# Cognitive Behavioral Therapy for Reproductive Concerns and Psychological Status in Reproductive‐aged Breast Cancer Survivors: A Pretest‐Posttest Intervention Study

## TL;DR

A six-week cognitive behavioral therapy program significantly reduced fertility concerns and improved mental health in young breast cancer survivors.

## Contribution

This study demonstrates the effectiveness of CBT in addressing fertility-related distress and psychological symptoms in premenopausal breast cancer survivors.

## Key findings

- CBT significantly reduced scores on five of six fertility concern subscales.
- Participants showed significant decreases in depression, anxiety, and stress symptoms.
- Improvements were observed in concerns about fertility potential, partner disclosure, and personal health.

## Abstract

Reproductive‐aged breast cancer (BC) survivors face significant distress related to fertility concerns and psychological health, yet interventions specifically targeting these issues are lacking.

This study aimed to evaluate the effectiveness of a cognitive‐behavioral therapy (CBT) intervention on fertility concerns and psychological status in this population.

A quasi‐experimental pretest‐posttest study.

This study was conducted with 30 premenopausal BC survivors who desired future pregnancy. Participants were recruited via convenience sampling from a hospital and a clinic in Sari, Northern Iran. They underwent a six‐week, group‐based, face‐to‐face CBT program delivered by a reproductive health specialist. Fertility concerns were measured using the reproductive concerns after cancer (RCAC) scale, and psychological status was assessed with the depression, anxiety, and stress Scales (DASS‐21) at baseline and immediately post‐intervention. Data were analyzed using paired t‐tests and the Bonferroni correction using in SPSS 24.

The CBT intervention resulted in statistically significant reductions in scores across five of the six RCAC subscales: concerns about fertility potential, partner disclosure, child's health, personal health, and becoming pregnant (p < 0.001). Concerns regarding acceptance of possible infertility did not show a significant change (p = 0.628). Furthermore, participants demonstrated significant decreases in symptoms of depression (p < 0.001), anxiety (p < 0.001), and stress (p = 0.031) on the DASS‐21.

A structured CBT intervention is an effective short‐term strategy for alleviating specific fertility‐related concerns and improving the psychological well‐being of premenopausal BC survivors. The findings support the integration of psychological support, particularly CBT, into survivorship care programs to address the complex reproductive and mental health challenges faced by this group. Further research with a control group and long‐term follow‐up is recommended to confirm these findings.

This pretest‐posttest intervention study evaluated a structured, six‐week CBT program for premenopausal BC survivors desiring pregnancy. The intervention led to significant, large‐magnitude improvements, effectively reducing distress across five key areas of fertility concern including fertility potential, partner disclosure, and pregnancy—and significantly alleviating symptoms of depression, anxiety, and stress. The findings provide strong preliminary evidence that targeted CBT is a potent short‐term strategy to enhance psychological well‐being and address the complex reproductive challenges faced by this population, advocating for its integration into standard survivorship care.