Health-related quality of life in breast cancer survivors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Peixian ,  YE Guolin

Department of Breast Surgery, The First People’s Hospital of Foshan, Foshan, Guangdong 528000, P. R. China;

Corresponding author：

YE Guolin, Email: yglin@fsyyy.com

Keywords：

breast cancer; health-related quality of life; mental health

DOI：

10.7507/1007-9424.202106032

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the possible influential factors and the effectiveness of interventions for quality of life in breast cancer survivors. Method The latest literatures about studies on quality of life in breast cancer survivors were reviewed. Results Although the cure rate and survival rate of patients with breast cancer had improved, breast cancer as a major stress event, the disease itself and treatment related adverse reactions might cause the fatigue, activity decline, anxiety, depression, and other negative emotions of patients, which seriously affected the quality of life of patients and survival prognosis. The patients’ age, socio-economic background, tumor characteristics, and treatment methods were the factors affecting their quality of life. To a certain extent, meditation, music therapy, and proper physical exercise could improve the quality of life of patients with breast cancer. Conclusion Breast cancer itself and related treatment methods may affect not only the affected organs, but also multiple dimensions of patients’ quality of life, so attention should be paid to improve quality of life in breast cancer survivors, providing with individualized interventions.

Citation： CHEN Peixian, YE Guolin. Health-related quality of life in breast cancer survivors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(11): 1510-1515. doi: 10.7507/1007-9424.202106032 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
4.	Park J, Rodriguez JL, O’Brien KM, et al. Health-related quality of life outcomes among breast cancer survivors. Cancer, 2021, 127(7): 1114-1125.
5.	Fernández de Larrea-Baz N, Pérez-Gómez B, Guerrero-Zotano Á, et al. Primary breast cancer and health related quality of life in Spanish women: the EpiGEICAM case-control study. Sci Rep, 2020, 10(1): 7741.
6.	Kang KD, Bae S, Kim HJ, et al. The relationship between physical activity intensity and mental health status in patients with breast cancer. J Korean Med Sci, 2017, 32(8): 1345-1350.
7.	Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol, 2019, 5(12): 1749-1768.
8.	Lim JW. The impact of comorbidity on the relationship between life stress and health-related quality of life for Chinese- and Korean-American breast cancer survivors. Ethn Health, 2018, 23(1): 16-32.
9.	Harrison JM, Davis MA, Barton DL, et al. Functional status and quality of life among breast cancer survivors with heart failure: results of the medicare health outcomes survey. Support Care Cancer, 2017, 25(8): 2463-2473.
10.	Fanakidou I, Zyga S, Alikari V, et al. Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: the role of breast reconstruction. Qual Life Res, 2018, 27(2): 539-543.
11.	Carreira H, Williams R, Müller M, et al. Associations between breast cancer survivorship and adverse mental health outcomes: a systematic review. J Natl Cancer Inst, 2018, 110(12): 1311-1327.
12.	Nardin S, Mora E, Varughese FM, et al. Breast cancer survivorship, quality of life, and late toxicities. Front Oncol, 2020, 10: 864.
13.	Lewis-Smith H, Diedrichs PC, Rumsey N, et al. Efficacy of psychosocial and physical activity-based interventions to improve body image among women treated for breast cancer: a systematic review. Psychooncology, 2018, 27(12): 2687-2699.
14.	Salakari M, Nurminen R, Sillanmäki L, et al. The importance of and satisfaction with sex life among breast cancer survivors in comparison with healthy female controls and women with mental depression or arterial hypertension: results from the finnish nationwide HeSSup cohort study. Support Care Cancer, 2020, 28(8): 3847-3854.
15.	Wang X, Zhang Y, Fan Y, et al. Effects of music intervention on the physical and mental status of patients with breast cancer: a systematic review and meta-analysis. Breast Care (Basel), 2018, 13(3): 183-190.
16.	Fatiregun OA, Olagunju AT, Erinfolami AR, et al. Anxiety disorders in breast cancer: prevalence, types, and determinants. J Psychosoc Oncol, 2016, 34(5): 432-447.
17.	Balcells-Diaz E, Daunis-I-Estadella P. Shoulder strength value differences between genders and age groups. J Shoulder Elbow Surg, 2018, 27(3): 463-469.
18.	Murgia A, Hortobágyi T, Wijnen A, et al. Effects of age and sex on shoulder biomechanics and relative effort during functional tasks. J Biomech, 2018, 81: 132-139.
19.	Mokhatri-Hesari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes, 2020, 18(1): 338.
20.	Tsaras K, Papathanasiou IV, Mitsi D, et al. Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors. Asian Pac J Cancer Prev, 2018, 19(6): 1661-1669.
21.	Lu Q, You J, Kavanagh A, et al. Differences in quality of life between American and Chinese breast cancer survivors. Support Care Cancer, 2016, 24(9): 3775-3782.
22.	Zhou K, Wang W, Li M, et al. Body image mediates the relationship between post-surgery needs and health-related quality of life among women with breast cancer: a cross-sectional study. Health Qual Life Outcomes, 2020, 18(1): 163.
23.	Jagsi R, Abrahamse PH, Lee KL, et al. Treatment decisions and employment of breast cancer patients: results of a population-based survey. Cancer, 2017, 123(24): 4791-4799.
24.	Vidt ME, Potochny J, Dodge D, et al. The influence of mastectomy and reconstruction on residual upper limb function in breast cancer survivors. Breast Cancer Res Treat, 2020, 182(3): 531-541.
25.	Tsai HY, Kuo RN, Chung KP. Quality of life of breast cancer survivors following breast-conserving therapy versus mastectomy: a multicenter study in Taiwan. Jpn J Clin Oncol, 2017, 47(10): 909-918.
26.	Słowik AJ, Jabłoński MJ, Michałowska-Kaczmarczyk AM, et al. Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. Psychiatr Pol, 2017, 51(5): 871-888.
27.	Koehler LA, Hunter DW, Blaes AH, et al. Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: an 18-month follow-up. Phys Ther, 2018, 98(6): 518-527.
28.	王春英, 季玮, 孙晓, 等. 乳腺癌患者前哨淋巴结活检术后生活质量研究. 中国普外基础与临床杂志, 2011, 18(9): 922-925.
29.	Akezaki Y, Nakata E, Kikuuchi M, et al. Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection. Breast Cancer, 2020, 27(2): 284-290.
30.	Sinaei F, Zendehdel K, Adili M, et al. Association between breast reconstruction surgery and quality of life in Iranian breast cancer patients. Acta Med Iran, 2017, 55(1): 35-41.
31.	Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol, 2017, 35(22): 2499-2506.
32.	Adamowicz K, Baczkowska-Waliszewska Z. Quality of life during chemotherapy, hormonotherapy or antiHER2 therapy of patients with advanced, metastatic breast cancer in clinical practice. Health Qual Life Outcomes, 2020, 18(1): 134.
33.	Silvestris E, Dellino M, Cafforio P, et al. Breast cancer: an update on treatment-related infertility. J Cancer Res Clin Oncol, 2020, 146(3): 647-657.
34.	Hormozi M, Hashemi SM, Shahraki S. Investigating relationship between pre- and post- chemotherapy cognitive performance with levels of depression and anxiety in breast cancer patients: a cross-sectional study. Asian Pac J Cancer Prev, 2019, 20(12): 3831-3837.
35.	艾中平, 高晓岚, 李金凤, 等. 乳腺癌手术病人术后化疗期间生存质量的变化趋势及其影响因素. 护理研究, 2016, 30(13): 1566-1571.
36.	Wöckel A, Schwentner L, Krockenberger M, et al. Predictors of the course of quality of life during therapy in women with primary breast cancer. Qual Life Res, 2017, 26(8): 2201-2208.
37.	Eide S, Feng ZP. Doxorubicin chemotherapy-induced “chemo-brain”: meta-analysis. Eur J Pharmacol, 2020, 881: 173078.
38.	邱冬梅, 张梅, 邹沅晔. 新辅助化疗方案对乳腺癌患者不良反应及生活质量的影响. 医学综述, 2016, 22(11): 2212-2215.
39.	Farthmann J, Hanjalic-Beck A, Veit J, et al. The impact of chemotherapy for breast cancer on sexual function and health-related quality of life. Support Care Cancer, 2016, 24(6): 2603-2609.
40.	Custódio ID, Marinho Eda C, Gontijo CA, et al. Impact of chemotherapy on diet and nutritional status of women with breast cancer: a prospective study. PLoS One, 2016, 11(6): e0157113.
41.	Roberts KE, Rickett K, Feng S, et al. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev, 2020, 1(1): CD012988.
42.	Lee B, Jung EA, Yoo JJ, et al. Prevalence, incidence and risk factors of tamoxifen-related non-alcoholic fatty liver disease: a systematic review and meta-analysis. Liver Int, 2020, 40(6): 1344-1355.
43.	Lee JI, Yu JH, Anh SG, et al. Aromatase inhibitors and newly developed nonalcoholic fatty liver disease in postmenopausal patients with early breast cancer: a propensity score-matched cohort study. Oncologist, 2019, 24(8): e653-e661.
44.	Iioka Y, Iwata T, Yamauchi H. Symptoms and QOL in breast cancer patients receiving hormone therapy in Japan. Breast Cancer, 2020, 27(1): 62-69.
45.	Conte P, Schneeweiss A, Loibl S, et al. Patient-reported outcomes from KATHERINE: a phase 3 study of adjuvant trastuzumab emtansine versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer. Cancer, 2020, 126(13): 3132-3139.
46.	El-Sabawi B, Sosin M, Carey JN, et al. Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol, 2015, 112(5): 458-464.
47.	Van der Gucht K, Melis M, Ahmadoun S, et al. A mindfulness-based intervention for breast cancer patients with cognitive impairment after chemotherapy: study protocol of a three-group randomized controlled trial. Trials, 2020, 21(1): 290.
48.	Elimimian E, Elson L, Bilani N, et al. Long-term effect of a nonrandomized psychosocial mindfulness-based intervention in Hispanic/Latina breast cancer survivors. Integr Cancer Ther, 2020, 19: 1534735419890682.
49.	Piet J, Würtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. J Consult Clin Psychol, 2012, 80(6): 1007-1020.
50.	Zhang MF, Wen YS, Liu WY, et al. Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: a meta-analysis. Medicine (Baltimore), 2015, 94(45): e0897-e0900.
51.	Johns SA, Brown LF, Beck-Coon K, et al. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology, 2015, 24(8): 885-893.
52.	Nakamura Y, Lipschitz DL, Kuhn R, et al. Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv, 2013, 7(2): 165-182.
53.	Shin WK, Song S, Jung SY, et al. The association between physical activity and health-related quality of life among breast cancer survivors. Health Qual Life Outcomes, 2017, 15(1): 132.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
4. Park J, Rodriguez JL, O’Brien KM, et al. Health-related quality of life outcomes among breast cancer survivors. Cancer, 2021, 127(7): 1114-1125.
5. Fernández de Larrea-Baz N, Pérez-Gómez B, Guerrero-Zotano Á, et al. Primary breast cancer and health related quality of life in Spanish women: the EpiGEICAM case-control study. Sci Rep, 2020, 10(1): 7741.
6. Kang KD, Bae S, Kim HJ, et al. The relationship between physical activity intensity and mental health status in patients with breast cancer. J Korean Med Sci, 2017, 32(8): 1345-1350.
7. Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study. JAMA Oncol, 2019, 5(12): 1749-1768.
8. Lim JW. The impact of comorbidity on the relationship between life stress and health-related quality of life for Chinese- and Korean-American breast cancer survivors. Ethn Health, 2018, 23(1): 16-32.
9. Harrison JM, Davis MA, Barton DL, et al. Functional status and quality of life among breast cancer survivors with heart failure: results of the medicare health outcomes survey. Support Care Cancer, 2017, 25(8): 2463-2473.
10. Fanakidou I, Zyga S, Alikari V, et al. Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: the role of breast reconstruction. Qual Life Res, 2018, 27(2): 539-543.
11. Carreira H, Williams R, Müller M, et al. Associations between breast cancer survivorship and adverse mental health outcomes: a systematic review. J Natl Cancer Inst, 2018, 110(12): 1311-1327.
12. Nardin S, Mora E, Varughese FM, et al. Breast cancer survivorship, quality of life, and late toxicities. Front Oncol, 2020, 10: 864.
13. Lewis-Smith H, Diedrichs PC, Rumsey N, et al. Efficacy of psychosocial and physical activity-based interventions to improve body image among women treated for breast cancer: a systematic review. Psychooncology, 2018, 27(12): 2687-2699.
14. Salakari M, Nurminen R, Sillanmäki L, et al. The importance of and satisfaction with sex life among breast cancer survivors in comparison with healthy female controls and women with mental depression or arterial hypertension: results from the finnish nationwide HeSSup cohort study. Support Care Cancer, 2020, 28(8): 3847-3854.
15. Wang X, Zhang Y, Fan Y, et al. Effects of music intervention on the physical and mental status of patients with breast cancer: a systematic review and meta-analysis. Breast Care (Basel), 2018, 13(3): 183-190.
16. Fatiregun OA, Olagunju AT, Erinfolami AR, et al. Anxiety disorders in breast cancer: prevalence, types, and determinants. J Psychosoc Oncol, 2016, 34(5): 432-447.
17. Balcells-Diaz E, Daunis-I-Estadella P. Shoulder strength value differences between genders and age groups. J Shoulder Elbow Surg, 2018, 27(3): 463-469.
18. Murgia A, Hortobágyi T, Wijnen A, et al. Effects of age and sex on shoulder biomechanics and relative effort during functional tasks. J Biomech, 2018, 81: 132-139.
19. Mokhatri-Hesari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes, 2020, 18(1): 338.
20. Tsaras K, Papathanasiou IV, Mitsi D, et al. Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors. Asian Pac J Cancer Prev, 2018, 19(6): 1661-1669.
21. Lu Q, You J, Kavanagh A, et al. Differences in quality of life between American and Chinese breast cancer survivors. Support Care Cancer, 2016, 24(9): 3775-3782.
22. Zhou K, Wang W, Li M, et al. Body image mediates the relationship between post-surgery needs and health-related quality of life among women with breast cancer: a cross-sectional study. Health Qual Life Outcomes, 2020, 18(1): 163.
23. Jagsi R, Abrahamse PH, Lee KL, et al. Treatment decisions and employment of breast cancer patients: results of a population-based survey. Cancer, 2017, 123(24): 4791-4799.
24. Vidt ME, Potochny J, Dodge D, et al. The influence of mastectomy and reconstruction on residual upper limb function in breast cancer survivors. Breast Cancer Res Treat, 2020, 182(3): 531-541.
25. Tsai HY, Kuo RN, Chung KP. Quality of life of breast cancer survivors following breast-conserving therapy versus mastectomy: a multicenter study in Taiwan. Jpn J Clin Oncol, 2017, 47(10): 909-918.
26. Słowik AJ, Jabłoński MJ, Michałowska-Kaczmarczyk AM, et al. Evaluation of quality of life in women with breast cancer, with particular emphasis on sexual satisfaction, future perspectives and body image, depending on the method of surgery. Psychiatr Pol, 2017, 51(5): 871-888.
27. Koehler LA, Hunter DW, Blaes AH, et al. Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: an 18-month follow-up. Phys Ther, 2018, 98(6): 518-527.
28. 王春英, 季玮, 孙晓, 等. 乳腺癌患者前哨淋巴结活检术后生活质量研究. 中国普外基础与临床杂志, 2011, 18(9): 922-925.
29. Akezaki Y, Nakata E, Kikuuchi M, et al. Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection. Breast Cancer, 2020, 27(2): 284-290.
30. Sinaei F, Zendehdel K, Adili M, et al. Association between breast reconstruction surgery and quality of life in Iranian breast cancer patients. Acta Med Iran, 2017, 55(1): 35-41.
31. Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. J Clin Oncol, 2017, 35(22): 2499-2506.
32. Adamowicz K, Baczkowska-Waliszewska Z. Quality of life during chemotherapy, hormonotherapy or antiHER2 therapy of patients with advanced, metastatic breast cancer in clinical practice. Health Qual Life Outcomes, 2020, 18(1): 134.
33. Silvestris E, Dellino M, Cafforio P, et al. Breast cancer: an update on treatment-related infertility. J Cancer Res Clin Oncol, 2020, 146(3): 647-657.
34. Hormozi M, Hashemi SM, Shahraki S. Investigating relationship between pre- and post- chemotherapy cognitive performance with levels of depression and anxiety in breast cancer patients: a cross-sectional study. Asian Pac J Cancer Prev, 2019, 20(12): 3831-3837.
35. 艾中平, 高晓岚, 李金凤, 等. 乳腺癌手术病人术后化疗期间生存质量的变化趋势及其影响因素. 护理研究, 2016, 30(13): 1566-1571.
36. Wöckel A, Schwentner L, Krockenberger M, et al. Predictors of the course of quality of life during therapy in women with primary breast cancer. Qual Life Res, 2017, 26(8): 2201-2208.
37. Eide S, Feng ZP. Doxorubicin chemotherapy-induced “chemo-brain”: meta-analysis. Eur J Pharmacol, 2020, 881: 173078.
38. 邱冬梅, 张梅, 邹沅晔. 新辅助化疗方案对乳腺癌患者不良反应及生活质量的影响. 医学综述, 2016, 22(11): 2212-2215.
39. Farthmann J, Hanjalic-Beck A, Veit J, et al. The impact of chemotherapy for breast cancer on sexual function and health-related quality of life. Support Care Cancer, 2016, 24(6): 2603-2609.
40. Custódio ID, Marinho Eda C, Gontijo CA, et al. Impact of chemotherapy on diet and nutritional status of women with breast cancer: a prospective study. PLoS One, 2016, 11(6): e0157113.
41. Roberts KE, Rickett K, Feng S, et al. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev, 2020, 1(1): CD012988.
42. Lee B, Jung EA, Yoo JJ, et al. Prevalence, incidence and risk factors of tamoxifen-related non-alcoholic fatty liver disease: a systematic review and meta-analysis. Liver Int, 2020, 40(6): 1344-1355.
43. Lee JI, Yu JH, Anh SG, et al. Aromatase inhibitors and newly developed nonalcoholic fatty liver disease in postmenopausal patients with early breast cancer: a propensity score-matched cohort study. Oncologist, 2019, 24(8): e653-e661.
44. Iioka Y, Iwata T, Yamauchi H. Symptoms and QOL in breast cancer patients receiving hormone therapy in Japan. Breast Cancer, 2020, 27(1): 62-69.
45. Conte P, Schneeweiss A, Loibl S, et al. Patient-reported outcomes from KATHERINE: a phase 3 study of adjuvant trastuzumab emtansine versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer. Cancer, 2020, 126(13): 3132-3139.
46. El-Sabawi B, Sosin M, Carey JN, et al. Breast reconstruction and adjuvant therapy: a systematic review of surgical outcomes. J Surg Oncol, 2015, 112(5): 458-464.
47. Van der Gucht K, Melis M, Ahmadoun S, et al. A mindfulness-based intervention for breast cancer patients with cognitive impairment after chemotherapy: study protocol of a three-group randomized controlled trial. Trials, 2020, 21(1): 290.
48. Elimimian E, Elson L, Bilani N, et al. Long-term effect of a nonrandomized psychosocial mindfulness-based intervention in Hispanic/Latina breast cancer survivors. Integr Cancer Ther, 2020, 19: 1534735419890682.
49. Piet J, Würtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. J Consult Clin Psychol, 2012, 80(6): 1007-1020.
50. Zhang MF, Wen YS, Liu WY, et al. Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: a meta-analysis. Medicine (Baltimore), 2015, 94(45): e0897-e0900.
51. Johns SA, Brown LF, Beck-Coon K, et al. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology, 2015, 24(8): 885-893.
52. Nakamura Y, Lipschitz DL, Kuhn R, et al. Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv, 2013, 7(2): 165-182.
53. Shin WK, Song S, Jung SY, et al. The association between physical activity and health-related quality of life among breast cancer survivors. Health Qual Life Outcomes, 2017, 15(1): 132.

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Health-related quality of life in breast cancer survivors

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