1
|
Darabi Z, Sangouni AA, Ghayour-Mobarhan M, Ferns GA, Khayyatzadeh SS. The association between lifelines diet score (LLDS) with depression and quality of life in Iranian adolescent girls. Nutr J 2024; 23:19. [PMID: 38355569 PMCID: PMC10868061 DOI: 10.1186/s12937-024-00913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND It has been proposed that a greater degree of adherence to a healthy dietary pattern is associated with a lower risk of depression and a poor quality of life (QoL). The Lifelines diet score (LLDS) is a new, evidence-base scoring system to define the quality of diet. We designed a cross-sectional study to investigate the association between LLDS with depression and QoL in Iranian adolescent girls. METHODS A total of 733 female adolescents were recruited from Mashhad and Sabzevar cities, Iran. Depression and QoL were assessed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaires, respectively. The LLDS was defined by dividing intakes of 12 food groups with negative or positive health effects into quintiles ranging 12 to 60 points. To explore the association between LLDS with QoL and depression, logistic regression was used in crude and adjusted models. RESULTS The prevalence of depression and poor QoL was 24% and 49%, respectively. After adjusting for confounding factors, adolescent girls in the highest quartile of LLDS compared with the participants in the lowest quartile had a 42% lower probability of reporting depressive symptoms (OR: 0.58; 95% CI: 0.35-0.97, P = 0.03). In addition, the participants in the highest quartile of LLDS had lower odds of poor QoL compared with the subjects in the lowest quartile (OR: 0.65; 95% CI: 0.42-0.92, P = 0.04). CONCLUSIONS There is an inverse relationship between LLDS with risk of depression and poor QoL. Prospective and interventional investigations are needed to reach a clear vision.
Collapse
Affiliation(s)
- Zahra Darabi
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abbas Ali Sangouni
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Majid Ghayour-Mobarhan
- International UNESCO center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Sayyed Saeid Khayyatzadeh
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| |
Collapse
|
2
|
Leach MJ, Barber G, Monacella S, Jamieson P, Trinh T, Vo N, Schmidt U, Byrne A, Ristevski E. Physical activity, obesity, and quality of life among rural Australian cancer survivors: a cross-sectional study. Support Care Cancer 2023; 31:222. [PMID: 36939924 PMCID: PMC10027785 DOI: 10.1007/s00520-023-07691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/13/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE We aimed to describe physical activity (PA), obesity, and quality of life (QoL) among rural Australian cancer survivors, assess whether total and item-specific QoL are associated with sufficient PA and obesity, and assess whether PA and obesity interact with respect to QoL. METHODS In a cross-sectional study, convenience sampling was used to recruit adult cancer survivors via a chemotherapy day unit and allied health professionals at a rural hospital in Baw Baw Shire, Australia. Exclusion criteria were acute malnutrition and end-of-life care. PA and QoL were measured using Godin-Shephard and 7-item Functional Assessment of Cancer Therapy (FACT-G7) questionnaires, respectively. Factors associated with total and item-specific QoL were assessed via linear and logistic regression, respectively. RESULTS Among 103 rural cancer survivors, the median age was 66 years, 35% were sufficiently physically active, and 41% presented with obesity. Mean/median total QoL scores were 17 on the FACT-G7 scale (0-28; higher scores indicate better QoL). Sufficient PA was associated with better QoL ([Formula: see text]=2.29; 95% confidence interval [CI] = 0.26, 4.33) and more energy (odds ratio [OR] = 4.00, 95% CI = 1.48, 10.78) while obesity was associated with worse QoL ([Formula: see text]=-2.09; 95% CI = -4.17, -0.01) and more pain (OR = 3.88, 95% CI = 1.29, 11.68). The PA-obesity interaction was non-significant (p-value = 0.83). CONCLUSIONS This is the first known study conducted among rural survivors of any cancer to find sufficient PA and obesity are associated with better and worse QoL, respectively. PA, weight management, and QoL-including energy and pain-should be considered when targeting and tailoring supportive care interventions for rural cancer survivors.
Collapse
Affiliation(s)
- Michael J Leach
- School of Rural Health, Monash University, Warragul, Bendigo, VIC, Australia.
| | | | | | | | - Thi Trinh
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Ngan Vo
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Ulla Schmidt
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Anny Byrne
- West Gippsland Healthcare Group, Warragul, VIC, Australia
| | - Eli Ristevski
- School of Rural Health, Monash University, Warragul, VIC, Australia
| |
Collapse
|
3
|
Schroeder J, Reitz LK, Vieira FGK, da Silva EL, Di Pietro PF. Low to moderate adherence to 2018 diet and physical exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research is associated with prooxidant biochemical profile in women undergoing adjuvant breast cancer treatment. Nutr Res 2023; 109:1-11. [PMID: 36538844 DOI: 10.1016/j.nutres.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/05/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022]
Abstract
Adequate adherence to the 2018 diet and exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) can possibly result in less oxidative stress, lower risk to chemo- and radiotoxicity, lower risk of relapse, and increased quality of life in breast cancer survivors. This observational study aims to investigate the influence of adherence to updated recommendations of the WCRF/AICR on oxidative stress biomarkers in women with breast cancer undergoing adjuvant treatment (AT). We hypothesized that adherence to WCRF/AICR recommendations is inversely related to oxidative damage biomarkers and directly associated with antioxidant status. Women (n = 78) were evaluated before (T0) and after AT. After collecting anthropometric, physical activity, and food consumption data, a standardized score of adherence to WCRF/AICR recommendations was applied. The sample was divided into low-medium adherence and high adherence groups. Blood samples were collected at both timepoints for oxidative stress biomarkers analysis. Multiple linear regression analyzes were applied to verify associations between WCRF/AICR score and biomarkers. We found that low-medium adherence to WCRF/AICR recommendations at T0 affected lower levels of reduced glutathione (P= .003) and higher levels of lipid hydroperoxides (P= .002) and plasma carbonylated proteins (P= .001) after AT. The WCRF/AICR score at T0 was inversely associated with changes in plasma carbonylated protein concentrations after AT (adjusted β = -0.359; P= .01). Our findings suggest that high WCRF/AICR score before and during AT may provide greater stability of antioxidant capacity and protection against exacerbated oxidative stress.
Collapse
Affiliation(s)
- Jaqueline Schroeder
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, 88040-370, SC, Brazil
| | - Luiza Kuhnen Reitz
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, 88040-370, SC, Brazil
| | | | - Edson Luiz da Silva
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, 88040-370, SC, Brazil; Department of Clinical Analyses, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, 88010-790, SC, Brazil
| | - Patricia Faria Di Pietro
- Post Graduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, 88040-370, SC, Brazil.
| |
Collapse
|
4
|
Haidari RE, Anota A, Dabakuyo-Yonli TS, Guillemin F, Conroy T, Velten M, Jolly D, Causeret S, Cuisenier J, Graesslin O, Abbas LA, Nerich V. Utility values and its time to deterioration in breast cancer patients after diagnosis and during treatments. Qual Life Res 2022; 31:3077-3085. [PMID: 35590124 DOI: 10.1007/s11136-022-03157-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The potential effects of breast cancer (BC) on health-related quality of life (HRQoL) should be considered in clinical and policy decision-making, as the economic burden of BC management is currently assessed. In the last decades, time-to-HRQoL score deterioration (TTD) has been proposed as an approach to the analysis of longitudinal HRQoL in oncology. The main objectives of the current study were to investigate the evolution of the utility values in BC patients after diagnosis and during follow-ups and to evaluate the TTD in utility values among women in all stages of BC. METHODS Health-state utility values (HSUV) were assessed using the EuroQol 5-Dimension 3-Level at diagnosis, at the end of the first hospitalization and 3 and 6 months after the first hospitalization. For a given baseline score, HSUV was considered to have deteriorated if this score decreased by ≥ 0.08 points of the EQ-5D utility index score and ≥ 7 points of the EQ visual analogue scale. TTD curves were calculated using the Kaplan-Meier estimation method. RESULTS Overall 381 patients were enrolled between February 2006 and February 2008. The highest proportions of respondents at the baseline and all follow-ups reporting some and extreme problems were in pain discomfort and anxiety/depression dimensions; more than 80% of patients experienced a deterioration in EQ-5D utility index score and EQ VAS score with a median TTD of 3.15 months and 6.24 Months, respectively. CONCLUSIONS BC patients undergoing therapy need psychological support to cope with their discomfort, pain, depression, anxiety, and fear during the process of diagnosis and treatment to improve their QoL.
Collapse
Affiliation(s)
- Rana El Haidari
- INSERM (French Institut of Health and Medical Research), UMR1098 (Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique), EFS BFC (Etablissement Français du Sang Bourgogne Franche-Comté), University of Bourgogne Franche-Comté, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, 25000, Besançon, France.
| | - Amelie Anota
- Biostatistics Unit, Department of Clinical Research and Innovation & Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France.,French National Platform Quality of Life and Cancer, Montpellier, France
| | - Tienhan S Dabakuyo-Yonli
- French National Platform Quality of Life and Cancer, Montpellier, France.,Biostatistics and Epidemiology Unit, Centre Georges François Leclerc, 1 rue Professeur Marion, Dijon, France
| | - Francis Guillemin
- French National Platform Quality of Life and Cancer, Montpellier, France.,CHRU Nancy, Inserm, Université de Lorraine, CIC Epidemiologie Clinique, Nancy, France
| | - Thierry Conroy
- Institut de Cancérologie de Lorraine, Medical Oncology Department, 54519, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, APEMAC, Équipe MICS, 54000, Nancy, France
| | - Michel Velten
- French National Platform Quality of Life and Cancer, Montpellier, France.,Department of Epidemiology and Public Health, Faculty of Medicine, University of Strasbourg, 3430, Strasbourg, EA, France.,Department of Epidemiology and Biostatistics, Paul Strauss Comprehensive Cancer Center, Strasbourg, France
| | - Damien Jolly
- French National Platform Quality of Life and Cancer, Montpellier, France.,Clinical Epidemiology Department, Hôpital Robert. Debré, University Hospital, Rue du Général Koenig, 51092, Reims cedex, France
| | - Sylvain Causeret
- Surgery Department, Centre Georges François Leclerc, Dijon, France
| | - Jean Cuisenier
- Surgery Department, Centre Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Gynecological and Obstetric Department, Institut Mère Enfant, University Hospital of Reims, URCA (Université de Reims Champagne Ardenne), Reims, France
| | - Linda Abou Abbas
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese university, Beirut, 1001, Lebanon
| | - Virginie Nerich
- Biostatistics Unit, Department of Clinical Research and Innovation & Department of Human and Social Sciences, Centre Léon Bérard, Lyon, France.,Department of Pharmacy, University Hospital of Besançon, 25030, Besançon, France
| |
Collapse
|
5
|
Wu T, Arevalo C, Hsu FC, Hong S, Parada H, Yang M, Pierce JP. Independent and Joint Associations of Pessimism, Total Calorie Intake and Acid-Producing Diets with Insomnia Symptoms among Breast Cancer Survivors. J Clin Med 2022; 11:jcm11102828. [PMID: 35628953 PMCID: PMC9147353 DOI: 10.3390/jcm11102828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Insomnia is prevalent in up to 40% of breast cancer survivors. Few studies have examined pessimism and dietary factors as risk factors for insomnia among breast cancer survivors. We leveraged a cohort of 2944 breast cancer survivors who enrolled in the Women’s Healthy Eating and Living study; these survivors provided dietary, insomnia, mental health, demographic, and lifestyle information at baseline and at 1- and 4-year follow-up assessments. Insomnia symptoms were assessed using the Women’s Health Initiative (WHI)-Insomnia Rating Scale, and pessimism was assessed using the Life Orientation Test Revised (LOT-R). Total calorie intake and acid-producing diets were assessed using 24 h dietary recalls. Multivariable-adjusted generalized estimating equation (GEE) models were used to test the independent and joint effects of psychological and dietary factors on insomnia. In the multivariable model, women in the third tertile of pessimism had greater odds (OR = 1.57 95% CI [1.37−1.79]) of insomnia when compared to women in the lowest tertile. Total calorie intake and acid-producing diets were each independently and significantly associated with insomnia symptoms. Further, pessimism and calorie intake/acid-producing diets were jointly associated with insomnia. For instance, women with pessimism scores in tertile 3 and total calorie intakes < median reported 2 times the odds (OR = 2.09; 95% CI [1.51−3.47]) of insomnia compared to women with pessimism score in tertile 1 and calorie intakes < median. Our results highlight the need for patient care regarding mental health, and recommendations of healthy dietary intakes for breast cancer survivors.
Collapse
Affiliation(s)
- Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.A.); (H.P.J.); (M.Y.)
- Moores Cancer Center, University of California, San Diego, CA 92037, USA;
- Correspondence:
| | - Cesar Arevalo
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.A.); (H.P.J.); (M.Y.)
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA;
| | - Suzi Hong
- Department of Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA;
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.A.); (H.P.J.); (M.Y.)
- Moores Cancer Center, University of California, San Diego, CA 92037, USA;
| | - Mingan Yang
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (C.A.); (H.P.J.); (M.Y.)
| | - John P. Pierce
- Moores Cancer Center, University of California, San Diego, CA 92037, USA;
| |
Collapse
|
6
|
Lei YY, Ho SC, Kwok C, Cheng A, Cheung KL, Lee R, Mo FKF, Yeo W. Association of high adherence to vegetables and fruits dietary pattern with quality of life among Chinese women with early-stage breast cancer. Qual Life Res 2022; 31:1371-1384. [PMID: 34532834 PMCID: PMC9023405 DOI: 10.1007/s11136-021-02985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Dietary intake and patients' quality of life (QoL) are important supportive care issues in breast cancer survivorship. This study aimed to identify dietary pattern before and after breast cancer diagnosis. In addition, the association between dietary patterns and QoL were cross-sectionally and longitudinally investigated. METHODS A breast cancer cohort which included 1462 Chinese women were longitudinally interviewed at four time-points, namely baseline, 18-, 36-, and 60 months after diagnosis. At each follow-up, validated food frequency questionnaires (FFQ) were used to assess patients' dietary intake, and factor analysis was used to derive dietary patterns. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) were used to measure QoL at each follow-up. This study included 1368, 1226, 1079 and 1095 patients with invasive disease who completed assessment at baseline, 18-, 36- and 60-month follow-up and had detailed data of dietary intake and QoL. RESULTS Based on data obtained at 18-month follow-up, two major dietary patterns were identified: "grain and animal food pattern" and "vegetables and fruits pattern". Similar dietary patterns were obtained at baseline, 36- and 60- month follow-up. Generalized Estimating Equations (GEE) were used to analyze the longitudinal associations between dietary patterns and QoL over the four follow-ups. High intake of grain and animal food was inversely associated with scores for role functioning (B = - 0.744; 95%CI - 0.147 to - 0.017), dyspnea (B = - 0.092; 95%CI - 0.092 to - 0.092) and constipation (B = - 1.355; 95%CI - 2.174 to - 0.536). Vegetables and fruits intake were positively associated with scores for global health status/QoL (B = 1.282; 95%CI 0.545-2.019), physical functioning (B = 0.545; 95%CI: 0.037-1.053), emotional functioning (B = 1.426; 95%CI 0.653-2.200) and cognitive functioning (B = 0.822; 95%CI 0.007-1.637), while inversely associated with scores for nausea and vomiting (B = - 0.382; 95%CI - 0.694 to - 0.071), dyspnea (B = - 0.570; 95%CI - 0.570 to - 0.570), insomnia (B = - 1.412; 95%CI - 2.647 to - 0.177), loss of appetite (B = - 0.722; 95%CI - 1.311 to - 0.132), constipation (B = - 2.028; 95%CI - 2.775 to - 1.281) and diarrhea (B = - 0.929; 95%CI - 1.481 to - 0.377). CONCLUSION This study suggested that high adherence to "grain and animal food pattern" or "vegetables and fruits pattern" was significantly associated with several aspects of QoL. For instance, vegetables and fruits pattern appears to have beneficial effect on global health status/QoL among Chinese breast cancer patients. Prospective follow-up data could further confirm whether a specific dietary pattern has impact on cancer outcomes.
Collapse
Affiliation(s)
- Yuan-Yuan Lei
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Suzanne C Ho
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Carol Kwok
- Department of Clinical Oncology, Princess Margaret Hospital, New Territories, Hong Kong SAR, China
| | - Ashley Cheng
- Department of Clinical Oncology, Princess Margaret Hospital, New Territories, Hong Kong SAR, China
| | - Ka Li Cheung
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Roselle Lee
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Frankie K F Mo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory in Oncology in South China, Faculty of Medicine, Hong Kong Cancer Institute, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
- State Key Laboratory in Oncology in South China, Faculty of Medicine, Hong Kong Cancer Institute, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China.
| |
Collapse
|
7
|
Ching SSY, Mok ESB. Adoption of healthy lifestyles among Chinese cancer survivors during the first five years after completion of treatment. ETHNICITY & HEALTH 2022; 27:137-156. [PMID: 31238712 DOI: 10.1080/13557858.2019.1634182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
Objectives: The number of cancer survivors is increasing as a result of advances in detection and treatment. Lifestyle is a significant modifiable factor in the development of cancer. Most studies on healthy lifestyles have been conducted in Western countries. Cultural influences on the pursuit of healthy lifestyles among Chinese cancer survivors remain largely unexplored. The objectives of this qualitative study are to explore the experiences of Chinese cancer survivors in adopting healthy lifestyles, with a focus on their goals, the challenges they face, and the influences of Chinese culture.Design: Thirty-two Chinese breast and colorectal cancer survivors in their first five years after treatment were recruited from a hospital in Hong Kong to participate in eight focus groups. Qualitative content analysis was adopted to analyse the data.Results: The adoption of a healthy lifestyle was a strategy through which the participants exercised choice to restore balance in their health after developing cancer. Diet, exercise, psychological well-being, the use of traditional Chinese medicine (TCM) and health/dietary supplements, and attending medical consultations/follow-up visits were the behaviours adopted by the participants, with the goal of improving their health, controlling their cancer and preventing relapse, and managing the residual physical symptoms of their illness. In adopting a healthy lifestyle, the participants encountered challenges such as a lack of reliable and practical instructions from healthcare professionals. Chinese cultural beliefs concerning the nature of food, TCM, minimizing social disturbances, and collaborative control influenced their lifestyle.Conclusions: The cancer survivors adopted a range of healthy lifestyles but encountered challenges. Clarifying the principles of food choice while addressing Chinese beliefs regarding therapeutic food and the use of TCM, clarifying queries about conflicting information, and developing plans according to the needs, and competing demands of survivors can facilitate collaborative control between healthcare professionals and cancer survivors.
Collapse
Affiliation(s)
- S S Y Ching
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - E S B Mok
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| |
Collapse
|
8
|
Zheng C, Yu LX, Jia HY, Cui SD, Tian FG, Fan ZM, Geng CZ, Cao XC, Yang ZL, Wang X, Liang H, Wang S, Jiang HC, Duan XN, Wang HB, Li GL, Wang QT, Zhang JG, Jin F, Tang JH, Li L, Zhu SG, Zuo WS, Wang F, Zhou F, Xiang YJ, Guo MM, Wang YJ, Huang SY, Liu LY, Yu ZG. Relationship Between Lifestyle Habits and Health-Related Quality of Life of Recently Diagnosed Breast Cancer Patients: A Comparison Between Younger and Older Women in China. Front Public Health 2021; 9:767151. [PMID: 34976926 PMCID: PMC8714764 DOI: 10.3389/fpubh.2021.767151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to evaluate the relationship between lifestyle habits and health-related quality of life (HRQoL) among different ages who were initially diagnosed with breast cancer (within the first 2 weeks) and to determine the contribution of lifestyle habits factors on HRQoL. Methods: Patients with breast cancer were recruited from 22 hospitals in 11 provinces or municipalities in northern and eastern China. The Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) was used to measure HRQoL. Chi-square test, ANOVA, and multivariable generalized linear models were conducted to identify the differences in HRQoL between two age groups (age <50 years and ≥50 years) and to evaluate the contribution of lifestyle habits factors on HRQoL of patients with breast cancer. Results: About 1,199 eligible patients with breast cancer were used for analysis. Younger women (aged <50 years) appeared to show lower scores than older women (aged ≥50 years) in HRQoL subscales, including emotional well-being (p = 0.003), functional well-being (p = 0.006), breast cancer subscale (p = 0.038), and FACT-B Total scores (p = 0.028). Tea and alcohol consumption and being very satisfied with sleep and current life were the strongest predictors of higher HRQoL in younger group. Meanwhile, no coffee consumption, frequent participation in physical activities, high sleep satisfaction, and current life satisfaction were the key predictors of higher HRQoL in older women with breast cancer. Conclusion: The relationship of the nine lifestyle habit items with HRQoL differed among younger and older women. The associated variable of low HRQoL can help clinicians take intervention early in order to improve the prognosis of patients with breast cancer.
Collapse
Affiliation(s)
- Chao Zheng
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Li-Xiang Yu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Hong-Ying Jia
- Center of Evidence-Based Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shu-De Cui
- Department of Breast Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Fu-Guo Tian
- Department of Breast Surgery, Shanxi Cancer Hospital, Taiyuan, China
| | - Zhi-Min Fan
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Cui-Zhi Geng
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xu-Chen Cao
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhen-Lin Yang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Xiang Wang
- Department of Breast Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Liang
- Department of General Surgery, Linyi People's Hospital, Linyi, China
| | - Shu Wang
- Breast Disease Center, Peking University People's Hospital, Beijing, China
| | - Hong-Chuan Jiang
- Department of General Surgery, Beijing Chaoyang Hospital, Beijing, China
| | - Xue-Ning Duan
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Hai-Bo Wang
- Breast Center, Qingdao University Affiliated Hospital, Qingdao, China
| | - Guo-Lou Li
- Department of Breast and Thyroid Surgery, Weifang Traditional Chinese Hospital, Weifang, China
| | - Qi-Tang Wang
- Department of Breast Surgery, The Second Affiliated Hospital of Qingdao Medical College, Qingdao Central Hospital, Qingdao, China
| | - Jian-Guo Zhang
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jin-Hai Tang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Liang Li
- Department of Breast and Thyroid Surgery, Zibo Central Hospital, Zibo, China
| | - Shi-Guang Zhu
- Department of Breast Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Wen-Shu Zuo
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Fei Zhou
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Yu-Juan Xiang
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Ming-Ming Guo
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Yong-Jiu Wang
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Shu-Ya Huang
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Li-Yuan Liu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
- *Correspondence: Li-Yuan Liu ; orcid.org/0000-0002-9862-7471
| | - Zhi-Gang Yu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| |
Collapse
|
9
|
Lei YY, Ho SC, Cheung KL, Yeo VA, Lee R, Kwok C, Cheng A, Mo FKF, Yeo W. Higher Level of Sports Activities Participation during Five-Year Survival Is Associated with Better Quality of Life among Chinese Breast Cancer Survivors. Cancers (Basel) 2021; 13:cancers13236056. [PMID: 34885168 PMCID: PMC8656618 DOI: 10.3390/cancers13236056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Engaging in sports activities is strongly encouraged for cancer survivors. We aim to investigate the association between the level of sports activities participation post-diagnosis and quality of life (QoL) among Chinese women with early-stage breast cancer during the first five years of survival. Notably, we confirm in this work that regular participation in sports activities following cancer diagnosis may have a positive effect on patients’ QoL. Abstract Evidence about the association between the level of sports activities participation post-diagnosis and quality of life (QoL) among Chinese women with early-stage breast cancer is limited. A validated modified Chinese Baecke questionnaire was used to prospectively measure sports activities among a breast cancer cohort at four time-points: baseline and 18, 36, and 60 months after diagnosis (sports activities during the previous 12 months before each interview); QoL was measured at the same time. In total, 1289, 1125, and 1116 patients were included in the analyses at 18-, 36- and 60-month follow-up, respectively. The percentages of patients who belonged to no (0 metabolic equivalent of task (MET)-hours per week), low-level (<10 MET-hours/week), and high-level (≥10 MET-hours/week) sports activities group were 20.7%, 45.5%, and 33.8% at 18-month follow-up, respectively; the corresponding figures at 36 and 60 months differed slightly. Using data from the three follow-ups, generalized estimating equation (GEE) analyses showed that higher levels of sports activities participation were associated with better QoL in several items as well as fewer symptoms. The present findings in Chinese women with breast cancer provide important evidence on the beneficial effect of regular participation in sports activities following cancer diagnosis on patients’ QoL.
Collapse
Affiliation(s)
- Yuan-Yuan Lei
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China; (Y.-Y.L.); (K.L.C.); (V.A.Y.); (R.L.); (F.K.F.M.)
| | - Suzanne C. Ho
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - Ka-Li Cheung
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China; (Y.-Y.L.); (K.L.C.); (V.A.Y.); (R.L.); (F.K.F.M.)
| | - Victoria A. Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China; (Y.-Y.L.); (K.L.C.); (V.A.Y.); (R.L.); (F.K.F.M.)
| | - Roselle Lee
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China; (Y.-Y.L.); (K.L.C.); (V.A.Y.); (R.L.); (F.K.F.M.)
| | - Carol Kwok
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China; (C.K.); (A.C.)
| | - Ashley Cheng
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China; (C.K.); (A.C.)
| | - Frankie K. F. Mo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China; (Y.-Y.L.); (K.L.C.); (V.A.Y.); (R.L.); (F.K.F.M.)
- State Key Laboratory in Oncology in South China, Faculty of Medicine, Hong Kong Cancer Institute, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - Winnie Yeo
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong, China; (Y.-Y.L.); (K.L.C.); (V.A.Y.); (R.L.); (F.K.F.M.)
- State Key Laboratory in Oncology in South China, Faculty of Medicine, Hong Kong Cancer Institute, The Chinese University of Hong Kong, New Territories, Hong Kong, China
- Correspondence: ; Tel.: +852-26322118
| |
Collapse
|
10
|
Association between Fruit and Vegetable Intake and Physical Activity among Breast Cancer Survivors: A Longitudinal Study. Curr Oncol 2021; 28:5025-5034. [PMID: 34940061 PMCID: PMC8699935 DOI: 10.3390/curroncol28060422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
This study examines the association between rates of change in daily fruit and vegetable intake and in weekly levels of moderate-to-vigorous intensity physical activity (MVPA) over a 15-month period in women following primary treatment completion for breast cancer. Breast cancer survivors (N = 199) self-reported fruit and vegetable intake and wore an accelerometer for 7 consecutive days to measure levels of MVPA on five occasions every 3 months. Multivariate latent growth modeling revealed that the rate of change in fruit and vegetable intake was not associated with the rate of change in levels of MVPA. Baseline (Mean = 3.46 months post-treatment) levels of MVPA were not associated with the rate of change of daily fruit and vegetable intake; likewise, baseline fruit and vegetable intake was not associated with the rate of change in levels of MVPA. Behavioral interventions promoting fruit and vegetable intake should not be assumed to yield concomitant effects in promoting MVPA or vice versa.
Collapse
|
11
|
Costa DSJ, Mercieca-Bebber R, Rutherford C, Tait MA, King MT. How is quality of life defined and assessed in published research? Qual Life Res 2021; 30:2109-2121. [PMID: 33792834 DOI: 10.1007/s11136-021-02826-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To ensure clarity in communication in the field of quality of life research, and meaningful use of 'quality of life' as a research outcome, requires two things: awareness that there is a range of conceptualisations and definitions of 'quality of life', and for any particular study, consistency between the way the term is defined and operationalised in that setting. We aimed to identify how frequently research articles described (HR)QOL as a construct of interest, how frequently they referred to "patient-reported outcome (measures)", which patient-reported outcome measures were used, and how (HR)QOL was defined. METHODS We reviewed all Quality of Life Research articles published in 2017 and recorded whether they described health-related quality of life or quality of life as constructs of interest, and/or mentioned the term(s) patient-reported outcome (measures). We recorded definitions of (HR)QOL stated and questionnaires used. We classified articles according to constructs assessed and instruments used, and examined whether articles citing the same definition used the same questionnaires. RESULTS We reviewed 300 articles; 65% stated that (HR)QOL was a construct of interest, 27% mentioned patient-reported outcome (measures), and 20% mentioned neither. Fifty-one articles provided definitions of (HR)QOL, citing 66 sources, with 11 definitions cited more than once. PROMIS, SF, EQ-5D, and EORTC instruments were the most commonly used. The only definition and questionnaire consistently used together were the WHO definitions/instruments. CONCLUSION These results demonstrate considerable heterogeneity in the definition and operationalisation of (HR)QOL, between and within studies. This limits meaningful interpretation of (HR)QOL scores and complicates literature searches. Investigators should define constructs and select instruments aligned with their definitions.
Collapse
Affiliation(s)
- Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Rebecca Mercieca-Bebber
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
- Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, NSW, Australia
| | - Margaret-Ann Tait
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
12
|
Quality of Life in Women Diagnosed with Breast Cancer after a 12-Month Treatment of Lifestyle Modifications. Nutrients 2020; 13:nu13010136. [PMID: 33396551 PMCID: PMC7824271 DOI: 10.3390/nu13010136] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
Healthy lifestyles are associated with better health-related quality of life (HRQoL), favorable prognosis and lower mortality in breast cancer (BC) survivors. We investigated changes in HRQoL after a 12-month lifestyle modification program in 227 BC survivors participating in DEDiCa trial (Mediterranean diet, exercise, vitamin D). HRQoL was evaluated through validated questionnaires: EQ-5D-3L, EORTC-QLQ-C30 and EORTC QLQ-BR23. Baseline changes were tested using analysis of variance. Multiple regression analyses were performed to assess treatment effects on HRQoL. Increases were observed in global health status (p < 0.001), physical (p = 0.003), role (p = 0.002) and social functioning (p < 0.001), body image (p < 0.001), future perspective (p < 0.001), well-being (p = 0.001), and reductions in fatigue (p < 0.001), nausea and vomiting (p = 0.015), dyspnea (p = 0.001), constipation (p = 0.049), financial problems (p = 0.012), sexual functioning (p = 0.025), systematic therapy side effects (p < 0.001) and breast symptoms (p = 0.004). Multiple regression analyses found inverse associations between changes in BMI and global health status (p = 0.048) and between serum 25(OH)D levels and breast symptoms (p = 0.002). A healthy lifestyle treatment of traditional Mediterranean diet and exercise may impact positively on HRQoL in BC survivors possibly through reductions in body weight while vitamin D sufficiency may improve BC-related symptoms. These findings are relevant to BC survivors whose lower HRQoL negatively affects treatment compliance and disease outcomes.
Collapse
|
13
|
Vajdi M, Farhangi MA. A systematic review of the association between dietary patterns and health-related quality of life. Health Qual Life Outcomes 2020; 18:337. [PMID: 33046091 PMCID: PMC7552532 DOI: 10.1186/s12955-020-01581-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health related quality of life (HRQOL) is a potent indicator of individual's happiness and life satisfaction. The way in which the HRQOL is affected by the diet is a topic of constant interest and debate among researchers. Evaluating the association between single nutrients or foods and HRQOL fails to take into consideration the complex interactions between nutrients. Also, the findings from previous investigations on the relationship between dietary patterns and HRQOL have been inconsistent. Therefore, our aim was to assess the existing evidence regarding the relationship between the dietary patterns and HRQOL by conducting a systematic review. METHODS A literature search was conducted in PubMed, Scopus, Web of Sciences and Google scholar databases from inception to March 2020, to identify studies that investigated associations between the dietary patterns (regardless of methods used to define dietary patterns) and HRQOL domains. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised their quality using the Newcastle-Ottawa Scale (NOS). RESULTS Thirteen studies (four longitudinal, and nine cross-sectional studies), with a total of 43,445 subjects, were included. Of the studies included in this review, eight studies evaluated the association between "Mediterranean" dietary patterns (MDP) and HRQOL, while five studies examined the association between different dietary patterns ("Healthy", "Unhealthy", "Western", "Fruit and vegetable", "Bread and butter" and etc.) and HRQOL. Excluding three studies which showed no significant association, healthy dietary patterns such as MDP, "Healthy" and "Fruit and vegetable" dietary patterns were associated with better HRQOL in physical and mental components scores. The quality assessment of included studies according to NOS criteria were ranged between medium to high quality. CONCLUSION According to the current evidence, "Healthy" dietary patterns and "Mediterranean" dietary patterns are associated with better dimension scores of HRQOL in both physical and mental summaries. While, unhealthy dietary patterns and "Western" dietary patterns are associated with lower scores of HRQOL. Further longitudinal studies are required to clarify the association between dietary patterns and HRQOL.
Collapse
Affiliation(s)
- Mahdi Vajdi
- Research Center for Evidence Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | |
Collapse
|
14
|
Porciello G, Montagnese C, Crispo A, Grimaldi M, Libra M, Vitale S, Palumbo E, Pica R, Calabrese I, Cubisino S, Falzone L, Poletto L, Martinuzzo V, Prete M, Esindi N, Thomas G, Cianniello D, Pinto M, Laurentiis MD, Pacilio C, Rinaldo M, D’Aiuto M, Serraino D, Massarut S, Evangelista C, Steffan A, Catalano F, Banna GL, Scandurra G, Ferraù F, Rossello R, Antonelli G, Guerra G, Farina A, Messina F, Riccardi G, Gatti D, Jenkins DJA, Minopoli A, Grilli B, Cavalcanti E, Celentano E, Botti G, Montella M, Augustin LSA. Mediterranean diet and quality of life in women treated for breast cancer: A baseline analysis of DEDiCa multicentre trial. PLoS One 2020; 15:e0239803. [PMID: 33031478 PMCID: PMC7544033 DOI: 10.1371/journal.pone.0239803] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/15/2020] [Indexed: 02/08/2023] Open
Abstract
Evidence suggests a beneficial role of the Mediterranean Diet (MedDiet) on health-related quality of life (HRQoL) in healthy subjects. HRQoL is relevant in cancer therapy and disease outcomes, therefore we investigated the association between adherence to the MedDiet and HRQoL in breast cancer survivors participating in the multicentre trial DEDiCa. Diet and HRQoL were assessed at baseline in a subgroup of 309 women enrolled within 12 months of breast cancer diagnosis without metastasis (stages I-III, mean age 52±1 yrs, BMI 27±7 kg/m2). The 14-item PREDIMED questionnaire was used to analyse adherence to the MedDiet. HRQoL was assessed with three validated questionnaires measuring physical, mental, emotional and social factors: EQ-5D-3L, EORTC QLQ-C30 and EORTC QLQ-BR23. Analysis of variance (ANOVA) and multivariate analyses were performed to assess the possible role of the MedDiet on HRQoL. Patients with higher adherence to MedDiet (PREDIMED score >7) showed significantly higher scores for physical functioning (p = 0.02) and lower scores on the symptomatic pain scale (p = 0.04) assessed by the EORTC QLQ-C30 questionnaire compared to patients with a lower adherence to MedDiet (PREDIMED score ≤7). Higher scores from the EQ-5D-3L indicating higher well-being were observed mainly in participants with higher MedDiet adherence (p = 0.05). In adjusted multivariate analyses significant positive associations were found between MedDiet, physical functioning (p = 0.001) and EQ 5D-3L score (p = 0.003) while inverse associations were found with pain and insomnia symptoms (p = 0.005 and p = 0.029, respectively). These results suggest that higher adherence to the MedDiet in breast cancer survivors is associated with better aspects of quality of life, specifically higher physical functioning, better sleep, lower pain and generally higher well-being confirming findings in healthy subjects.
Collapse
Affiliation(s)
- Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
- * E-mail:
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Rosa Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Serena Cubisino
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Luigina Poletto
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Valentina Martinuzzo
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Nadia Esindi
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | - Daniela Cianniello
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Michelino De Laurentiis
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Carmen Pacilio
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Massimo Rinaldo
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Samuele Massarut
- Division of Breast Cancer Surgery, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Chiara Evangelista
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers Unit, National Cancer Institute Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | | | | | | | | | | | | | | | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, ON, Canada
| | - Anita Minopoli
- Laboratory Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Bruna Grilli
- Laboratory Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Ernesta Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Maurizio Montella
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Livia S. A. Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| |
Collapse
|
15
|
Li J, Pang H, Sun Z, Zhao L, Bai C. Health status of middle-aged and older cancer survivors: a nationwide cross-sectional study from the China Health and Retirement Longitudinal Study (CHARLS). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:183. [PMID: 32309330 PMCID: PMC7154473 DOI: 10.21037/atm.2020.01.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The number of Chinese cancer survivors has increased bolstered by the combined trends of an aging population and improved cancer survival; however, related research on cancer survivorship remains limited. Therefore, this study aimed to provide an overview of the health status of middle-aged and older cancer survivors in China. Methods We used the cross-sectional self-reported survey data from wave 4 in the China Health and Retirement Longitudinal Study (CHARLS). A total of 354 cancer survivors and 16,664 participants without cancer were identified from CHARLS. Physical and mental health, health behavior, and health care information collected by questionnaire were compared between these two groups. Results Compared with the general middle-aged and older population, cancer survivors had more concomitant chronic diseases (2.75 vs. 2.00, P<0.001). In addition, cancer survivors were found to be more statistically likely to have difficulties with activity (3.53 vs. 2.39, P<0.001) and have depressive symptoms (10.07 vs. 8.01, P<0.001) compared with participants without cancer. Also, cancer survivors were less likely to drink compared to those without a cancer diagnosis (OR 0.49; 95% CI, 0.36–0.66, P<0.001), but smoking behavior and physical activity did not show a significant difference. Coexisting chronic diseases and smoking harmed the physical and mental health of middle-aged and older people. We also found that cancer survivors had higher medical care expenses when compared with participants without cancer. Conclusions Cancer survivors older than 45 years in China have poorer outcomes in comorbidities and physical and mental health than their age-matched individual counterparts without cancer. Therefore, a higher quality and more cost-effective supportive care for these individuals is needed.
Collapse
Affiliation(s)
- Jiarui Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| | - Haiyu Pang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhao Sun
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| | - Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| |
Collapse
|
16
|
He D, Qiao Y, Xiong S, Liu S, Ke C, Shen Y. Association between Dietary Quality and Prediabetes based on the Diet Balance Index. Sci Rep 2020; 10:3190. [PMID: 32081975 PMCID: PMC7035297 DOI: 10.1038/s41598-020-60153-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/06/2020] [Indexed: 01/20/2023] Open
Abstract
Dietary quality is an important factor influencing prediabetes, but few studies have applied the Chinese Diet Balance Index (DBI-16) to evaluate the dietary quality of individuals with prediabetes and explore the associations between dietary quality and prediabetes. In our study, the lower-bound score, higher-bound score and diet quality distance, were respectively calculated to assess dietary quality based on each food group. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95%CI) of unfavorable dietary quality leading to prediabetes in every subgroup. The results were shown that individuals with prediabetes had excessive intake in the categories of cereals, salt and inadequate intake in vegetables, fish and diet variety than participants without prediabetes (all P < 0.01). Unfavourable dietary quality was significantly associated with an increased risk of prediabetes (OR: 1.45, 95%CI: 1.29-1.63), especially among the subjects who lived in rural areas (OR: 1.63, 95%CI: 1.25-1.76), those who had abdominal obesity (OR: 1.58, 95%CI: 1.36-1.85), those who smoked (OR: 1.58, 95%CI: 1.30-1.93), those who consumed alcohol (OR: 1.57, 95%CI: 1.28-1.93) and those who did not drink tea (OR: 1.64, 95%CI: 1.42-1.88). In Conclusion, unfavourable dietary quality was significantly associated with an increased risk of prediabetes.
Collapse
Affiliation(s)
- Dingliu He
- Department of Epidemiology and Biostatistics, School of Public Heath, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, P.R. China
- Department of Clinical Nutrition, Yancheng No.1 People's Hospital, Yancheng, 224001, China
| | - Yanan Qiao
- Department of Epidemiology and Biostatistics, School of Public Heath, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, P.R. China
| | - Suting Xiong
- Department of Epidemiology and Biostatistics, School of Public Heath, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, P.R. China
| | - Siyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Heath, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, P.R. China
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Heath, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, P.R. China.
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Heath, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, P.R. China.
| |
Collapse
|
17
|
The Effects of Diet and Dietary Interventions on the Quality of Life among Breast Cancer Survivors: A Cross-Sectional Analysis and a Systematic Review of Experimental Studies. Cancers (Basel) 2020; 12:cancers12020322. [PMID: 32019093 PMCID: PMC7072135 DOI: 10.3390/cancers12020322] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 12/14/2022] Open
Abstract
There is an ongoing need for solid evidence about the effects of healthy behaviors, and particularly diet, on the quality of life (QoL) among breast cancer survivors. We first conducted a cross-sectional study on 68 Italian stage I-III breast cancer survivors, to investigate the association of adherence to the Mediterranean diet (MD), physical activity and weight status with QoL. Adherence to MD and physical activity was assessed using structured questionnaires. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality-of-Life tools. We showed that low consumption of red meat and carbonated beverages, daily consumption of wine and high consumption of dishes seasoned with sofrito had beneficial effects on several QoL subscales. By contrast, using olive oil as the main culinary fat, low consumption of commercial sweets and high consumption of nuts were associated with negative effects. Overall, these findings resulted in a null effect of adherence to MD on QoL. Furthermore, we observed better QoL sub-scores among women who performed moderate physical activity (i.e., diarrhea) and those who were underweight/normal weight (i.e., physical functioning and dyspnea) if compared with their counterparts (p-values ≤ 0.003 after correction for multiple comparison). Next, we performed a systematic review of nine experimental studies to summarize whether dietary interventions might improve QoL among breast cancer patients. All the studies demonstrated significant improvements in overall QoL and/or its subscales after the interventions. However, differences in study design, interventions and tools used for QoL assessment did not allow us to provide an overall estimate. Moreover, only a single-arm trial evaluated the effect of an exclusive dietary-based intervention, while others combined dietary recommendations with physical activity and weight loss programs. For these reasons, our study encourages more efforts to improve the robustness of current evidence, through more homogenous tools, larger population-based studies and further randomized controlled trials.
Collapse
|
18
|
The relationship between diet and cognitive function in adult cancer survivors: a systematic review. J Cancer Surviv 2019; 13:773-791. [PMID: 31399855 DOI: 10.1007/s11764-019-00796-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/01/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To perform a systematic review identifying how dietary factors are related to cognitive function in cancer survivors who are not currently undergoing primary treatment. METHODS Using the PRISMA framework, a search was conducted for studies published before February 2019 across multiple databases, identifying 2304 unique articles. Twelve met final inclusion criteria and were evaluated through narrative synthesis. This review was registered with the International Prospective Register Of Systematic Reviews (CRD42018111941). RESULTS Included studies were heterogeneous in methodology and in dietary and cognitive variables investigated making direct comparisons difficult. Evidence of a relationship between diet and cognition was mixed; the most consistent evidence was identified in relation to a positive relationship between fruit and vegetable intake and cognitive function (both self-reported and objectively tested) in five out of six studies, but was not concordant across all studies. CONCLUSION Preliminary evidence exists that a greater fruit and vegetable intake is associated with better cognitive functioning in cancer survivors, as has been reported in healthy populations; however, these data are correlational and include relatively small samples. Most evidence related to breast cancer survivors, with individual studies extending to colorectal and stomach cancer survivors. Experimental trials are needed to identify causal attribution of dietary factors on cognitive function in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS At this time, there is not sufficient evidence to make dietary or nutritional recommendations specifically for improving cognitive function in cancer survivors. This should be considered in light of the general paucity of research on this subject, necessitating further investigations.
Collapse
|
19
|
Higher vegetable intake and vegetable variety is associated with a better self-reported health-related quality of life (HR-QoL) in a cross-sectional survey of rural northern Ghanaian women in fertile age. BMC Public Health 2018; 18:920. [PMID: 30053856 PMCID: PMC6062975 DOI: 10.1186/s12889-018-5845-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 07/12/2018] [Indexed: 12/27/2022] Open
Abstract
Background A higher vegetable intake plays an important role in promoting general health and well-being, but there is a dearth of data on the independent effect of vegetable intake on health-related quality of life (HR-QoL). This study contributes to evidence on the independent effect of vegetable consumption on HR-QoL among women in fertile age. Methods A cross-sectional study of a sample of rural women in fertile age (15–49 years, n = 187), randomly selected from 6 rural communities in the Tolon and Savelugu Districts, Northern Region of Ghana. Vegetable consumption in the past month was assessed with a 27-item semi-quantitative food frequency questionnaire; self-reported HR-QoL with the Short Form Health Survey (SF-36); nutritional status with anthropometry; household food security with the household hunger scale (HHS) and demographic and socio-economic related covariates with a pre-tested semi-structured questionnaire using face-face interviews. Generalised Linear Models were fitted to assess adjusted mean scores and their 95% confidence intervals (95% CIs) by terciles of vegetable intake and vegetable variety score (VVS) for the HR-QoL, its physical health (PH) and mental health (MH) domains and the SF-36 subscales. Results The mean vegetable intake of the women was 324.6 ± 196.1 g/day. The mean scores of the HR-QoL, PH and MH were 69.5 ± 13.6, 72.6 ± 17.4 and 66.4 ± 12.6 respectively. The alpha Cronbach measure of reliability for the HR-QoL, PH and MH were 0.78, 0.75 and 0.62 respectively. After adjusting for potential confounders such as age, body-mass-index (BMI), parity, educational status, occupation, marital status, HHS and household asset index, we observed an increasing trend across terciles of vegetable intake in the past month for the HR-QoL (P-trend = 0.0003), PH (P-trend = 0.02), MH (P-trend = 0.001) as well as the physical functioning (P-trend = 0.01), role-physical (P-trend <.0001), and role emotional (P-trend <.0001) domains of the SF-36. The multivariate model of the results also showed a significant increasing trend in the adjusted mean scores of the HR-QoL (P-trend = 0.04), MH (P-trend = 0.001) as well as 4 subscales of the SF-36 [role-physical (P-trend = 0.02), role-emotional (P-trend = 0.05), emotional well-being (P-trend = 0.002) and vitality (P-trend <.0001)] across terciles of the VVS. Conclusion The results of the present study suggest a potential beneficial role of high vegetable intake and consumption of more varied vegetables on HR-QoL. Further research is needed to determine the mechanisms driving these influences. Electronic supplementary material The online version of this article (10.1186/s12889-018-5845-3) contains supplementary material, which is available to authorized users.
Collapse
|
20
|
Abstract
OBJECTIVE To summarise the evidence on determinants of health-related quality of life (HRQL) in Asian patients with breast cancer. DESIGN Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO (CRD42015032468). METHODS According to the PRISMA guidelines, databases of MEDLINE (PubMed), Embase and PsycINFO were systematically searched using the following terms and synonyms: breast cancer, quality of life and Asia. Articles reporting on HRQL using EORTC-QLQ-C30, EORTC-QLQ-BR23, FACT-G and FACT-B questionnaires in Asian patients with breast cancer were eligible for inclusion. The methodological quality of each article was assessed using the quality assessment scale for cross-sectional studies or the Newcastle-Ottawa Quality Assessment Scale for cohort studies. RESULTS Fifty-seven articles were selected for this qualitative synthesis, of which 43 (75%) were cross-sectional and 14 (25%) were longitudinal studies. Over 75 different determinants of HRQL were studied with either the EORTC or FACT questionnaires. Patients with comorbidities, treated with chemotherapy, with less social support and with more unmet needs have poorer HRQL. HRQL improves over time. Discordant results in studies were found in the association of age, marital status, household income, type of surgery, radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being. CONCLUSIONS In Asia, patients with breast cancer, in particular those with other comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQL. Appropriate social support and meeting the needs of patients may improve patients' HRQL.
Collapse
Affiliation(s)
- Peh Joo Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sofie A M Gernaat
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Surgery, National University of Singapore, Singapore
| | - Helena M Verkooijen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
21
|
Choi YS, Song R, Ku BJ. Effects of a T'ai Chi-Based Health Promotion Program on Metabolic Syndrome Markers, Health Behaviors, and Quality of Life in Middle-Aged Male Office Workers: A Randomized Trial. J Altern Complement Med 2017; 23:949-956. [PMID: 28654312 DOI: 10.1089/acm.2017.0057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the effects of a t'ai chi-applied worksite health promotion program on metabolic syndrome markers, health behaviors, and quality of life in middle-aged male office workers at a high risk of metabolic syndrome. DESIGN A prospective randomized controlled study. SETTING Health center of a government office building in Korea. SUBJECTS Forty-three male office workers with two or more metabolic syndrome markers. INTERVENTIONS The office workers were randomly assigned either to an experimental group that received t'ai chi combined with health education twice weekly for 12 weeks, or to a control group that received health education only. OUTCOME MEASURES Blood sampling for metabolic syndrome markers and structured questionnaires for health behaviors and quality of life. RESULTS The experimental group showed significant reductions in systolic (t = -3.103, p = 0.003) and diastolic (t = -2.159, p = 0.037) blood pressures and the triglyceride level (t = -2.451, p = 0.019) compared with the control group. Those in the experimental group also performed health behaviors more frequently (t = 4.047, p < 0.001) and reported a significantly better quality of life (t = 3.193, p = 0.003) than those in the control group. CONCLUSION The study findings show that t'ai chi was an effective adjunctive intervention in a worksite health promotion program for middle-aged office workers at a high risk of metabolic syndrome. Future studies should examine the long-term effects of t'ai chi-applied worksite health promotion programs in individuals with confirmed metabolic syndrome.
Collapse
Affiliation(s)
- Ye-Sook Choi
- 1 Department of Nursing, Daejeon Health Institute of Technology , Daejeon, South Korea
| | - Rhayun Song
- 2 College of Nursing, Chungnam National University , Daejeon, South Korea
| | - Bon Jeong Ku
- 3 College of Medicine, Chungnam National University , Daejeon, South Korea
| |
Collapse
|