Breast cancer remains one of the most prevalent malignancies affecting women globally, including India. Radiation therapy, an essential component of breast cancer treatment, is associated with a range of side effects, such as skin irritation, fatigue, dysphagia, and emotional distress, which can significantly impair patients’ Quality of Life (QoL). Often, patients lack sufficient knowledge about managing these side effects at home, which underlines the importance of educational support. Nurse-led interventions have shown promise in bridging this knowledge gap and empowering patients to take an active role in their care. This study aimed to (1) evaluate the quality of life among breast cancer patients undergoing radiation therapy, (2) assess their knowledge regarding home care management of radiation-related side effects before and after an educational intervention, and (3) determine the effectiveness of a nurse-led intervention. A quantitative, pre-experimental one-group pre-test and post-test design was used, involving 60 breast cancer patients receiving radiation therapy at the Regional Cancer Center, Rohtak. Tools included WHOQOL-BREF and a self-structured knowledge questionnaire. A nurse-led pamphlet-based educational intervention was provided post-pretest, with post-test conducted on day seven. Results showed improved QoL scores across all domains and a statistically significant increase in knowledge scores from pre-test (6.4 ± 3.26) to post-test (12.75 ± 2.63). The paired t-test value of 10.38 (p < 0.05) confirmed the intervention’s effectiveness. Nurse-led educational interventions significantly enhance patient knowledge, supporting better home management of radiation therapy side effects and potentially improving quality of life.

Keywords: Breast cancer, radiation therapy, nurse-led intervention, quality of life, patient education

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1. Mahvi DA, Liu R, Grinstaff MW, Colson YL, Raut CP. Local cancer recurrence: The realities, challenges, and opportunities for new therapies. CA Cancer J Clin. 2018 Nov;68(6):488–505.
2. Narod SA. Personalised medicine and population health: Breast and ovarian cancer. Hum Genet. 2018 Oct;137(10):769–78.
3. Srivastava S, Kumar A. Breast cancer survivorship among Indian women: An overview. Asian J Nurs Educ Res. 2022 Jul;12(3):262–6.
4. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May–Jun;74(3):229–63. doi: 10.3322/caac.21834.
5. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209–49. doi: 10.3322/caac.21660.
6. India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: The Global Burden of Disease Study 1990–2016. Lancet Oncol. 2018 Oct;19(10):1289–306. doi: 10.1016/S1470-2045(18)30447–9.
7. Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol. 2017 Aug;13(4):289–95.
8. Krigel S, Myers J, Befort C, Krebill H, Klemp J. ‘Cancer changes everything!’ Exploring the lived experiences of women with metastatic breast cancer. Int J Palliat Nurs. 2014;20(7):334–42.
9. Ng HS, Vitry A, Koczwara B, Roder D, McBride ML. Patterns of comorbidities in women with breast cancer: A Canadian population-based study. Cancer Causes Control. 2019;30(9):931–41.
10. Montazeri A. Health-related quality of life in breast cancer patients: A bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008 Aug 29;27(1):32. doi: 10.1186/1756–9966-27–32.
11. Azharuddin SK, Kumar P, S N, Chauhan AK, Kumar P, Nigam J, et al. Comparison of dosimetric parameters and clinical outcomes in inversely planned intensity-modulated radiotherapy (IMRT) and field-in-field forward planned IMRT for the treatment of breast cancer. Cureus. 2022 Jul 9;14(7):e26692. doi: 10.7759/cureus.26692.
12. Cavalcante LG, Domingues RA, Oliveira BD, Fernandes MA, Pessoa EC, Abbade LP. Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: A cohort study. An Bras Dermatol. 2024 Jan 22;99(1):57–65.
13. Holli K, Pitkänen M, Järvenpää R, Rajala J, Lahtela S, Hyödynmaa S, et al. Early skin and lung reactions in breast cancer patients after radiotherapy: Prospective study. Radiother Oncol. 2002 Aug 1;64(2):163–9.
14. Roldan B. Breast cancer is rising in young people: 4 possible reasons why. org. Available from: https://www.breastcancer.org/news/why-are-young-people-getting-breast-cancer.
15. Young AM, Charalambous A, Owen RI, Njodzeka B, Oldenmenger WH, Alqudimat MR, et al. Essential oncology nursing care along the cancer continuum. Lancet Oncol. 2020 Dec 1;21(12):e555–63.
16. Poirier P. Nursing-led management of side effects of radiation: Evidence-based recommendations for practice. Nurs Res Rev. 2013;3:47–57. doi: 10.2147/NRR.S34112.
17. Montazeri A, et al. Quality of life in breast cancer patients: A literature review. BMC Cancer. 2001;1:70. doi: 10.1186/1471-2407-1-70.
18. Gaston CM, Mitchell G. Information giving and decision-making in patients with advanced cancer: A systematic review. Soc Sci Med. 2005;61(10):2252–64. doi: 10.1016/j.socscimed.2005.04.015.
19. DiMatteo MR, et al. Patient adherence and medical treatment outcomes: A meta-analysis. Med Care. 2002;40(9):794–811. doi: 10.1097/01.MLR.0000024612.61993.2D.
20. Given B, et al. Reducing the economic burden of cancer care: Patient navigation and coordination. Semin Oncol Nurs. 2014;30(2):85–8. doi: 10.1016/j.soncn.2014.02.002.
21. Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100–3. doi: 10.1370/afm.1239.
22. Howell D, et al. Pan-Canadian practice guideline: Screening, assessment, and care of psychosocial distress (depression, anxiety) in adults with cancer. Canadian Partnership Against Cancer; 2015. Available from: https://cdn.wildapricot.com/268234/resources/Documents/36APAN~1.PDF.
23. Guleser GN, Tasci S, Kalplan B. The experience of symptoms and informational needs of cancer patients undergoing radiotherapy. J Cancer Educ. 2012 Mar;27(1):46–53.
24. Kearney N, Richardson A. Nursing Patients with Cancer: Principles and Practice. 1st ed. United Kingdom: Elsevier; 2006. p. 277.
25. Rutten LJ, Arora NK, Bakos AD, Aziz N, Rowland J. Information needs and sources of information among cancer patients: A systematic review of research. Patient Educ Couns. 2005 Jun;57(3):250–61.
26. Dunn J, Steginga SK, Rose P, Scott J, Allison R. Evaluating patient education materials about radiation therapy. Patient Educ Couns. 2004 Mar;52(3):325–32. doi: 10.1016/S0738-3991(03)00108-3.
27. Boers-Doets CB, Wiseman T, Radia B, Hammond R. Early recognition and management of side effects related to systemic anticancer therapy for advanced breast cancer. Semin Oncol Nurs. 2024 Jan 3;40(1):151553.
28. Narayanan G, Awadallah MS, Krishnasamy R. Breast cancer-related physical, psychological, social, and spiritual domains of quality of life among women in Bahrain. F1000Research. 2023 Feb 16;12:184.
29. da Silva JG, Costa DT, Cavalcanti ID, Nogueira MC, Oliveira DA. Quality of life in women with breast cancer treated at a radiotherapy centre in Caruaru, Pernambuco, Brazil. Can Oncol Nurs J. 2022;32(2):162–8.
30. Sivakumar VP, Susila C. Effectiveness of self-care measures on knowledge, self-efficacy and performance status among cancer patients. J Caring Sci. 2021 Mar 1;10(1):1–8. doi: 10.34172/jcs.2021.003.
31. Murkute U, Nausheen SN. A study to assess effect of information booklet on knowledge regarding side effect management in the patients of head and neck cancer undergoing external radiation therapy in selected hospital. Int J Health Sci Res. 2021 Jul;11(7):281–9. doi: 10.52403/ijhsr.20210738.
32. VanderWalde NA, Martin MY, Kocak M, Morningstar C, Deal AM, Nyrop KA, et al. Randomized phase II study of a home-based walking intervention for radiation-related fatigue among older patients with breast cancer. J Geriatr Oncol. 2021 Mar 1;12(2):227–34.
33. Haussmann J, Corradini S, Nestle-Kraemling C, Bölke E, Njanang FJD, Tamaskovics B, et al. Recent advances in radiotherapy of breast cancer. Radiat Oncol. 2020 Mar 30;15(1):71. doi: 10.1186/s13014-020-01501-x.
34. Stueber TN, Diessner J, Bartmann C, Leinert E, Janni W, Herr D, et al. Effect of adjuvant radiotherapy in elderly patients with breast cancer. PLoS One. 2020 May 20;15(5):e0229518.
35. Coughlin SS, Caplan LS, Williams V. Home-based physical activity interventions for breast cancer patients receiving primary therapy: A systematic review. Breast Cancer Res Treat. 2019 Dec;178(3):513–22. doi: 10.1007/s10549-019-05424-4.
36. Nageeti TH, Elzahrany HR, Gabra AO, Obaid AA, Jastania RA. Quality of life assessment of breast cancer patients in Saudi Arabia. J Fam Community Med. 2019 May 1;26(2):98–102.
37. Champ CE, Ohri N, Klement RJ, Cantor M, Beriwal S, Glaser SM, et al. Assessing changes in the activity levels of breast cancer patients during radiation therapy. Clin Breast Cancer. 2018 Feb 1;18(1):e1–6.
38. Andersen ER, Eilertsen G, Myklebust AM, Eriksen S. Women’s experience of acute skin toxicity following radiation therapy in breast cancer. J Multidiscip Healthc. 2018 Feb 23;11:139–48. doi: 10.2147/JMDH.S155538.
39. Gangane N, Khairkar P, Hurtig AK, San Sebastián M. Quality of life determinants in breast cancer patients in central rural India. Asian Pac J Cancer Prev. 2017;18(12):3325–31.
40. Jensen KE, Soril LJ, Stelfox HT, Clement FM, Lin Y, Marshall DA. Side effects associated with the use of intensity-modulated radiation therapy in breast cancer patients undergoing adjuvant radiation therapy: A systematic review and meta-analysis. J Med Imaging Radiat Sci. 2017 Dec 1;48(4):402–13.
41. Xiao C, Miller AH, Felger J, Mister D, Liu T, Torres MA. A prospective study of quality of life in breast cancer patients undergoing radiation therapy. Adv Radiat Oncol. 2016 Jan 1;1(1):10–6.
42. Van Dijck S, Nelissen P, Verbelen H, Tjalma W, Gebruers N. The effects of physical self-management on quality of life in breast cancer patients: A systematic review. Breast. 2016 Aug;28:20–8. doi: 10.1016/j.breast.2016.04.010.
43. Kluthcovsky AC, Urbanetz AA. Fatigue and quality of life in breast cancer survivors: A comparative study. Rev Bras Ginecol Obstet. 2015 Mar;37(3):119–26. doi: 10.1590/SO100-720320150005247.
44. Maguire R, Ream E, Richardson A, Connaghan J, Johnston B, Kotronoulas G, et al. Development of a novel remote patient monitoring system: the advanced symptom management system for radiotherapy to improve the symptom experience of patients with lung cancer receiving radiotherapy. Cancer Nurs. 2015 Mar 1;38(2):E37–47.
45. Steindorf K, Schmidt ME, Klassen O, Ulrich CM, Oelmann J, Habermann N, et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: Results on cancer-related fatigue and quality of life. Ann Oncol. 2014 Nov 1;25(11):2237–43.
46. Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014 Nov 1;2014(50):346–58.
47. Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, et al. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: A prospective cohort study. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):565–71.
48. Jassim GA, Whitford DL. Quality of life of Bahraini women with breast cancer: A cross-sectional study. BMC Cancer. 2013 Apr 28;13:212. doi: 10.1186/1471-2407-13-212.
49. Chen X, Li X, Wang Z, Zheng R, Zhang F, Zhao J, et al. Evidence-based summary of the prevention and management of radiation dermatitis in patients with breast cancer. Asia Pac J Oncol Nurs. 2024 Jul 14;11(9):100556. doi: 10.1016/j.apjon.2024.100556.
50. Wani SQ, Khan T, Teeli AM, Khan NA, Wani SY, Ashfaq-ul-Hassan. Quality of life assessment in survivors of breast cancer. J Cancer Res Ther. 2012 Apr–Jun;8(2):272–6. doi: 10.4103/0973-1482.98986.
51. Ko HK, Park GJ. Effects of self-efficacy promotion program on self-efficacy, self-care behavior, and quality of life in breast cancer patients receiving radiotherapy. J Korean Oncol Nurs. 2011 Aug 1;11(2):136–46.
52. Revelian S. Teaching and learning strategies in inclusive public primary schools in Tanzania. Asian J Educ Soc Stud. 2022 Dec 29;37(4):89–103.
53. Shukla S. Variables, hypotheses and stages of research. In: Interdisciplinary Conference on Social Science Research: Capacity Building Programme for Social Science Faculty Members; 2018 May; New Delhi, India.
54. Lee H, Lim Y, Yoo MS, Kim Y. Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: An exploratory study. Cancer Nurs. 2011 Nov 1;34(6):E22–30.
55. Aramide K. Is mixed-method really a research design? Synthesis for discourse. AIMS Accra Bespoke Conf Proc. 2023; doi: 10.22624/AIMS/ACCRABESPOKE2023P23.
56. Momoh O. Population definition in statistics and how to measure it. Investopedia; 2022. Available from: https://www.investopedia.com/terms/p/population.asp.
57. Casteel A, Bridier D. Describing populations and samples in doctoral student research. Int J Dr Stud. 2021 Jan 1;16:339–62. Available from: http://ijds.org/Volume16/IJDSv16p339-362Casteel7067.pdf.
58. Singh AS, Masuku MB. Sampling techniques and determination of sample size in applied statistics research: An overview. Int J Econ Commer Manag. 2014 Nov;2(11):1–22.
59. Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm. 2008 Dec 1;65(23):2276–84.

Breast cancer remains one of the most prevalent malignancies affecting women globally, including India. Radiation therapy, an essential component of breast cancer treatment, is associated with a range of side effects, such as skin irritation, fatigue, dysphagia, and emotional distress, which can significantly impair patients’ Quality of Life (QoL). Often, patients lack sufficient knowledge about managing these side effects at home, which underlines the importance of educational support. Nurse-led interventions have shown promise in bridging this knowledge gap and empowering patients to take an active role in their care. This study aimed to (1) evaluate the quality of life among breast cancer patients undergoing radiation therapy, (2) assess their knowledge regarding home care management of radiation-related side effects before and after an educational intervention, and (3) determine the effectiveness of a nurse-led intervention. A quantitative, pre-experimental one-group pre-test and post-test design was used, involving 60 breast cancer patients receiving radiation therapy at the Regional Cancer Center, Rohtak. Tools included WHOQOL-BREF and a self-structured knowledge questionnaire. A nurse-led pamphlet-based educational intervention was provided post-pretest, with post-test conducted on day seven. Results showed improved QoL scores across all domains and a statistically significant increase in knowledge scores from pre-test (6.4 ± 3.26) to post-test (12.75 ± 2.63). The paired t-test value of 10.38 (p < 0.05) confirmed the intervention’s effectiveness. Nurse-led educational interventions significantly enhance patient knowledge, supporting better home management of radiation therapy side effects and potentially improving quality of life.

Keywords: Breast cancer, radiation therapy, nurse-led intervention, quality of life, patient education

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. Mahvi DA, Liu R, Grinstaff MW, Colson YL, Raut CP. Local cancer recurrence: The realities, challenges, and opportunities for new therapies. CA Cancer J Clin. 2018 Nov;68(6):488–505.
2. Narod SA. Personalised medicine and population health: Breast and ovarian cancer. Hum Genet. 2018 Oct;137(10):769–78.
3. Srivastava S, Kumar A. Breast cancer survivorship among Indian women: An overview. Asian J Nurs Educ Res. 2022 Jul;12(3):262–6.
4. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May–Jun;74(3):229–63. doi: 10.3322/caac.21834.
5. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May;71(3):209–49. doi: 10.3322/caac.21660.
6. India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: The Global Burden of Disease Study 1990–2016. Lancet Oncol. 2018 Oct;19(10):1289–306. doi: 10.1016/S1470-2045(18)30447–9.
7. Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol. 2017 Aug;13(4):289–95.
8. Krigel S, Myers J, Befort C, Krebill H, Klemp J. ‘Cancer changes everything!’ Exploring the lived experiences of women with metastatic breast cancer. Int J Palliat Nurs. 2014;20(7):334–42.
9. Ng HS, Vitry A, Koczwara B, Roder D, McBride ML. Patterns of comorbidities in women with breast cancer: A Canadian population-based study. Cancer Causes Control. 2019;30(9):931–41.
10. Montazeri A. Health-related quality of life in breast cancer patients: A bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008 Aug 29;27(1):32. doi: 10.1186/1756–9966-27–32.
11. Azharuddin SK, Kumar P, S N, Chauhan AK, Kumar P, Nigam J, et al. Comparison of dosimetric parameters and clinical outcomes in inversely planned intensity-modulated radiotherapy (IMRT) and field-in-field forward planned IMRT for the treatment of breast cancer. Cureus. 2022 Jul 9;14(7):e26692. doi: 10.7759/cureus.26692.
12. Cavalcante LG, Domingues RA, Oliveira BD, Fernandes MA, Pessoa EC, Abbade LP. Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: A cohort study. An Bras Dermatol. 2024 Jan 22;99(1):57–65.
13. Holli K, Pitkänen M, Järvenpää R, Rajala J, Lahtela S, Hyödynmaa S, et al. Early skin and lung reactions in breast cancer patients after radiotherapy: Prospective study. Radiother Oncol. 2002 Aug 1;64(2):163–9.
14. Roldan B. Breast cancer is rising in young people: 4 possible reasons why. org. Available from: https://www.breastcancer.org/news/why-are-young-people-getting-breast-cancer.
15. Young AM, Charalambous A, Owen RI, Njodzeka B, Oldenmenger WH, Alqudimat MR, et al. Essential oncology nursing care along the cancer continuum. Lancet Oncol. 2020 Dec 1;21(12):e555–63.
16. Poirier P. Nursing-led management of side effects of radiation: Evidence-based recommendations for practice. Nurs Res Rev. 2013;3:47–57. doi: 10.2147/NRR.S34112.
17. Montazeri A, et al. Quality of life in breast cancer patients: A literature review. BMC Cancer. 2001;1:70. doi: 10.1186/1471-2407-1-70.
18. Gaston CM, Mitchell G. Information giving and decision-making in patients with advanced cancer: A systematic review. Soc Sci Med. 2005;61(10):2252–64. doi: 10.1016/j.socscimed.2005.04.015.
19. DiMatteo MR, et al. Patient adherence and medical treatment outcomes: A meta-analysis. Med Care. 2002;40(9):794–811. doi: 10.1097/01.MLR.0000024612.61993.2D.
20. Given B, et al. Reducing the economic burden of cancer care: Patient navigation and coordination. Semin Oncol Nurs. 2014;30(2):85–8. doi: 10.1016/j.soncn.2014.02.002.
21. Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100–3. doi: 10.1370/afm.1239.
22. Howell D, et al. Pan-Canadian practice guideline: Screening, assessment, and care of psychosocial distress (depression, anxiety) in adults with cancer. Canadian Partnership Against Cancer; 2015. Available from: https://cdn.wildapricot.com/268234/resources/Documents/36APAN~1.PDF.
23. Guleser GN, Tasci S, Kalplan B. The experience of symptoms and informational needs of cancer patients undergoing radiotherapy. J Cancer Educ. 2012 Mar;27(1):46–53.
24. Kearney N, Richardson A. Nursing Patients with Cancer: Principles and Practice. 1st ed. United Kingdom: Elsevier; 2006. p. 277.
25. Rutten LJ, Arora NK, Bakos AD, Aziz N, Rowland J. Information needs and sources of information among cancer patients: A systematic review of research. Patient Educ Couns. 2005 Jun;57(3):250–61.
26. Dunn J, Steginga SK, Rose P, Scott J, Allison R. Evaluating patient education materials about radiation therapy. Patient Educ Couns. 2004 Mar;52(3):325–32. doi: 10.1016/S0738-3991(03)00108-3.
27. Boers-Doets CB, Wiseman T, Radia B, Hammond R. Early recognition and management of side effects related to systemic anticancer therapy for advanced breast cancer. Semin Oncol Nurs. 2024 Jan 3;40(1):151553.
28. Narayanan G, Awadallah MS, Krishnasamy R. Breast cancer-related physical, psychological, social, and spiritual domains of quality of life among women in Bahrain. F1000Research. 2023 Feb 16;12:184.
29. da Silva JG, Costa DT, Cavalcanti ID, Nogueira MC, Oliveira DA. Quality of life in women with breast cancer treated at a radiotherapy centre in Caruaru, Pernambuco, Brazil. Can Oncol Nurs J. 2022;32(2):162–8.
30. Sivakumar VP, Susila C. Effectiveness of self-care measures on knowledge, self-efficacy and performance status among cancer patients. J Caring Sci. 2021 Mar 1;10(1):1–8. doi: 10.34172/jcs.2021.003.
31. Murkute U, Nausheen SN. A study to assess effect of information booklet on knowledge regarding side effect management in the patients of head and neck cancer undergoing external radiation therapy in selected hospital. Int J Health Sci Res. 2021 Jul;11(7):281–9. doi: 10.52403/ijhsr.20210738.
32. VanderWalde NA, Martin MY, Kocak M, Morningstar C, Deal AM, Nyrop KA, et al. Randomized phase II study of a home-based walking intervention for radiation-related fatigue among older patients with breast cancer. J Geriatr Oncol. 2021 Mar 1;12(2):227–34.
33. Haussmann J, Corradini S, Nestle-Kraemling C, Bölke E, Njanang FJD, Tamaskovics B, et al. Recent advances in radiotherapy of breast cancer. Radiat Oncol. 2020 Mar 30;15(1):71. doi: 10.1186/s13014-020-01501-x.
34. Stueber TN, Diessner J, Bartmann C, Leinert E, Janni W, Herr D, et al. Effect of adjuvant radiotherapy in elderly patients with breast cancer. PLoS One. 2020 May 20;15(5):e0229518.
35. Coughlin SS, Caplan LS, Williams V. Home-based physical activity interventions for breast cancer patients receiving primary therapy: A systematic review. Breast Cancer Res Treat. 2019 Dec;178(3):513–22. doi: 10.1007/s10549-019-05424-4.
36. Nageeti TH, Elzahrany HR, Gabra AO, Obaid AA, Jastania RA. Quality of life assessment of breast cancer patients in Saudi Arabia. J Fam Community Med. 2019 May 1;26(2):98–102.
37. Champ CE, Ohri N, Klement RJ, Cantor M, Beriwal S, Glaser SM, et al. Assessing changes in the activity levels of breast cancer patients during radiation therapy. Clin Breast Cancer. 2018 Feb 1;18(1):e1–6.
38. Andersen ER, Eilertsen G, Myklebust AM, Eriksen S. Women’s experience of acute skin toxicity following radiation therapy in breast cancer. J Multidiscip Healthc. 2018 Feb 23;11:139–48. doi: 10.2147/JMDH.S155538.
39. Gangane N, Khairkar P, Hurtig AK, San Sebastián M. Quality of life determinants in breast cancer patients in central rural India. Asian Pac J Cancer Prev. 2017;18(12):3325–31.
40. Jensen KE, Soril LJ, Stelfox HT, Clement FM, Lin Y, Marshall DA. Side effects associated with the use of intensity-modulated radiation therapy in breast cancer patients undergoing adjuvant radiation therapy: A systematic review and meta-analysis. J Med Imaging Radiat Sci. 2017 Dec 1;48(4):402–13.
41. Xiao C, Miller AH, Felger J, Mister D, Liu T, Torres MA. A prospective study of quality of life in breast cancer patients undergoing radiation therapy. Adv Radiat Oncol. 2016 Jan 1;1(1):10–6.
42. Van Dijck S, Nelissen P, Verbelen H, Tjalma W, Gebruers N. The effects of physical self-management on quality of life in breast cancer patients: A systematic review. Breast. 2016 Aug;28:20–8. doi: 10.1016/j.breast.2016.04.010.
43. Kluthcovsky AC, Urbanetz AA. Fatigue and quality of life in breast cancer survivors: A comparative study. Rev Bras Ginecol Obstet. 2015 Mar;37(3):119–26. doi: 10.1590/SO100-720320150005247.
44. Maguire R, Ream E, Richardson A, Connaghan J, Johnston B, Kotronoulas G, et al. Development of a novel remote patient monitoring system: the advanced symptom management system for radiotherapy to improve the symptom experience of patients with lung cancer receiving radiotherapy. Cancer Nurs. 2015 Mar 1;38(2):E37–47.
45. Steindorf K, Schmidt ME, Klassen O, Ulrich CM, Oelmann J, Habermann N, et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: Results on cancer-related fatigue and quality of life. Ann Oncol. 2014 Nov 1;25(11):2237–43.
46. Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014 Nov 1;2014(50):346–58.
47. Warren LE, Miller CL, Horick N, Skolny MN, Jammallo LS, Sadek BT, et al. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: A prospective cohort study. Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):565–71.
48. Jassim GA, Whitford DL. Quality of life of Bahraini women with breast cancer: A cross-sectional study. BMC Cancer. 2013 Apr 28;13:212. doi: 10.1186/1471-2407-13-212.
49. Chen X, Li X, Wang Z, Zheng R, Zhang F, Zhao J, et al. Evidence-based summary of the prevention and management of radiation dermatitis in patients with breast cancer. Asia Pac J Oncol Nurs. 2024 Jul 14;11(9):100556. doi: 10.1016/j.apjon.2024.100556.
50. Wani SQ, Khan T, Teeli AM, Khan NA, Wani SY, Ashfaq-ul-Hassan. Quality of life assessment in survivors of breast cancer. J Cancer Res Ther. 2012 Apr–Jun;8(2):272–6. doi: 10.4103/0973-1482.98986.
51. Ko HK, Park GJ. Effects of self-efficacy promotion program on self-efficacy, self-care behavior, and quality of life in breast cancer patients receiving radiotherapy. J Korean Oncol Nurs. 2011 Aug 1;11(2):136–46.
52. Revelian S. Teaching and learning strategies in inclusive public primary schools in Tanzania. Asian J Educ Soc Stud. 2022 Dec 29;37(4):89–103.
53. Shukla S. Variables, hypotheses and stages of research. In: Interdisciplinary Conference on Social Science Research: Capacity Building Programme for Social Science Faculty Members; 2018 May; New Delhi, India.
54. Lee H, Lim Y, Yoo MS, Kim Y. Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: An exploratory study. Cancer Nurs. 2011 Nov 1;34(6):E22–30.
55. Aramide K. Is mixed-method really a research design? Synthesis for discourse. AIMS Accra Bespoke Conf Proc. 2023; doi: 10.22624/AIMS/ACCRABESPOKE2023P23.
56. Momoh O. Population definition in statistics and how to measure it. Investopedia; 2022. Available from: https://www.investopedia.com/terms/p/population.asp.
57. Casteel A, Bridier D. Describing populations and samples in doctoral student research. Int J Dr Stud. 2021 Jan 1;16:339–62. Available from: http://ijds.org/Volume16/IJDSv16p339-362Casteel7067.pdf.
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