Social Determinants of Health and Their Impact on Quality of Life in Young Female Breast Cancer Survivors, the Mediating Role of Treatment Regret: A Path Analysis.

Purpose: This study focused on developing and testing a comprehensive model that explores the social determinants of health influencing the quality of life of young breast cancer survivors, particularly highlighting the impact of treatment regret. Methods: This descriptive-analytical study with a cross-sectional design was conducted on 462 young female breast cancer survivors referred to the Yazd Radiation Therapy Center. Data were collected using a demographic questionnaire, the standard decision regret scale, the perceived social support scale, the reproductive concern inventory, and the quality-of-life questionnaire for breast cancer survivors. Then, using path analysis test, the relationship between social determinants of health and quality of life in breast cancer survivors was examined. Data were analyzed by SPSS-26 and LISREL-8 software. Results: According to the results of path analysis, among the structural determinants of health examined, socioeconomic status (β=0.279) had the most positive effect on the quality of life. Also, among the intermediate determinants, treatment regret (β=-0.26) and fertility concerns (β=-0.36) had the most direct and negative effect on the quality of life of breast cancer survivors. The fertility concerns had the most indirect and negative effect on the quality of life of young female survivors with the mediation of treatment regret (β=-0.039). The results also indicated an acceptable goodness of fit for the model. Conclusion: Socioeconomic status had the strongest influence on the quality of life of young breast cancer survivors, partly through social support. Fertility concerns also affected quality of life directly and indirectly via treatment regret. Addressing fertility-related distress should be a key component of supportive care. Although fertility preservation options such as egg or embryo freezing exist in Iran, limited access and awareness highlight the need for early fertility counseling and integrated psychosocial support to improve survivors' well-being. Implications for Cancer Survivors: To improve their quality of life, it is essential to implement strategies such as creating support groups in treatment centers, offering counseling on fertility options, and providing regular follow-up programs for their physical and mental health.