INTRODUCTION: Fertility-sparing treatment (FST) is vital for young women with endometrial cancer (EC) or atypical endometrial hyperplasia (AEH). While oncologic outcomes are well reported, longitudinal psychological trajectories during FST remain unclear. This study aimed to evaluate changes and determinants of anxiety and depression during FST. METHODS: In this prospective randomized trial, patients aged 18-40 years with G1-2 EC or AEH undergoing FST between 2023 and 2025 were enrolled. Treatment consisted of GnRHa plus aromatase inhibitors or oral progestins. Psychological status was assessed every 12 weeks using the Hospital Anxiety and Depression Scale. Longitudinal trajectories were analyzed using linear mixed-effects models and stratified by time to complete remission (CR: 3, 6, or ≥ 9 months). RESULTS: A total of 187 patients were included, with a median follow-up of 5 months (IQR 3-7). Anxiety scores declined significantly over time in the linear mixed-effects model (-0.162 points per 3 months, P = 0.003), whereas depression remained stable (P > 0.05). From baseline to CR (n = 157), anxiety severity significantly improved (P = 0.002), with 62.5% of patients with mild anxiety returning to normal range; no significant change in depression was observed (P = 0.556). Anxiety reduction was observed in patients achieving CR within 3 or 6 months (both P < 0.05) and not in those requiring ≥9 months (P = 0.733). No clinical or demographic variables were independently associated with psychological outcomes. CONCLUSION: During FST, anxiety decreases progressively while depression remains stable. Anxiety improvement appears to be associated with earlier CR, suggesting a potential time-dependent pattern. Routine psychological screening is warranted, particularly for patients with delayed remission. Longer-term psychological trajectories after CR require further study.
Cao et al. (Fri,) studied this question.