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Interv
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2
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ter
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ti
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s,
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n
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stra
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sig
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siti
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ts
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sy
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d
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terv
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ffe
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ti
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ly
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teg
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to
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fo
r
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st
c
a
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c
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p
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ts.
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a
lt
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c
ti
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rs
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o
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o
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o
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th
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ies
to
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d
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re
ss
p
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c
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s
o
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F
u
rth
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ies
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m
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n
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e
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term
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c
ti
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ss
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K
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w
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s
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B
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an
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Ps
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ch
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lo
g
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well
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Qu
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C
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Stu
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[
1
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.
Acc
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[
3
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,
[
4
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.
T
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h
ig
h
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I
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8
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6
I
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to
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p
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s
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r
ev
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D
w
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et
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a
n
in
g
s
ih
)
1711
T
h
e
d
iag
n
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s
is
an
d
tr
ea
tm
en
t
o
f
b
r
ea
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t
ca
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d
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,
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d
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ten
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tr
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lev
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[
5
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.
Patien
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tain
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[
6
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-
[
8
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.
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R
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lly
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y
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ical
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h
allen
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o
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th
e
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is
ea
s
e
[
9
]
.
T
h
e
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o
d
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p
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r
ates
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to
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at
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ter
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d
u
r
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[
1
0
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.
Patien
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ig
h
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e
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ie
v
e
b
etter
p
s
y
ch
o
lo
g
ical
an
d
clin
ical
o
u
tco
m
es
[
1
1
]
.
C
o
n
v
er
s
ely
,
l
o
w
r
esil
ien
ce
ca
n
lead
to
i
n
cr
ea
s
ed
s
tr
ess
,
d
ep
r
ess
io
n
,
an
d
d
if
f
icu
lty
m
a
n
ag
in
g
em
o
tio
n
al
d
is
tr
ess
[
1
2
]
-
[
1
4
]
.
S
e
v
e
r
a
l
r
es
i
li
e
n
c
e
-
b
as
e
d
i
n
t
e
r
v
e
n
t
i
o
n
s
,
s
u
c
h
a
s
c
o
g
n
it
i
v
e
b
eh
a
v
i
o
r
a
l
t
h
e
r
a
p
y
,
m
i
n
d
f
u
l
n
e
s
s
t
r
a
i
n
i
n
g
,
s
o
c
i
a
l s
u
p
p
o
r
t p
r
o
g
r
a
m
s
,
a
n
d
p
s
y
c
h
o
e
d
u
c
a
t
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o
n
,
h
a
v
e
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n
d
e
v
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l
o
p
e
d
t
o
a
d
d
r
es
s
t
h
es
e
c
h
a
l
l
e
n
g
e
s
[
1
5
]
.
H
o
w
e
v
e
r
,
p
r
e
v
i
o
u
s
s
t
u
d
i
es
o
f
t
e
n
v
a
r
y
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n
d
e
s
i
g
n
,
t
a
r
g
e
t
p
o
p
u
l
a
t
i
o
n
,
a
n
d
o
u
t
c
o
m
e
m
e
a
s
u
r
es
,
m
a
k
i
n
g
i
t
d
i
f
f
i
c
u
lt
t
o
d
r
a
w
d
e
f
i
n
i
t
i
v
e
c
o
n
cl
u
s
i
o
n
s
a
b
o
u
t
th
e
i
r
e
f
f
e
c
t
i
v
e
n
ess
.
T
h
e
r
e
is
als
o
l
i
m
i
t
e
d
s
y
n
t
h
e
s
i
s
o
f
e
v
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d
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n
c
e
s
p
e
ci
f
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c
t
o
b
r
e
a
s
t
c
a
n
c
e
r
p
a
t
i
e
n
t
s
,
p
a
r
t
ic
u
l
a
r
l
y
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n
l
o
w
-
a
n
d
m
i
d
d
l
e
-
i
n
c
o
m
e
c
o
u
n
t
r
i
e
s
l
i
k
e
I
n
d
o
n
e
s
i
a
.
T
h
e
r
e
f
o
r
e
,
t
h
i
s
s
t
u
d
y
a
i
m
s
t
o
s
y
s
te
m
a
t
i
ca
l
l
y
r
e
v
i
e
w
a
v
ai
l
a
b
le
i
n
t
e
r
v
e
n
t
i
o
n
s
t
o
e
n
h
a
n
c
e
r
e
s
i
l
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n
c
e
a
m
o
n
g
b
r
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a
s
t
c
a
n
c
e
r
p
a
t
i
e
n
ts
,
i
d
e
n
ti
f
y
t
h
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m
o
s
t
e
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f
e
c
ti
v
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a
p
p
r
o
a
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h
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s
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n
d
p
r
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d
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d
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c
e
-
b
a
s
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g
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c
e
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o
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h
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a
l
t
h
c
a
r
e
p
r
a
c
ti
t
i
o
n
e
r
s
.
2.
M
E
T
H
O
D
W
e
co
m
p
iled
p
er
tin
e
n
t
r
esear
ch
o
n
b
o
o
s
tin
g
b
r
ea
s
t
ca
n
ce
r
p
atien
ts
'
r
esil
ien
ce
th
r
o
u
g
h
s
y
s
tem
atic
r
ev
iews.
Utilizin
g
th
e
J
o
an
n
a
B
r
ig
g
s
I
n
s
titu
te
Gu
id
elin
es
an
d
th
e
C
en
tr
e
f
o
r
R
ev
iew
an
d
Dis
s
em
in
atio
n
,
we
em
p
lo
y
ed
th
e
PR
I
SMA
ch
ec
k
lis
t o
f
q
u
esti
o
n
s
to
ass
ess
th
e
s
t
u
d
y
'
s
q
u
ality
[
1
6
]
,
[
1
7
]
.
2
.
1
.
Sea
rc
h str
a
t
eg
y
a
nd
inclu
s
io
n c
rit
er
ia
f
o
r
s
y
s
t
em
a
t
ic
re
v
iews
A
s
tr
ateg
ic
liter
atu
r
e
s
ea
r
ch
was
co
n
d
u
cted
u
s
in
g
ter
m
s
s
u
ch
as
“r
esil
ien
ce
,
”
“b
r
ea
s
t
ca
n
ce
r
,
”
“RC
T
,
”
an
d
“stre
s
s
.
”
B
o
o
lean
o
p
er
at
o
r
s
(
AND/OR)
wer
e
ap
p
lied
to
r
e
f
in
e
th
e
s
ea
r
ch
.
AND
R
C
T
A
ND
Stre
s
s
;
lo
o
k
in
g
f
o
r
p
e
r
tin
en
t
p
u
b
licatio
n
s
f
r
o
m
o
th
er
r
e
f
er
en
ce
s
;
s
ea
r
ch
in
g
ar
ticles
in
d
atab
ases
lik
e
Sco
p
u
s
,
Scien
ce
Dir
ec
t,
Pro
Qu
est,
an
d
W
eb
o
f
Scien
ce
.
T
h
e
PIC
OS
cr
iter
ia
(
p
o
p
u
latio
n
,
in
ter
v
en
tio
n
,
co
m
p
ar
is
o
n
,
o
u
tco
m
e,
an
d
s
tu
d
y
d
esig
n
)
a
r
e
u
s
ed
to
d
ef
in
e
th
e
in
clu
s
io
n
cr
iter
ia
f
o
r
jo
u
r
n
al
ar
ticles
p
u
b
lis
h
ed
d
u
r
in
g
th
e
p
r
ev
io
u
s
f
i
v
e
y
ea
r
s
,
f
r
o
m
2
0
1
9
to
2
0
2
4
,
as sh
o
w
n
in
T
a
b
le
1
.
T
ab
le
1
.
I
n
clu
s
io
n
an
d
ex
clu
s
i
o
n
cr
iter
ia
with
PICOS
C
r
i
t
e
r
i
a
I
n
c
l
u
s
i
o
n
Ex
c
l
u
s
i
o
n
P
o
p
u
l
a
t
i
o
n
b
r
e
a
s
t
c
a
n
c
e
r
O
t
h
e
r
t
h
a
n
b
r
e
a
s
t
c
a
n
c
e
r
I
n
t
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r
v
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n
t
i
o
n
I
n
c
r
e
a
ses
r
e
si
s
t
a
n
c
e
Th
e
r
e
a
r
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n
o
e
x
c
l
u
s
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o
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c
r
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t
e
r
i
a
C
o
m
p
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t
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O
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se
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t
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Ty
p
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b
l
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c
a
t
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n
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l
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d
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s s
u
b
j
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t
e
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t
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p
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e
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r
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v
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U
n
r
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d
r
e
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a
r
c
h
st
u
d
i
e
s
Y
e
a
r
s
2
0
1
9
sa
mp
a
i
2
0
2
4
P
r
e
2
0
1
9
La
n
g
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a
g
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En
g
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sh
La
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a
g
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b
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d
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E
n
g
l
i
s
h
7
9
5
a
r
ticles
f
r
o
m
4
s
o
u
r
ce
s
(
S
co
p
u
s
,
Scien
ce
Dir
ec
t,
Pro
Qu
e
s
t,
an
d
W
eb
o
f
Scien
ce
)
we
r
e
f
o
u
n
d
in
th
e
s
ea
r
ch
r
esu
lts
.
On
e
o
f
th
e
twen
ty
-
one
ar
ticles
th
at
wer
e
ass
es
s
ed
d
id
n
o
t
f
it
th
e
r
eq
u
ir
em
en
ts
s
in
ce
it
h
ad
n
o
th
in
g
t
o
d
o
with
th
e
s
tu
d
y
'
s
g
o
al.
T
wen
ty
p
ap
e
r
s
th
at
s
atis
f
y
th
e
in
clu
s
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n
cr
iter
ia
an
d
th
e
r
esear
ch
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ic
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e
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s
elec
ted
f
o
r
in
clu
s
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n
in
th
is
s
tu
d
y
.
T
h
e
in
cl
u
s
io
n
cr
iter
ia,
wh
ich
in
clu
d
e:
i)
R
C
T
an
d
ex
p
er
im
en
ts
p
u
b
lis
h
ed
in
E
n
g
lis
h
-
lan
g
u
ag
e
p
ee
r
-
r
e
v
iewe
d
jo
u
r
n
als
b
et
wee
n
2
0
1
9
an
d
2
0
2
4
;
ii)
s
tu
d
y
p
ar
ticip
an
ts
wit
h
a
clin
ical
d
iag
n
o
s
is
o
f
b
r
ea
s
t
ca
n
ce
r
;
an
d
iii)
in
ter
v
en
tio
n
s
p
r
o
m
o
tin
g
r
esil
ien
ce
,
ar
e
u
s
ed
to
ev
alu
ate
th
e
titl
e
an
d
ab
s
tr
ac
t
m
an
u
s
cr
ip
ts
f
o
r
r
elev
an
ce
to
th
e
to
p
ic.
T
h
e
w
h
o
le
ar
ticle
is
r
ev
iewe
d
to
ev
al
u
ate
if
it
s
h
o
u
ld
b
e
in
clu
d
ed
if
th
e
f
ir
s
t
r
ev
iew
'
s
f
i
n
d
in
g
s
d
o
n
o
t
clea
r
ly
r
e
v
ea
l
its
r
elev
an
ce
.
T
o
g
u
ar
an
tee
th
at
th
e
o
r
ig
in
al
ar
ticle
is
u
ltima
tely
in
clu
d
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in
th
e
r
ev
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th
e
en
tire
co
n
ten
t
is
r
ea
d
o
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ce
it
h
as
b
ee
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g
ath
er
ed
.
H
er
e,
twen
ty
ar
ticles
s
atis
f
y
th
e
r
eq
u
ir
em
en
ts
f
o
r
in
clu
s
io
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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I
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Sci
,
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l.
14
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4
,
Dec
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b
er
20
25
:
1
7
1
0
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1
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1
9
1712
2
.
2
.
Study
s
elec
t
io
n,
da
t
a
ex
t
ra
ct
io
n,
a
nd
ma
na
g
e
m
ent
Dete
r
m
in
e
wh
eth
er
cr
u
cial
el
em
en
ts
,
lik
e
th
e
r
esear
ch
d
es
ig
n
,
s
y
s
tem
atic
r
ev
iew,
clin
ic
al
tr
ials
,
ca
s
e
co
n
tr
o
l,
c
r
o
s
s
-
s
ec
tio
n
al,
ca
s
e
r
ep
o
r
t,
d
escr
ip
tiv
e
s
tu
d
y
,
an
d
ex
p
e
r
im
en
t
,
n
ee
d
to
b
e
tak
en
o
u
t
o
f
ea
ch
s
tu
d
y
.
Patien
ts
with
b
r
ea
s
t
ca
n
ce
r
m
ad
e
u
p
th
e
s
am
p
le
p
o
p
u
latio
n
.
T
h
e
m
ajo
r
r
esu
lts
,
an
aly
tical
tech
n
iq
u
es,
an
d
co
n
cl
u
s
io
n
s
p
er
tain
in
g
to
th
er
ap
ies
aim
ed
at
en
h
an
cin
g
p
atien
ts
'
r
esil
ien
ce
in
th
e
f
ac
e
o
f
b
r
ea
s
t
ca
n
ce
r
.
Ma
k
e
a
tab
le
to
in
cl
u
d
e
th
e
in
f
o
r
m
atio
n
g
lean
e
d
f
r
o
m
e
ac
h
s
tu
d
y
,
alo
n
g
with
a
n
y
p
er
tin
en
t
d
etails
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d
co
n
clu
s
io
n
s
p
er
tain
in
g
to
th
e
s
u
b
ject
o
f
th
e
in
v
esti
g
atio
n
.
Ma
k
e
s
u
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e
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.
[
1
8
]
.
T
h
i
s
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w
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it
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3.
RE
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D
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ates
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u
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PR
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SMA
3
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2
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tio
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s
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r
esil
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ce
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h
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p
ar
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’
ag
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d
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r
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1
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3
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8
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1
[
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9
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S
p
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B
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a
s
t
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≥
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1
1
[
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n
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a
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2
[
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a
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≥
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[
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[
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[
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[
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P
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Lu
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3
9
[
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7
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S
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[
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a
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c
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>
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3.
3
.
1
.
F
a
m
ily
a
nd
s
o
cia
l su
pp
o
rt
C
an
ce
r
p
atien
ts
'
wel
l
-
b
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g
h
as
b
ee
n
d
em
o
n
s
tr
ated
to
b
en
ef
it
f
r
o
m
f
a
m
ilial,
s
p
ir
itu
al,
an
d
s
o
cial
s
u
p
p
o
r
t
r
o
les,
wh
ich
in
clu
d
e
m
o
r
al,
p
r
ac
tical,
a
n
d
em
o
tio
n
al
ca
r
e
f
r
o
m
p
atien
ts
'
r
elativ
e
s
[
3
9
]
,
[
4
0
]
.
So
cial
s
u
p
p
o
r
t,
tr
u
s
t,
an
d
p
ar
ticip
ati
o
n
in
s
o
cial
n
etwo
r
k
in
g
s
ites
ca
n
also
p
lay
im
p
o
r
tan
t
h
ea
lth
-
r
elate
d
r
o
les
[
4
1
]
.
T
h
e
f
am
ily
is
o
f
te
n
th
e
p
r
im
ar
y
s
o
u
r
ce
o
f
s
u
p
p
o
r
t in
t
h
e
p
ati
en
t'
s
jo
u
r
n
ey
d
u
r
i
n
g
tr
e
atm
e
n
t
[
4
2
]
-
[
4
4
]
.
T
h
e
p
u
r
p
o
s
e
o
f
th
e
s
tu
d
y
was
to
ass
es
s
r
esil
ien
ce
in
ca
n
ce
r
p
atien
ts
an
d
th
e
v
ar
iab
les
th
at
af
f
ec
ted
it.
T
h
e
s
tu
d
y
em
p
h
asized
th
e
v
alu
e
o
f
s
o
cial
s
u
p
p
o
r
t
in
a
d
d
itio
n
to
th
e
ef
f
ec
ts
o
f
tr
a
ch
eo
to
m
y
,
an
x
iety
,
d
ep
r
ess
io
n
,
an
d
f
am
ily
s
ize
o
n
r
esil
ien
ce
.
R
esil
ien
ce
was
al
s
o
f
o
u
n
d
to
b
e
s
ig
n
if
ican
tly
in
f
lu
en
ce
d
b
y
f
o
r
m
al
ed
u
ca
tio
n
an
d
its
f
u
n
ctio
n
in
f
am
ily
d
ec
is
io
n
-
m
ak
in
g
[
4
5
]
.
Fo
r
p
atien
ts
to
im
p
r
o
v
e
th
eir
g
en
er
al
h
ea
lth
an
d
r
ec
o
v
er
f
r
o
m
d
is
ea
s
e,
s
p
o
u
s
es' e
m
o
tio
n
al
s
u
p
p
o
r
t a
n
d
f
r
ien
d
s
'
in
f
o
r
m
e
d
s
u
p
p
o
r
t a
r
e
c
r
u
cial
[
4
6
]
.
Hu
s
b
an
d
s
ca
r
in
g
f
o
r
th
eir
s
p
o
u
s
es
with
b
r
ea
s
t
ca
n
ce
r
m
a
y
h
av
e
less
s
tr
ess
if
th
ey
h
av
e
g
r
e
ater
s
o
cial
s
u
p
p
o
r
t,
f
a
m
ily
r
esil
ien
ce
,
an
d
p
er
s
o
n
al
r
esil
ien
ce
[
4
7
]
-
[
4
9
]
.
C
an
ce
r
p
atien
ts
'
q
u
ality
o
f
life
is
s
ig
n
if
ican
tly
im
p
ac
ted
b
y
f
am
ily
r
esil
ien
ce
[
1
4
]
,
an
d
b
r
ea
s
t
ca
n
ce
r
p
atien
ts
h
av
e
h
ig
h
lig
h
ted
im
p
o
r
ta
n
t
in
f
o
r
m
ati
o
n
th
at
s
o
cial
n
etwo
r
k
s
r
eq
u
ir
e
in
o
r
d
er
to
ef
f
ec
tiv
ely
ass
is
t
th
em
.
R
esear
ch
h
as
d
em
o
n
s
tr
ated
a
s
u
b
s
tan
tial
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
f
am
ily
r
esil
ien
ce
,
th
e
q
u
ality
o
f
in
ter
p
er
s
o
n
al
co
m
m
u
n
icatio
n
,
an
d
th
e
im
p
r
ess
io
n
o
f
s
u
p
p
o
r
t
f
r
o
m
o
n
e'
s
s
p
o
u
s
e
[
5
0
]
.
Fam
ily
-
ce
n
ter
ed
l
u
n
g
ca
n
ce
r
tr
ea
tm
e
n
t
is
r
ec
o
m
m
en
d
ed
,
as
is
th
e
d
ev
elo
p
m
e
n
t o
f
a
p
p
r
o
p
r
iate
f
a
m
ily
s
u
p
p
o
r
t
n
etwo
r
k
s
[
5
1
]
,
[
5
2
]
.
R
esear
ch
o
n
th
e
ca
r
eg
iv
i
n
g
b
u
r
d
e
n
o
f
f
am
ilie
s
with
lu
n
g
ca
n
ce
r
p
atien
ts
co
n
d
u
cted
in
C
h
in
a
d
em
o
n
s
tr
ates
th
e
s
ig
n
if
ican
t
im
p
ac
t
th
at
f
am
ily
r
esil
ien
ce
h
as
in
m
itig
atin
g
ca
r
eg
i
v
in
g
s
tr
ess
[
5
3
]
.
Go
o
d
s
o
cial
s
u
p
p
o
r
t
ca
n
in
cr
ea
s
e
f
a
m
ily
r
esil
ien
ce
,
th
er
eb
y
r
e
d
u
c
in
g
th
e
b
u
r
d
en
o
f
n
u
r
s
in
g
an
d
em
p
h
asizin
g
t
h
e
im
p
o
r
tan
ce
o
f
f
am
ily
-
ce
n
tr
ic
c
ar
e
[
5
4
]
,
[
5
5
]
.
Fo
r
th
e
r
elativ
e
s
o
f
b
r
ea
s
t c
an
ce
r
p
atien
ts
to
b
e
ab
le
to
ad
ju
s
t a
n
d
g
et
th
r
o
u
g
h
th
e
d
i
f
f
icu
lties
,
f
a
m
ily
r
esil
ien
ce
is
also
ess
en
tial.
I
t
h
as
b
ee
n
d
e
m
o
n
s
tr
ated
t
h
a
t
f
am
ily
r
esil
ien
ce
-
f
o
cu
s
ed
in
te
r
v
en
tio
n
s
a
r
e
b
en
ef
icial
in
lo
wer
in
g
s
tr
ess
,
an
x
iety
,
an
d
d
ep
r
ess
io
n
wh
ile
als
o
en
h
a
n
cin
g
s
o
cial
s
u
p
p
o
r
t
an
d
p
r
o
b
lem
-
s
o
lv
i
n
g
s
k
ills
[
5
0
]
.
I
n
ad
d
itio
n
,
im
p
r
o
v
ed
co
m
m
u
n
icatio
n
a
n
d
s
u
p
p
o
r
t
b
etwe
en
p
ar
t
n
er
s
ca
n
in
cr
ea
s
e
f
am
ily
r
esil
ien
c
e
to
tr
an
s
itio
n
al
g
y
n
ec
o
lo
g
ic
al
ca
n
ce
r
s
.
Hea
lth
s
er
v
ices
in
r
u
r
al
a
r
ea
s
m
ay
co
n
s
id
er
ex
p
an
d
in
g
tr
an
s
p
o
r
t
atio
n
ass
is
tan
ce
an
d
ac
ce
s
s
to
b
en
ef
its
to
r
ed
u
ce
n
u
r
s
in
g
s
tr
ess
[
5
6
]
.
T
h
e
r
esear
ch
er
s
will
also
test
th
e
ef
f
ec
tiv
en
ess
o
f
f
am
ily
r
esil
ien
ce
in
ter
v
e
n
tio
n
p
r
o
g
r
am
s
th
at
f
o
cu
s
o
n
b
r
ea
s
t
can
ce
r
p
atien
ts
,
in
clu
d
in
g
o
n
lin
e
f
am
ily
g
ath
er
in
g
s
led
b
y
tr
ain
ed
p
r
o
f
ess
io
n
als,
wh
ich
ar
e
ex
p
ec
ted
t
o
im
p
r
o
v
e
r
esil
ien
ce
in
b
r
ea
s
t c
a
n
ce
r
p
atien
t f
a
m
ilies
[
5
7
]
.
C
o
m
p
r
eh
en
d
in
g
th
e
in
ter
p
la
y
o
f
p
s
y
ch
o
lo
g
ical,
s
o
cial,
an
d
s
p
ir
itu
al
elem
en
ts
m
ig
h
t
lead
to
m
o
r
e
all
-
en
co
m
p
ass
in
g
a
n
d
e
f
f
icac
io
u
s
ap
p
r
o
ac
h
es
f
o
r
ad
d
r
ess
in
g
m
e
n
tal
h
ea
lth
is
s
u
es
in
ca
n
ce
r
p
at
ien
ts
[
5
8
]
.
Ho
lis
tic
th
er
ap
y
r
eq
u
ir
es
ac
k
n
o
wled
g
i
n
g
th
e
im
p
o
r
tan
ce
o
f
s
p
ir
itu
al
ity
in
m
en
tal
h
ea
lth
a
n
d
r
eh
a
b
ilit
atio
n
in
a
d
d
itio
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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6
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t J Pu
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Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
7
1
0
-
1
7
1
9
1714
to
b
io
lo
g
ical,
p
s
y
ch
o
lo
g
ical,
a
n
d
s
o
cial
f
ac
to
r
s
[
5
9
]
-
[
6
1
]
.
T
h
e
s
tu
d
y
also
c
o
v
er
s
th
e
v
ar
ia
b
les
th
at
af
f
ec
t
th
e
b
u
r
d
e
n
th
at
C
h
in
ese
ca
r
eg
iv
er
s
o
f
lu
n
g
ca
n
ce
r
p
atien
ts
p
er
ce
iv
e.
I
t
also
em
p
h
asi
ze
s
th
e
s
ig
n
if
ican
ce
o
f
f
am
ily
-
ce
n
tr
ic
ca
r
e
an
d
th
e
r
o
l
e
th
at
f
am
ily
r
esil
ien
ce
p
lay
s
as
a
m
ed
iato
r
b
etwe
en
th
e
lev
el
o
f
s
o
cial
s
u
p
p
o
r
t
an
d
ca
r
eg
i
v
er
b
u
r
d
e
n
[
5
3
]
.
T
ab
le
3
.
I
n
ter
v
en
tio
n
s
to
en
h
a
n
ce
th
e
r
esil
ien
ce
o
f
ca
n
ce
r
p
a
tien
ts
No
R
e
se
a
r
c
h
Ty
p
e
o
f
r
e
s
e
a
r
c
h
I
n
t
e
r
v
e
n
t
i
o
n
C
l
u
st
e
r
i
n
g
i
n
t
e
r
v
e
n
t
i
o
n
1
[
1
9
]
RCT
P
e
e
r
s
u
p
p
o
r
t
p
r
o
g
r
a
m
F
a
mi
l
y
a
n
d
so
c
i
a
l
su
p
p
o
r
t
2
[
2
0
]
P
r
e
t
e
s
t
s a
n
d
p
o
s
t
t
e
st
s
,
a
n
d
a
c
o
n
t
r
o
l
g
r
o
u
p
su
p
p
o
r
t
g
r
o
u
p
i
n
t
e
r
v
e
n
t
i
o
n
3
[
2
1
]
RCT
M
u
s
i
c
p
s
y
c
h
o
t
h
e
r
a
p
y
M
u
s
i
c
t
h
e
r
a
p
y
4
[
2
2
]
RCT
M
u
s
i
c
i
n
t
e
r
v
e
n
t
i
o
n
5
[
2
3
]
RCT
M
i
n
d
f
u
l
w
a
l
k
i
n
g
M
i
n
d
f
u
l
n
e
ss
6
[
2
4
]
RCT
M
i
n
d
f
u
l
n
e
ss
-
b
a
se
d
f
i
t
n
e
ss
t
r
a
i
n
i
n
g
p
r
o
g
r
a
m
7
[
2
5
]
A
si
n
g
l
e
-
g
r
o
u
p
p
r
e
t
e
s
t
a
n
d
r
e
p
e
a
t
e
d
mi
d
-
a
n
d
p
o
s
t
-
t
e
st
M
i
n
d
f
u
l
n
e
ss
-
b
a
se
d
S
t
r
e
ss re
d
u
c
t
i
o
n
8
[
2
6
]
RCT
M
i
n
d
f
u
l
n
e
ss
-
b
a
se
d
c
o
g
n
i
t
i
v
e
t
h
e
r
a
p
y
i
n
t
e
r
v
e
n
t
i
o
n
9
[
2
7
]
N
o
n
r
a
n
d
o
mi
z
e
d
M
i
n
d
f
u
l
n
e
ss
-
b
a
se
d
S
t
r
e
ss
r
e
d
u
c
t
i
o
n
1
0
[
2
8
]
M
i
x
e
d
-
me
t
h
o
d
s
u
n
c
o
n
t
r
o
l
l
e
d
s
t
u
d
y
C
o
g
n
i
t
i
v
e
b
e
h
a
v
i
o
u
r
a
l
t
h
e
r
a
p
y
,
a
c
c
e
p
t
a
n
c
e
a
n
d
c
o
mm
i
t
me
n
t
t
h
e
r
a
p
y
,
mi
n
d
f
u
l
n
e
ss,
a
n
d
p
o
si
t
i
v
e
p
s
y
c
h
o
l
o
g
y
1
1
[
2
9
]
RCT
Ed
u
c
a
t
e
t
h
e
f
r
e
d
r
i
c
k
so
n
p
o
si
t
i
v
e
e
m
o
t
i
o
n
s
1
2
[
3
0
]
RCT
P
sy
c
h
o
l
o
g
i
c
a
l
i
n
t
e
r
v
e
n
t
i
o
n
1
3
[
3
1
]
RCT
P
sy
c
h
o
s
o
c
i
a
l
i
n
t
e
r
v
e
n
t
i
o
n
1
4
[
3
2
]
RCT
F
a
mi
l
y
c
e
n
t
e
r
e
d
p
o
s
i
t
i
v
e
p
s
y
c
h
o
l
o
g
i
c
a
l
i
n
t
e
r
v
e
n
t
i
o
n
1
5
[
3
3
]
RCT
C
o
g
n
i
t
i
v
e
b
e
h
a
v
i
o
r
a
l
Th
e
r
a
p
y
C
o
g
n
i
t
i
v
e
b
e
h
a
v
i
o
r
a
l
t
h
e
r
a
p
y
1
6
[
3
4
]
RCT
C
o
g
n
i
t
i
v
e
b
e
h
a
v
i
o
r
a
l
t
h
e
r
a
p
y
17
[
3
5
]
RCT
C
y
c
l
i
c
a
d
j
u
st
m
e
n
t
t
r
a
i
n
i
n
g
(
C
A
T)
u
s
i
n
g
W
e
C
h
a
t
f
o
r
w
o
me
n
w
i
t
h
b
r
e
a
s
t
c
a
n
c
e
r
D
i
g
i
t
a
l
-
b
a
se
d
i
n
t
e
r
v
e
n
t
i
o
n
s
18
[
3
6
]
RCT
D
i
g
i
t
a
l
H
O
P
E
p
r
o
g
r
a
m
19
[
3
7
]
RCT
P
sy
c
h
o
e
d
u
c
a
t
i
o
n
a
l
i
n
t
e
r
v
e
n
t
i
o
n
P
sy
c
h
o
e
d
u
c
a
t
i
o
n
a
l
i
n
t
e
r
v
e
n
t
i
o
n
20
[
3
8
]
A
M
i
x
e
d
M
e
t
h
o
d
s S
t
u
d
y
P
sy
c
h
o
e
d
u
c
a
t
i
o
n
a
l
i
n
t
e
r
v
e
n
t
i
o
n
3.
3
.
2
.
M
us
ic
t
hera
py
Patien
ts
w
ith
b
r
ea
s
t
ca
n
ce
r
f
r
eq
u
e
n
tly
h
av
e
clin
ically
s
u
b
s
tan
tial
d
ep
r
ess
io
n
an
d
m
ild
an
x
iety
.
Fo
llo
win
g
an
ar
t
-
b
ased
m
an
d
a
la
in
ter
v
en
tio
n
,
t
h
ey
ex
p
er
ien
c
ed
a
m
ar
k
ed
r
ed
u
ctio
n
in
f
ea
r
.
No
n
eth
eless
,
th
eir
an
x
iety
d
id
n
o
t
g
o
d
o
wn
,
m
o
s
t
lik
ely
as
a
r
esu
lt
o
f
o
u
ts
id
e
in
f
lu
en
ce
s
lik
e
th
e
C
OVI
D
-
19
ep
id
e
m
ic.
T
h
e
s
tu
d
y
'
s
f
in
d
in
g
s
s
h
o
wed
th
at
a
lth
o
u
g
h
ar
t
-
b
ased
m
an
d
ala
tr
e
atm
en
ts
wer
e
ef
f
ec
tiv
e
i
n
r
e
d
u
cin
g
p
atien
ts
'
f
ea
r
,
th
ey
wer
e
less
ef
f
ec
tiv
e
in
r
e
d
u
cin
g
th
eir
a
n
x
iety
,
p
o
s
s
ib
ly
d
u
e
to
o
u
ts
id
e
f
ac
to
r
s
[
6
2
]
.
Nu
m
e
r
o
u
s
elem
e
n
ts
,
in
clu
d
in
g
h
o
w
o
p
tim
is
m
,
r
esil
ien
ce
,
a
n
d
s
o
cial
s
u
p
p
o
r
t
af
f
ec
t
o
n
e'
s
well
-
b
ein
g
,
h
av
e
an
im
p
ac
t
o
n
th
e
q
u
alit
y
o
f
life
ex
p
e
r
ien
ce
d
b
y
ca
n
ce
r
p
atien
ts
.
T
h
ese
elem
en
ts
ar
e
cr
u
cial
f
o
r
th
e
f
lex
ib
ilit
y
an
d
o
v
e
r
all
h
ea
lth
o
f
p
atien
ts
,
an
d
th
ey
m
ay
b
e
u
s
ed
to
d
ev
elo
p
n
ew
th
er
ap
eu
tic
ap
p
r
o
ac
h
es
[
4
6
]
.
I
n
ad
d
itio
n
,
th
e
r
esear
ch
h
i
g
h
l
ig
h
ts
th
e
s
ig
n
if
ican
ce
o
f
f
am
ily
r
esil
ien
ce
in
ter
v
en
tio
n
s
as
a
m
ea
n
s
o
f
ass
i
s
tin
g
r
elativ
es
o
f
b
r
ea
s
t
ca
n
ce
r
p
atien
ts
in
b
etter
m
an
ag
i
n
g
t
h
eir
ch
allen
g
es
[
5
4
]
.
T
h
e
r
e
p
o
r
t'
s
o
th
er
p
a
p
er
s
em
p
h
asize
th
e
n
ee
d
to
id
e
n
t
if
y
th
e
em
er
g
e
n
cy
p
r
o
f
ile
o
f
p
atien
ts
with
g
y
n
ec
o
lo
g
ica
l
ca
n
ce
r
r
ec
eiv
in
g
ch
em
o
th
er
a
p
y
,
c
o
m
p
r
e
h
en
d
th
eir
r
is
k
f
ac
to
r
s
,
an
d
o
f
f
er
s
u
ita
b
le
p
s
y
ch
o
s
o
cial
s
u
p
p
o
r
t ser
v
i
ce
s
[
6
3
]
.
3
.
3
.
3
.
M
ind
f
uln
e
s
s
Min
d
f
u
ln
ess
is
a
p
r
ac
tice
o
f
f
u
ll
co
n
s
cio
u
s
n
ess
in
v
o
lv
i
n
g
atten
tio
n
to
cu
r
r
en
t
ex
p
er
ie
n
c
es
with
o
u
t
ju
d
g
m
en
t.
Min
d
f
u
ln
ess
is
u
s
ef
u
l
in
r
e
d
u
cin
g
s
tr
ess
,
an
x
iety
,
an
d
d
ep
r
ess
io
n
,
as
well
as
im
p
r
o
v
i
n
g
em
o
tio
n
al
an
d
m
en
tal
well
-
b
ein
g
.
I
n
b
r
ea
s
t
ca
n
ce
r
p
atien
ts
,
m
in
d
f
u
l
n
ess
h
elp
s
m
an
ag
e
th
e
p
h
y
s
ical
an
d
em
o
tio
n
al
s
y
m
p
to
m
s
ass
o
ciate
d
with
th
e
d
is
ea
s
e
an
d
its
tr
ea
tm
en
t.
Var
io
u
s
tech
n
iq
u
es,
s
u
c
h
as
m
ed
it
atio
n
an
d
y
o
g
a
,
ar
e
f
r
eq
u
e
n
tly
u
s
ed
,
an
d
r
esear
ch
s
h
o
ws
th
at
m
in
d
f
u
ln
ess
is
ef
f
ec
tiv
e
in
im
p
r
o
v
i
n
g
th
e
q
u
ality
o
f
life
o
f
p
atien
ts
.
T
h
is
s
ec
tio
n
also
r
e
co
m
m
e
n
d
s
in
teg
r
atin
g
m
in
d
f
u
l
n
ess
in
to
c
an
ce
r
p
atien
t
ca
r
e
p
r
o
g
r
am
s
a
n
d
tr
ai
n
in
g
m
ed
ical
s
taf
f
to
s
u
p
p
o
r
t
th
ese
p
r
ac
tice
s
.
Min
d
f
u
ln
ess
-
b
ased
s
tr
ess
r
ed
u
ctio
n
(
MBS
R
)
is
an
in
ter
v
e
n
tio
n
th
at
en
h
an
ce
s
s
u
f
f
er
in
g
to
ler
a
n
ce
a
n
d
e
n
d
u
r
an
ce
b
y
p
r
o
m
o
tin
g
ch
an
g
es
in
m
in
d
f
u
ln
ess
.
R
esil
ien
ce
is
d
e
f
in
ed
as
th
e
ab
ilit
y
to
g
et
b
ac
k
an
d
r
ec
o
v
er
q
u
ick
l
y
f
r
o
m
s
tr
ess
,
an
d
m
in
d
f
u
ln
ess
tr
ain
in
g
h
as b
ee
n
s
h
o
wn
to
en
h
an
ce
s
elf
-
esteem
,
wh
ich
s
h
o
ws
r
esil
ien
ce
.
Ho
wev
er
,
n
o
r
esear
ch
h
as
d
ir
ec
tly
ex
p
lo
r
e
d
th
e
e
f
f
ec
ts
o
f
MBS
R
o
n
s
u
f
f
er
in
g
to
ler
an
ce
an
d
r
esil
ien
ce
.
MBS
R
h
as
th
e
p
o
ten
tial
to
eq
u
ip
in
d
iv
id
u
als
with
p
r
o
tectiv
e
ab
ili
ties
th
at
s
tr
en
g
th
en
p
s
y
ch
o
lo
g
ical
h
ea
lth
an
d
r
ed
u
ce
th
e
r
is
k
o
f
d
ev
elo
p
in
g
f
u
tu
r
e
p
s
y
ch
o
p
at
h
o
lo
g
ies
[
6
4
]
-
[
6
6
]
.
I
n
cr
ea
s
in
g
th
e
n
u
m
b
er
o
f
ev
id
en
ce
-
b
ased
p
s
y
ch
o
s
o
cial
tr
ea
tm
en
ts
in
clu
d
ed
in
m
en
tal
h
ea
l
th
ca
r
e
ca
n
h
elp
p
atien
ts
g
ain
n
ew
s
k
ills
,
b
ec
o
m
e
m
o
r
e
in
d
ep
e
n
d
en
t,
a
n
d
b
e
m
o
r
e
m
o
tiv
ated
to
r
ec
o
v
er
[
6
7
]
.
T
h
e
s
tu
d
y
em
p
h
asizes
th
e
im
p
o
r
tan
ce
o
f
g
iv
in
g
p
atien
ts
a
ch
o
ice
an
d
en
h
a
n
ci
n
g
d
ialo
g
u
e
b
e
twee
n
p
atien
ts
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
n
terven
tio
n
s
to
imp
r
o
ve
r
esil
ien
ce
in
b
r
ea
s
t c
a
n
ce
r
p
a
tien
ts
:
a
s
ystema
tic
r
ev
iew
(
D
w
i
R
et
n
a
n
in
g
s
ih
)
1715
th
er
ap
is
ts
in
m
e
n
tal
h
ea
lth
ca
r
e.
E
v
al
u
atio
n
o
f
th
e
ef
f
ec
tiv
e
n
ess
o
f
in
te
r
v
en
tio
n
s
is
cr
u
cia
l
to
p
er
f
ec
tin
g
an
d
o
p
tim
izin
g
f
u
tu
r
e
r
esil
ien
ce
p
r
o
g
r
a
m
s
[
6
8
]
,
[
6
9
]
.
T
h
e
ar
t
icle
also
d
is
cu
s
s
es
d
if
f
er
en
t
an
x
iety
p
r
o
f
iles
in
p
ati
en
ts
with
g
y
n
ec
o
lo
g
ical
ca
n
ce
r
u
n
d
er
g
o
in
g
ch
e
m
o
th
e
r
ap
y
,
em
p
h
asizin
g
th
e
im
p
o
r
tan
ce
o
f
ass
ess
in
g
an
x
ieties,
u
n
d
er
s
tan
d
i
n
g
r
is
k
f
ac
to
r
s
,
an
d
p
r
o
v
i
d
in
g
a
p
p
r
o
p
r
i
ate
p
s
y
ch
o
s
o
cial
s
u
p
p
o
r
t ser
v
i
ce
s
[
6
3
]
.
3
.
3
.
4
.
Co
g
nitiv
e
beha
v
io
r
a
l t
hera
py
(
CB
T
)
A
b
r
o
ad
tech
n
i
q
u
e
ca
lled
co
g
n
itiv
e
-
b
eh
a
v
io
r
al
th
er
a
p
y
(
C
B
T
)
r
ed
u
ce
s
n
eg
ativ
e
th
o
u
g
h
t
p
atter
n
s
,
en
co
u
r
a
g
es
jo
y
f
u
l
ac
tiv
ities
,
an
d
im
p
r
o
v
es
s
o
cial
an
d
p
r
o
b
l
em
-
s
o
lv
in
g
s
k
ills
[
7
0
]
,
[
7
1
]
.
Su
p
p
o
r
t
-
e
x
p
r
ess
iv
e
g
r
o
u
p
th
e
r
ap
y
,
m
in
d
f
u
ln
ess
,
p
o
s
itiv
e
p
s
y
ch
o
lo
g
y
,
a
n
d
atte
n
tio
n
-
b
ased
p
s
y
ch
o
th
er
ap
y
a
r
e
f
u
r
t
h
er
t
h
er
ap
ies.
T
h
e
g
o
als
o
f
all
th
ese
in
ter
v
en
tio
n
s
ar
e
to
im
p
r
o
v
e
th
e
a
b
ilit
y
to
s
o
lv
e
p
r
o
b
lem
s
,
b
e
s
elf
-
s
u
f
f
icien
t,
o
p
tim
is
tic,
an
d
to
ler
ate
b
ad
cir
cu
m
s
tan
c
es
an
d
em
o
tio
n
s
.
R
esis
tan
ce
tr
ain
in
g
h
as
d
e
m
o
n
s
tr
ated
b
en
ef
its
f
o
r
c
an
ce
r
p
atien
ts
'
d
ev
elo
p
m
en
t
an
d
p
o
s
t
-
tr
au
m
atic
en
d
u
r
a
n
ce
,
p
ar
ticu
lar
ly
f
o
llo
win
g
d
ia
g
n
o
s
is
an
d
as
th
e
in
ter
v
en
tio
n
'
s
len
g
th
in
cr
ea
s
es
[
7
2
]
.
R
esear
ch
o
n
p
atien
ts
with
b
r
e
ast
ca
n
ce
r
wh
o
u
n
d
er
wen
t
C
B
T
r
ev
ea
led
r
e
d
u
ce
d
f
ee
lin
g
s
o
f
a
n
x
iety
an
d
s
ad
n
ess
an
d
en
h
a
n
ce
d
r
es
ilien
ce
[
7
3
]
.
T
h
is
im
p
lies
th
at
C
B
T
m
ay
b
e
a
u
s
ef
u
l
s
tr
ateg
y
f
o
r
r
aisi
n
g
b
r
ea
s
t
ca
n
ce
r
p
atien
ts
'
q
u
ality
o
f
life
.
I
t's
n
o
r
m
al
f
o
r
wo
m
en
wh
o
g
et
a
b
r
ea
s
t
ca
n
ce
r
d
iag
n
o
s
is
to
h
av
e
f
ee
lin
g
s
o
f
d
esp
er
atio
n
a
n
d
an
x
iety
ab
o
u
t
th
e
f
u
tu
r
e.
Hav
in
g
r
ec
eiv
e
d
C
B
T
,
th
o
u
g
h
,
i
n
d
iv
id
u
als
ar
e
ab
le
to
g
et
o
v
e
r
n
eg
ativ
e
id
ea
s
a
n
d
m
u
s
ter
th
e
will
to
b
attle
th
e
illn
ess
.
T
h
e
y
lear
n
h
o
w
to
c
o
n
tr
o
l
th
eir
s
tr
e
s
s
an
d
an
x
iety
with
th
e
u
s
e
o
f
C
B
T
,
wh
ich
e
n
h
an
c
es
th
eir
q
u
ality
o
f
life
a
n
d
q
u
i
ck
en
s
th
e
h
ea
lin
g
p
r
o
ce
s
s
.
B
y
u
s
in
g
t
h
is
s
tr
ateg
y
,
k
id
s
ca
n
b
ec
o
m
e
m
o
r
e
r
esil
ien
t
an
d
f
ee
l
m
o
r
e
p
o
wer
f
u
l
wh
en
f
ac
e
d
with
o
b
s
tacle
s
[
7
4
]
.
I
n
c
h
r
o
n
ic
p
ai
n
d
is
o
r
d
er
s
,
C
B
T
is
a
d
o
m
in
an
t
p
s
y
ch
o
lo
g
ical
in
te
r
v
en
tio
n
ai
m
ed
at
h
elp
in
g
p
atien
ts
co
p
e
with
th
eir
co
n
d
itio
n
,
wh
ile
MBS
R
f
o
cu
s
es
o
n
in
cr
ea
s
in
g
awa
r
en
ess
an
d
ex
p
er
ien
cin
g
ac
ce
p
tan
ce
.
I
n
a
n
u
m
b
er
o
f
ch
r
o
n
ic
p
ai
n
p
r
o
b
lem
s
,
atten
tio
n
tr
ea
tm
en
ts
h
av
e
d
em
o
n
s
tr
ated
b
en
e
f
its
o
v
er
tr
ad
itio
n
al
tr
ea
tm
en
t;
h
o
w
ev
er
,
f
u
r
th
e
r
s
tu
d
y
is
r
eq
u
ir
ed
to
e
v
alu
ate
th
eir
e
f
f
icac
y
with
C
B
T
[
7
5
]
.
C
an
ce
r
p
atien
ts
'
r
es
ilie
n
ce
h
as
b
ee
n
p
r
o
v
e
n
to
b
e
g
r
ea
tly
in
cr
ea
s
ed
b
y
p
s
y
ch
o
lo
g
ical
t
h
er
ap
ies,
in
clu
d
in
g
C
B
T
,
wh
ich
h
as
b
ee
n
lin
k
ed
to
en
h
an
ce
d
q
u
ality
o
f
life
an
d
p
o
s
t
-
tr
au
m
atic
g
r
o
wth
[
7
6
]
,
[
7
7
]
.
Fu
r
th
er
m
o
r
e
,
r
esil
ien
ce
an
d
p
s
y
ch
o
lo
g
ical
tr
ea
tm
e
n
ts
h
av
e
b
ee
n
co
n
n
ec
ted
,
i
n
d
icatin
g
th
at
a
d
ec
r
ea
s
e
in
ch
r
o
n
ic
s
tr
ess
in
b
r
ea
s
t
ca
n
ce
r
p
atien
ts
m
ay
h
av
e
an
ef
f
ec
t
o
n
th
e
d
is
ea
s
e's
p
r
o
g
r
ess
io
n
[
7
8
]
.
I
n
o
r
d
er
to
h
elp
b
r
ea
s
t
ca
n
ce
r
f
am
ilies
b
etter
ad
ap
t
a
n
d
m
an
ag
e
th
e
o
b
s
tacle
s
g
iv
en
b
y
th
e
d
is
ea
s
e,
f
am
ily
r
esil
ien
ce
in
ter
v
en
tio
n
s
h
av
e
also
b
ee
n
r
ec
o
m
m
en
d
e
d
[
7
9
]
,
u
n
d
er
s
co
r
i
n
g
th
e
s
ig
n
if
ican
ce
o
f
a
co
m
p
r
eh
en
s
iv
e
ap
p
r
o
ac
h
to
r
esil
ien
ce
in
th
e
co
n
tex
t o
f
b
r
ea
s
t c
an
ce
r
th
er
a
p
y
a
n
d
ca
r
e
.
3
.
3
.
5
.
I
nte
rv
ent
io
n t
hro
ug
h dig
it
a
l
I
t
h
as
b
ee
n
d
em
o
n
s
tr
ated
th
at
cy
clica
l
ad
ap
tatio
n
tr
ai
n
in
g
(
C
AT
)
o
n
W
eCh
at
en
h
a
n
ce
s
p
s
y
ch
o
lo
g
ical
r
esil
ien
ce
an
d
lo
wer
s
an
x
iety
an
d
d
esp
air
in
b
r
ea
s
t
ca
n
ce
r
s
u
r
v
iv
o
r
s
wh
o
h
a
v
e
h
ad
s
u
r
g
er
y
.
C
AT
im
p
r
o
v
es
m
en
tal
h
ea
lth
an
d
g
en
er
al
w
ell
-
b
ein
g
b
y
ass
is
tin
g
p
atien
ts
in
o
v
er
co
m
in
g
th
e
p
s
y
c
h
o
l
o
g
ical
an
d
p
h
y
s
ical
st
r
ain
o
f
ca
n
ce
r
th
er
ap
y
[
9
]
.
R
eh
ab
ilit
atio
n
in
s
titu
tio
n
s
m
ay
o
f
f
er
p
atien
ts
co
m
p
r
eh
en
s
iv
e
ca
r
e
b
y
in
teg
r
atin
g
p
h
y
s
ical
ac
tiv
ity
,
d
iet,
a
n
d
C
AT
th
r
o
u
g
h
p
latf
o
r
m
s
lik
e
W
eCh
at.
B
y
f
ac
ilit
atin
g
s
im
p
le
ac
ce
s
s
an
d
co
m
m
u
n
icatio
n
,
W
eCh
at
f
o
s
ter
s
a
s
en
s
e
o
f
s
u
p
p
o
r
t
an
d
u
n
ity
b
etwe
en
p
atien
t
s
an
d
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als.
T
h
e
p
latf
o
r
m
a
ls
o
m
ak
es
it
ea
s
y
f
o
r
p
atien
ts
to
tr
ac
k
th
eir
p
r
o
g
r
ess
,
s
et
g
o
als,
an
d
r
ec
eiv
e
g
u
id
an
ce
f
r
o
m
th
eir
ca
r
e
team
.
Ov
er
all,
in
teg
r
atin
g
C
AT
th
r
o
u
g
h
W
eCh
at
in
to
b
r
ea
s
t
ca
n
ce
r
r
eh
ab
ilit
atio
n
p
r
o
g
r
a
m
s
ca
n
im
p
r
o
v
e
p
atien
t
en
d
u
r
a
n
ce
an
d
q
u
ality
o
f
lif
e
[
8
0
]
.
I
n
c
o
n
clu
s
io
n
,
W
eCh
at’
s
in
teg
r
atio
n
in
to
b
r
ea
s
t r
eh
ab
ilit
atio
n
ca
n
g
r
ea
tl
y
im
p
r
o
v
e
p
atien
t e
x
p
er
ien
ce
an
d
r
ec
o
v
er
y
o
u
tco
m
es
[
8
1
]
.
3
.
3
.
6
.
P
s
y
cho
educa
t
io
na
l int
er
v
ent
io
n
Ps
y
ch
o
ed
u
ca
tio
n
al
t
r
ea
t
m
en
ts
ca
n
b
en
e
f
it
ca
n
ce
r
p
atien
ts
'
p
h
y
s
ical
h
ea
lth
in
th
e
lo
n
g
r
u
n
,
as
well
as
th
eir
q
u
ality
o
f
life
an
d
co
n
f
i
d
en
ce
in
th
e
s
h
o
r
t
ter
m
.
T
h
ey
ca
n
also
r
ed
u
ce
s
tr
ess
,
an
x
iet
y
,
an
d
s
ad
n
ess
[
8
2
]
.
T
h
er
e
a
r
e
in
d
icatio
n
s
th
at
th
es
e
ap
p
r
o
ac
h
es
m
ay
b
e
ab
le
to
a
d
d
r
es
s
th
e
in
s
o
m
n
ia
is
s
u
e,
ev
e
n
wh
en
th
e
r
e
h
av
e
b
ee
n
n
o
ap
p
r
ec
iab
le
c
h
an
g
es
in
th
e
p
atien
t'
s
g
en
er
al
q
u
alit
y
o
f
life
o
r
ab
ilit
y
to
p
er
f
o
r
m
p
h
y
s
ically
.
Fu
tu
r
e
s
tu
d
ies s
h
o
u
ld
lo
o
k
at
th
ese
f
i
n
d
in
g
s
in
m
o
r
e
d
etail
[
8
2
]
.
4.
CO
NCLU
SI
O
N
T
h
is
s
y
s
tem
atic
r
ev
iew
d
em
o
n
s
tr
ates
th
at
in
ter
v
en
tio
n
s
s
u
ch
as
m
in
d
f
u
l
n
ess
-
b
ased
p
r
o
g
r
a
m
s
,
co
g
n
itiv
e
b
eh
av
i
o
r
al
th
er
ap
y
,
m
u
s
ic
th
er
ap
y
,
p
s
y
ch
o
e
d
u
ca
ti
o
n
,
a
n
d
d
ig
ital
h
ea
lth
a
p
p
licatio
n
s
ar
e
ef
f
ec
tiv
e
in
en
h
an
cin
g
r
esil
ien
ce
,
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
,
a
n
d
q
u
alit
y
o
f
life
am
o
n
g
b
r
ea
s
t
ca
n
c
er
p
atien
ts
.
T
h
ese
f
in
d
in
g
s
p
r
o
v
i
d
e
s
tr
o
n
g
ev
id
e
n
ce
f
o
r
in
teg
r
atin
g
r
esil
ien
ce
-
f
o
cu
s
ed
s
tr
ateg
ies
in
to
s
u
p
p
o
r
tiv
e
ca
r
e,
t
h
er
eb
y
en
ab
lin
g
h
ea
lth
ca
r
e
p
r
ac
titi
o
n
er
s
to
a
d
d
r
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b
o
th
p
h
y
s
ical
an
d
p
s
y
ch
o
s
o
cial
n
ee
d
s
in
a
co
m
p
r
eh
e
n
s
iv
e
an
d
h
o
lis
tic
m
an
n
er
.
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2
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]
E.
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