Factors and pathways influencing fertility anxiety in reproductive-age male cancer patients: a stress process theory perspective

Graphical Abstract Abstract Background Fertility concerns among cancer patients of reproductive age are widespread and persist for 5–10 years from diagnosis through treatment, with effects that often surpass those associated with the cancer itself. Unlike female patients who exhibit stronger self-disclosure tendencies, male cancer patients tend to internalize emotions when confronting fertility issues, resisting open discussion or expression of their feelings. Consequently, they experience higher levels of uncertainty and anxiety regarding their fertility status. Objective To examine the effects and pathways of various variables on fertility concerns among male cancer patients of reproductive age based on the stress process theory. Methods A multicenter study in Shanxi Province randomly recruited 365 male cancer patients of reproductive age, who completed six questionnaires. Results Univariate analysis revealed that higher age groups, higher education level, urogenital system cancer, later clinical stage, childlessness, lower economic income, and fertility desire (59.38, 39.599, 8.407, 8.304, 4.877, 9.968, 5.780, P < 0.001) were all associated with increased levels of fertility anxiety. Pearson correlation analysis revealed that high quality of life, medical social support, coping strategies, and high self-efficacy (P < 0.01) alleviated fertility anxiety, while avoidance and surrender coping strategies increased it. The structural equation model, under the assumed causal order, showed that both medical social support and coping styles exhibited significant indirect effects across all path relationships, constituting partial mediation. Conclusion The stress process theory reveals diverse influencing variables and pathways for fertility anxiety among male cancer patients of reproductive age. Clinical practice should adopt multidimensional interventions to alleviate anxiety related to fertility issues, enhancing treatment outcomes and achieving therapeutic goals. Lay summary Cancer can leave young men worried about whether they can ever become fathers. We asked 365 male patients in Shanxi what shaped these worries. Older, less-educated men with advanced or certain cancer types felt more fear, while those who already had children, earned more money, or still wanted children felt calmer. Good social support, better coping skills, and strong self-belief lowered fear, whereas avoidance or giving up made it worse. Doctors should offer emotional, social, and practical help to ease these concerns.