Quality of Life of Women Survived after Breast Cancer Surgery

  • Alyaa F. A. Ibrahim*, Howaida A. H. Fahmy Elsaba
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Alyaa F. A. Ibrahim*, Howaida A. H. Fahmy Elsaba, “Quality of Life of Women Survived after Breast Cancer Surgery”, ijmhs, vol. 10, no. 04, pp. 907–921, Apr. 2020.
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Abstract

Introduction: Quality of life(QOL) is a complicated and multidimensional
measure that affects the diagnosis and impact the treatment of a disease. QOL
continuously impacts the daily lives and activities of patients with breast cancer
during and after recovery. The current study aimed to: identify the
relationship between bio socio-demographic characteristics and quality of life
of women identify the relationship between bio socio-demographic
characteristics and quality of life of women undergone surgery as a treatment
for breast cancer. Methodology: a descriptive cross-sectional design was
adopted. Data was collected by conducting home visits for 120 randomly
elected adult women who had undergone breast surgery as a treatment for
breast cancer. Bio-socio-demographic structured interview schedule, QLQ-C30
and QLQ-C23 were used for data collection. Results: there was significantly
higher frequencies effect of marital status, tumor condition before surgery,
client’s activity and time period between diagnosis & surgery as predictors on
QLQ-C30 (p = <0.01). While; education, family income, family housing and
after surgery treatment had slight significance frequencies effect on QLQ-C30
(p < 0.05). significantly higher frequencies effect of family housing, tumor
condition before surgery, activity level and time period between diagnosis &
surgery as predictors on QLQ-C23 (p = <0.01). While; education, marital status
and after surgery treatment has slight significance frequencies effect on QLQ-
C23 (p < 0.05). But, occupation, breast cancer stage, after surgery medical
problem and family history were not predicted by relation to QLQ-C23 (p >
0.05). Conclusion: The overall quality of life of the study participants was
below average compared to international references. Functional and symptom
scales were affected in women after surgery. There was significantly higher
frequencies effect of demographic factors as marital status, education, family
income, family housing and clinical characteristics as tumor condition before
surgery, breast cancer stage, client’s activity, time period between diagnosis &
surgery and post-surgery treatment as predictors on QLQ-C30 and QLQ-C23.
While, age, occupation, after surgery medical problem and family history were
not predicted by relation to participants’ quality of life. Key words: Breast
cancer, quality of life, therapy impact, breast cancer survivals

KEYWORDS:

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References

1.A. Dujmovi?, D. Mar?inko, K. Buli?, H.Kisi?, M. Dudukovi?, and D. Mijatovi?,“Quality of life and depression amongfemale patients undergoing surgicaltreatment for breast cancer: Aprospective study,” Psychiatr. Danub.,vol. 29, no. 3, pp. 345–350, Sep. 2017,doi: 10.24869/psyd.2017.345. 2.L. N. Shulman, W. Willett, A. Sievers,and F. M. Knaul, “Breast cancer indeveloping countries: Opportunities forimproved survival,” J. Oncol., vol. 2010,2010, doi: 10.1155/2010/595167. 3.R. Chow et al., “Quality of life andsymptom burden in patients with breastcancer treated with mastectomy andlumpectomy,” Support. Care Cancer,vol. 24, no. 5, pp. 2191–2199, May 2016,doi: 10.1007/s00520-015-3027-8. 4.G. I. Gewaifel, M. M. Bahnasy, I.Kharboush, and G. Omneya, “GeospatialAnalysis of Breast Cancer in Alexandria:Application of a Novel Public HealthTool,” Egypt. J. Community Med., vol. 37, no. 2, pp. 27–36, 2019, doi: 10.21608/ejcm.2019.30913. 5.A. S. Ibrahim, H. M. Khaled, N. N.Mikhail, H. Baraka, and H. Kamel,“Cancer incidence in Egypt: Results ofthe national population-based cancerregistry program,” J. Cancer Epidemiol.,vol.2014, 2014, doi: 10.1155/2014/437971. 6.J. Gu, G. Groot, L. Holtslander, and R.Engler-Stringer, “Understandingwomen’s choice of mastectomy versusbreast conserving therapy in early-stagebreast cancer,” Clin. Med. InsightsOncol., vol. 11, p. 117955491769126,Jan.2017, doi: 10.1177/1179554917691266. 7.J. M. Mehta et al., “Breast CancerScreening: Women’s Attitudes andBeliefs in Light of Updated United StatesPreventive Services Task Force andAmerican Cancer Society Guidelines,” J.Women’s Heal., vol. 28, no. 3, pp. 302–313, Mar. 2019, doi: 10.1089/jwh.2017.6885. 8.O. Olufemi, S. Omowumni, O. Ajoke,and A. Olufemi, “Knowledge andAwareness of Breast Cancer andScreening Methods among FemaleUndergraduate Students in a Semi-UrbanCollege Of Culture and Humanities,Nigeria,” Int. J. Caring Sci., vol. 10, no.1, p. 88, 2017. 9.Z. E. Winters et al., “Internationalvalidation of the European Organisationfor Research and Treatment of CancerQLQ-BRECON23 quality-of-lifequestionnaire for women undergoingbreast reconstruction,” Br. J. Surg., vol.105, no. 3, pp. 209–222, Feb. 2018, doi:10.1002/bjs.10656. 10.P. B. Gordon, “Breast cancer screening,”Can. Fam. Physician, vol. 65, no. 7,2019. 11.T. H. Tran, N. L. Trinh, Y. Hoang, T. L. Nguyen, and T. T. Vu, “Health-Related Quality of Life Among Vietnamese Breast Cancer Women,” Cancer Control, vol. 26, no. 1, Jan. 2019, doi: 10.1177/1073274819862787. 12.S. Triberti, L. Savioni, V. Sebri, and G.Pravettoni, “eHealth for improvingquality of life in breast cancer patients: Asystematic review,” Cancer TreatmentReviews, vol. 74. W.B. Saunders Ltd, pp.1–14, 01-Mar-2019, doi:10.1016/j.ctrv.2019.01.003. 13.M. E. Schmidt, S. Scherer, J.Wiskemann, and K. Steindorf, “Return towork after breast cancer: The role oftreatment-related side effects andpotential impact on quality of life,” Eur.J. Cancer Care (Engl)., vol. 28, no. 4, p.e13051, Jul.2019, doi: 10.1111/ecc.13051. 14.D. E. Ediebah et al., “Does change inhealth-related quality of life score predictsurvival? Analysis of EORTC 08975lung cancer trial,” Br. J. Cancer, vol.110, no. 10, pp. 2427–2433, May 2014,doi: 10.1038/bjc.2014.208. 15.A. Sharma, L. G. Walker, and J. R. T.Monson, “Baseline Quality of LifeFactors Predict Long Term Survival afterElective Resection for ColorectalCancer,” Int. J. Surg. Oncol., vol. 2013,2013, doi: 10.1155/2013/269510. 16.N. K. Aaronson et al., “The Europeanorganization for research and treatmentof cancer QLQ-C30: A quality-of-lifeinstrument for use in internationalclinical trials in oncology,” J. Natl.Cancer Inst., vol. 85, no. 5, pp. 365–376,1993, doi: 10.1093/jnci/85.5.365. 17.EORTC, “EORTC QLQ-C30 ScoringManual The EORTC QLQ-C30Introduction,” EORTC QLQ-C30 ScoringMan., vol. 30, pp. 1–67, 2001, doi:D/2001/6136/001. 18.J. Nguyen et al., “EORTC QLQ-BR23and FACT-B for the assessment ofquality of life in patients with breastcancer: A literature review,” Journal ofComparative Effectiveness Research, vol.4, no. 2. Future Medicine Ltd., pp. 157–166, 01-Mar-2015, doi: 10.2217/cer.14.76. 19.H. Michelson, C. Bolund, B. Nilsson, andY. Brandberg, “Health-Related Quality ofLife measured by the EORTC QLQ-C30 -Reference values from a large sample of the Swedish population,” Acta Oncol. (Madr)., vol. 39, no. 4, pp. 477–484, 2000, doi: 10.1080/028418600750013384. 20.Z. Katarzyna, T. A. Beata, N. Wojciech,K. Jan, and J. Joanna, “Validity andreliability of the quality of lifequestionnaire (EORTC QLQ C30) and itsbreast cancer module (EORTC QLQBR23),” Ginekol. Pol., vol. 81, no. 4, pp.262–267, Apr. 2010. 21.D. Pytka and M. Spych, “Women’squality of life after mastectomy,” J.PUBLIC Heal. Nurs. Med. RESCUE, vol.46, no. 2012_4, pp. 42–49, 2012. 22.S. Gokgoz et al., “Health Related Qualityof Life among Breast Cancer Patients: aStudy from Turkey,” Glob. J. Health Sci.,vol. 3, no. 2, p. p140, Sep. 2011, doi:10.5539/gjhs.v3n2p140. 23.A. J. S?owik, M. J. Jab?o?ski, A. M.Micha?owska-Kaczmarczyk, and R. Jach,“Badanie jako?ci zycia kobiet z rakiempiersi, ze szczególnym uwzgl?dnieniemsatysfakcji seksualnej i perspektyw naprzysz?o?? oraz obrazu cia?a w zalezno?ciod zastosowanej metody leczeniaoperacyjnego,” Psychiatr. Pol., vol. 51,no. 5, pp. 871–888, 2017, doi:10.12740/PP/OnlineFirst/63787. 24.A. M. Hassen, G. Taye, M. Gizaw, and F.M. Hussien, “Quality of life andassociated factors among patients withbreast cancer under chemotherapy atTikur Anbessa specialized hospital,Addis Ababa, Ethiopia,” PLoS One, vol.14, no. 9, 2019, doi: 10.1371/journal.pone.0222629. 25.S. Manandhar, D. S. Shrestha, P.Taechaboonsermsk, S. Siri, and J.Suparp, “Quality of life among breastcancer patients undergoing treatment innational cancer centers in Nepal,” AsianPacific J. Cancer Prev., vol. 15, no. 22,pp. 9753–9757,2014, doi: 10.7314/APJCP.2014.15.22.9753. 26.B. H. Rahou, K. El Rhazi, Z. Hanchi, F.Ouasmani, B. Benazzouz, and S. Ahid, “Quality of Life among Moroccan Women Undergoing Treatment of Breast Cancer,” Br. J. Med. Med. Res., May 2017. 27.N. Scott et al., Reference Values Manual,2nd ed. Brussels, Belgium: EORTCQuality of Life Group, 2008. 28.M. Lavdaniti et al., “Factors InfluencingQuality of Life in Breast Cancer PatientsSix Months after the Completion ofChemotherapy,” Diseases, vol. 7, no. 1,p.26,Feb. 2019, doi: 10.3390/diseases7010026. 29.A. Daldoul et al., “Factors predictive ofquality of life among breast cancerpatients,” Asian Pacific J. Cancer Prev.,vol. 19, no. 6, pp. 1671–1675, Jun. 2018,doi: 10.22034/APJCP.2018.19.6.1671. 30.H.-Y. Tsai, R. Nien-Chen Kuo, and K.Chung, “Quality of life of breast cancersurvivors following breast-conservingtherapy versus mastectomy: a multicenterstudy in Taiwan,” JJCO Japanese J.Clin. Oncol. Japanese J. Clin. Oncol.,vol. 47, no. 10, pp. 909–918, 2017, doi:10.1093/jjco/hyx099. 31.W. Chu et al., “Determinants of qualityof life among long-term breast cancersurvivors,” Quality of Life Research, vol.25.Springer, pp. 1981–1990, 2016, doi:10.2307/44852490. 32.B. Yan et al., “Determinants of quality oflife for breast cancer patients inShanghai, China,” PLoS One, vol. 11, no.4, Apr. 2016, doi: 10.1371/journal.pone.0153714. 33.S. Stündag and A. Zencirci, “Factorsaffecting the quality of life of cancerpatients undergoing chemotherapy: Aquestionnaire study,” Asia-Pacific J.Oncol. Nurs., vol. 2, no. 1, p. 17, 2015,doi: 10.4103/2347-5625.152402. 34.I. Yildiz, M. Ozguroglu, T. Toptas, H.Turna, F. Sen, and M. Yildiz, “Patterns ofcomplementary and alternative medicineuse among turkish cancer patients,” J.Palliat. Med., vol. 16, no. 4, pp. 383–390,Apr. 2013, doi: 10.1089/jpm.2012.0226. 35.R. C. Miller et al., “Marital status andquality of life in patients with esophagealcancer or Barrett’s Esophagus: The Mayo Clinic Esophageal Adenocarcinoma and Barrett’s Esophagus registry study,” Dig. Dis. Sci., vol. 55, no. 10, pp. 2860–2868, Oct. 2010, doi: 10.1007/s10620-009-1100-1. 36.R. Ivanauskien?, R. Kregždyt?, and Ž.Padaiga, “Evaluation of health-relatedquality of life in patients with breastcancer,” Medicina (B. Aires)., vol. 46, no.5, p.351,May 2010, doi: 10.3390/medicina46050050. 37.M. Lidgren, N. Wilking, B. Jönsson, andC. Rehnberg, “Health related quality oflife in different states of breast cancer,”Qual. Life Res., vol. 16, no. 6, pp. 1073–1081, Aug. 2007, doi: 10.1007/s11136-007-9202-8. 38.M. Y. Egan, S. McEwen, L. Sikora, M.Chasen, M. Fitch, and S. Eldred,“Rehabilitation following cancertreatment,” Disability and Rehabilitation,vol. 35, no. 26. Taylor & Francis, pp.2245–2258,2013, doi: 10.3109/09638288.2013.774441. 39.S. F. A. Duijts, M. M. Faber, H. S. A.Oldenburg, M. van Beurden, and N. K.Aaronson, “Effectiveness of behavioraltechniques and physical exercise onpsychosocial functioning and health-related quality of life in breast cancerpatients and survivors-a meta-analysis,”Psychooncology., vol. 20, no. 2, pp. 115– 126, Feb. 2011, doi: 10.1002/pon.1728. 40.S. El Fakir et al., “Health-related qualityof life among breast cancer patients andinfluencing factors in Morocco,” AsianPacific J. Cancer Prev., vol. 17, no. 12,pp. 5063–5069,2016, doi: 10.22034/APJCP.2016.17.12.5063. 41.A. F. Leclerc et al., “Exercise andEducation Program After Breast Cancer:Benefits on Quality of Life andSymptoms at 3, 6, 12, and 24 Months’ Follow-up,” Clin. Breast Cancer, vol. 18, no. 5, pp. e1189–e1204, Oct. 2018, doi: 10.1016/j.clbc.2018.05.004. 42.E. M. Mortada, R. A. Salem, O. S.Elseifi, and O. M. Khalil, “ComparingHealth-Related Quality of Life amongBreast Cancer Patients ReceivingDifferent Plans of Treatment, Egypt,” J.Community Health, vol. 43, no. 6, pp.1183–1191, Dec.2018, doi: 10.1007/s10900-018-0538-5. 43.P. Hopwood, J. Haviland, J. Mills, G.Sumo, and J. M Bliss, “The impact of ageand clinical factors on quality of life inearly breast cancer: An analysis of 2208women recruited to the UK START Trial(Standardisation of Breast RadiotherapyTrial),” Breast, vol. 16, no. 3, pp. 241–251, Jun. 2007, doi: 10.1016/j.breast.2006.11.003.

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References

1.A. Dujmovi?, D. Mar?inko, K. Buli?, H.Kisi?, M. Dudukovi?, and D. Mijatovi?,“Quality of life and depression amongfemale patients undergoing surgicaltreatment for breast cancer: Aprospective study,” Psychiatr. Danub.,vol. 29, no. 3, pp. 345–350, Sep. 2017,doi: 10.24869/psyd.2017.345.
2.L. N. Shulman, W. Willett, A. Sievers,and F. M. Knaul, “Breast cancer indeveloping countries: Opportunities forimproved survival,” J. Oncol., vol. 2010,2010, doi: 10.1155/2010/595167.
3.R. Chow et al., “Quality of life andsymptom burden in patients with breastcancer treated with mastectomy andlumpectomy,” Support. Care Cancer,vol. 24, no. 5, pp. 2191–2199, May 2016,doi: 10.1007/s00520-015-3027-8.
4.G. I. Gewaifel, M. M. Bahnasy, I.Kharboush, and G. Omneya, “GeospatialAnalysis of Breast Cancer in Alexandria:Application of a Novel Public HealthTool,” Egypt. J. Community Med., vol. 37, no. 2, pp. 27–36, 2019, doi: 10.21608/ejcm.2019.30913.
5.A. S. Ibrahim, H. M. Khaled, N. N.Mikhail, H. Baraka, and H. Kamel,“Cancer incidence in Egypt: Results ofthe national population-based cancerregistry program,” J. Cancer Epidemiol.,vol.2014, 2014, doi: 10.1155/2014/437971.
6.J. Gu, G. Groot, L. Holtslander, and R.Engler-Stringer, “Understandingwomen’s choice of mastectomy versusbreast conserving therapy in early-stagebreast cancer,” Clin. Med. InsightsOncol., vol. 11, p. 117955491769126,Jan.2017, doi: 10.1177/1179554917691266.
7.J. M. Mehta et al., “Breast CancerScreening: Women’s Attitudes andBeliefs in Light of Updated United StatesPreventive Services Task Force andAmerican Cancer Society Guidelines,” J.Women’s Heal., vol. 28, no. 3, pp. 302–313, Mar. 2019, doi: 10.1089/jwh.2017.6885.
8.O. Olufemi, S. Omowumni, O. Ajoke,and A. Olufemi, “Knowledge andAwareness of Breast Cancer andScreening Methods among FemaleUndergraduate Students in a Semi-UrbanCollege Of Culture and Humanities,Nigeria,” Int. J. Caring Sci., vol. 10, no.1, p. 88, 2017.
9.Z. E. Winters et al., “Internationalvalidation of the European Organisationfor Research and Treatment of CancerQLQ-BRECON23 quality-of-lifequestionnaire for women undergoingbreast reconstruction,” Br. J. Surg., vol.105, no. 3, pp. 209–222, Feb. 2018, doi:10.1002/bjs.10656.
10.P. B. Gordon, “Breast cancer screening,”Can. Fam. Physician, vol. 65, no. 7,2019.
11.T. H. Tran, N. L. Trinh, Y. Hoang, T. L. Nguyen, and T. T. Vu, “Health-Related Quality of Life Among Vietnamese Breast Cancer Women,” Cancer Control, vol. 26, no. 1, Jan. 2019,
doi: 10.1177/1073274819862787.
12.S. Triberti, L. Savioni, V. Sebri, and G.Pravettoni, “eHealth for improvingquality of life in breast cancer patients: Asystematic review,” Cancer TreatmentReviews, vol. 74. W.B. Saunders Ltd, pp.1–14, 01-Mar-2019, doi:10.1016/j.ctrv.2019.01.003.
13.M. E. Schmidt, S. Scherer, J.Wiskemann, and K. Steindorf, “Return towork after breast cancer: The role oftreatment-related side effects andpotential impact on quality of life,” Eur.J. Cancer Care (Engl)., vol. 28, no. 4, p.e13051, Jul.2019, doi: 10.1111/ecc.13051.
14.D. E. Ediebah et al., “Does change inhealth-related quality of life score predictsurvival? Analysis of EORTC 08975lung cancer trial,” Br. J. Cancer, vol.110, no. 10, pp. 2427–2433, May 2014,doi: 10.1038/bjc.2014.208.
15.A. Sharma, L. G. Walker, and J. R. T.Monson, “Baseline Quality of LifeFactors Predict Long Term Survival afterElective Resection for ColorectalCancer,” Int. J. Surg. Oncol., vol. 2013,2013, doi: 10.1155/2013/269510.
16.N. K. Aaronson et al., “The Europeanorganization for research and treatmentof cancer QLQ-C30: A quality-of-lifeinstrument for use in internationalclinical trials in oncology,” J. Natl.Cancer Inst., vol. 85, no. 5, pp. 365–376,1993, doi: 10.1093/jnci/85.5.365.
17.EORTC, “EORTC QLQ-C30 ScoringManual The EORTC QLQ-C30Introduction,” EORTC QLQ-C30 ScoringMan., vol. 30, pp. 1–67, 2001, doi:D/2001/6136/001.
18.J. Nguyen et al., “EORTC QLQ-BR23and FACT-B for the assessment ofquality of life in patients with breastcancer: A literature review,” Journal ofComparative Effectiveness Research, vol.4, no. 2. Future Medicine Ltd., pp. 157–166, 01-Mar-2015, doi: 10.2217/cer.14.76.
19.H. Michelson, C. Bolund, B. Nilsson, andY. Brandberg, “Health-Related Quality ofLife measured by the EORTC QLQ-C30 -Reference values from a large sample of the Swedish population,” Acta Oncol. (Madr)., vol. 39, no. 4, pp. 477–484, 2000, doi: 10.1080/028418600750013384.
20.Z. Katarzyna, T. A. Beata, N. Wojciech,K. Jan, and J. Joanna, “Validity andreliability of the quality of lifequestionnaire (EORTC QLQ C30) and itsbreast cancer module (EORTC QLQBR23),” Ginekol. Pol., vol. 81, no. 4, pp.262–267, Apr. 2010.
21.D. Pytka and M. Spych, “Women’squality of life after mastectomy,” J.PUBLIC Heal. Nurs. Med. RESCUE, vol.46, no. 2012_4, pp. 42–49, 2012.
22.S. Gokgoz et al., “Health Related Qualityof Life among Breast Cancer Patients: aStudy from Turkey,” Glob. J. Health Sci.,vol. 3, no. 2, p. p140, Sep. 2011, doi:10.5539/gjhs.v3n2p140.
23.A. J. S?owik, M. J. Jab?o?ski, A. M.Micha?owska-Kaczmarczyk, and R. Jach,“Badanie jako?ci zycia kobiet z rakiempiersi, ze szczególnym uwzgl?dnieniemsatysfakcji seksualnej i perspektyw naprzysz?o?? oraz obrazu cia?a w zalezno?ciod zastosowanej metody leczeniaoperacyjnego,” Psychiatr. Pol., vol. 51,no. 5, pp. 871–888, 2017, doi:10.12740/PP/OnlineFirst/63787.
24.A. M. Hassen, G. Taye, M. Gizaw, and F.M. Hussien, “Quality of life andassociated factors among patients withbreast cancer under chemotherapy atTikur Anbessa specialized hospital,Addis Ababa, Ethiopia,” PLoS One, vol.14, no. 9, 2019, doi: 10.1371/journal.pone.0222629.
25.S. Manandhar, D. S. Shrestha, P.Taechaboonsermsk, S. Siri, and J.Suparp, “Quality of life among breastcancer patients undergoing treatment innational cancer centers in Nepal,” AsianPacific J. Cancer Prev., vol. 15, no. 22,pp. 9753–9757,2014, doi: 10.7314/APJCP.2014.15.22.9753.
26.B. H. Rahou, K. El Rhazi, Z. Hanchi, F.Ouasmani, B. Benazzouz, and S. Ahid,
“Quality of Life among Moroccan Women Undergoing Treatment of Breast Cancer,” Br. J. Med. Med. Res., May 2017.
27.N. Scott et al., Reference Values Manual,2nd ed. Brussels, Belgium: EORTCQuality of Life Group, 2008.
28.M. Lavdaniti et al., “Factors InfluencingQuality of Life in Breast Cancer PatientsSix Months after the Completion ofChemotherapy,” Diseases, vol. 7, no. 1,p.26,Feb. 2019, doi: 10.3390/diseases7010026.
29.A. Daldoul et al., “Factors predictive ofquality of life among breast cancerpatients,” Asian Pacific J. Cancer Prev.,vol. 19, no. 6, pp. 1671–1675, Jun. 2018,doi: 10.22034/APJCP.2018.19.6.1671.
30.H.-Y. Tsai, R. Nien-Chen Kuo, and K.Chung, “Quality of life of breast cancersurvivors following breast-conservingtherapy versus mastectomy: a multicenterstudy in Taiwan,” JJCO Japanese J.Clin. Oncol. Japanese J. Clin. Oncol.,vol. 47, no. 10, pp. 909–918, 2017, doi:10.1093/jjco/hyx099.
31.W. Chu et al., “Determinants of qualityof life among long-term breast cancersurvivors,” Quality of Life Research, vol.25.Springer, pp. 1981–1990, 2016, doi:10.2307/44852490.
32.B. Yan et al., “Determinants of quality oflife for breast cancer patients inShanghai, China,” PLoS One, vol. 11, no.4, Apr. 2016, doi: 10.1371/journal.pone.0153714.
33.S. Stündag and A. Zencirci, “Factorsaffecting the quality of life of cancerpatients undergoing chemotherapy: Aquestionnaire study,” Asia-Pacific J.Oncol. Nurs., vol. 2, no. 1, p. 17, 2015,doi: 10.4103/2347-5625.152402.
34.I. Yildiz, M. Ozguroglu, T. Toptas, H.Turna, F. Sen, and M. Yildiz, “Patterns ofcomplementary and alternative medicineuse among turkish cancer patients,” J.Palliat. Med., vol. 16, no. 4, pp. 383–390,Apr. 2013, doi: 10.1089/jpm.2012.0226.
35.R. C. Miller et al., “Marital status andquality of life in patients with esophagealcancer or Barrett’s Esophagus: The Mayo Clinic Esophageal Adenocarcinoma and Barrett’s Esophagus registry study,” Dig. Dis. Sci., vol. 55, no. 10, pp. 2860–2868, Oct. 2010, doi: 10.1007/s10620-009-1100-1.
36.R. Ivanauskien?, R. Kregždyt?, and Ž.Padaiga, “Evaluation of health-relatedquality of life in patients with breastcancer,” Medicina (B. Aires)., vol. 46, no.5, p.351,May 2010, doi: 10.3390/medicina46050050.
37.M. Lidgren, N. Wilking, B. Jönsson, andC. Rehnberg, “Health related quality oflife in different states of breast cancer,”Qual. Life Res., vol. 16, no. 6, pp. 1073–1081, Aug. 2007, doi: 10.1007/s11136-007-9202-8.
38.M. Y. Egan, S. McEwen, L. Sikora, M.Chasen, M. Fitch, and S. Eldred,“Rehabilitation following cancertreatment,” Disability and Rehabilitation,vol. 35, no. 26. Taylor & Francis, pp.2245–2258,2013, doi: 10.3109/09638288.2013.774441.
39.S. F. A. Duijts, M. M. Faber, H. S. A.Oldenburg, M. van Beurden, and N. K.Aaronson, “Effectiveness of behavioraltechniques and physical exercise onpsychosocial functioning and health-related quality of life in breast cancerpatients and survivors-a meta-analysis,”Psychooncology., vol. 20, no. 2, pp. 115–
126, Feb. 2011, doi: 10.1002/pon.1728.
40.S. El Fakir et al., “Health-related qualityof life among breast cancer patients andinfluencing factors in Morocco,” AsianPacific J. Cancer Prev., vol. 17, no. 12,pp. 5063–5069,2016, doi: 10.22034/APJCP.2016.17.12.5063.
41.A. F. Leclerc et al., “Exercise andEducation Program After Breast Cancer:Benefits on Quality of Life andSymptoms at 3, 6, 12, and 24 Months’ Follow-up,” Clin. Breast Cancer, vol. 18, no. 5, pp. e1189–e1204, Oct. 2018, doi: 10.1016/j.clbc.2018.05.004.
42.E. M. Mortada, R. A. Salem, O. S.Elseifi, and O. M. Khalil, “ComparingHealth-Related Quality of Life amongBreast Cancer Patients ReceivingDifferent Plans of Treatment, Egypt,” J.Community Health, vol. 43, no. 6, pp.1183–1191, Dec.2018, doi: 10.1007/s10900-018-0538-5.
43.P. Hopwood, J. Haviland, J. Mills, G.Sumo, and J. M Bliss, “The impact of ageand clinical factors on quality of life inearly breast cancer: An analysis of 2208women recruited to the UK START Trial(Standardisation of Breast RadiotherapyTrial),” Breast, vol. 16, no. 3, pp. 241–251, Jun. 2007, doi: 10.1016/j.breast.2006.11.003.

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