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Dixit N, Sarkar U, Trejo E, Couey P, Rivadeneira NA, Ciccarelli B, Burke N. Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study. Cancer Control 2021; 28:10732748211038734. [PMID: 34657452 PMCID: PMC8521758 DOI: 10.1177/10732748211038734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The current number of breast cancer survivors (BCS) in the United States is approximately 3.8 million, and this number is further expected to increase with improvement in treatments. Survivorship care plans (SCPs) are patient-centered tools that are designed to meet cancer survivors' informational needs about their treatment history, recommended health care, and health maintenance. However, the data on SCP benefits remain uncertain, especially in low-income and racial and ethnic minority cancer survivors. Patient navigation is an effective intervention to improve patient adherence and experience of interdisciplinary breast cancer treatment. Objectives This study sought to understand the role of lay patient navigators (LPN) in survivorship care planning for BCS in safety-net settings. Methods This study is a mixed methods pilot randomized clinical trial to understand the role of patient navigation in cancer survivorship care planning in a public hospital. We invited BCS who had completed active breast cancer treatment within 5 years. LPNs discussed survivorship care planning and survivorship care-related issues with BCS in the intervention arm over a 6-month intervention period and accompanied patients to their primary care appointment. LPNs also encouraged survivors to discuss health care issues with oncology and primary care providers. The primary objective was to assess BCS’ health-related quality of life (HRQOL). The secondary objectives were self-efficacy and implementation. We assessed implementation with 45–60-min semi-structured interviews with 15 BCS recruited from the intervention arm and 60-min focus groups with the oncologists and separately with LPNs. Results We enrolled 40 patients, 20 randomized to usual care and 20 randomized to LPN navigation. We did not find a statistically significant difference between the two arms in HRQOL. There was also no difference in self-efficacy between the two arms. Qualitative analysis identified implementation barriers to intervention that may have contributed to less effective intervention. Implications for Cancer Survivors Future survivorship care planning interventions need to consider: Cancer survivors’ needs and preferences, the need for dedicated resources, and the role of electronic health records in survivorship care plan delivery.
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Affiliation(s)
- Niharika Dixit
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Evelin Trejo
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul Couey
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Natalie A Rivadeneira
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Center for Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Barbara Ciccarelli
- Cancer Navigation Program, San Francisco Department of Public Health, San Francisco, California, USA
| | - Nancy Burke
- School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, California, USA
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Alberts NM, Leisenring WM, Flynn JS, Whitton J, Gibson TM, Jibb L, McDonald A, Ford J, Moraveji N, Dear BF, Krull KR, Robison LL, Stinson JN, Armstrong GT. Wearable Respiratory Monitoring and Feedback for Chronic Pain in Adult Survivors of Childhood Cancer: A Feasibility Randomized Controlled Trial From the Childhood Cancer Survivor Study. JCO Clin Cancer Inform 2021; 4:1014-1026. [PMID: 33147073 DOI: 10.1200/cci.20.00070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Approximately 40% of childhood cancer survivors experience chronic pain, with many also reporting pain-related disability. Given associations established in the general population among respiration, anxiety, and pain, continuous tracking and feedback of respiration may help survivors manage pain. METHODS A feasibility, nonblinded, randomized controlled trial (RCT) comparing wearable respiratory monitoring with a control group examined feasibility, acceptability, and preliminary efficacy among survivors of childhood cancer with chronic pain who were ≥ 18 years of age, able to speak and read English, lived in the United States, and had access to a smartphone and the Internet. The primary outcomes were pain interference, pain severity, anxiety, negative affect, and perceived stress. The intervention group (n = 32) received a wearable respiratory monitor, used the device, and completed an in-application breathing exercise daily for 30 days. The control group (n = 33) received psychoeducation after completion of the study. RESULTS Almost all participants in the intervention group (n = 31 of 32) and control group (n = 32 of 33) completed the study. Of those who completed the intervention, 90.3% wore the device for ≥ 50% of the trial. Posttreatment improvement for negative affect (Cohen d = 0.59; 95% CI, 0.09 to 1.10) was significantly greater in the intervention group compared with the control group. A follow-up study (n = 24) examined acceptability and feasibility of a second-generation device among those who completed the RCT. Most survivors (81.0%) wore the device daily during the trial and 85.7% reported satisfaction with the device and the application. CONCLUSION The results of this pilot study support the acceptability and feasibility of wearable respiratory monitoring among survivors of childhood cancer. Larger randomized trials are needed to assess efficacy and maintenance of this intervention for chronic pain.
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Affiliation(s)
- Nicole M Alberts
- St Jude Children's Research Hospital, Memphis, TN.,Concordia University, Montréal, Quebec, Canada
| | | | | | | | | | - Lindsay Jibb
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - James Ford
- St Jude Children's Research Hospital, Memphis, TN
| | | | - Blake F Dear
- Macquarie University, Sydney, New South Wales, Australia
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Ashing KT, Yeung S, Lai L, Young L, Wong AG. A preliminary prospective study of health-related quality of life among Chinese-American breast cancer survivors. Support Care Cancer 2021; 29:6021-6030. [PMID: 33783625 DOI: 10.1007/s00520-021-06181-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study examined the predictors of health-related quality of life (HRQOL) and changes in HRQOL over a 1-year period among Chinese-American breast cancer survivors (BCS). METHODS A two-wave longitudinal research design included participants from hospital-based cancer registries and community organizations in Los Angeles. Participants completed mailed questionnaires at baseline and 12-month follow-up. HRQOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G v.4). Change in HRQOL was assessed using a 7-point meaningful change score. RESULTS Participants were 73 Chinese-American BCS, a majority of whom were middle-aged (M = 54.6, SD = 9.2), lower income (63% < 45K), and diagnosed with stage I-II (83%) breast cancer. Regression analyses showed that multilevel contextual factors including general health perception, quality of care, life stress, and improvement in general health perception significantly predicted HRQOL at baseline and follow-up. The final model explained 72% of the variance of HRQOL. The examination of meaningful change indicated that improvement was reported by 32% (n = 22) and deterioration by 25% (n = 17); the majority indicated minimal change (43%, n = 30). Improvement was associated with increases in family communication, social support, and general health perception, while deterioration was associated with declines in social support, family communication, and general health perception. CONCLUSION Findings indicate that among Chinese-American BCS, HRQOL is influenced by socioecological factors such as family communication and life stress. Results suggest that cancer survivorship outcomes research may benefit from theoretical foundations that examine the broader contextual dimensions that seem to impact and predict HRQOL. Implications for research are discussed.
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Affiliation(s)
- Kimlin Tam Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Beckman Research Institute, 1500 E Duarte Road, Duarte, CA, 91010-3000, USA.
| | - Sophia Yeung
- Lung Cancer Screening and Prevention Program, City of Hope National Medical Center, Duarte, CA, USA
| | - Lily Lai
- Lung Cancer Screening and Prevention Program, City of Hope National Medical Center, Duarte, CA, USA
| | - Lucy Young
- Herald Cancer Association, Chinese Christian Herald Crusades, San Gabriel, CA, USA
| | - Alison G Wong
- Fuller Theological Seminary, School of Psychology & Marriage and Family Therapy, Pasadena, CA, USA
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Dirkse D, Hadjistavropoulos HD, Alberts NA, Karin E, Schneider LH, Titov N, Dear BF. Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy. J Cancer Surviv 2020; 14:211-225. [PMID: 31853727 DOI: 10.1007/s11764-019-00810-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the effectiveness and acceptability of two low-intensity methods of offering a transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) intervention for treating symptoms of anxiety and depression among cancer survivors. METHODS Cancer survivors with symptoms of anxiety or depression (n = 86) were randomly assigned to receive a transdiagnostic ICBT programme (Wellbeing After Cancer) that was either guided by a technician (n = 42) or self-guided (n = 44). Measures of anxiety, depression, fear of cancer recurrence, and quality of life were completed at pre-treatment, post-treatment, and 4 weeks following treatment completion. RESULTS Large within-group effect sizes were observed on measures of depression, anxiety, and mental health-related quality of life (d range, 0.98-1.86) at post-treatment. Medium effects were found for reductions in fear of cancer recurrence (d range, 0.65-0.78). Non-inferiority was established for the primary outcome measures of anxiety and depression. All participants reported high satisfaction ratings of the programme; however, technician-guided participants were slightly more satisfied with their level of support (d = 0.57, p = .014). CONCLUSIONS The Wellbeing After Cancer Course was associated with improved levels of anxiety, depression, fear of cancer recurrence, and quality of life, regardless of how ICBT was offered. IMPLICATIONS FOR CANCER SURVIVORS ICBT is emerging as an accessible and effective treatment for depression, anxiety, and fear of cancer recurrence in cancer survivors. The success of non-therapist-guided options increases the potential scalability of ICBT, which is particularly valuable for cancer survivors from rural areas who have less access to mental health services.
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Affiliation(s)
- D Dirkse
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, PZ 350 - 771 Bannatyne Avenue, Winnipeg, MB, R3E 3N4, Canada.
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - H D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N A Alberts
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - L H Schneider
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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Zhou K, Li M, Wang W, An J, Huo L, He X, Li J, Zhuang G, Li X. Reliability, validity, and sensitivity of the Chinese Short-Form 36 Health Survey version 2 (SF-36v2) in women with breast cancer. J Eval Clin Pract 2019; 25:864-872. [PMID: 30548365 DOI: 10.1111/jep.13088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The psychometrics of the Short-Form 36 Health Survey version 2 (SF-36v2) in female breast cancer patients remains unknown. This study aimed to test the reliability, validity, and sensitivity of the Chinese SF-36v2 in women with breast cancer. METHODS The sample included 326 eligible participants. The reliability and the item convergent and discriminant validity were estimated using Cronbach α (≥0.70) and the multi-trait multi-item matrix analysis, respectively. The structural validity was tested using confirmatory factor analysis. Sensitivity was determined via an analysis of variance and the relative efficiency for initially diagnosed cases (yes vs no) as well as the time since diagnosis (years) before and after stratifying by initially diagnosed cases. RESULTS The overall Cronbach α was 0.91 (eight scales range: 0.72-0.92). All hypothesized item-scale correlations were greater than the alternatives (r ≥ 0.40). With acceptable model fit indices, the physical functioning, role-physical, bodily pain, and general health subscales had stronger contributions to the physical component summary (goodness-of-fit index [GFI]: 0.92, parsimony goodness-of-fit index [PGFI]: 0.60, comparative fit index [CFI]: 0.91, Tucker-Lewis index [TLI]: 0.93, adjusted goodness-of-fit index [AGFI]: 0.91, root mean square error of approximation [RMSEA]: 0.06, normed chi-squared [NC]: 2.65), while the vitality, social functioning, role-emotional, and mental health subscales contributed more to the mental component summary (GFI: 0.91, PGFI: 0.62, CFI: 0.91, TLI: 0.92, AGFI: 0.91, RMSEA: 0.07, NC: 2.76). The relative efficiencies with significant F-statistics were found for mental health (relative efficiency: 34.28; initially diagnosed cases), physical functioning (12.88; time since diagnosis), and physical functioning (5.80), role-physical (5.15), bodily pain (7.70), social functioning (4.62), role-emotional (4.72), mental health (4.75), and physical component summary (6.96; initially diagnosed cases with time since diagnosis; P < 0.05 for all variables). CONCLUSIONS Chinese SF-36v2 has acceptable psychometric properties and is suitable for women with breast cancer.
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Affiliation(s)
- Kaina Zhou
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Minjie Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Wen Wang
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jinghua An
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lanting Huo
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Xiaole He
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Guihua Zhuang
- School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University Health Science Centre, Xi'an, China
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The impact of communication style on patient satisfaction. Breast Cancer Res Treat 2019; 176:349-356. [DOI: 10.1007/s10549-019-05232-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
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Bhandari NR, Kathe N, Hayes C, Payakachat N. Reliability and validity of SF-12v2 among adults with self-reported cancer. Res Social Adm Pharm 2018; 14:1080-1084. [PMID: 29366669 DOI: 10.1016/j.sapharm.2018.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The SF-12v2 has been validated in general population and other conditions but the evidence is limited in Americans with cancer. OBJECTIVE To assess reliability and validity of SF-12v2 among adults with self-reported cancer using the Medical Expenditure Panel Survey (MEPS). METHODS Self-reported cancer participants (SCPs) were identified from 2003 MEPS. SF-12v2 was administered as part of self-administered questionnaires. Physical (PCS12) and mental (MCS12) component scores of SF-12v2 were evaluated for reliability (internal consistency, test-retest) and validity (convergent, discriminant, predictive, concurrent). RESULTS 420 SCPs were identified with average age of 59.3 years (SE = 0.9). 10.7% had multiple cancers (>1) and 52% had at least one other chronic condition (OCC). Average PCS12 and MCS12 were 45.09 (SE = 0.5) and 50.75 (SE = 0.5). PCS12 and MCS12 demonstrated high internal consistency (αPCS12 = 0.89; αMCS12 = 0.88), acceptable test-retest reliability (ICCPCS12 = 0.82; ICCMCS12 = 0.73), strongly correlated with most of the expected EQ-5D domains (r = 0.51-0.71), and demonstrated strong convergent validity on perceived health (r = 0.61) and perceived mental health (r = 0.52). PCS12 and MCS12 were able to discriminate between groups with and without physical/cognitive limitations. Only PCS12 was negatively correlated with number of OCCs. CONCLUSION The SF-12v2 is a reliable and valid instrument to quantify health-related quality of life among adults with self-reported cancer.
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Affiliation(s)
- Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Niranjan Kathe
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey Hayes
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Pan Y, Jones PS, Pothier P. The Relationship Between Mutuality and Health-Related Quality of Life in Adult Child Caregivers in China. JOURNAL OF FAMILY NURSING 2017; 23:366-391. [PMID: 28795855 DOI: 10.1177/1074840717718540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The strain inherent in caregiving relationships between adult children and aging parents is a prominent issue in contemporary China due to a combination of demographic and socioeconomic changes. The purpose of this study was to explore how mutuality, a positive quality of caregiving relationships, contributes to the physical health and mental health (health-related quality of life [HRQoL]) of adult child caregivers [ACCs] of parent stroke survivors. A cross-sectional correlational study was conducted on a nonproportional quota sample of 126 ACCs, using questionnaires of demographics, the 15-item Mutuality Scale, and the Second Version of the Standard 12-Item Health Survey (SF-12v2). Higher mutuality was found to be correlated with better caregiver physical health and mental health. However, after adjusting for the covariates, mutuality significantly explained 4.6% of the variance of caregiver physical health (β = .22, ΔR2 = .046, p < .01) but it did not significantly explain the variance of caregiver mental health. Although multiple factors correlate with Chinese family caregivers' HRQoL, this was the first study exploring the impact of caregiver-care receiver dyadic relationships on caregiver HRQoL in mainland China by using a mutuality scale with SF-12v2. Despite the fact that the Chinese tradition of filial piety can facilitate mutuality, socioeconomic changes and legislation that require adult children to care for aging parents appear to create high stress among family caregivers. Higher levels of mutuality contribute to better physical health in Chinese family caregivers. Therefore, culturally appropriate family nursing strategies and social policies in China could enhance caregiver mutuality and potentially promote their HRQoL, in particular physical health.
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Affiliation(s)
- Yuqin Pan
- 1 Jinhua Polytechnic, Zhejiang Province, China
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Treanor C, Donnelly M. A methodological review of the Short Form Health Survey 36 (SF-36) and its derivatives among breast cancer survivors. Qual Life Res 2014; 24:339-62. [PMID: 25139502 DOI: 10.1007/s11136-014-0785-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE A systematic review of the validity, reliability and sensitivity of the Short Form (SF) health survey measures among breast cancer survivors. METHODS We searched a number of databases for peer-reviewed papers. The methodological quality of the papers was assessed using the COnsenus-based Standards for the selection of health Measurement INstruments (COSMIN). RESULTS The review identified seven papers that assessed the psychometric properties of the SF-36 (n = 5), partial SF-36 (n = 1) and SF-12 (n = 1) among breast cancer survivors. Internal consistency scores for the SF measures ranged from acceptable to good across a range of language and ethnic sub-groups. The SF-36 demonstrated good convergent validity with respective subscales of the Functional Assessment of Cancer Treatment-General scale and two lymphedema-specific measures. Divergent validity between the SF-36 and Lymph-ICF was modest. The SF-36 demonstrated good factor structure in the total breast cancer survivor study samples. However, the factor structure appeared to differ between specific language and ethnic sub-groups. The SF-36 discriminated between survivors who reported or did not report symptoms on the Breast Cancer Prevention Trial Symptom Checklist and SF-36 physical sub-scales, but not mental sub-scales, discriminated between survivors with or without lymphedema. Methodological quality scores varied between and within papers. CONCLUSION Short Form measures appear to provide a reliable and valid indication of general health status among breast cancer survivors though the limited data suggests that particular caution is required when interpreting scores provided by non-English language groups. Further research is required to test the sensitivity or responsiveness of the measure.
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Affiliation(s)
- Charlene Treanor
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland,
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