Social Support as a Mediator Between Fear of Cancer Recurrence and Fertility Intention in Young Women With Breast Cancer

Social Support as a Mediator Between Fear of Cancer Recurrence and Fertility Intention in Young Women With Breast Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Social Support as a Mediator Between Fear of Cancer Recurrence and Fertility Intention in Young Women With Breast Cancer Yinhuan Wang, Qingqiu Chen, Junlan Liu, Yongju Wang, Dan Li, Chaixiu Li, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7944340/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To examine the mediating role of social support in the relationship between fear of cancer recurrence (FCR) and fertility intention among reproductive-aged women with breast cancer. Methods This study employed a cross-sectional design, utilising convenience sampling to select 231 women of reproductive-aged diagnosed with breast cancer and treated at a tertiary hospital in Chongqing between December 2023 and June 2024 as research subjects.Participants completed a demographic questionnaire, the Fertility Intention Scale, the Social Support Rating Scale, and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF).Pearson correlation analysis was conducted to examine the inter-variable correlations, followed by the construction of a structural equation model using AMOS 26 software, with bootstrap method applied to verify the mediation effects. Results Fertility intention was negatively correlated with FCR (r = -0.610, P < 0.001) and positively correlated with social support (r = 0.673, P < 0.001). Social support was also negatively correlated with FCR (r = -0.521, P < 0.001). Structural equation modeling revealed that social support partially mediated the relationship between FCR and fertility intention, accounting for 27.93% of the total effect. Conclusion Enhancing social support may help alleviate FCR and subsequently increase fertility intention among reproductive-aged women with breast cancer. Breast cancer Fertility intention Fear of cancer recurrence Social support Reproductive-aged women Mediation analysis Figures Figure 1 Introduction Breast cancer is the most commonly diagnosed cancer among women, accounting for 32% of all new female cancer cases in 2024[ 1 ] In China, breast cancer tends to be diagnosed at a notably younger age compared to Western countries. A recent national study reported that the median age at diagnosis in Chinese women is 48–50 years, significantly lower than the 64 years observed in the United States[ 2 ].With the advancement of medical technologies, long-term survival has significantly improved, allowing more patients to become survivorship. However, the diagnosis and treatment of cancer impose considerable psychological and quality-of-life challenges. In 2018, approximately 645,000 premenopausal breast cancer cases were diagnosed globally—accounting for about 31% of all new breast cancer cases—highlighting a substantial disease burden among women of reproductive age[ 3 ].Influenced by national fertility policies, increasing education levels, career development, and changes in lifestyle, many women are diagnosed with breast cancer before having children. Even among those who have already given birth, a portion of younger survivors still have fertility desires. According to a research report, about 35% of breast cancer survivors of childbearing age expressed their desire to have children after treatment, including 14.2% of multiparas who wanted to have a second child.[ 4 ]. “Fertility intention refers to an individual’s desire or pursuit to have children, shaped by expectations surrounding the number, timing, gender, and quality of offspring. It is influenced by a complex interplay of individual sociodemographic characteristics and macro-level social factors, such as norms, cultural values, economic status, and family systems[ 5 ]. Research indicates that the psychological stress experienced by individuals facing infertility is comparable to that of those diagnosed with serious illnesses like cancer, with about 30% of women in infertility clinics reporting clinical levels of anxiety or depression[ 6 ].Fear of cancer recurrence (FCR) is one of the most important psychological barriers to fertility planning; patients with high levels of FCR often exhibit lower fertility intention. Conversely, social support has been shown to play a protective and promotive role in this context. Adequate social support can help patients face recurrence risks more positively and reduce anxiety related to FCR[ 7 ]. However, few studies have examined the interaction among these three variables. This study therefore examines the interplay between FCR, fertility aspirations, and social support among women of reproductive-aged women with breast cancer, investigating the role of social support within this context. Methods Participants This study employed G*Power 3.1 software to estimate the required sample size. Assuming a median effect size of 0.25, a significance level (α) of 0.05, and a power (1-β) of 0.95, with a 10% attrition rate factored in, the minimum required sample size was calculated to be 231 subjects.A cross-sectional study design was adopted. From December 2023 to June 2024, 231 women of childbearing age with breast cancer who underwent breast and thyroid surgery in a tertiary hospital in Chongqing, China were recruited by convenient sampling. The inclusion criteria were: (1) aged 18 to 40 years, (2) pathologically diagnosed with breast cancer, (3) had undergone breast cancer surgery, and (4) normal cognitive and communication ability to complete the survey. Exclusion criteria included: (1) having other malignant tumors, (2) having severe cardiovascular, cerebrovascular, hepatic or renal diseases, (3) a history of psychiatric illness, and (4) patients with stage IV tumor. Data Collection Data were collected through face-to-face questionnaires administered by trained healthcare professionals using standardized instructions. Prior to data collection, all participants were informed of the purpose, procedure, and scientific value of the study, and written informed consent was obtained. The survey was anonymous and completed independently by participants, and questionnaires were collected immediately on site. A total of 254 questionnaires were distributed in this study, with 231 valid responses obtained, yielding a valid response rate of 90.94%. This research was approved by the hospital's ethics committee (approval number: (B)KY2024069).This study was performed in line with the principles of the Declaration of Helsinki. Measures Four instruments were used in this study: (1) a demographic questionnaire, (2) the Fertility Intention Scale, (3) the Social Support Rating Scale (SSRS), and (4) the Fear of Progression Questionnaire–Short Form (FoP-Q-SF). The demographic data collection included information about the patients’ age, education level, marital status, employment status, monthly household income, type of medical insurance, parity, and number of children (8 items in total) Fertility Intention Scale The Fertility Intention Scale was developed by Li Chin-Ching and colleagues in 2018[ 8 ], this scale consists of 15 items across four dimensions: fertility risk, disease control, social support, and well-being. It uses a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with higher scores indicating stronger fertility intention. The scale has demonstrated good internal consistency (Cronbach’s α = 0.88), item-factor correlations (0.69–0.98), inter-factor correlations (0.21–0.46), test–retest reliability (0.61), and construct validity (0.88). Social Support Rating Scale (SSRS) The SSRS was developed by Shuiyuan Xiao[ 9 ], the SSRS includes 10 items across three dimensions: subjective support (items 1, 3, 4, 5), objective support (items 2, 6, 7), and utilization of support (items 8–10). Items are scored on 4-point Likert scales, or as count variables for the number of support sources. Total scores range from 12 to 66, with higher scores indicating stronger social support. The SSRS has demonstrated good reliability and validity in Chinese populations. Fear of Progression Questionnaire–Short Form (FoP-Q-SF) The Chinese version of the FoP-Q-SF used in this study was translated and revised by Wu Qiyun et al. in 2015[ 10 ]. It contains 12 items across two dimensions—physical health and social/family functioning—rated on a 5-point Likert scale (1 = never to 5 = always), with total scores ranging from 12 to 60. Higher scores indicate more severe fear of cancer recurrence. A total score ≥ 34 indicates clinical levels of psychological dysfunction. The scale has good psychometric properties in Chinese breast cancer populations, with Cronbach’s α = 0.815 in this study. Statistical Analysis Data were entered and analysed using SPSS 26.0 statistical software; Quantitative data were described as mean ± standard deviation (M ± SD), while qualitative data were presented as case numbers and percentages (%). One-way analysis of variance (ANOVA) was employed to compare differences in fertility intention scores among breast cancer patients of reproductive-aged women across various demographic characteristics. Pearson correlation analysis examined the relationships among cancer recurrence fear, fertility intention, and social support in breast cancer patients. Structural equation modelling was constructed using AMOS 26 software. The Bootstrap method was employed to validate the mediating effect of social support on the relationship between fear of cancer recurrence and fertility desire among women of childbearing age with breast cancer. The significance level was set at α = 0.05. Prior to data analysis, all measurement items underwent Harman's univariate test. Factors with eigenvalues > 1 were extracted, with the first factor explaining 31.53% of variance—below the critical threshold of 40.0%—indicating no common method bias in the research data. Results Comparison of fertility intention scores among participants with different sociodemographic characteristics Significant differences in fertility intention scores were found among patients of different ages, education levels, monthly household income, type of surgery, and number of children (P < 0.05). Detailed results are presented in Table 1 . Table 1 Comparison of fertility intention scores among breast cancer patients in reproductive age with different characteristics (n = 231, x ± s). Characteristics N(%) Fertility intention score t/F P value age 7.706 0.021 ≤ 30 31 44.68 ± 7.18 31–35 74 44.69 ± 10.10 36–40 126 41.83 ± 9.29 Education 13.825 0.003 Junior high school and below 52 44.67 ± 8.77 High school or technical secondary school 39 47.08 ± 8.40 college 58 42.09 ± 8.72 Bachelor's degree or above 82 41.00 ± 10.03 Marital status 0.120 0.729 Unmarried/divorced 38 43.63 ± 9.46 married 193 43.03 ± 9.39 Place of residence 5.122 0.077 city 138 42.35 ± 9.51 countryside 49 44.39 ± 6.72 County 44 44.16 ± 11.28 Medical insurance payment method 3.011 0.222 Cooperative medical insurance 76 44.09 ± 10.28 Health care 148 42.57 ± 8.61 At your own expense 7 44.43 ± 14.70 Incumbency 1.855 0.173 Not on the job 103 43.56 ± 9.68 incumbency 128 42.77 ± 9.16 Household per capita income 9.033 0.029 1001–3000 36 43.19 ± 9.79 3001–5000 63 40.37 ± 7.32 5001–8000 62 45.76 ± 9.09 8000 above 70 43.24 ± 10.51 Staging of disease 5.078 0.166 Phase 1 65 41.06 ± 8.31 Phase 2 131 44.37 ± 9.71 Phase 3 31 42.32 ± 10.02 Phase 4 4 42.25 ± 4.50 Surgical modality 8.719 0.013 Breast conservation 83 41.13 ± 9.72 Full cut 78 45.38 ± 9.56 reconstruction 70 42.97 ± 8.28 Number of children 8.093 0.044 0 44 46.00 ± 8.97 1 93 41.72 ± 9.68 2 87 42.97 ± 9.32 3 7 45.71 ± 4.07 Time of diagnosis of disease 1.701 0.427 ≤ 1 year 114 43.68 ± 8.44 1–3 years 77 41.62 ± 8.59 Greater than 3 40 44.43 ± 12.72 Correlations among fertility intention, social support, and FCR Pearson correlation analysis revealed that fertility intention was negatively correlated with fear of cancer recurrence (FCR) (r = − 0.610, P < 0.001) and positively correlated with social support (r = 0.673, P < 0.001). Social support was also negatively correlated with FCR (r = − 0.521, P < 0.001). Correlation analysis of fertility intention, social support, and fear of cancer recurrence in reproductive-aged breast cancer patients are shown in Table 2 . Table 2 Correlation analysis of fertility intention, social support, and FCR in reproductive-aged breast cancer patients (n = 231) Iteam Score (x ± s) Fertility risk Disease control Social support sub-item Sense of well-being Total score of fertility intention Subjective support Objective support Utilization of support Total score for social support Physiological health Social family Total score for fear of disease progression Fertility risk 15.82 ± 5.13 1 Disease control 14.25 ± 2.85 .478** 1 Social support sub-item 7.87 ± 2.74 .407** .435** 1 Sense of well-being 5.19 ± 1.73 .300** .231** .352** 1 Total score of fertility intention 43.13 ± 9.38 .866** .734** .711** .521** 1 Subjective support 24.81 ± 3.97 .404** .430** .386** .325** .524** 1 Objective support 9.65 ± 2.02 .449** .376** .347** .282** .513** .302** 1 Utilization of support 8.29 ± 1.67 .405** .401** .467** .301** .535** .378** .451** 1 Total score for social support 42.75 ± 5.96 .535** .526** .505** .396** .673** .874** .667** .685** 1 Physiological health 17.48 ± 4.77 − .427** − .800** − .445** − .232** − .649** − .406** − .361** − .446** − .518** 1 Social family 17.09 ± 4.69 − .333** − .345** − .343** − .192** − .422** − .326** − .252** − .338** − .397** .547** 1 Total score for fear of disease progression 34.56 ± 8.33 − .432** − .653** − .448** − .241** − .610** − .417** − .349** − .446** − .521** .882** .877** 1 Note: **. Correlation is significant at the 0.01 level (2-tailed). Mediating role of social support between FCR and fertility intention Table 3 lists the goodness-of-fit indices for the initial and modified models.The fit of our structural model showed that the χ2/df ratio of 2.439. Generally, an χ2/df ratio below 3 is considered an indicator of a good fit, suggesting that our model adequately captures the underlying structure of the data. Additionally, the IFI, TLI and CFI all offer further evidence of the model's adequacy. With values of 0.960 for IFI, of 0.959 for CFI, and 0.929 for TLI, the model exceeds the commonly accepted threshold of 0.90 for these indices, indicating a good fit between the hypothesised model and the observed data. These indices are particularly useful as they are less sensitive to sample size and account for model complexity. The root mean square error of approximation (RMSEA) value is 0.079, suggesting a reasonable fit. Table 3 Fit indices for the developed model Fitting indicators X 2 /df IFI CFI TLI RMSEA NFI standard 0.90 > 0.85 > 0.80 0.80 model 2.439 0.960 0.959 0.929 0.079 0.933 The Bootstrap method (5,000 iterations) was used to test the significance of indirect effects. The 95% confidence intervals for all pathways did not include zero, indicating a significant partial mediating effect of social support in the relationship between FCR and fertility intention. The indirect effect accounted for 27.93% of the total effect .See details in Table 4 and Fig. 1 . Direct effect: FCR → Fertility intention (β = − 0.621, P = 0.010) Indirect effect: FCR → Social support (β = − 0.605, P < 0.001); Social support Fertility intention (β = 0.399, P = 0.008) Mediated pathway: FCR → Social support → Fertility intention (β = − 0.241, P = 0.009) Total effect: β = − 0.863 These results suggest that social support plays a significant partial mediating role in mitigating the negative impact of fear of recurrence on fertility intention in reproductive-aged breast cancer patients. Table 4 Mediation analysis of social support between fear of cancer recurrence and fertility intention Type of effect path Effect size P-value 95%CI Direct effects Fertility intentions<-Fear of cancer recurrence -0.621 0.010 -0.966 -0.258 Mediation effect Social support<-Fear of cancer recurrence -0.605 < 0.001 -0.867 -0.419 Fertility intentions<-Social support 0.399 0.008 0.114 1.098 Fertility intentions<-Social support <-Fear of cancer recurrence -0.241 0.009 -0.696 -0.063 Total effect Fertility intentions<-Fear of cancer recurrence -0.863 < 0.001 -1.203 -0.567 Discussion This study focuses on anxiety and depression among reproductive-aged women with breast cancer, employing structural equation modelling to examine the relationships among their fertility intentions, social support, and fear of cancer recurrence. Furthermore, the research explores the potential partial mediating role of social support between fear of cancer recurrence and fertility intentions. Results indicate that fertility desire exhibits a negative correlation with fear of cancer recurrence and a positive correlation with social support. Concurrently, social support demonstrates a negative correlation with FCR. Current status of fertility intention, social support, and FCR among reproductive-aged women with breast cancer In this study, the mean fertility intention score among reproductive-aged women with breast cancer was 43.13 ± 9.38, which is consistent with findings from previous research in similar populations[ 11 ]. Overall, participants demonstrated a moderate to high level of fertility intention during cancer treatment, suggesting that fertility-related concerns remain highly relevant and should not be overlooked in clinical practice. Univariate analyses showed that age, educational level, monthly household income, type of surgery, and number of children significantly influenced fertility intention. These findings align with prior studies[ 12 ].Specifically, fertility intention tends to decline with increasing age. Women with higher education levels may possess greater awareness of fertility preservation and thus show stronger fertility motivation. Parity is also influential—patients who already have children are generally less inclined to pursue future pregnancies. Financial constraints further affect decisions, as the perceived cost of raising a child may deter low-income families. Surgical type also plays a role: patients undergoing total mastectomy are less likely to express fertility intention compared to those receiving breast-conserving or reconstructive procedures. Many women worry that cancer treatment may jeopardize future fertility. A Chinese survey stated that, only 26% of young breast cancer patients reported having received fertility preservation counseling at diagnosis[ 13 ]. International guidelines—including those from ASCO—strongly recommend that oncology teams form multidisciplinary fertility preservation teams comprising breast surgeons, reproductive endocrinologists, oncologists, obstetricians, genetic counselors, and psychologists to ensure timely fertility counseling before treatment initiation[ 14 ]. In this study, the mean social support score was 42.75 ± 5.96, indicating generally good support levels among participants. Social support, as a key psychosocial resource, plays a dual role in stress adaptation. It can not only buffer negative emotions such as anxiety and depression (emotional regulation) but also promote physical and psychological recovery (health promotion). Studies have consistently shown that greater social support is associated with improved psychological resilience in cancer patients[ 15 ]. The mean FCR score in our sample was 34.56 ± 8.33, similar to previous findings[ 16 ]. Unmarried women tended to express concerns about marriage, childbirth, and genetic risks. Married women often feared that recurrence could harm their marital relationship or compromise family stability. Therefore, it is essential to provide psychological support during treatment to reduce anxiety and fear and improve emotional well-being in this population. Relationships among fertility intention, social support, and FCR The study confirmed significant negative correlations between fertility intention and FCR and negative correlations between social support and FCR, as well as a significant positive correlation between fertility intention and social support. These findings reinforce prior evidence that FCR is a critical psychological barrier to fertility decision-making in breast cancer survivors[ 17 , 18 ]. FCR often manifests as persistent anxiety about recurrence or disease progression, and it can interfere with long-term life planning, including the desire to have children. A qualitative study of 27 breast cancer survivors found that 74% reported thinking about recurrence at least monthly, with some doing so multiple times per week[ 19 ]. FCR has been shown to trigger avoidance of fertility-related decisions. Internet-based cognitive behavioral therapy (CBT) has proven effective in alleviating FCR-related distress and uncertainty[ 20 ], suggesting that such interventions could benefit patients hesitant about childbearing. Social support emerged as a protective factor for both FCR and fertility intention. Previous studies have demonstrated its buffering effects on stress and its positive role in improving treatment adherence, emotional resilience, and decision-making confidence[ 21 , 22 ]. Young women, in particular, frequently report a strong need for peer support to navigate fertility decisions—citing the ability to share information, gain emotional empathy, and feel less isolated. Nurses can facilitate this by connecting patients to survivor networks and providing trusted peer resources, thus helping them make informed choices regarding fertility[ 23 , 24 ]. A significant negative association between social support and fear of cancer recurrence has been documented in recent research. A systematic review and meta-analysis involving Chinese cancer patients reported a pooled correlation coefficient of r ≈ − 0.35 (P < 0.01) between perceived social support and FCR, supporting our finding of r = − 0.521[ 25 ]. Additionally, a multicenter Chinese study found that greater social support significantly alleviated FCR in breast cancer survivors, with nursing recommendations emphasizing tailored interventions based on patients' individual support needs[ 26 ]. Social support plays a crucial role in alleviating anxiety related to FCR by providing emotional, informational, and tangible assistance, fostering a sense of belonging and acceptance, and encouraging social interaction and engagement[ 27 ]. Hu et al.[ 28 ] emphasized that receiving multidimensional social support—from family members, friends, and healthcare providers—offers substantial psychosocial benefits for cancer survivors. These include reduced psychological stress, enhanced self-efficacy, and improved treatment adherence, all of which contribute to mitigating FCR. Path analysis further confirmed that higher levels of social support are associated with lower levels of fear of cancer recurrence. Social support mediates the relationship between FCR and fertility intention Another significant research discovery pertains to the mediating role of social support between FCR and fertility intention. This suggests that fostering positive social support may assist the reproductive-aged women with breast cancer in avoiding victimization from FCR, thereby increasing their fertility intention. Structural equation modeling revealed that social support partially mediated the relationship between FCR and fertility intention, accounting for 27.93% of the total effect. This indicates that increased social support may reduce the psychological distress associated with recurrence fears, thereby improving reproductive decision-making. Reproductive-aged breast cancer patients often face multifaceted psychological and social pressures from spouses, family, and society. To strengthen their social support systems, particular emphasis should be placed on the role of partner support. Interventions such as family conferences, couples counseling, and peer support groups can be implemented. In clinical practice, healthcare providers can utilize decision aids to deliver systematic and standardized fertility-related counseling, while adopting multidisciplinary team (MDT) consultations to enhance patients’ fertility decision-making capacity.Building upon reinforced social support, gynecologists and oncologists should provide comprehensive and thorough fertility preservation options along with professional guidance on long-term family planning as early as possible, thereby alleviating fear of cancer recurrence (FCR). Social support encompasses not only emotional encouragement and reassurance but also extends to informational resources and assistance in navigating complex medical options and content. Therefore, by ensuring adequate social support, patients’ uncertainty and anxiety during the decision-making process can be significantly reduced, ultimately enhancing their reproductive health knowledge and decision confidence[ 29 ]. Conclusions This study demonstrates that reproductive-aged women with breast cancer exhibit relatively low levels of fertility intention, and that (FCR) is a key psychological factor negatively affecting fertility decision-making. Social support not only directly enhances fertility intention but also partially mediates the adverse impact of FCR. These findings highlight the importance of developing targeted interventions that reduce psychological distress and strengthen social support systems. Clinicians and policymakers should consider integrating fertility counseling, mental health support, and social resource mobilization into cancer survivorship care to improve patients’ reproductive well-being. Given national policies encouraging childbirth, supporting young breast cancer survivors in their fertility decisions is essential not only for individual and family-level health, but also for broader public health objectives. Limitations This study has several limitations. First, the sample was drawn from a single tertiary hospital in Chongqing, which may restrict the generalizability of the findings. Future research should recruit participants from diverse geographic regions and healthcare settings, including community-based populations, to enhance external validity. Second, the majority of participants were diagnosed within 1–3 years prior to the study; therefore, the long-term impact of survivorship duration on fertility intention remains unknown and requires longitudinal exploration. Third, key psychosocial variables such as marital relationship quality and evolving reproductive attitudes were not assessed. These factors may play a significant role in fertility-related decision-making and should be incorporated into future research models for a more comprehensive understanding. Declarations Data availability Data will be available upon request to the corresponding author by e-mail. Authors' contributions Authors and Affiliations Yinhuan Wang Qingqiu Chen Junlan Liu Yongju WangDan Li Chaixiu Li Xiaona Yan Shuang Song Yi ZhangGuozhi Zhang and Ying Yang Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing,400038, China. Contributions Yinhuan Wang and Ying Yang were responsible for the conception and design, Qingqiu Chen, Yongju Wang,Junlan Liu, Dan Li, and Xiaona Yan contributed to the data collection, Yinhuan Wang, Chaixiu Li, and Shuang Song participated in the data analysis and drafting of the manuscript, Ying Yang and Guozhi Zhang revised the manuscript, and Yi Zhang was responsible for the supervision and support of the study. Corresponding authors Correspondence to Guozhi Zhang and Ying Yang. Ethics approval and consent to participate The data collection for this study has been approved by the Ethics Committee of the First Affiliated Hospital of the Army Medical University. and all participants provided written informed consent. As the dataset is publicly accessible and free of identifiable information, additional ethical approval and informed consent were not required. Consent for publication All authors have consented to the publication of this article. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available because they contain protected health information (PHI) of the participants, but are available from the corresponding author on reasonable request with appropriate ethics approvals and data sharing agreements Ethics declarations Ethics approval This study was performed in line with the principles of the Declaration of Helsinki.This study has been approved by the Ethics Committee of the First Affiliated Hospital of the Army Medical University (Approval Number: (B) KY2024069).Written informed consent was obtained from the participants. Competing interests The authors declare no conflicts of interest. Funding This research was supported by the Chongqing Medical Research Major Project (2024DBXM001). 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Psychooncology. 2021;30:176–84. Baek SY, Kim H-K, Park S, Yu JH, Lee MH, Youn HJ, et al. Multidisciplinary Shared Decision Making for Fertility Preservation in Young Women With Breast Cancer. J Breast Cancer. 2023;26:582–92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7944340","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554245199,"identity":"48a1c7ab-1fd8-4f3b-9269-b9543bd42cb2","order_by":0,"name":"Yinhuan Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Army Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yinhuan","middleName":"","lastName":"Wang","suffix":""},{"id":554245200,"identity":"871e0fc8-5148-4ee3-8053-29ceb9b452c7","order_by":1,"name":"Qingqiu Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Army 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09:24:11","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118512,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7944340/v1/1f4252362349121bce95ffb2.html"},{"id":97667566,"identity":"f753b435-4a19-4041-8054-0c9d19c36cd5","added_by":"auto","created_at":"2025-12-08 09:23:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":173130,"visible":true,"origin":"","legend":"\u003cp\u003ePath diagram of the mediation model\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7944340/v1/8e7996989e092739e162915f.png"},{"id":107804213,"identity":"e7106d3e-7d32-49eb-ae36-c1a6f9f6da18","added_by":"auto","created_at":"2026-04-25 21:09:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":601410,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7944340/v1/3e41a3a9-2e0e-4de7-8cb0-e31051f5feb0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Social Support as a Mediator Between Fear of Cancer Recurrence and Fertility Intention in Young Women With Breast Cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer is the most commonly diagnosed cancer among women, accounting for 32% of all new female cancer cases in 2024[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In China, breast cancer tends to be diagnosed at a notably younger age compared to Western countries. A recent national study reported that the median age at diagnosis in Chinese women is 48\u0026ndash;50 years, significantly lower than the 64 years observed in the United States[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].With the advancement of medical technologies, long-term survival has significantly improved, allowing more patients to become survivorship. However, the diagnosis and treatment of cancer impose considerable psychological and quality-of-life challenges.\u003c/p\u003e\u003cp\u003eIn 2018, approximately 645,000 premenopausal breast cancer cases were diagnosed globally\u0026mdash;accounting for about 31% of all new breast cancer cases\u0026mdash;highlighting a substantial disease burden among women of reproductive age[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Influenced by national fertility policies, increasing education levels, career development, and changes in lifestyle, many women are diagnosed with breast cancer before having children. Even among those who have already given birth, a portion of younger survivors still have fertility desires. According to a research report, about 35% of breast cancer survivors of childbearing age expressed their desire to have children after treatment, including 14.2% of multiparas who wanted to have a second child.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u0026ldquo;Fertility intention refers to an individual\u0026rsquo;s desire or pursuit to have children, shaped by expectations surrounding the number, timing, gender, and quality of offspring. It is influenced by a complex interplay of individual sociodemographic characteristics and macro-level social factors, such as norms, cultural values, economic status, and family systems[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Research indicates that the psychological stress experienced by individuals facing infertility is comparable to that of those diagnosed with serious illnesses like cancer, with about 30% of women in infertility clinics reporting clinical levels of anxiety or depression[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].Fear of cancer recurrence (FCR) is one of the most important psychological barriers to fertility planning; patients with high levels of FCR often exhibit lower fertility intention. Conversely, social support has been shown to play a protective and promotive role in this context. Adequate social support can help patients face recurrence risks more positively and reduce anxiety related to FCR[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, few studies have examined the interaction among these three variables. This study therefore examines the interplay between FCR, fertility aspirations, and social support among women of reproductive-aged women with breast cancer, investigating the role of social support within this context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThis study employed G*Power 3.1 software to estimate the required sample size. Assuming a median effect size of 0.25, a significance level (α) of 0.05, and a power (1-β) of 0.95, with a 10% attrition rate factored in, the minimum required sample size was calculated to be 231 subjects.A cross-sectional study design was adopted. From December 2023 to June 2024, 231 women of childbearing age with breast cancer who underwent breast and thyroid surgery in a tertiary hospital in Chongqing, China were recruited by convenient sampling.\u003c/p\u003e\u003cp\u003eThe inclusion criteria were: (1) aged 18 to 40 years, (2) pathologically diagnosed with breast cancer, (3) had undergone breast cancer surgery, and (4) normal cognitive and communication ability to complete the survey.\u003c/p\u003e\u003cp\u003eExclusion criteria included: (1) having other malignant tumors, (2) having severe cardiovascular, cerebrovascular, hepatic or renal diseases, (3) a history of psychiatric illness, and (4) patients with stage IV tumor.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData were collected through face-to-face questionnaires administered by trained healthcare professionals using standardized instructions. Prior to data collection, all participants were informed of the purpose, procedure, and scientific value of the study, and written informed consent was obtained. The survey was anonymous and completed independently by participants, and questionnaires were collected immediately on site.\u003c/p\u003e\u003cp\u003eA total of 254 questionnaires were distributed in this study, with 231 valid responses obtained, yielding a valid response rate of 90.94%. This research was approved by the hospital's ethics committee (approval number: (B)KY2024069).This study was performed in line with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eFour instruments were used in this study: (1) a demographic questionnaire, (2) the Fertility Intention Scale, (3) the Social Support Rating Scale (SSRS), and (4) the Fear of Progression Questionnaire\u0026ndash;Short Form (FoP-Q-SF). The demographic data collection included information about the patients\u0026rsquo; age, education level, marital status, employment status, monthly household income, type of medical insurance, parity, and number of children (8 items in total)\u003c/p\u003e\n\u003ch3\u003eFertility Intention Scale\u003c/h3\u003e\n\u003cp\u003eThe Fertility Intention Scale was developed by Li Chin-Ching and colleagues in 2018[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], this scale consists of 15 items across four dimensions: fertility risk, disease control, social support, and well-being. It uses a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree), with higher scores indicating stronger fertility intention. The scale has demonstrated good internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.88), item-factor correlations (0.69\u0026ndash;0.98), inter-factor correlations (0.21\u0026ndash;0.46), test\u0026ndash;retest reliability (0.61), and construct validity (0.88).\u003c/p\u003e\n\u003ch3\u003eSocial Support Rating Scale (SSRS)\u003c/h3\u003e\n\u003cp\u003eThe SSRS was developed by Shuiyuan Xiao[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the SSRS includes 10 items across three dimensions: subjective support (items 1, 3, 4, 5), objective support (items 2, 6, 7), and utilization of support (items 8\u0026ndash;10). Items are scored on 4-point Likert scales, or as count variables for the number of support sources. Total scores range from 12 to 66, with higher scores indicating stronger social support. The SSRS has demonstrated good reliability and validity in Chinese populations.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eFear of Progression Questionnaire\u0026ndash;Short Form (FoP-Q-SF)\u003c/h2\u003e\u003cp\u003eThe Chinese version of the FoP-Q-SF used in this study was translated and revised by Wu Qiyun et al. in 2015[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It contains 12 items across two dimensions\u0026mdash;physical health and social/family functioning\u0026mdash;rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;never to 5\u0026thinsp;=\u0026thinsp;always), with total scores ranging from 12 to 60. Higher scores indicate more severe fear of cancer recurrence. A total score\u0026thinsp;\u0026ge;\u0026thinsp;34 indicates clinical levels of psychological dysfunction. The scale has good psychometric properties in Chinese breast cancer populations, with Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.815 in this study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were entered and analysed using SPSS 26.0 statistical software; Quantitative data were described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), while qualitative data were presented as case numbers and percentages (%). One-way analysis of variance (ANOVA) was employed to compare differences in fertility intention scores among breast cancer patients of reproductive-aged women across various demographic characteristics. Pearson correlation analysis examined the relationships among cancer recurrence fear, fertility intention, and social support in breast cancer patients.\u003c/p\u003e\u003cp\u003eStructural equation modelling was constructed using AMOS 26 software. The Bootstrap method was employed to validate the mediating effect of social support on the relationship between fear of cancer recurrence and fertility desire among women of childbearing age with breast cancer. The significance level was set at α\u0026thinsp;=\u0026thinsp;0.05. Prior to data analysis, all measurement items underwent Harman's univariate test. Factors with eigenvalues\u0026thinsp;\u0026gt;\u0026thinsp;1 were extracted, with the first factor explaining 31.53% of variance\u0026mdash;below the critical threshold of 40.0%\u0026mdash;indicating no common method bias in the research data.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eComparison of fertility intention scores among participants with different sociodemographic characteristics\u003c/h2\u003e\u003cp\u003eSignificant differences in fertility intention scores were found among patients of different ages, education levels, monthly household income, type of surgery, and number of children (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of fertility intention scores among breast cancer patients in reproductive age with different characteristics (n\u0026thinsp;=\u0026thinsp;231, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFertility intention score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et/F\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.69\u0026thinsp;\u0026plusmn;\u0026thinsp;10.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.825\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school or technical secondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e47.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecollege\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.09\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor's degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.729\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried/divorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.35\u0026thinsp;\u0026plusmn;\u0026thinsp;9.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecountryside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCounty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.16\u0026thinsp;\u0026plusmn;\u0026thinsp;11.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical insurance payment method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCooperative medical insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.09\u0026thinsp;\u0026plusmn;\u0026thinsp;10.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.57\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAt your own expense\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.43\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncumbency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.855\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.173\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot on the job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.56\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eincumbency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold per capita income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1001\u0026ndash;3000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.19\u0026thinsp;\u0026plusmn;\u0026thinsp;9.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3001\u0026ndash;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e40.37\u0026thinsp;\u0026plusmn;\u0026thinsp;7.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5001\u0026ndash;8000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.76\u0026thinsp;\u0026plusmn;\u0026thinsp;9.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8000 above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.24\u0026thinsp;\u0026plusmn;\u0026thinsp;10.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaging of disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.06\u0026thinsp;\u0026plusmn;\u0026thinsp;8.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.37\u0026thinsp;\u0026plusmn;\u0026thinsp;9.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical modality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast conservation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFull cut\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ereconstruction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.97\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.044\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e46.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e42.97\u0026thinsp;\u0026plusmn;\u0026thinsp;9.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e45.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime of diagnosis of disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.701\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e41.62\u0026thinsp;\u0026plusmn;\u0026thinsp;8.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGreater than 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.43\u0026thinsp;\u0026plusmn;\u0026thinsp;12.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eCorrelations among fertility intention, social support, and FCR\u003c/h2\u003e\u003cp\u003ePearson correlation analysis revealed that fertility intention was negatively correlated with fear of cancer recurrence (FCR) (r = \u0026minus;\u0026thinsp;0.610, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and positively correlated with social support (r\u0026thinsp;=\u0026thinsp;0.673, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Social support was also negatively correlated with FCR (r = \u0026minus;\u0026thinsp;0.521, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Correlation analysis of fertility intention, social support, and fear of cancer recurrence in reproductive-aged breast cancer patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation analysis of fertility intention, social support, and FCR in reproductive-aged breast cancer patients (n\u0026thinsp;=\u0026thinsp;231)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIteam\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScore (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFertility risk\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisease control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSocial support sub-item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSense of well-being\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal score of fertility intention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSubjective support\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eObjective support\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eUtilization of support\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal score for social support\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003ePhysiological health\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eSocial family\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eTotal score for fear of disease progression\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFertility risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisease control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e14.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.478**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial support sub-item\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e7.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.407**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.435**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of well-being\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.300**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.231**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.352**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score of fertility intention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e43.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.866**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.734**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.711**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.521**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubjective support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e24.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.404**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.430**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.386**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.325**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.524**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObjective support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.449**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.376**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.347**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.282**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.513**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.302**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUtilization of support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.405**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.401**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.467**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.301**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.535**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.378**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.451**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score for social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e42.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.535**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.526**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.505**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.396**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.673**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.874**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.667**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.685**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysiological health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e17.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.427**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.800**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.445**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.232**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.649**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.406**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.361**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.446**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.518**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e17.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.333**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.345**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.343**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.192**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.422**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.326**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.252**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.338**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.397**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.547**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal score for fear of disease progression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e34.56\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.432**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.653**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.448**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.241**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.610**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.417**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.349**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.446**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.521**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.882**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e.877**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eNote: **. Correlation is significant at the 0.01 level (2-tailed).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eMediating role of social support between FCR and fertility intention\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e lists the goodness-of-fit indices for the initial and modified models.The fit of our structural model showed that the χ2/df ratio of 2.439. Generally, an χ2/df ratio below 3 is considered an indicator of a good fit, suggesting that our model adequately captures the underlying structure of the data. Additionally, the IFI, TLI and CFI all offer further evidence of the model's adequacy. With values of 0.960 for IFI, of 0.959 for CFI, and 0.929 for TLI, the model exceeds the commonly accepted threshold of 0.90 for these indices, indicating a good fit between the hypothesised model and the observed data. These indices are particularly useful as they are less sensitive to sample size and account for model complexity. The root mean square error of approximation (RMSEA) value is 0.079, suggesting a reasonable fit.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFit indices for the developed model\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFitting indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e/df\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTLI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNFI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003estandard\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emodel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.933\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe Bootstrap method (5,000 iterations) was used to test the significance of indirect effects. The 95% confidence intervals for all pathways did not include zero, indicating a significant partial mediating effect of social support in the relationship between FCR and fertility intention. The indirect effect accounted for 27.93% of the total effect .See details in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDirect effect: FCR \u0026rarr; Fertility intention (β = \u0026minus;\u0026thinsp;0.621, P\u0026thinsp;=\u0026thinsp;0.010)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIndirect effect: FCR \u0026rarr; Social support (β = \u0026minus;\u0026thinsp;0.605, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); Social support Fertility intention (β\u0026thinsp;=\u0026thinsp;0.399, P\u0026thinsp;=\u0026thinsp;0.008)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMediated pathway: FCR \u0026rarr; Social support \u0026rarr; Fertility intention (β = \u0026minus;\u0026thinsp;0.241, P\u0026thinsp;=\u0026thinsp;0.009)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTotal effect: β = \u0026minus;\u0026thinsp;0.863\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThese results suggest that social support plays a significant partial mediating role in mitigating the negative impact of fear of recurrence on fertility intention in reproductive-aged breast cancer patients.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMediation analysis of social support between fear of cancer recurrence and fertility intention\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of effect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003epath\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEffect size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFertility intentions\u0026lt;-Fear of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.258\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMediation effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial support\u0026lt;-Fear of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.605\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.867\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFertility intentions\u0026lt;-Social support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFertility intentions\u0026lt;-Social support\u003c/p\u003e\u003cp\u003e\u0026lt;-Fear of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.696\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.063\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal effect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFertility intentions\u0026lt;-Fear of cancer recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.567\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study focuses on anxiety and depression among reproductive-aged women with breast cancer, employing structural equation modelling to examine the relationships among their fertility intentions, social support, and fear of cancer recurrence. Furthermore, the research explores the potential partial mediating role of social support between fear of cancer recurrence and fertility intentions. Results indicate that fertility desire exhibits a negative correlation with fear of cancer recurrence and a positive correlation with social support. Concurrently, social support demonstrates a negative correlation with FCR.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eCurrent status of fertility intention, social support, and FCR among reproductive-aged women with breast cancer\u003c/h2\u003e\u003cp\u003eIn this study, the mean fertility intention score among reproductive-aged women with breast cancer was 43.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38, which is consistent with findings from previous research in similar populations[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Overall, participants demonstrated a moderate to high level of fertility intention during cancer treatment, suggesting that fertility-related concerns remain highly relevant and should not be overlooked in clinical practice.\u003c/p\u003e\u003cp\u003eUnivariate analyses showed that age, educational level, monthly household income, type of surgery, and number of children significantly influenced fertility intention. These findings align with prior studies[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].Specifically, fertility intention tends to decline with increasing age. Women with higher education levels may possess greater awareness of fertility preservation and thus show stronger fertility motivation. Parity is also influential\u0026mdash;patients who already have children are generally less inclined to pursue future pregnancies. Financial constraints further affect decisions, as the perceived cost of raising a child may deter low-income families.\u003c/p\u003e\u003cp\u003eSurgical type also plays a role: patients undergoing total mastectomy are less likely to express fertility intention compared to those receiving breast-conserving or reconstructive procedures. Many women worry that cancer treatment may jeopardize future fertility. A Chinese survey stated that, only 26% of young breast cancer patients reported having received fertility preservation counseling at diagnosis[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. International guidelines\u0026mdash;including those from ASCO\u0026mdash;strongly recommend that oncology teams form multidisciplinary fertility preservation teams comprising breast surgeons, reproductive endocrinologists, oncologists, obstetricians, genetic counselors, and psychologists to ensure timely fertility counseling before treatment initiation[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, the mean social support score was 42.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.96, indicating generally good support levels among participants. Social support, as a key psychosocial resource, plays a dual role in stress adaptation. It can not only buffer negative emotions such as anxiety and depression (emotional regulation) but also promote physical and psychological recovery (health promotion). Studies have consistently shown that greater social support is associated with improved psychological resilience in cancer patients[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe mean FCR score in our sample was 34.56\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33, similar to previous findings[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Unmarried women tended to express concerns about marriage, childbirth, and genetic risks. Married women often feared that recurrence could harm their marital relationship or compromise family stability. Therefore, it is essential to provide psychological support during treatment to reduce anxiety and fear and improve emotional well-being in this population.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eRelationships among fertility intention, social support, and FCR\u003c/h2\u003e\u003cp\u003eThe study confirmed significant negative correlations between fertility intention and FCR and negative correlations between social support and FCR, as well as a significant positive correlation between fertility intention and social support.\u003c/p\u003e\u003cp\u003eThese findings reinforce prior evidence that FCR is a critical psychological barrier to fertility decision-making in breast cancer survivors[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. FCR often manifests as persistent anxiety about recurrence or disease progression, and it can interfere with long-term life planning, including the desire to have children. A qualitative study of 27 breast cancer survivors found that 74% reported thinking about recurrence at least monthly, with some doing so multiple times per week[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. FCR has been shown to trigger avoidance of fertility-related decisions. Internet-based cognitive behavioral therapy (CBT) has proven effective in alleviating FCR-related distress and uncertainty[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], suggesting that such interventions could benefit patients hesitant about childbearing.\u003c/p\u003e\u003cp\u003eSocial support emerged as a protective factor for both FCR and fertility intention. Previous studies have demonstrated its buffering effects on stress and its positive role in improving treatment adherence, emotional resilience, and decision-making confidence[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Young women, in particular, frequently report a strong need for peer support to navigate fertility decisions\u0026mdash;citing the ability to share information, gain emotional empathy, and feel less isolated. Nurses can facilitate this by connecting patients to survivor networks and providing trusted peer resources, thus helping them make informed choices regarding fertility[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA significant negative association between social support and fear of cancer recurrence has been documented in recent research. A systematic review and meta-analysis involving Chinese cancer patients reported a pooled correlation coefficient of r \u0026asymp; \u0026minus;\u0026thinsp;0.35 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) between perceived social support and FCR, supporting our finding of r = \u0026minus;\u0026thinsp;0.521[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, a multicenter Chinese study found that greater social support significantly alleviated FCR in breast cancer survivors, with nursing recommendations emphasizing tailored interventions based on patients' individual support needs[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Social support plays a crucial role in alleviating anxiety related to FCR by providing emotional, informational, and tangible assistance, fostering a sense of belonging and acceptance, and encouraging social interaction and engagement[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Hu et al.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] emphasized that receiving multidimensional social support\u0026mdash;from family members, friends, and healthcare providers\u0026mdash;offers substantial psychosocial benefits for cancer survivors. These include reduced psychological stress, enhanced self-efficacy, and improved treatment adherence, all of which contribute to mitigating FCR. Path analysis further confirmed that higher levels of social support are associated with lower levels of fear of cancer recurrence.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSocial support mediates the relationship between FCR and fertility intention\u003c/h2\u003e\u003cp\u003eAnother significant research discovery pertains to the mediating role of social support between FCR and fertility intention. This suggests that fostering positive social support may assist the reproductive-aged women with breast cancer in avoiding victimization from FCR, thereby increasing their fertility intention.\u003c/p\u003e\u003cp\u003eStructural equation modeling revealed that social support partially mediated the relationship between FCR and fertility intention, accounting for 27.93% of the total effect. This indicates that increased social support may reduce the psychological distress associated with recurrence fears, thereby improving reproductive decision-making.\u003c/p\u003e\u003cp\u003eReproductive-aged breast cancer patients often face multifaceted psychological and social pressures from spouses, family, and society. To strengthen their social support systems, particular emphasis should be placed on the role of partner support. Interventions such as family conferences, couples counseling, and peer support groups can be implemented. In clinical practice, healthcare providers can utilize decision aids to deliver systematic and standardized fertility-related counseling, while adopting multidisciplinary team (MDT) consultations to enhance patients\u0026rsquo; fertility decision-making capacity.Building upon reinforced social support, gynecologists and oncologists should provide comprehensive and thorough fertility preservation options along with professional guidance on long-term family planning as early as possible, thereby alleviating fear of cancer recurrence (FCR). Social support encompasses not only emotional encouragement and reassurance but also extends to informational resources and assistance in navigating complex medical options and content. Therefore, by ensuring adequate social support, patients\u0026rsquo; uncertainty and anxiety during the decision-making process can be significantly reduced, ultimately enhancing their reproductive health knowledge and decision confidence[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates that reproductive-aged women with breast cancer exhibit relatively low levels of fertility intention, and that (FCR) is a key psychological factor negatively affecting fertility decision-making. Social support not only directly enhances fertility intention but also partially mediates the adverse impact of FCR.\u003c/p\u003e\n\u003cp\u003eThese findings highlight the importance of developing targeted interventions that reduce psychological distress and strengthen social support systems. Clinicians and policymakers should consider integrating fertility counseling, mental health support, and social resource mobilization into cancer survivorship care to improve patients\u0026rsquo; reproductive well-being. Given national policies encouraging childbirth, supporting young breast cancer survivors in their fertility decisions is essential not only for individual and family-level health, but also for broader public health objectives.\u003c/p\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eLimitations\u003c/h2\u003e\n \u003cp\u003eThis study has several limitations. First, the sample was drawn from a single tertiary hospital in Chongqing, which may restrict the generalizability of the findings. Future research should recruit participants from diverse geographic regions and healthcare settings, including community-based populations, to enhance external validity. Second, the majority of participants were diagnosed within 1\u0026ndash;3 years prior to the study; therefore, the long-term impact of survivorship duration on fertility intention remains unknown and requires longitudinal exploration. Third, key psychosocial variables such as marital relationship quality and evolving reproductive attitudes were not assessed. These factors may play a significant role in fertility-related decision-making and should be incorporated into future research models for a more comprehensive understanding.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be available upon request to the corresponding author by e-mail.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eYinhuan Wang Qingqiu Chen Junlan Liu Yongju WangDan Li Chaixiu Li Xiaona Yan Shuang Song Yi ZhangGuozhi Zhang and Ying Yang\u003c/p\u003e\n\u003cp\u003eDepartment of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing,400038, China.\u003c/p\u003e\n\u003cp\u003eContributions\u003c/p\u003e\n\u003cp\u003eYinhuan Wang and Ying Yang were responsible for the conception and design, Qingqiu Chen, Yongju Wang,Junlan Liu, Dan Li, and Xiaona Yan contributed to the data collection, Yinhuan Wang, Chaixiu Li, and Shuang Song participated in the data analysis and drafting of the manuscript, Ying Yang and Guozhi Zhang revised the manuscript, and Yi Zhang was responsible for the supervision and support of the study.\u003c/p\u003e\n\u003cp\u003eCorresponding authors\u003c/p\u003e\n\u003cp\u003eCorrespondence to\u003cu\u003e\u0026nbsp;Guozhi Zhang\u003c/u\u003e and \u003cu\u003eYing Yang.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collection for this study has been approved by the Ethics Committee of the First Affiliated Hospital of the Army Medical University. and all participants provided written informed consent. As the dataset is publicly accessible and free of identifiable information, additional ethical approval and informed consent were not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have consented to the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available because they contain protected health information (PHI) of the participants, but are available from the corresponding author on reasonable request with appropriate ethics approvals and data sharing agreements\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki.This study has been approved by the Ethics Committee of the First Affiliated Hospital of the Army Medical University (Approval Number: (B) KY2024069).Written informed consent was obtained from the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Chongqing Medical Research Major Project (2024DBXM001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to express their gratitude to the hospital platform, the departmental team, and all individuals involved in this study for their contributions and support to the research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSiegel RL, Giaquinto AN, Jemal A. 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Clin Nurs Res. 2020;29:411\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eB\u0026aacute;rtolo A, Neves M, Carvalho B, Reis S, Val\u0026eacute;rio E, Santos IM, et al. Fertility under uncertainty: exploring differences in fertility-related concerns and psychosocial aspects between breast cancer survivors and non-cancer infertile women. Breast Cancer. 2020;27:1177\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQiu J, Tang L, Li P, Fu J. An investigation into the reproductive concerns of young women with breast cancer. Asia Pac J Oncol Nurs. 2022;9:100055.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSu HI, Lacchetti C, Letourneau J, Partridge AH, Qamar R, Quinn GP, et al. Fertility Preservation in People With Cancer: ASCO Guideline Update. JCO. 2025;43:1488\u0026ndash;515.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen HL, Schj\u0026oslash;lberg TK, Sm\u0026aring;stuen MC, Utne I. Social support in early-stage breast cancer patients with fatigue. BMC Womens Health. 2020;20:243.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu C, Chen L, Zheng J, Yu X, Gao H, Qiu L, et al. Latent Profiles of Fear of Cancer Recurrence in Breast Cancer Patients of Reproductive Age and Associations With Reproductive Concerns. J Adv Nurs. 2025;81:3013\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTauber NM, O\u0026rsquo;Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, et al. Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis. J Clin Oncol. 2019;37:2899\u0026ndash;915.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoch L, Bertram H, Eberle A, Holleczek B, Schmid-H\u0026ouml;pfner S, Waldmann A, et al. Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship\u0026ndash;a multi-regional population-based study. Psychooncology. 2014;23:547\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDe Vries J, Den Oudsten BL, Jacobs PMEP, Roukema JA. How breast cancer survivors cope with fear of recurrence: a focus group study. Support Care Cancer. 2014;22:705\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZachariae R, Amidi A, Damholdt MF, Clausen CDR, Dahlgaard J, Lord H, et al. Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial. J Natl Cancer Inst. 2018;110:880\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu Z, Sun D, Sun J. Social Support and Fear of Cancer Recurrence Among Chinese Breast Cancer Survivors: The Mediation Role of Illness Uncertainty. 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Relationship between social support and fear of cancer recurrence among Chinese cancer patients: A systematic review and meta-analysis. Front Psychiatry. 2023;14:1136013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZheng W, Hu M, Liu Y. Social support can alleviate the fear of cancer recurrence in postoperative patients with lung carcinoma. Am J Transl Res. 2022;14:4804\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkati-Aliabad H, Ansari-Moghadam A, Mohammadi M, Kargar S, Shahraki-Sanavi F. The prevalence of anxiety and depression and its association with coping strategies, supportive care needs, and social support among women with breast cancer. Support Care Cancer. 2022;30:703\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHu X, Wang W, Wang Y, Liu K. Fear of cancer recurrence in patients with multiple myeloma: Prevalence and predictors based on a family model analysis. Psychooncology. 2021;30:176\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaek SY, Kim H-K, Park S, Yu JH, Lee MH, Youn HJ, et al. Multidisciplinary Shared Decision Making for Fertility Preservation in Young Women With Breast Cancer. J Breast Cancer. 2023;26:582\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Fertility intention, Fear of cancer recurrence, Social support, Reproductive-aged women, Mediation analysis","lastPublishedDoi":"10.21203/rs.3.rs-7944340/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7944340/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo examine the mediating role of social support in the relationship between fear of cancer recurrence (FCR) and fertility intention among reproductive-aged women with breast cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e This study employed a cross-sectional design, utilising convenience sampling to select 231 women of reproductive-aged diagnosed with breast cancer and treated at a tertiary hospital in Chongqing between December 2023 and June 2024 as research subjects.Participants completed a demographic questionnaire, the Fertility Intention Scale, the Social Support Rating Scale, and the Fear of Progression Questionnaire-Short Form (FoP-Q-SF).Pearson correlation analysis was conducted to examine the inter-variable correlations, followed by the construction of a structural equation model using AMOS 26 software, with bootstrap method applied to verify the mediation effects.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFertility intention was negatively correlated with FCR (r = -0.610, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and positively correlated with social support (r\u0026thinsp;=\u0026thinsp;0.673, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Social support was also negatively correlated with FCR (r = -0.521, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Structural equation modeling revealed that social support partially mediated the relationship between FCR and fertility intention, accounting for 27.93% of the total effect.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEnhancing social support may help alleviate FCR and subsequently increase fertility intention among reproductive-aged women with breast cancer.\u003c/p\u003e","manuscriptTitle":"Social Support as a Mediator Between Fear of Cancer Recurrence and Fertility Intention in Young Women With Breast Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 10:56:30","doi":"10.21203/rs.3.rs-7944340/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"88719c0d-7c99-4a24-896e-417fd4ec633a","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-25T21:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 10:56:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7944340","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7944340","identity":"rs-7944340","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}