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Prevalence of Depression in Breast Cancer Survivors: a Systematic Review of Observational Studies
Open accessAbstract
BACKGROUND: Depression is common in breast cancer patients. The aim of this paper was to make a systematic review of its prevalence and associated factors oin breast cancer survivors. MATERIALS AND METHODS: An extensive systematic electronic review (PUBMED, CINAHL, PsyINFO and Ovid) and handsearch were carried out to retrieve published articles up to November 2012, using Depression OR Dysthymia AND (Cancer OR Tumor OR Neoplasms as the keywords. Information about the design of the studies, measuring scale, characteristics of the participants, prevalence of depression and its associated factors from the included studies were extracted and summarized. RESULTS: We identified 32 eligible studies that recruited 10,826 breast cancer survivors. Most were cross-sectional or prospective designed. The most frequent instrument used to screen depression was the Center for Epidemiological Studies for Depression (CES-D, n=11 studies) followed by the Beck Depression Inventory (BDI, n=6 studies) and the Hospital Anxiety and Depression Scale (HADS, n=6 studies). CES-D returned about similar prevalence of depression (median=22%, range=13-56%) with BDI (median=22%, range=17-48%) but higher than HADS (median=10%, range=1-22%). Depression was associated with several socio-demographic variables, cancer-related factors, treatment-related factors, subject psychological factors, lifestyle factors, social support and quality of life. CONCLUSIONS: Breast cancer survivors are at risk for depression so that detection of associated factors is important in clinical practice.
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“Recent reviews by Zainal et al. (2013) and Maass et al. (2015) determined that the prevalence of depression and anxiety in breast cancer survivors varies from 6% to 56% and 17,9% to 33,3%, respectively.”
From A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol (2019) · cites this paper as Zainal et al., 2013
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“When compared to the general female population, the prevalence of depression was found to be higher and persistent over >5 years after diagnosis, while the prevalence of anxiety was considered equivalent to results exhibited by the general female population.”
From A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol (2019) · cites this paper as Zainal et al., 2013
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BackgroundHER-2 Positive Breast Cancer - a Mini-Review
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“Breast cancer is one of among all with increased incidence, high mortality rate, and high economic and social costs (Zainal et al., 2013).”
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Breast Cancer Screening Barriers from the Womans Perspective: a Meta-synthesis
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“, 2013) Breast cancer (BC) is one of them with increased incidence, high mortality rate, and high economic and social costs (Zainal et al., 2013).”
BackgroundPatsou, E. D., Alexias, G., Anagnostopoulos, F., & Karamouzis, M. V. (2017) · ESMO Open · doi:10.1136/esmoopen-2017-000271 · Cited by 96
“1136/esmoopen-2017-000271 from active treatment to recovery, in which the transition from being a ‘patient’ with breast cancer to ‘survivor’ takes place through living after recovery, including those who are symptom free or stable and finally up to the phase where advanced cancer, recurrence and death may occur.(4) 6…”
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Kim, M., Kim, S. Y., Kim, J. H., Park, B., & Choi, H. G. (2017) · PLoS ONE · doi:10.1371/journal.pone.0175395 · Cited by 72
Women with breast cancer taking chemotherapy: depression symptoms and treatment adherence
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“Tais sintomas, presentes em cerca de 22% das pacientes(4), podem evoluir para um quadro crônico e impossibilitálas de desempenhar suas tarefas cotidianas e, em situações mais graves, resultar em suicídio.”
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“Therefore, breast cancer causes patients to have a disrupted image of their body, which results in decreased self-esteem, fear of losing femininity, sexual dysfunctions, anxiety, depression, desperateness, feelings of guilt and embarrassment, fear of relapse, isolation and fear of death (Gümüş, 2006; Aygin and Eti Asl…”
BackgroundDepression and family support in breast cancer patients
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“Potential reasons for the inconsistency in the literature include differences in methodology (many different tools for screening and diagnosis of depression are used), there are too much differences in defining the research population, and often the entire population of patients with breast cancer is comprised without…”
BackgroundVardar‐Yağlı, N., Şener, G., Sağlam, M., Kutukcu, E. C., Arıkan, H., Inal-Ince, D., Savcı, S., Altundağ, K., Kutluk, T., Ozisik, Y. Y., et al. (2015) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2015.16.2.585 · Cited by 60
“Most of the breast cancer patients suffer psychological problems (Bleiker et al., 2000; Zainal et al., 2013; AbuHelalah et al., 2014) because of pain and associated functional limitations after treatment (Cantarero- Naciye Vardar-Yagli et al Villanueva et al., 2011; Charlier et al., 2012).”
BackgroundPsychological interventions for women with non-metastatic breast cancer
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“In the literature, studies showed the important role of lower educational status on depression and anxiety (Zainal et al., 2013).”
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Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients
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“Depressive mood is a common symptom among breast cancer survivors which remains even after the completion of cancer treatment.(2) It has been shown that at some point, right after diagnosis or even throughout their survivorship, all breast cancer survivors will encounter some degree of physical and psychological side…”
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“However, women’s mental health can be impacted years after a breast cancer diagnosis [41,42] and increase the urgency for ongoing supportive care.”
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“In this regard, the identification, diagnosis and treatment of depression not only affects the quality of life of individuals, but also affects their survival rate and increases their ability to cope with diseases (Didehdar Ardebil et al., 2013; Zainal et al., 2013).”
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Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study
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Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review
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Psychosocial factors associated with quality of life in cancer survivors: umbrella review
Voskanyan, V., Marzorati, C., Sala, D., Grasso, R., Pietrobon, R. S., van der Heide, I., Engelaar, M., Bos, N., Caraceni, A. T., Couespel, N., et al. (2024) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-024-05749-8 · Cited by 35
“…ties well with the analyzed studies published within the last 10 years reporting social support and depression having a profound effect on QoL (Zainal et al. 2013; Howard-Anderson et al. 2012; Rimmer et al. 2023; Aizpurua-Perez and Perez-Tejada 2020; Bours et al. 2016; Dunne et al. 2017;…”
BackgroundInfluentialHealth Locus of Control in Indonesian Women with Breast Cancer: a Comparison with Healthy Women
Iskandarsyah, A., de Klerk, C., Suardi, D. R., Sadarjoen, S. S., & Passchier, J. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.21.9191 · Cited by 31
“Keywords: Health locus of control - anxiety - depression - breast cancer - Indonesia Buzlu, 2011; Abu-Helalah et al., 2014), and 4.5% to 37% (Massie et al., 2011; Nazlican et al., 2012; Zainal et al., 2013), respectively.”
BackgroundInfluentialFactors Predictive of Quality of Life among Breast Cancer Patients
Daldoul, A., Khechine, W., Bhiri, H., Ammar, N., Bouriga, R., Krir, M. W., Soltani, S., Zoukar, O., Rhim, M. S., Bouslah, S., et al. (2018) · Europe PMC (PubMed Central) · doi:10.22034/apjcp.2018.19.6.1671 · Cited by 31
“Thanks to these progresses, patients’ quality of life is becoming more and more important and its evaluation is of increasing interest (Zainal et al., 2013).”
BackgroundThe quality of life of Croatian women after mastectomy: a cross-sectional single-center study
Pačarić, S., Kristek, J., Mirat, J., Kondža, G., Turk, T., Farčić, N., Orkić, Ž., & Nemčić, A. (2018) · BMC Public Health · doi:10.1186/s12889-018-5929-0 · Cited by 29
Gharaei, H. A., Dianatinasab, M., kouhestani, M., Fararouei, M., Moameri, H., Pakzad, R., & Ghaiasvand, R. (2019) · Epidemiology and Health · doi:10.4178/epih.e2019030 · Cited by 29
“Stata version 14 (StataCorp., College Station, TX, USA) was used for the statistical analysis [20].”
BackgroundResultInfluentialRelated Factors with Depression and Anxiety in Mastectomized Women Breast Cancer Survivors
Álvarez-Pardo, S., PAZ, J. A. D., Romero-Pérez, E., Tánori-Tapia, J., Rendón-Delcid, P. A., González-Bernal, J., Fernández-Solana, J., Simón-Vicente, L., Mielgo-Ayuso, J., & González-Santos, J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20042881 · Cited by 31
“The results are in agreement with a large number of studies which state that the side effects of treatment, such as nausea, vomiting, fatigue and deterioration of body image caused by alopecia, skin or nail problems, are one of the triggers for this symptomatology [12,34,37,38].”
ResultParra, G., Soto‐Ruiz, N., Martín‐Rodríguez, L. S., Escalada‐Hernández, P., & García‐Vivar, C. (2023) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2023.151418 · Cited by 33
Chow, P. I., Drago, F., Kennedy, E. M., & Cohn, W. F. (2019) · JMIR Cancer · doi:10.2196/15750 · Cited by 28
“Depression, which affects between 10% and 25% of survivors of women’s cancer [4,9,10], is perhaps the most studied psychosocial effect of cancer treatment.”
BackgroundPrevalence of Severe Depression in Iranian Women with Breast Cancer: A Meta-Analysis
Isfahani, P., Arefy, M., & Shamsaii, M. (2020) · Depression Research and Treatment · doi:10.1155/2020/5871402 · Cited by 28
“For example, a 2017 study reported that the prevalence of depression was 22% in women with breast cancer in an Indian city [8].”
BackgroundPsychosocial and family‐centered support among breast cancer patients with dependent children
Hammersen, F., Pursche, T., Fischer, D., Katalinic, A., & Waldmann, A. (2020) · Psycho-Oncology · doi:10.1002/pon.5585 · Cited by 39
Xu, C., Ganesan, K., Liu, X., Ye, Q.-B., Cheung, Y., Liu, D., Zhong, S.-W., & Chen, J. (2022) · Cancers · doi:10.3390/cancers14030475 · Cited by 25
Taira, N., Iwata, H., Hasegawa, Y., Sakai, T., Higaki, K., Kihara, K., Yamaguchi, T., Ohsumi, S., Shimozuma, K., & Ohashi, Y. (2014) · Breast Cancer Research and Treatment · doi:10.1007/s10549-014-2935-5 · Cited by 28
miR‑519 regulates the proliferation of breast cancer cells via targeting human antigen�R
Ren, L., Li, Y., Zhao, Q., Fan, L., Tan, B., Zang, A., & Yang, H. (2019) · Oncology Letters · doi:10.3892/ol.2019.11230 · Cited by 27
“There are numerous causes of breast cancer, including lifestyle (obesity, alcohol, Western-style diet) (5), depression and anxiety disorder (6) and gene mutations, including breast cancer (BRCA) gene mutation (7); however, the mechanisms underlying breast cancer pathogenesis remain unclear.”
BackgroundPuszczałowska-Lizis, E., Flak, K., Biskup, M., & Žák, M. (2020) · Cancer Control · doi:10.1177/1073274819900407 · Cited by 26
“Depressed mood, apathy, anxiety, excessive sense of fatigue, and abandonment of previously pursued passions and hobbies may well bring about deep depression and, in extreme cases, suicidal thoughts.(8-10) Pursuit of psychological therapy in oncological diseases is a long-term and very complex process.”
BackgroundPrevalence of Depression and the Quality-of-Life of Breast Cancer Patients in Jordan
Alquraan, L. T., Alzoubi, K. H., Rababa'h, S. Y., Karasneh, R. A., Al-Azzam, S. I., & Al‐Azayzih, A. (2020) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s277243 · Cited by 26
Mihic-Góngora, L., Jiménez‐Fonseca, P., Hernández, R., Gil-Raga, M., Pacheco-Barcía, V., Manzano, A., Polo, S. H., Antoñanzas, M., Corral, M. J., Arbizu, M. V., et al. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01034-y · Cited by 31
“Psychological distress and depression have been proven to be risk factors [12, 25] and spirituality to be protective in the development of depression [13, 26].”
BackgroundMendes-Santos, C., Weiderpass, E., Santana, R., & Andersson, G. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.01.004 · Cited by 24
Kim, S., Kim, S., Shin, I., Park, M., Yoon, J.-H., Yoon, J., & Kim, J. (2017) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2017.09.009 · Cited by 23
Comfort and Anxiety Levels of Women with Early Stage Breast Cancer Who Receive Radiotherapy
Unver, G. T., & Yücel, Ş. Ç. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.5.2109 · Cited by 22
“…with breast cancer in Turkey (Alacacioglu et al., 2009; Turhal et al., 2010; Dastan and Buzlu, 2011; Tasci et al., 2012) and around the world (Zainal et al., 2013; Schleife et al., 2014; Stafford et al., 2014); there are many studies that analyze the impact of non-pharmacological…”
BackgroundInfluentialSocial support, quality of life and mental health status in breast cancer patients
shrestha, J. S., Shrestha, A., Sapkota, A., Sharma, R., Shrestha, S., Shestha, S., Amatya, K., & Gautam, M. (2017) · Cancer Reports and Reviews · doi:10.15761/crr.1000107 · Cited by 22
“Results and discussion On average, the prevalence of depression and anxiety among cancer patients ranged from 20 to 30%, according to the study published in Asia Pacific Journal of oncology [13] and BMJ [14].”
BackgroundAzizi, M., Heshmatnia, F., Milani, H., Shahhosseini, Z., Marvdashti, L. M., & Moghadam, Z. B. (2024) · Brain and Behavior · doi:10.1002/brb3.70098 · Cited by 23
“According to the results of two studies that examined the prevalence of psychiatric disorders in BC survivors, the prevalence of depression and anxiety was 6%–56% and 17.9%–33%, respectively (Maass et al. 2015; Zainal et al. 2013).”
InfluentialMioduszewski, O., Hatchard, T., Fang, Z., Poulin, P. A., Khoo, E., Romanow, H. C., Shergill, Y., Tennant, E. M., Schneider, M. A., Browne, N., et al. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-020-00903-w · Cited by 22
“Left unregulated, feelings of hopelessness, anxiety, negative automatic thoughts, and cognitive errors associated with psychological distress may lead to increased rates of psychopathology, a known vulnerability associated with breast cancer survivorship [4, 5].”
BackgroundMcNeish, B. L., Richardson, J. K., & Whitney, D. G. (2022) · European Journal of Cancer Care · doi:10.1111/ecc.13648 · Cited by 21
Bredicean, A., Crainiceanu, Z., Oprean, C., Riviș, I., Papavă, I., Secoșan, I., Frandeș, M., Giurgi-Oncu, C., & Grujic, D. (2019) · BMC Women's Health · doi:10.1186/s12905-020-00898-7 · Cited by 18
Milbury, K., Kavanagh, A., Meng, Z., Chen, Z., Chandwani, K. D., Garcia, K., Perkins, G. H., McQuade, J. L., Raghuram, N. V., Nagarathna, R., et al. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3612-0 · Cited by 20
“Because previous studies focused entirely on healthy, community samples, the current study seeks to examine if the noted positive affect response pattern (or potential affect suppression) generalizes to women with breast cancer, who are more vulnerable to depressive symptoms than the general population [6, 7, 12].”
BackgroundAyeni, O., Joffe, M., Cubasch, H., Rinaldi, S., Taljaard‐Krugell, C., Vorster, E., Romieu, I., & Norris, S. A. (2019) · South African Medical Journal · doi:10.7196/samj.2019.v109i4.13465 · Cited by 20
“5% to 50% among women with breast cancer, depending on definitions and methods of assessment of psychological disorders.[24,25] There have been conflicting reports on the association of education with breast cancer.”
BackgroundBreast reconstruction after mastectomy: does it decrease depression at the long-term?
de Raaff, C. A. L., Derks, E. A.-J., Torensma, B., Honig, A., & Vrouenraets, B. C. (2016) · Gland Surgery · doi:10.21037/gs.2016.05.02 · Cited by 20
“Although mastectomy without breast reconstruction (M) is a very effective and often curative procedure, it has a profound mutilating effect that inevitably influences a patient psychologically, often causing not only negative body image and anxiety, but also depression (2,3), a condition that is associated with breast…”
BackgroundAminnasab, A., Mohammadi, S., Zareinezhad, M., Chatrrouz, T., Mirghafari, S. B., & Rahmani, S. (2018) · PubMed Central · Cited by 19
Acid-Producing Diet and Depressive Symptoms among Breast Cancer Survivors: A Longitudinal Study
Wu, T., Hsu, F., & Pierce, J. P. (2020) · Cancers · doi:10.3390/cancers12113183 · Cited by 20
Park, C.-Y., Kim, K., Kim, Y., Zhu, R., Hain, L., Seferovic, H., Kim, M., Woo, H. J., Hwang, H., Lee, S. H., et al. (2024) · ACS Nano · doi:10.1021/acsnano.4c00360 · Cited by 18
Wang, Y., Huang, T., Li, H., Fu, J., Ao, H., Lu, L., Han, M., Guo, Y., Feng, Y., & Wang, X. (2020) · Drug Delivery · doi:10.1080/10717544.2020.1716877 · Cited by 18
“…multiple drug resistance (Peng et al., 2009; Akram et al., 2017; Chatterjee & Bivona, 2019), which will in return aggravate the patient’s depression (Rao et al., 2019), the most widely occurred symptom among the breast cancer patients (Zainal et al., 2013; Shah et al., 2014; Stanton & Bower, 2015).”
BackgroundNilsson, M. I., Saboonchi, F., Alexanderson, K. A. E., Olsson, M., Wennman‐Larsen, A., & Petersson, L. (2015) · Journal of Cancer Survivorship · doi:10.1007/s11764-015-0502-7 · Cited by 17
Shih, I.-H., Lin, C., & Fang, S. (2020) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2020.101816 · Cited by 16
Batcha, J. S. D., Raju, A. P., Matcha, S., Elstin Raj, S., Udupa, K., Gota, V., & Mallayasamy, S. (2022) · Biology · doi:10.3390/biology12010051 · Cited by 17
“The result was a significant drop in endoxifen concentration, leading to subtherapeutic concentrations [53,54].”
BackgroundBreast cancer treatment and recovery: pets’ roles as emotional buffers and stressors
Kogan, L. R., Currin-McCulloch, J. A., & Cook, L. S. (2023) · BMC Women s Health · doi:10.1186/s12905-023-02662-z · Cited by 18
“Many people diagnosed with breast cancer struggle with depression and anxiety [134, 135, 137], and having dependents can exacerbate these negative effects [14, 65].”
BackgroundBrandt‐Salmeri, A., & Przybyła-Basista, H. (2019) · Health Psychology Report · doi:10.5114/hpr.2019.84213 · Cited by 16
The Prevalence of Depression in Iranian Women With Breast Cancer: A Meta-Analysis
Isfahani, P., Zare, S. M. H., & Shamsaii, M. (2020) · Quarterly of Horizon of Medical Sciences · doi:10.32598/hms.26.2.3207.1 · Cited by 16
Home-Based Psychoeducational Intervention for Breast Cancer Survivors
İnan, F. Ş., & Üstün, B. (2017) · Cancer Nursing · doi:10.1097/ncc.0000000000000483 · Cited by 16
“In the present study, the rates of baseline distress, anxiety, and depression were higher than those reported in other studies.(12,14) It has been reported that physical symptoms (eg, fatigue and pain), poor general health, increased awareness of symptoms, the lack of preparation for lingering symptoms, insufficient s…”
ResultFactors Affecting the Quality of Life of Korean Cancer Survivors Who Return to the Workplace
Han, K., Park, E., Kim, S. J., Jang, S., Shin, J., Kim, C. O., Choi, J. W., & Lee, S. G. (2014) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2014.15.20.8783 · Cited by 15
Hassan, M., Barakat, Z., Fares, Y., & Abbas, L. A. (2023) · Health and Quality of Life Outcomes · doi:10.1186/s12955-023-02095-0 · Cited by 15
Casavilca-Zambrano, S. A., Custodio, N., Liendo-Picoaga, R., Cancino-Maldonado, K., Esenarro, L., Montesinos, R., Bertani, S., Fejerman, L., Guerchet, M., & Vidaurre, T. (2020) · Seminars in Oncology · doi:10.1053/j.seminoncol.2020.08.003 · Cited by 14
Carreira, H., Williams, R., Müller, M., Harewood, R., & Bhaskaran, K. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0551-2 · Cited by 15
Kaur, M. N., Klassen, A. F., Xie, F., Bordeleau, L. J., Zhong, T., Cano, S., Tsangaris, E., Breitkopf, T., Kuspinar, A., & Pusic, A. L. (2021) · BMC Women s Health · doi:10.1186/s12905-020-01125-z · Cited by 15
Pan, M., Wu, K., Zhao, J., Hou, X., Chen, P., & Wang, B. (2023) · International Journal of Nursing Knowledge · doi:10.1111/2047-3095.12418 · Cited by 11
“The incidence of depression in breast cancer survivors is 56%, which is much higher than that in healthy women (Zainal et al., 2013”
Follow-up and Cancer Survivorship
Neuman, H. B., & Schumacher, J. R. (2022) · Surgical Clinics of North America · doi:10.1016/j.suc.2022.08.009 · Cited by 15
Metadata
- Authors
- Zainal, N. Z., Nik-Jaafar, N. R., Baharudin, A., Sabki, Z. A., & Ng, C. G.
- Affiliations
- University of Malaya (MY)
- University Kebangsaan Malaysia Medical Centre (MY)
- Venue
- Asian Pacific Journal of Cancer Prevention
- Published
- 2013-04-30
- Volume
- 14
- Issue
- 4
- Pages
- 2649-2656
- ISSN
- 1513-7368 (ISSN-L)
- OpenAlex
- W2107370237
- Cited by
- 204
- References
- 56
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 17 · 2023: 17 · 2022: 20 · 2021: 20 · 2020: 22 · 2019: 24 · 2018: 15 · 2017: 15 · 2016: 12 · 2015: 15 · 2014: 13 · 2013: 1
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Asian Pacific Journal of Cancer Prevention (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- depression, breast cancer survivors, prevalence, risk factors, depression screening, CES-D, Beck Depression Inventory, Hospital Anxiety and Depression Scale, social support, quality of life, lifestyle factors, cancer treatment effects
- MeSH terms
- Adult, Aged, Aged, 80 and over, Breast Neoplasms, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Obesity, Prognosis, Receptors, Estrogen, Receptors, Progesterone, Retrospective Studies, Body Mass Index, Survival Rate, Erb-b2 Receptor Tyrosine Kinases, Young Adult
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