultural and religious perceptions [ 21 ]. Additionally, Zaami et al. (2022) suggested that although interest in fertility preservation exists, its uptake remains limited due to fear of invasive procedures, health‑related concerns, and misinformation [ 22 ]. Findings from Omani‑Samani et al. (2021) similarly indicate insufficient awareness among adult cancer patients and parents of pediatric patients [ 23 ]. A systematic review by Wang, Anazodo, and Logan (2019) further demonstrated that many cancer patients have unmet information needs related to fertility, resulting in uncertainty and difficulty in making informed fertility preservation decisions [ 24 ]. Their review emphasized the importance of patient decision aids in supporting clearer, more confident decision‑making for reproductive planning. With respect to reproductive concerns, fertility intentions, and decisional conflict, nearly all women in the present study presented high levels of reproductive concern and strong fertility intentions, whereas most reported low decisional conflict, underscoring the need for supportive and holistic fertility [ 25 ]. This finding is comparable to the findings of Ruggeri et al. (2019), who reported that many young breast cancer survivors continue to desire biological children after treatment [ 26 ]. Similarly, Ruddy et al. (2014) reported substantial concern about infertility among younger patients, even among those who already had children [ 27 ]. The cross‑sectional study by Ramya Sindi (2020) also contributes context, showing that although approximately half of the surveyed cancer patients were aware of fertility preservation, few had discussed these options with healthcare providers before starting treatment [ 28 ]. This highlights the ongoing need for public education and structured fertility counseling services. In contrast, Ko et al. (2023) reported that a proportion of older women expressed limited interest in learning about fertility preservation, often due to a reduced desire for future childbearing ([ 29 – 30 ]). However, nearly half of the participants in their study reported that fertility concerns still influenced their treatment decisions, and some women changed their reproductive preferences after treatment. This finding reinforces the dynamic nature of fertility-related decision‑making among cancer patients [ 31 ]. Our findings also revealed that younger and more educated women demonstrated better infertility knowledge, greater reproductive awareness, and stronger fertility intentions. This finding agrees with that of Ko et al. (2023), who reported that education level and age are strong predictors of fertility-related knowledge and interest in fertility preservation [ 29 ]. The findings of this study highlight clear gaps in reproductive knowledge and access to fertility‑related information, which is directly related to Sustainable Development Goal 3.7. This global target calls for universal access to sexual and reproductive health services, including counseling, education, and decision‑support tools. The limited awareness observed among participants and the inconsistent provision of fertility counseling indicate that current practices fall short of SDG 3.7 commitments. Enhancing fertility education, integrating structured oncofertility counseling into routine oncology care, and ensuring equitable access to preservation services are essential steps toward supporting reproductive rights and improving the long‑term well‑being of young women with cancer. From a practical standpoint, the findings of this study carry important implications for clinical practice and service planning in oncofertility care. The coexistence of limited infertility knowledge with high reproductive concerns and strong fertility intentions underscores the need for timely and structured fertility‑related discussions at the point of cancer diagnosis. For healthcare providers, particularly oncology nurses and physicians, initiating brief, standardized fertility counseling during routine clinical encounters may represent a feasible and low‑cost approach to addressing unmet informational needs. At the service and policy level, integrating simple educational materials and clear referral pathways to fertility specialists within oncology units may increase awareness without imposing substantial resource demands. In addition, patient advocacy and support groups can play a complementary role by providing peer‑based education and emotional support, which may help alleviate reproductive anxiety and support informed decision‑making. Such context‑appropriate strategies are particularly relevant in resource‑limited settings and align with efforts to improve equitable access to reproductive health information and counseling. Although marital status plays a central role in determining available fertility preservation options in the Egyptian context, the present study focused primarily on fertility awareness and decisional perceptions rather than method--specific choices.

Women’s reproductive health is a global priority reflected in Sustainable development goal 3, which calls for equitable access to high-quality reproductive health services and reliable information by 2030 [ 1 , 2 ]. SDG 3.7 further emphasizes the need to integrate sexual and reproductive health counseling into routine care, a goal particularly relevant for women at risk of treatment-related infertility [ 3 ]. As cancer survival has improved, fertility preservation has become an essential dimension of survival, supporting long-term well-being and quality of life for female cancer patients [ 4 ]. For women diagnosed during their reproductive years, fertility concerns are common and often emotionally distressing. Evidence shows that maintaining the possibility of future childbearing supports psychological adjustment, whereas anticipated infertility contributes to worry and reduced well-being. Despite international recommendations for early fertility counseling, gaps in communication and limited access to fertility information remain [ 5 – 7 ]. Nurses play a central role in supporting decision-making by offering education, emotional support, and coordination across oncology and fertility services [ 8 ]. Strengthening this role is important to ensure that women receive consistent and timely guidance. Understanding women’s awareness of reproductive risks and available preservation options is therefore essential [ 9 , 10 ]. This study aims to explore female cancer patients’ awareness of reproductive concerns related to oncofertility preservation.

Supplementary Material 1. Supplementary Material 1.