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Long term side effects

Late Effects of Cancer Treatment

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Some patients will continue to experience side effects from the initial treatment. 

 

These side effects include: 

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-Physical side effects

-Psychological side effects 

 

 

Physical Side effects:

This section reviews long-term physical adverse after primary therapy in breast cancer survivors.

 

Lymphedema
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Lymphedema is a condition characterized by the buildup of lymph fluid in the interstitial tissue, leading to swelling in areas such as the limbs, neck, trunk, or genitals, and is associated with solid tumours caused by melanoma, breast, genitourinary, gynaecological, and head and neck cancer​

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Why does lymphedema happen? 

It is a common side effect of cancer treatment, and can occur due to blockage or damage to the lymphatic system can occur due to tumor pressure on the lymph nodes or vessels, the spread of cancer cells into the lymphatic channels (known as lymphangitic carcinomatosis), removal or surgery on lymph nodes, or as a result of radiation therapy or chemotherapy.

 

At first, the affected area can become slightly swollen, uncomfortable, and “tingly,” and then may get more swollen over time. If the lymphedema progresses, the limb (or other areas) can become even more swollen, uncomfortable, heavy, or numb. Early treatment of lymphedema is important, so you should tell your doctor if you experience any of these symptoms. Your doctor may also rule out other causes like recurrent breast cancer, infection or thrombosis. The good news is that today there are more options than ever, for treating lymphedema, and most have demonstrated effectiveness in research studies.

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Stages of lymphedema:​​

1. Stage 0:

  • No swelling but there may be subtle symptoms, such as:

    • A heavy feeling in a limb

    • Feeling of fatigue in a limb

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​2. Stage 1:​

  • Swelling can be seen on the side of body that was treated

  • Swelling in a limb is reduced with elevation

  • An indent in the skin may occur when pressure is applied (called pitting)

  • Area with lymphedema is larger, heavier, or stiffer

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3. Stage 2:

  • The swollen area has a spongy texture

  • Swelling in limb does not decrease with elevation

  • An indent in the skin (pitting) is less visible as swelling increases

  • Scar tissue may form making the swollen area larger and feel hard

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​4. Stage 3:

  • Swelling has further increased making the area larger

  • Skin of swollen area is severely dry, scaly, or thickened

  • In the limbs, fluid leakage and blisters are common

  • Moving limbs or turning your neck may be limited

  • Skin of swollen area may have fungal infections or benign tumors

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​Lymphedema risk factors:

  • Survivors who have undergone surgery, radiation, or chemoradiation involving the lymph node system are at increased risk of developing lymphedema

  • Additional factors that can raise this risk include having a sentinel node biopsy, a body mass index (BMI) over 30 kg/m², localized infections, a higher number of lymph nodes removed, and a more extensive initial spread of the disease.

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​Screening for lymphedema:

Effective screening for lymphedema involves using both objective measurements and patient-reported symptoms to detect early signs of swelling. The goal is to identify and treat lymphedema as soon as possible, ideally before it causes significant discomfort or functional issues.

1. Baseline measurements: Before surgery, it is important to measure the size of both arms to establish a baseline. This helps distinguish true swelling from natural differences between arms.

2. Tape measure: Tape is used to measure the circumference of specific points along the arm. These measurements are then used to calculate the total limb volume.

3. Perometry: Uses infrared light to quickly and accurately measure limb volume.

4. Bioimpedance Spectroscopy (BIS): Measures tissue resistance to electrical current, reflecting fluid content in the limb.

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Treatment options:

  • Self-care management:

  1.  Apply gentle pressure and keep your hands soft and relaxed​

  2. Use just enough pressure to softly stretch the skin to its natural extent, then ease up and allow the skin to return to its original position. If you can feel the muscles beneath your fingers, you're pressing too hard.

  3. Use the palms of your hands instead of your fingertips to maximize contact with the skin and effectively stimulate the lymphatic vessels.

  4. Perform the massage in the direction of parts of your body that haven't been affected by cancer treatment.

  5. Ensure you're comfortable during the process. You might support the arm on the side that had cancer treatment with a table or pillows, allowing your shoulder and arm to relax. You can do self-massage while sitting, standing, or lying down, whichever position feels best for you.

  6. Incorporate self-massage into your routine (similar to other self-care activities) in a way that suits your lifestyle.

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  • Skin care (infection control):

  1. ​Thorough skin and nail care is important to help prevent infections and entry points for bacteria

  2. If you notice any abrasions or small tears, such as paper cuts, treat them immediately with a topical antibiotic to reduce the risk of infection

  3. Use a mirror to carefully examine areas that are hard to see, especially if you have neuropathy, to spot any issues early

  4. Wash the affected limb daily with a pH-neutral soap, and dry it thoroughly, paying special attention to areas between fingers and toes to prevent moisture buildup and skin problems

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  • Compression

There are several types of compression:

  1. Compression bandaging: Multi-layered “short-stretch” bandages are used to reduce swelling

  2. Compression garment: A compression sleeve may be used to prevent lymphedema, as it can delay or prevent lymphatic fluid buildup and swelling

  3. Manual lymphatic draining: Manual lymphatic draining focuses on opening the lymphatic pathway, softening the scar tissues, and to promote and stimulate lymphatic drainage

  4. Pneumatic compression pump: Pneumatic devices are medical devices that use a series of inflatable sleeves placed around the affected limb. These sleeves automatically and gently inflate and deflate in a controlled sequence, applying pressure to help move excess lymphatic fluid out of the limb

  5. Electrically stimulated lymphatic drainage: A less commonly used intervention that involves applying electrical currents to tissues, which can influence cellular and molecular processes

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  • ​Progressive resistance training (exercise):

  1. This training involves gradually increasing the intensity (weight) or volume (sets and repetitions) in very small increments over time, with careful monitoring​

  2. This approach is ideally supervised by a lymphedema specialist to ensure safety and effectiveness, especially for individuals at risk of or managing lymphedema

  3. These exercises are found to be effective: 

  • Arm lifts (front and side)

  • Chest expansion exercises

  • Forearm flexion and extension

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  • Surgery, eligibility criteria:

  1. ​Lymphedema surgery is not yet a standard treatment in Canada and is typically reserved for severe cases that do not improve with conservative therapies like lymphatic drainage or compression.

  2. For patients diagnosed early, the usual approach is conservative management, which includes daily use of a compression garment guided by a lymphedema therapist for 3 to 6 months. In some cases, this may be sufficient to resolve swelling, especially in upper-extremity lymphedema.

  3. If swelling persists after this period, and the patient is medically fit, surgical options may be considered. In more advanced cases with significant swelling, pitting, and recurrent cellulitis (skin infection), patients often benefit from complete decongestive therapy until swelling is well-controlled before exploring surgery.

  4. Patients experiencing recurrent cellulitis may also benefit from preventive antibiotics to reduce infection risk. 

  5. Patients with uncontrolled primary cancer or recurrence near the original tumor site (such as lymph nodes or nearby tissues) are generally not candidates for surgery, as their treatment focus is on cancer management.

  6. Additionally, individuals with very high body weight (high BMI) are more prone to developing lymphedema naturally. Weight-loss efforts are encouraged, as reducing weight can lead to significant improvements and may reduce the need for surgical intervention.

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  • Medical therapies

Some oral medications, such as benzopyrones, have been tested in clinical trials to evaluate their potential to help reduce swelling, however there is no strong evidence​

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​Here are some other things that you can do at home to reduce the risk of recurrence or worsening of lymphedema. 

  • protect your arm, hand, chest, or other body parts from cuts, injury, overuse, extreme temperatures, and other situations that can increase the production of lymph

  • learn the signs and symptoms of infection including redness, warmth and increased swelling

  • Replace your compression garments when necessary 

  • set an exercise and weight control plan and stick to it!

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Pain ​

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Pain can be caused by all treatments for breast cancer and by the cancer itself. Pain varies depending on the individual and type of treatment. For example, some patients have relatively little discomfort with lumpectomy and require mild analgesics medication. Others may have moderate to severe pain after mastectomy and reconstruction that require stronger medication. Speak to your doctor as the plan for post-operative pain is best individualized between clinicians and patients with regular monitoring for pain relief. Good communication is essential to getting continuous relief for any pain you may experience due to breast cancer or its treatment. The nature of your pain can change over time, and this may require a change in your treatment.

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​Type of chronic pain syndromes per system:

1. Neurologic system

  • Chemotherapy-induced peripheral neuropathy

  • Postoperative pain syndromes

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2. Rheumatic system

  • Other sources of pain in cancer survivors include migratory, non-inflammatory muscle and joint pain (myalgias and arthralgias), which can result from treatments such as tamoxifen, aromatase inhibitors, radiation therapy, steroid use or tapering, and from physical deconditioning. d

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3. Integumentary system

  • Pain in cancer survivors can also result from graft-versus-host disease (GVHD), affecting the skin, mucous membranes, and musculoskeletal system

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4. Lymphatic system

  • Pain or discomfort may also occur from lymphedema, which can develop after breast surgery, axillary or inguinal lymph node removal, or radiation therapy

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5. Skeletal system

  • Osteoporosis

  • Osteonecrosis (bone tissue death) affecting the femoral head, knee, or humeral head

  • Osteonecrosis of the jaw from bisphosphonates, denosumab, or radiation to the head and neck

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6. Myofascial system 

  • Musculoskeletal pain in cancer survivors can include rotator cuff tendonitis, adhesive capsulitis (frozen shoulder), and neck or back pain

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7. GI/urinary/pelvic system

  • Chronic pain in cancer survivors may include chronic pelvic pain. Urinary or fecal urgency and incontinence are common, and radiation-related adhesions can also contribute to discomfort

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8. Genital system

  • Pain during sexual activity (dyspareunia) in cancer survivors can result from menopause, reduced vaginal lubrication due to radiation, or vaginal strictures/fibrosis caused by radiation dyspareunia

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Cancer treatment-related pain syndromes:

The following are the types of pain that can be caused by the different cancer treatments.

1. Surgery 

  • Surgery can lead to persistent post-surgical pain syndromes, such as postmastectomy pain and phantom limb pain.​

2. Radiation Therapy

  • Surgery can lead to persistent post-surgical pain syndromes, such as postmastectomy pain and phantom limb pain.​

3. Chemotherapy-Induced Peripheral Neuropathy

  • The most common pain syndrome caused by chemotherapy is chemotherapy-induced peripheral neuropathy (CIPN).​

4. Hematopoietic Cell Transplantation

  • In addition to chronic pain from chemotherapy or radiation therapy, chronic graft-versus-host disease (GVHD) is another source of persistent pain in recipients of hematopoietic cell transplantation.​

5. Hormonal Therapy

  • Aromatase inhibitors, often prescribed for several years after breast cancer treatment to prevent recurrence, can cause arthralgias, which are characterized by joint pain and stiffness.

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Treatment options:

Pharmacologic approaches:

1. Co-analgesics

  • Medications commonly used to manage pain in cancer survivors include antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and other therapies.​

2. Opioids

  • Opioids may be considered for cancer survivors experiencing moderate to severe pain that has not improved with non-opioid medications or non-drug approaches.

  • Clinicians prescribing opioids to cancer survivors should be aware of the risk factors for opioid misuse or abuse.​

Non-pharmacologic approaches:

1. Cognitive behavioral therapy

  • Pain that does not improve with medical treatment alone, or that occurs alongside other symptoms such as fatigue and emotional distress, should be referred for cognitive-behavioral therapy.​

2. Exercise

  • Strength training and aerobic exercises are effective in improving pain ​

3. Physical medicine and rehabilitation

  • Physical therapy

  • Transcutaneous electrical nerve stimulation

  • Scrambler therapy​

4. Integrative medicine approaches

  • Physical therapy

  • Transcutaneous electrical nerve stimulation

  • Scrambler therapy​

5. Interventional approaches

  • Local injections

  • Interventional neurostimulation therapies

  • Neuraxial analgesia
     

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Fatigue:

 

Cancer related fatigue (CRF) is a common yet under-reported side effect of most cancer treatments. However, many people with cancer also face other health or emotional issues that can contribute to or worsen their fatigue. Experts describe cancer-related fatigue as a feeling of physical, emotional, and/or mental exhaustion linked to cancer and its treatment. Unlike normal tiredness after a busy day, cancer-related fatigue is a persistent lack of energy that is distressing, does not improve with rest or sleep, and interferes with daily activities. Many cancer survivors continue to experience this type of fatigue for months or even years after their treatment has finished. 


Unlike typical fatigue, CRF tends to be more intense, lasts longer, and is not relieved by rest or sleep.  Known risk factors for CRF include medication side effects, unmanaged pain, anemia, emotional stress, sleep problems, poor nutrition, decreased physical fitness, and an increase in the number and severity of other health conditions. CRF can occur at any point during the cancer continuum.

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Common signs include:

  • Persistent feelings of tiredness

  • Lack of energy

  • Physical weakness

  • Cognitive impairments/delays

  • Sleep disturbances

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​Conditions that cause or worsen CRF include:

  • Anemia

  • Pain

  • Sleep-related problems

  • Depression

  • Anxiety

  • Diet or nutrition-related problems

  • Infection

  • Changes in thyroid functions

  • Rheumatologic or autoimmune disorders

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Treatment Options:
Non-pharmacological intervention:

1. Physical activity

  • Physical activity is recommended during and after cancer treatment. Evidence shows that those who exercise 3-5 hours per week may experience better health outcomes and fewer side effects, including fatigue. You can divide this time into shorter sessions of 10-15 minutes at different times of the day, depending on your energy levels. Most exercise programs have two main components: 

    • ​Cardiovascular endurance (cardio): Activities like walking, jogging, and swimming help get your heart pumping and blood flowing, improving heart and blood vessel health. Walking for 2-3 times per week for around 30-60 minutes can help with CRI. 

    • Weight training (resistance or strength training): This involves exercises that use resistance, such as bands, free weights, or your own body weight, to help build muscle strength. Regular resistance training is most effective when done consistently.

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2. Yoga

  • Yoga combines physical activity, meditation to focus the mind, and breathing and emotional control. These practices are believed to help balance the body and mind. Studies have shown that yoga can reduce fatigue, improve sleep quality, and decrease anxiety and depression in people with cancer.

  • There are many styles of yoga, ranging from gentle to more vigorous practices. It is important to practice under the guidance of a well-trained instructor to ensure safety and effectiveness. 

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3. Cognitive behavioral therapy (CBT)

  • Cognitive Behavioral Therapy (CBT) is an approach that helps individuals identify and change negative thoughts to promote positive behavioral changes. It is provided by mental health professionals such as behavioral therapists. 

  • One form of CBT, called cognitive restructuring, involves recognizing stress-inducing or negative thoughts as they happen. Once these thoughts are identified, you can work to modify or reframe them to improve your emotional well-being.

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4. Acupuncture

  • In acupuncture, a licensed or certified practitioner inserts very thin needles into specific points on your body.

  • You might experience mild discomfort or tingling when the needles are inserted, but other needles may not be felt at all.

  • Acupuncture can help reduce pain and lessen fatigue.

  •  Although generally safe, acupuncture may not be suitable for everyone, especially if you have certain health conditions such as a high risk of bleeding or infection.

  • It is important to ask your care team whether acupuncture is safe for you.

 

5. Massage therapy

  • Massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, and stroked.

  • It can help reduce stress, alleviate pain, and decrease cancer-related fatigue

  • Additional health benefits may include lower blood pressure and improved circulation.

  • Before scheduling a massage, verify that the therapist is experienced in cancer-specific massage techniques, as there are health risks associated with receiving treatment from a provider who is not trained in these areas.  

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6. Bright white light therapy

  • Bright white light therapy (BWLT) involves exposure to very bright fluorescent light from a device or box designed for home use.

  • The light stimulates the part of the brain that controls circadian rhythms.

  • The NCCN suggests 1250–10,000 lux in the morning for 30–40 minutes.

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7. Nutrition check-up

  • Cancer treatment frequently leads to side effects such as nausea, vomiting, diarrhea, mouth sores, changes in taste, and loss of appetite.

  •  As a result, many individuals may find themselves eating and drinking less overall.

  •  Consulting with a nutritionist or registered dietitian can be beneficial, as these professionals can provide personalized guidance on eating and drinking habits tailored to your health status and specific needs.

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Pharmacologic medications:

1. Melatonin

  • Not recommended for long term use due to insufficient evidence.​

2. Ginseng

  • Some evidence for American ginseng; not routinely recommended​

3. Omega polyunsaturated fatty acids

  • Studied at various doses, however there is insufficient evidence for routine use​​

4. Wakefulness agents

  • Armodafinil, modafinil - not routinely recommended​

5. Psychostimulants

  • Not routinely recommended​

6. Steroids

  • Short-term corticosteroids (e.g., prednisone, dexamethasone) for advanced cancer

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Remember to treat yourself kindly! If you are too fatigued to complete a task that you had planned, it is completely fine if you cannot wait. Ensure that you are your own first priority to avoid other potential adverse effects. Additionally, remember there are many people that are here to support you if you are in need of help.

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Chemotherapy-Induced Peripheral Neuropathy 

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Chemotherapy-induced peripheral neuropathy (CIPN) is a common and significant side effect experienced by some cancer patients. It is caused by certain chemotherapy drugs, including taxanes, platinum compounds, vinca alkaloids, and others. This condition results in nerve damage, leading to symptoms such as numbness, tingling, pain, and weakness, primarily in the hands and feet.

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Common signs include:

  • Numbness

  • Tingling

  • Pain, particularly in hand and feet

  • Cold sensitivity

  • Discomfort swallowing cold liquids

  • Muscle cramps

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Neuropathy often affects the upper and/or lower limbs, impacting daily activities and quality of life.

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When does it happen:

Symptoms of CIPN usually appear within the first two months of treatment, and can occur due to chemotherapy type, dose, and duration. Risk factors may include predisposing factors such as demographics, genetics, comorbidities, depression, and lack of physical activity.

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Treatment options:

Pharmacological:

  • NSAIDs

  • Acetaminophen (paracetamol)

  • Adjuvant analgesics

    • ​selected antidepressants (e.g., venlafaxine)

    • selected anticonvulsants (e.g., gabapentin and pregabalin)​

Non-pharmacological:

  • Acupuncture

  • Exercise

    • Sensorimotor training​

  • Compression therapy using surgical gloves

  • Cryotherapy

    • Frozen gloves and socks​

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​It is important to take safety precautions as the decreased feeling in your hands and feet may increase the risk of injury. 

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Acute Radiation Dermatitis (ARD)
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Acute radiation dermatitis (ARD) frequently occurs in cancer patients receiving radiotherapy and is typically characterized by redness (erythema), skin peeling (desquamation), and pain. The development of radiation dermatitis is a complex process involving damage to the skin layers caused by radiation, which affects the cells responsible for skin regeneration. This damage can impair the skin’s protective barrier and lead to increased inflammation, resulting in symptoms such as redness, pain, and various skin changes.​

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​Common signs include:

  • Changes in skin pigmentation

  • Pain

  • Burning

  • Tenderness

  • Pruritus (persistent intense itching)

  • Edema (swelling caused by excessive fluid)

  • Desquamation (skin shedding/peeling) either dry and/or moist, with ulceration in severe cases

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Risk factors:

​1. Treatment-related factors

  • Radiation dose

  • Irradiated volume

  • Bolus

  • Concurrent chemotherapy

  • Treatment positioning​

2. Intrinsic factors

  • BMI

  • Irradiation site

  • Smoking status

  • Skin pigmentation

 

Treatment options:

1. Topical non-steroidal agents and corticosteroids

  • Non-steroidal and steroidal agents have been studied for managing radiation dermatitis, with some research showing conflicting results

  • Biafine has been found to significantly reduce the risk of severe radiation dermatitis

  • Other agents, such as doxepin and sucralfate, have limited supporting evidence or have demonstrated only minimal benefit 

  • In terms of safety, there is some potential concern with few individuals facing side effects ​

2. Barrier films and dressings

  • Barrier films or dressings were found to be effective in preventing radiation dermatitis

  • There is some insufficient evidence on certain barrier films such as Hydrofilm, Mepilex Film, No-Sting Barrier Film, and SLND ​

3. Natural, miscellaneous, and alternative therapies

  • Natural products such as aloe vera, oral enzymes, olive oil, calendula, and curcumin have been studied with oral enzymes and olive oil show significant reduction in radiation dermatitis 

  • Other products such as honey-based products, vitamins, chamomile-based creams have shown minimal or no benefit  

4. Laser therapy

  • Photobiomodulation (low-level laser therapy) has been studied in multiple research efforts, with most findings indicating that it may help prevent or lessen the severity of acute radiation dermatitis 

5. Systemic and other treatments

  • Some studies have examined systemic agents such as oral enzyme mixtures, which showed potential in preventing acute radiation dermatitis 

  • However, evidence supporting the use of other systemic medications and multi-component therapies remains limited 

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Consult your healthcare provider before applying any products to the treated area, including makeup, hair removal tools, ointments, and creams.

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You may feel embarrassed or may not like the visual outcome of this side effect however use it as a battle scar to encourage you and remember your own strength. You are fighting this disease with so much bravery and strength. Be proud of yourself!

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Bone health (osteoporosis)

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Cancer and its treatments can cause bone loss which can increase the risk of fractures and osteoporosis. Osteoporosis is a complex condition influenced by genetic factors, but currently, there are no specific genetic markers used routinely to predict low bone strength or rapid bone loss. Low bone mineral density (BMD) can increase skeletal fragility and could induce the onset of osteopenia and osteoporosis.

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Common signs include:

  • Fractures 

  • Stooped posture or kyphosis (hunched back)

  • Loss of height over time

  • Bone tenderness or pain

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Treatment Options:

Non-pharmacologic Options

 

1. Exercise

  • Exercise has shown to be a potential to improve bone health among survivors, especially for those with bone metastases 

  • Aerobic exercises (e.g., walking, jogging, swimming) may help with preserving BMD

2. Avoid smoking 

  • Smoking cessation is important to bone health as it has been found that smoking can reduce BMD

3. Limit alcohol

  • Excessive alcohol consumption can cause impaired bone formations and mineralization

  • Alcohol sensitivity also plays a role as those with high alcohol sensitivity tend to experience earlier and more frequent bone metastasis compared to those with lower sensitivity

4. Get enough vitamin D

  • It has been found that higher vitamin D levels in survivors are associated with better bone mineralization which can help prevent or slow down bone loss 

  • How much vitamin D is needed: 

    • For those between 1 and 70 years of age, including women who are pregnant or lactating, the recommended dietary allowance (RDA) is 15 micrograms (μg) per day. Because 1 μg is equivalent  to 40 International Units (IU), this RDA can also be expressed as 600 IU per day.

    • For those 71 years or older, the RDA is 20 μg per day (800 IU per day).

  • Food  sources of vitamin D:

    • Fish: herring, mackerel, salmon, tune, swordfish, snapper

    • Milk

    • Kefir

    • Fortified plant based beverages

    • Margarine, fortified

    • Egg

    • Orange juice, fortified

    • Mushrooms, white

5. Include a serving of high protein food at each meal

  • Protein is an important macronutrient that influences collagen and hormone synthesis which helps with building bone mass 

  • The protein requirement is >1 gram  per kilogram of body weight each day 

6. Get enough calcium

  • Calcium is important for maintaining bone health, and individuals should take the adequate intake to maintain normal ionized calcium levels 

  • Adults aged 19-50 years should take 1000mg of calcium each day. Adults over 51 years, should take 1200mg 

  • Food sources of calcium:

    • Cheese: swiss, cheddar, mozzarella, cottage cheese, ricotta cheese, paneer cheese

    • Milk (skim, 1% or 2% MF or whole)

    • Buttermilk or Chocolate milk

    • Yogurt, plain

 

Pharmacologic Options

1. Bone-modifying agents

  • Antiresorptive agents (bisphosphonates and denosumab) are currently the most used to reduce to risk of both cancer-induced and cancer-therapy induced bone loss 

  • Bisphosphonates are alendronate, risedronate, and zoledronate

  • Denosumab are RANK ligand inhibitors 

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Why does it happen:

  • Oophorectomy (removal of ovaries)

  • Gonadotropic-releasing hormone (GnRH) agonists

  • Chemotherapy-induced ovarian failure or aromatase inhibitors (AIs) and antiandrogens

  • Hypogonadism (reduced hormone production)

  • Early menopause

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Risk factors:

  • Age

  • Female sex

  • Ethnicity (Asian or Caucasian)

  • Low levels of physical activity

  • Smoking

  • Alcohol consumption (>3 units per day)

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Menopausal and vasomotor symptoms

 

Menopause is defined as 12 months of amenorrhea and is caused by the cessation of ovarian reproduction function (absence of menstruation). Many survivors may experience menopausal symptoms regardless of ovarian function. In those with previous chemotherapy, pelvic radiation, or on tamoxifen, regular estradiol level testing can help confirm their current menopausal status.​

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Vasomotor symptoms (VMS) refer to the side effects caused by cancer treatments such as endocrine therapies, ovarian function suppression, and chemotherapy which suppress an individual’s estrogen levels.

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Common signs include:

  • Vasomotor symptoms (ie. hot flashes/night sweats)

  • Vaginal dryness

  • Urogenital symptoms (e.g., urogenital atrophy and urinary incontinence)  

  • Sexual dysfunction

  • Sleep disturbances

  • Mood disturbances + depression

  • Cognitive dysfunction

  • Arthralgias (joint pain)

  • Myalgias (muscle pain)

  • Fatigue

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Why does it happen:

  • Ovarian suppression caused by adjuvant endocrine treatment such as aromatase inhibitor or tamoxifen can lead to menopausal symptoms

  • This substantial decrease in estrogen can lead to symptoms similar to menopause, including hot flashes, vaginal dryness, and discomfort during sex 

  • These symptoms occur because estrogen is important for regulating body temperature and maintaining vaginal tissue health 

  • One of the main causes of hot flashes is the effect of low estrogen on the hypothalamus, a brain region that controls body temperature 

  • When estrogen levels are low, the hypothalamus becomes more sensitive to minor temperature changes, causing the body to react as if it is overheated, resulting in hot flashes 

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Treatment options:

Non-hormonal pharmacological:

1. Anticonvulsants

  • Gabapentin and pregabalin are anticonvulsants that can reduce hot flashes but may cause sedation if not carefully titrated 

  • It has been found that taking a dose of 900 mg per day of gabapentin can reduce hot flashes by 44% 

  • Using gabapentin at bedtime only can help reduce night sweats and improve sleep quality 

2. Selective serotonin reuptake inhibitors (SSRIs)/ Serotonin norepinephrine reuptake inhibitors (SNRIs)

  • Both SSRIs, such as paroxetine and fluoxetine, and SNRIs, such as venlafaxine, have been associated with reductions in hot flashes exceeding 50% 

  • SSRIs are effective in reducing the frequency and intensity of hot flashes by increasing serotonin levels which helps with regulating body temperature and reducing symptoms

3. Clonidine

  • A blood pressure medication that reduces hot flashes by around 40%, but side effects like dry mouth and dizziness limit its use 

  • It has been shown to be an effective alternative to hormonal therapy as it reduces hot flashes 

4. Oxybutynin

  • Used primarily for overactive bladder; has shown to significantly decrease hot flashes and improve quality of life, with manageable side effects 

  • Individuals who received oxybutynin reported seeing improvement in VMS symptoms, sleep and overall quality of life at 4 weeks of taking it

5. Fezolinetant

  • A non-hormonal oral medication approved in 2023 for menopausal VMS, currently under study for breast cancer survivors 

  • It was found to show improvement among individuals within moderate to severe VMS, with mild and not dose dependent symptoms such as nausea, headache, diarrhea 

6. Elinzanetant

  • A medication targeting brain receptors involved in temperature regulation, showing promise in reducing hot flashes in clinical trials 

  • A novel drug that has appeared to be well tolerated in current trials 

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Non-pharmacological: 
1. Physical Activity

  • Engaging in 150 mins of moderate-intensity or 75 mins of vigor intensity activity can be spread out over the course of a week — if considered feasible and safe

  • There is mixed results as to whether exercise effectively helps VMS, however moderate activity and strength training is suggested to be better than vigorous exercise

2. Acupuncture

  • Acupuncture is used as a treatment option for hot flashes in the general population but for cancer survivors, the evidence is quite limited 

  • It has been shown to reduce VMS symptoms in some but not all postmenopausal women 

3. Lifestyle

  • Limiting alcohol intake, engaging in physical activity, maintaining a healthy diet high in vegetables, fruits, beans/legumes, and whole grains could help with the menopausal symptoms 

  • Reducing alcohol and tobacco  may reduce VMS however the evidence is quite limited 

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Melancholy

Psychological Side effects 

You are not alone: Overcoming psychological issues 

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If you’re a breast cancer patient who’s experiencing significant depression or anxiety, you’re not alone. Roughly one-quarter of breast cancer survivors experience psychological issues after completion of therapy

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Fear of recurrence
​

Fear of recurrence (FCR) is defined as fear, worry, or concern about the possibility that cancer may return or progress.  This is one the most common unmet need of cancer survivors, as 40-50% have reported to feeling moderate-to-severe levels of FCR. Mild symptoms of FCR are the occasional thought (a few times a year) and mild anxiety, whereas subclinical FCR is having frequency thoughts (more than once a month) and moderate anxiety. 

There are medications your doctor can prescribe designed to help mood disturbances caused by chemical imbalances in the brain. But there are many things you can do on your own to help alleviate your sadness, fear and anxiety, such as, relaxation exercises, which can help improve your mood and reduce your feelings of anxiety and stress. Additionally, you can try yoga, meditation, massage, music or art therapy and get support from your family, friends or fellow breast cancer patients and survivors. Participating in support groups can help you find hope and new ways of coping with your feelings.

​

Treatment options:

1. Cognitive Behavioural Therapy

  • Cognitive behavioural therapy (CBT) focuses on the content of thoughts and aims to identify and change negative thoughts or biases to reduce distress and support psychological adjustment, and has is commonly used to treat FCR

2. Mind-body interventions

  • Mind–body interventions include practices such as meditation, relaxation techniques, creative arts, and mindfulness-based stress reduction (MBSR), and they may also include elements of cognitive behavioural therapy (CBT) 

  • Mindfulness and acceptance based therapy interventions were found to be effective in reducing FCR 

3. Psychoeducational Program

  • Psychoeducation is the process of providing information and education to individuals who are seeking or receiving mental health services, experiencing psychological symptoms, or accessing medical care. It may combine elements of cognitive behavioural therapy (CBT), group therapy, and educational approaches (CCO, 2024)

4. Non-mental Health Specialist

  • Interventions for fear of recurrence (FCR) can be delivered by non-mental health specialists, such as doctors, nurses, and radiation therapy technologists, as part of routine follow-up care in medical oncology clinics

5. Telecoaching

  • Telecoaching involves providing motivational interviews through telephone sessions 

  • One study found telecoaching to be effective in reducing FCR, however further research is required 

1000 fear sad recurrence patient.jpeg
Anxiety
​

Anxiety is a common psychological effect among cancer survivors regardless of their cancer stage, primary cancer site, and phase of treatment.  Death anxiety is a form of anxiety in which the individual has an extreme fear of death and is anxious when experiencing thoughts about dying or posthumous events. ​

 

Physical and psychological symptoms of anxiety include insomnia, hyper-vigilance to symptoms or events, shortness of breath, jitteriness, distractibility, worrying thoughts, apprehensive, low concentration, emotional numbness and fatigue. If these symptoms interfere with your quality of life and the ability to carry out daily activities, further evaluation and treatment may be required. Speak to your doctor if you are experiencing these symptoms. Treatments include, talk therapies, either individually or in a group, and anti-depressants. You may try relaxation exercises that can help improve your mood, such as, yoga, meditation, or massage.

​

Risk factors include:

1. Timing and Disease Factors:

  • Occurs more often in the acute phase following diagnosis of a life-threatening cancer

  • More common with advanced or longer duration of disease

2. Personal and Social Factors:

  • Unemployment

  • Younger age

  • Less satisfactory communication with healthcare providers

  • Insecure attachment style

  • Impaired social and cognitive functioning

3. Treatment-related Factors:

  • Chemotherapy

  • Radiotherapy

4. Pre-existing Conditions

  • Though a history of anxiety before cancer may increase risk, two-thirds of anxious cancer patients have no prior anxiety history

​

Risk Factors for death anxiety:

  • Female gender

  • Unemployment

  • Lower income

  • Less preparation for end-of-life

  • Lower resilience 

  • Lower self-esteem

​

Treatment options

Non-Pharmacological Options:

  1. Psychoeducation 

  • The effects of psychoeducation (behavioural, counselling, and education techniques) intervention for anxiety have observed be shown within 6 months 

  • It was found that face-to-face psychoeducation was effective in reducing anxiety and improving overall quality of life 

2. Supportive therapy (counselling, supportive–expressive)

  • A form of psychotherapy that aims to stabilize individuals, who are not suited for other forms of therapies 

  • Supportive therapy is shown to be effective for anxiety

3. Cognitive and behavioural interventions

  • Cognitive behavioural aims to use techniques to modify dysfunctional beliefs and correct the individual’s thinking by eliminating negative thoughts, this is found to be effective for anxiety 

4. Mindfulness-based therapy (MBT) (MBSR and MBCT)

  • MBSR focuses on mindfulness meditations to alleviate stress, stress, and anxiety 

  • MBSR has shown significant improvements in anxiety 

5. Other relaxation training

  • The Benson relaxation technique encourage creative visualization and relaxation of all the senses  and has been found to improve anxiety among cancer patients 

6. Meaning-centred therapy

  • This has been found to be effective for individuals with advanced stages of the disease

 

Pharmacological Options:

  1. Anxiolytics 

  • Data supporting the use of anxiolytics are absent within this setting

  • E.g., 

    •  Alprazolam

    • Lorazepam

2. Antidepressants (AD)

  • Evidence for AD is limited 

  • E.g.,

  • Fluoxetine

  • Paroxetine

  • Sertraline

  • Bupropion

  • Mirtazapine

​

Depression

​​

Survivorship can pose a risk to clinical depression and it was found that there is a 5-to10-year risk of late onset depression among different cancers; 14.7% in breast cancer, 9.9% in prostate cancer, 13.2% in colorectal cancer survivors. The role of stressors related to aging, such as other health conditions and the loss of a partner, in increasing the risk or severity of depression is not fully understood. Symptoms of depression are typically more severe in individuals with advanced illness or a high symptom burden. Furthermore, depression at diagnosis and throughout the cancer journey is linked to lower treatment adherence, increased inflammation, weakened immune function, and poorer survival outcomes
 

Risk factors include:

1. Medical: 

  • Advanced disease

  • Multiple treatments

  • Higher symptom effect

  • Comorbidities

  • Less rehabilitative options

  • Poor patient-physician relationship

2. Personal:

  • Prior psychiatric history

  • Past trauma

  • helplessness/hopelessness

  • Low education

  • Low income

  • Relationship issues

3. Social: 

  • Single

  • Limited social connections

  • Stigma

  • Socio-environmental stressors

​​

Treatment Options: 

Non-pharmacologic

1. Psychotherapy

  • Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) focus on changing maladaptive behaviors are frequently used among cancer survivors but the results are inconsistent

2. Alternative treatments

  • Examples include yoga, tai chi, mindfulness 

  • Studies have found that Qigong and mindfulness can reduce depressive symptoms among cancer survivors

 

Pharmacologic 

1. Antidepressants 

Antidepressants drugs have been shown to be beneficial for depression among cancer patients, how evidence is limited among survivors 

2. Selective serotonin reuptake inhibitors (SSRIs)/serotonin norepinephrine reuptake inhibitors (SNRIs)

SSRIs and SNRIs can be used in survivors with moderate to severe intensity major depression 

​

Screening tools:

These validated measures can be used to screen for depression:

  • PHQ-9 for Depression

  • GAD-7

  • PROMIS

​

It is important to get help immediately if you are experiencing thoughts of suicide.
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Cognitive Function

​

Cancer-related cognitive impairment (CRCI) refers to the subacute, chronic, and sometimes progressive decline in thinking and memory that people with cancer may experience due to the cancer itself and/or its treatments. Treatments associated with CRCI include chemotherapy, radiation therapy, surgery, hormonal therapy, targeted therapies (such as antibodies and small molecule inhibitors), and immunotherapy can cause this, and can be commonly referred to as “chemofog” or “chemo brain."

​

Common signs include:

  • Difficulty finding words

  • Trouble organizing thoughts and clearly expressing oneself

  • Increased forgetfulness (for example, misplacing everyday items like a wallet or keys, or entering a room and forgetting why)

  • Difficulty retaining new information (such as forgetting the name of someone you were just introduced to or new instructions)

  • Problems with concentration or completing tasks (tasks take much longer to finish)

  • Challenges with planning or making decisions

  • Difficulty multitasking (struggling to keep track of activities when interrupted or switching between tasks)

 

Cancer-related cognitive changes can make you feel frustrated, insecure, or fearful about your thinking abilities. Everyday tasks may take more effort, which can affect your daily life and productivity. This may lead to reduced confidence and feelings of helplessness as you try to keep up. You might worry about being seen as “less capable,” which can impact self-esteem and relationships. It’s important to remember that these cognitive changes are common during cancer treatment and do not reflect your intelligence or value. You are adjusting to challenging circumstances, and it is okay to seek support.

 

Why does it happen:

The reasons for CRCI are multifactorial as it can occur due to the tumor itself, sleep disorders, damage to the brain region, stress, DNA damage.

​

Risk factors include:

  • Older age and pre-existing neurodegenerative conditions

  • Known cognitive deficits from previous neurologic injury, such as stroke, TBI, or underlying neurodegenerative disorders

  • Medications used during cancer treatment

​

Treatment Options: 

1. Symptom-Oriented Interventions

  • Aerobic exercise

  • Yoga

  • Mindfulness meditation

  • Implementation of compensatory strategies

  • Strategies to support cognitive function include: taking notes; using smartphones to set alerts, reminders, or record important conversations; using self-talk (e.g., “What am I supposed to do next?”); practicing active listening by summarizing what you heard to confirm understanding; and keeping essential items, such as keys and your phone, in the same place consistently 

 

Pharmacologic Options: 

Some of the drugs investigated for use in CRCI include: 

1. Lithium and Fluoxetine  

  • These are being investigated as they have the potential to mitigate the harmful impacts of chemotherapy on the brain  

2. Phosphodiesterase inhibitors

  • This has the potential to help with the deterioration in the brain after chemotherapy    

3. Antidementia drugs

  • Medications such as cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists are commonly used to treat Alzheimer’s disease. Researchers are investigating whether these drugs might also help improve cognitive function in cancer survivors experiencing memory problems or mental fog 

4. Neurostimulants

  • Used for attention-deficit/hyperactivity disorder to help with lack of attention and focus 

5. Anti-inflammatory agents

  • New medications are being developed to reduce damage caused by free radicals (harmful molecules that can harm cells), protect the energy-producing parts of cells called mitochondria, and support their repair. These approaches aim to promote brain health and recovery after cancer treatment 

 

Practical Management

  • Routine screening for cancer-related cognitive impairment (CRCI) should be conducted during follow-up visits, whether the patient is currently receiving treatment or has completed it 

​

Post-traumatic Stress Disorder (PTSD) 
​

PTSD can develop after exposure to traumatic events such as a cancer diagnosis or treatment.  PTSD can affect quality of life which includes life satisfaction and psychosocial functioning even after treatment is completed.  The symptoms associated with PTSD may lead to significant distress and impairments in social interactions, work ability, and other areas of functioning.

 

Common signs:

  • Re-experiencing repeated disturbing memories, dreams or flashback 

  • Persistence avoided such as avoidance distressing memories, thoughts, feelings, or external reminders of the cancer

  • Negative alteration in mood or cognition such exaggerate negative beliefs about oneself or the world, feeling detached or estranged from others, lack of positive emotions, feelings of fear, horror, anger, guilt and/or shame

 

You might be at greater risk of developing PTSD if you:

  • Have a history of anxiety or depression

  • Have a history of trauma, PTS, ASD, or PTSD before cancer

  • Are diagnosed at a younger age, especially in childhood

  • Have advanced cancer at the time of your diagnosis

  • Don’t have a good support system

 

You can lower your risk by: 

  • Having a good understanding of your cancer diagnosis

  • Talking honestly and openly with your doctor or cancer care team

  • Having a strong support system

​

 

Treatment Options: 

1. Psychotherapy (talk therapy):  There are many different types of psychotherapy. Common types used to treat PTS, ASD and PTSD include:

  • Cognitive behavioral therapy (CBT) or trauma-focused CBT

    • There is mixed results when it comes to using CBT to treat PTSD, some studies show improvement where others found it not helpful 

    • Another study found that it was effective in reducing hyperarousal and intrusive thoughts but not avoidance 

  • Eye movement desensitization and reprocessing (EMDR)

    • EMDR was found to be effective in reducing PTSD symptoms for those going under active treatment 

  • Exposure therapy

    • Exposure therapy was recommended to treat PTSD among adults, however 

2. Medication

  • Medications used to treat anxiety or depression can help reduce negative thoughts and feelings in people with PTSD.

3. Support or peer groups

  • There is mixed results with using peer support groups to treat PTSD symptoms as some studies have found it be ineffective, whereas other found that using online forums have shown improvement 

​

​

Social issues

 

Cancer and its treatment can have a broad reach into the lives of cancer survivors, their caregivers and their social network (eg, friends, community, church). Specific issues that have been evaluated are discussed below.

​

  • Caregivers

Breast cancer exerts its effects on the spouse or significant other particularly during active treatment. Caring for a cancer patient can take a toll on the caregiver’s health. Available data has suggested that caregivers experience distress, anxiety and depression. Sharing thoughts and feelings about the cancer experience of both the patient and caregivers is found to decrease distress and/or depression.

​

  • Children

Mothers with breast cancer report various concerns about their children, ranging from their daily disruptions to questions about dying and leaving their children behind. It can also be a difficult conversation to talk to your children about breast cancer. Children of parents who are breast cancer survivors may face psychosocial issues. These include feelings of uncertainty, anxiety and isolation. A child's age, cognitive capacities, strengths and gender may influence children responses to their mother’s breast cancer. Recent studies have shown that adolescent females were found to be the most negatively impacted. One study demonstrated that among adolescent daughters of breast cancer survivors, those exhibiting greater anxiety had mothers who demonstrated greater anxiety in their relationship.

​

Adjustment to work
​

Symptoms that affect work can arise from a survivor’s treatment or disease status, particularly for those living with cancer long-term or coping with the effects of treatment. Some survivors may continue working during treatment, while others may need to start and stop work multiple times. 

​

Assessment for employment: 

  • Discuss with your healthcare provider on your concerns, needs, goals and desires related to work 

    • What abilities are required for the job (e.g., cognitive tasks, long periods of standing, use of hands)

  • Discuss barriers 

  • Practical concerns regarding employment (e.g., transportation, caregiving responsibilities, health insurance coverage, financial instability)

  • Discuss job flexibility, workplace accommodations, supportive work environment and paid sick leave

  • Discuss treatable contributing symptoms

    • Fatigue

    • pain/neuropathy

    • musculoskeletal/neurologic issues

    • Cognitive dysfunction

    • Anxiety, depression, distress 

    • vision/hearing changes 

  • Discuss comorbid conditions

    • Organ dysfunction

    • Hematologic dysfunction/infection risk

    • Alcohol/substance use

​

​​

References: ​

​

Al Maqbali, M. (2021). Cancer-related fatigue: an overview. British Journal of Nursing, 30(4), S36–S43. https://doi.org/10.12968/bjon.2021.30.4.s36

American Cancer Society. (2024). Post-traumatic Stress Disorder (PTSD) After Cancer. Cancer.org. https://www.cancer.org/cancer/survivorship/post-traumatic-stress-disorder-and-cancer.html

American Cancer Society. (2025a, June 2). Surgery for cancer | american cancer society. Www.cancer.org. https://www.cancer.org/cancer/managing-cancer/treatment-types/surgery.html

American Cancer Society. (2025b, September 24). Vaccinations and Flu Shots | Vaccinations During Cancer Treatment. Www.cancer.org. https://www.cancer.org/cancer/managing-cancer/side-effects/infections/vaccination-during-cancer-treatment.html

American Cancer Society. (2025c, October 29). Second Cancers. Cancer.org. https://www.cancer.org/cancer/survivorship/second-cancers-in-adults.html

American Cancer Society. (2025d, November 14). Music Therapy. Cancer.org. https://www.cancer.org/cancer/supportive-care/integrative-medicine/mind-body-and-body-based-therapies/music-therapy.html

https://www.apa.org/topics/sex-sexuality#:~:text=Sex%20refers%20to%20the%20characteristics%20and%20traits%20of,behavior%2C%20including%20gender%20identity%2C%20orientation%2C%20attitudes%2C%20and%20activity.

Andersen, B. L., Lacchetti, C., Kimlin Tam Ashing, Berek, J. S., Berman, B. S., Bolte, S., Dizon, D. S., Given, B. A., Nekhlyudov, L., Pirl, W. F., Stanton, A. L., & Rowland, J. H. (2023). Management of anxiety and depression in adult survivors of cancer: ASCO guideline update. Journal of Clinical Oncology, 41(18). https://doi.org/10.1200/jco.23.00293

Anderson, D. M., & Jones, V. (2023). Psychological interventions for cancer-related post-traumatic stress disorder: narrative review. BJPsych Bulletin, 1–10. https://doi.org/10.1192/bjb.2023.42

Andreu, Y., Soto-Rubio, A., Ramos-Campos, M., Escriche-Saura, A., Martínez, M., & Gavilá, J. (2022). Impact of hormone therapy side effects on health-related quality of life, distress, and well-being of breast cancer survivors. Scientific Reports, 12(1), 18673. https://doi.org/10.1038/s41598-022-22971-x

Arecco, L., Blondeaux, E., Bruzzone, M., Latocca, M. M., Mariamidze, E., Begijanashvili, S., Sokolovic, E., Gentile, G., Scavone, G., Ottonello, S., Boutros, A., Vaz-Luis, I., Saura, C., Anderson, R. A., Demeestere, I., Azim, H. A., de Azambuja, E., Peccatori, F. A., Del Mastro, L., & Partridge, A. H. (2023). Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis. ESMO Open, 8(6), 102031. https://doi.org/10.1016/j.esmoop.2023.102031

Baglivo, M., Martelli, F., Stefano Paolacci, Manara, E., Michelini, S., & Bertelli, M. (2020). Electrical stimulation in the treatment of lymphedema and associated skin ulcers. Lymphatic Research and Biology, 18(3), 270–276. https://doi.org/10.1089/lrb.2019.0052

Baid, R., Pai, H., Palshetkar, N., Pai, A., Pai, R., & Palshetkar, R. (2021). Oocyte cryopreservation - current scenario and future perspectives: A narrative review. Journal of Human Reproductive Sciences, 14(4), 340. https://doi.org/10.4103/jhrs.jhrs_173_21

Bakar, Y. (2024). Breast cancer-related lymphedema: From description to management. Managing Side Effects of Breast Cancer Treatment, 99–114. https://doi.org/10.1007/978-3-031-75480-7_8

BC Cancer. (2022, November). Oncology Nutrition Preventing Osteoporosis. BC Cancer. https://www.bccancer.bc.ca/nutrition-site/Documents/Patient%20Education/Osteoporosis%20Prevention%201.pdf

BC Cancer. (2024). Fertility and Cancer Impact of cancer on fertility. https://www.bccancer.bc.ca/managing-symptoms-site/Documents/Fertility-Cancer-Web.pdf

Beeler, D. M., O’Higgins, C., Brady, B., Walsh, D., & Reilly, R. (2025). Objective measurement of cancer-related fatigue. Supportive Care in Cancer, 33(8). https://doi.org/10.1007/s00520-025-09764-4

Behroozian, T., Bonomo, P., Patel, P., Kanee, L., Finkelstein, S., van den Hurk, C., Chow, E., Wolf, J. R., & Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology Study Group Radiation Dermatitis Guidelines Working Group. (2023). Multinational association of supportive care in cancer (MASCC) clinical practice guidelines for the prevention and management of acute radiation dermatitis: International delphi consensus-based recommendations. The Lancet. Oncology, 24(4), e172–e185. https://doi.org/10.1016/S1470-2045(23)00067-0

Behroozian, T., Goldshtein, D., Julie Ryan Wolf, Corina, Finkelstein, S., Lam, H., Patel, P., Kanee, L., Shing Fung Lee, Adrian Wai Chan, Chun, H., Saverio Caini, Mahal, S., Kennedy, S., Chow, E., Bonomo, P., Behroozian, T., Goldshtein, D., Julie Ryan Wolf, & Corina. (2023). MASCC clinical practice guidelines for the prevention and management 

of acute radiation dermatitis: part 1) systematic review. EClinicalMedicine, 58, 101886–101886. https://doi.org/10.1016/j.eclinm.2023.101886

Belzile‐Dugas, E., & Eisenberg, M. J. (2021). Radiation‐Induced cardiovascular disease: Review of an underrecognized pathology. Journal of the American Heart Association, 10(18). https://doi.org/10.1161/jaha.121.021686

Bernas, M., Al-Ghadban, S., Saskia R. J. Thiadens, Ashforth, K., Lin, W. C., Safa, B., Buntic, R. F., Paukshto, M., Rovnaya, A., & McNeely, M. L. (2023). Etiology and treatment of cancer-related secondary lymphedema. Clinical & Experimental Metastasis. https://doi.org/10.1007/s10585-023-10232-8

Bhinder, J. K., Kennedy, S. K. F., Faouk Al Aadah, C., & Al-Khaifi, M. (2025). 2024 SOGC, 2024 NCCN, 2022 ESO-ESMO, and 2018 ASCO: A comparison of female cancer survivorship guidelines for the management of sexual health concerns. Supportive Care in Cancer, 33(7). https://doi.org/10.1007/s00520-025-09640-1

Blaes, A., Nohria, A., Armenian, S., Bergom, C., Thavendiranathan, P., Barac, A., Sanchez-Petitto, G., Desai, S., Zullig, L. L., Morgans, A. K., & Herrmann, J. (2025). Cardiovascular considerations after cancer therapy. JACC: CardioOncology, 7(1), 1–19. https://doi.org/10.1016/j.jaccao.2024.06.006

Bokkers, K., Vlaming, M., Engelhardt, E. G., Zweemer, R. P., van Oort, I. M., Kiemeney, L. A. L. M., Bleiker, E. M. A., & Ausems, M. G. E. M. (2022). The feasibility of implementing mainstream germline genetic testing in routine cancer care—a systematic review. Cancers, 14(4), 1059. https://doi.org/10.3390/cancers14041059

Bower, J. E., Ganz, P. A., Irwin, M. R., Cole, S. W., Garet, D., Petersen, L., Asher, A., Hurvitz, S. A., & Crespi, C. M. (2021). Do all patients with cancer experience fatigue? A

longitudinal study of fatigue trajectories in women with breast cancer. Cancer, 127(8), 1334–1344. https://doi.org/10.1002/cncr.33327

Bradt, J., Dileo, C., Myers-Coffman, K., & Biondo, J. (2021). Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database of Systematic Reviews, 2021(10). https://doi.org/10.1002/14651858.cd006911.pub4

Breidenbach, C., Heidkamp, P., Hiltrop, K., Pfaff, H., Enders, A., Ernstmann, N., & Kowalski, C. (2022). Prevalence and determinants of anxiety and depression in long-term breast cancer survivors. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-03735-3

Canadian Cancer Society. (2015). Genetic testing. Canadian Cancer Society. https://cancer.ca/en/cancer-information/what-is-cancer/genes-and-cancer/genetic-testing

Cancer Care Ontario. (2025). Hormonal Therapy | Cancer Care Ontario. Cancercareontario.ca. https://www.cancercareontario.ca/en/cancer-treatments/hormonal-therapy

Cancer, C. (2016). Worrying that cancer will come back. Canadian Cancer Society. https://cancer.ca/en/living-with-cancer/life-after-treatment/worrying-that-cancer-will-com 

e-back

Cansız, G., Arıkan Dönmez, A., Kapucu, S., & Borman, P. (2022). The effect of a self-management lymphedema education program on lymphedema, lymphedema-related symptoms, patient compliance, daily living activities and patient activation in patients with breast cancer-related lymphedema: A quasi-experimental study. European Journal of Oncology Nursing, 56, 102081. https://doi.org/10.1016/j.ejon.2021.102081

Castañeda, S., Casas, A., González-del-Alba, A., Martínez-Díaz-Guerra, G., Nogués, X., Ojeda Thies, C., Torregrosa Suau, Ó., & Rodríguez-Lescure, Á. (2022). Bone loss induced by cancer treatments in breast and prostate cancer patients. Clinical and Translational Oncology, 24(11), 2090–2106. https://doi.org/10.1007/s12094-022-02872-1

Cedars, M. I. (2022). Evaluation of female fertility—amh and ovarian reserve testing. The Journal of Clinical Endocrinology & Metabolism, 107(6). https://doi.org/10.1210/clinem/dgac039

Chang, C.-P., Ho, T. F., Snyder, J., Dodson, M., Deshmukh, V., Newman, M., Date, A., N. Lynn Henry, & Hashibe, M. (2023). Breast cancer survivorship and sexual dysfunction: a population-based cohort study. Breast Cancer Research and Treatment, 200(1), 103–113. https://doi.org/10.1007/s10549-023-06953-9

Chaput, G., & Ibrahim, M. (2023). Cancer-related lymphedema. Canadian Family Physician, 69(10), 691–695. https://doi.org/10.46747/cfp.6910691

Chaudry, A., Vanaria, R. J., & Nestor, M. S. (2025). Radiation dermatitis: A comparative review of prevention and management. Dermatological Reviews, 6(4). https://doi.org/10.1002/der2.70043

Chaurasia, V., Pal, S., & Tiwari, B. (2018). Prediction of benign and malignant breast cancer using data mining techniques. Journal of Algorithms & Computational Technology, 12(2), 119–126. https://doi.org/10.1177/1748301818756225

Chen, M.-H., Zhao, J., Ogongo, M. K., Han, X., Zheng, Z., & K. Robin Yabroff. (2025). Associations of financial hardship and health status, social functioning, and mental health among cancer survivors in the united states: Findings from a nationally representative study. JCO Oncology Practice, 21(1), 78–88. https://doi.org/10.1200/op.23.00833

Cheng, P., Xu, L., Zhang, J., Liu, W., & Zhu, J. (2021). Role of arts therapy in patients with breast and gynecological cancers: A systematic review and meta-analysis. Journal of Palliative Medicine, 24(3), 443–452. https://doi.org/10.1089/jpm.2020.0468

Cherukuri, S. P., Chikatimalla, R., Dasaradhan, T., Koneti, J., Gadde, S., & Kalluru, R. (2022). Breast cancer and the cardiovascular disease: A narrative review. Cureus, 14(8). https://doi.org/10.7759/cureus.27917

Choi, T.-Y., Ang, L., Ji Hee Jun, Terje Alraek, & Myeong Soo Lee. (2022). Acupuncture and moxibustion for cancer-related fatigue: An overview of systematic reviews and meta-analysis. Cancers, 14(10), 2347–2347. https://doi.org/10.3390/cancers14102347

Chu, D.-T., Nguyen, T. T., Tien, N. L. B., Tran, D.-K., Jeong, J.-H., Anh, P. G., Thanh, V. V., Truong, D. T., & Dinh, T. C. (2020). Recent progress of stem cell therapy in cancer treatment: Molecular mechanisms and potential applications. Cells, 9(3), 563. https://doi.org/10.3390/cells9030563

Chukir, T., Taipaleenmäeki, H., Cheung, M., & Farooki, A. (2025). Bone health in cancer: perspective on the use of osteoanabolic agents. Therapeutic Advances in Endocrinology and Metabolism, 16. https://doi.org/10.1177/20420188251367252

Cole, K. M., Clemons, M., Alzahrani, M., Liu, M., Larocque, G., MacDonald, F., Hutton, B., Piper, A., Fernandes, R., Pond, G. R., Vandermeer, L., Emam, K. E., & McGee, S. F. (2022). Vasomotor symptoms in early breast cancer—a “real world” exploration of the patient experience. Supportive Care in Cancer, 30(5), 4437–4446. https://doi.org/10.1007/s00520-022-06848-3

Coleman, R., Hadji, P., Body, J.-J. ., Santini, D., Chow, E., Terpos, E., Oudard, S., Bruland, Ø., Flamen, P., Kurth, A., Poznak, C. V., Aapro, M., & Jordan, K. (2020). Bone health in 

cancer: ESMO Clinical Practice Guidelines†. Annals of Oncology, 0(0). https://doi.org/10.1016/j.annonc.2020.07.019

Curigliano, G., Lenihan, D., Fradley, M., Ganatra, S., Barac, A., Blaes, A., Herrmann, J., Porter, C., Lyon, A. R., Lancellotti, P., Patel, A., DeCara, J., Mitchell, J., Harrison, E., Moslehi, J., Witteles, R., Calabro, M. G., Orecchia, R., de Azambuja, E., & Zamorano, J. L. (2020). Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Annals of Oncology, 31(2), 171–190. https://doi.org/10.1016/j.annonc.2019.10.023

Cyr, M.-P., Dostie, R., Camden, C., Dumoulin, C., Bessette, P., Pina, A., Gotlieb, W. H., Lapointe-Milot, K., Mayrand, M.-H., & Morin, M. (2022). Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors suffering from pain during sexual intercourse: Results from a one-year follow-up mixed-method study. PLOS ONE, 17(1), e0262844. https://doi.org/10.1371/journal.pone.0262844

Czamanski-Cohen, J., Wiley, J., & Weihs, K. (2020). Protocol for the REPAT study: Role of emotional processing in art therapy for breast cancer palliative care patients. BMJ Open, 10(11), e037521. https://doi.org/10.1136/bmjopen-2020-037521

D’Errico, D., Schröder, T., & Gresswell, M. (2022). Therapist‐led interventions for the treatment of traumatic stress symptoms in cancer survivors: A systematic literature review. Psycho-Oncology. https://doi.org/10.1002/pon.5964

Daud, M. L., & De Simone, G. G. (2024). Management of pain in cancer patients – an update. Ecancermedicalscience, 18. https://doi.org/10.3332/ecancer.2024.1821

David, A., Hausner, D., & Frenkel, M. (2021). Cancer-Related fatigue—is there a role for complementary and integrative medicine? Current Oncology Reports, 23(12). https://doi.org/10.1007/s11912-021-01135-6

Di Tucci, C., Galati, G., Mattei, G., Chinè, A., Fracassi, A., & Muzii, L. (2022). Fertility after Cancer: Risks and Successes. Cancers, 14(10), 2500. https://doi.org/10.3390/cancers14102500

Donahue, P. M. C., MacKenzie, A., Filipovic, A., & Koelmeyer, L. (2023). Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Research and Treatment, 200(1), 1–14. https://doi.org/10.1007/s10549-023-06947-7

Du, Y., Guan, Y., Thome, K. T., & Dong, J. (2024). Music therapy and music intervention for NSCLC patients undergoing PET with fear of cancer recurrence. Integrative Cancer Therapies, 23. https://doi.org/10.1177/15347354241269898

Emery, J., Butow, P., Lai-Kwon, J., Nekhlyudov, L., Rynderman, M., & Jefford, M. (2022). Management of common clinical problems experienced by survivors of cancer. The Lancet, 399(10334), 1537–1550. https://doi.org/10.1016/s0140-6736(22)00242-2

Fabi, A., Bhargava, R., Fatigoni, S., Guglielmo, M., Horneber, M., Roila, F., Weis, J., Jordan, K., & Ripamonti, C. I. (2020). Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment. Annals of Oncology, 31(6), 713–723. https://doi.org/10.1016/j.annonc.2020.02.016

Fatima, S., Hirakawa, S., Gustavo Nader Marta, Saverio Caini, Beveridge, M., Bonomo, P., Chow, E., Corina, Julie Ryan Wolf, Lam, H., & Behroozian, T. (2023). Topical non-steroidal agents for the prevention of radiation dermatitis: a systematic review and 

David, A., Hausner, D., & Frenkel, M. (2021). Cancer-Related fatigue—is there a role for complementary and integrative medicine? Current Oncology Reports, 23(12). https://doi.org/10.1007/s11912-021-01135-6

Di Tucci, C., Galati, G., Mattei, G., Chinè, A., Fracassi, A., & Muzii, L. (2022). Fertility after Cancer: Risks and Successes. Cancers, 14(10), 2500. https://doi.org/10.3390/cancers14102500

Donahue, P. M. C., MacKenzie, A., Filipovic, A., & Koelmeyer, L. (2023). Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Research and Treatment, 200(1), 1–14. https://doi.org/10.1007/s10549-023-06947-7

Du, Y., Guan, Y., Thome, K. T., & Dong, J. (2024). Music therapy and music intervention for NSCLC patients undergoing PET with fear of cancer recurrence. Integrative Cancer Therapies, 23. https://doi.org/10.1177/15347354241269898

Emery, J., Butow, P., Lai-Kwon, J., Nekhlyudov, L., Rynderman, M., & Jefford, M. (2022). Management of common clinical problems experienced by survivors of cancer. The Lancet, 399(10334), 1537–1550. https://doi.org/10.1016/s0140-6736(22)00242-2

Fabi, A., Bhargava, R., Fatigoni, S., Guglielmo, M., Horneber, M., Roila, F., Weis, J., Jordan, K., & Ripamonti, C. I. (2020). Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment. Annals of Oncology, 31(6), 713–723. https://doi.org/10.1016/j.annonc.2020.02.016

Fatima, S., Hirakawa, S., Gustavo Nader Marta, Saverio Caini, Beveridge, M., Bonomo, P., Chow, E., Corina, Julie Ryan Wolf, Lam, H., & Behroozian, T. (2023). Topical non-steroidal agents for the prevention of radiation dermatitis: a systematic review and

Gatenby, C., & Simpson, P. (2023). Menopause: physiology, definitions, and symptoms. Best Practice & Research Clinical Endocrinology & Metabolism, 38(1), 101855–101855. https://doi.org/10.1016/j.beem.2023.101855

Giugliano, F., Giordano, E., Gilardi, L., Salimbeni, B. T., Zagami, P., Esposito, A., Marra, A., Trapani, D., Berton Giachetti, P. P. M., Malagutti, B., Henry, T., Deandreis, D., Curigliano, G., Ceci, F., & Criscitiello, C. (2025). Radioligand therapy in metastatic breast cancer: Harnessing precision oncology. Cancer Treatment Reviews, 136, 102940. https://doi.org/10.1016/j.ctrv.2025.102940

Giulia Binarelli, Mylène Duivon, Joly, F., Djihane Ahmed-Lecheheb, & Lange, M. (2023). Cancer-related cognitive impairment: current perspectives on the management of cognitive changes following cancer treatment. Expert Review of Neurotherapeutics, 23(3), 249–268. https://doi.org/10.1080/14737175.2023.2187288

Glare, P. A., Davies, P. S., Finlay, E., Gulati, A., Lemanne, D., Moryl, N., Oeffinger, K. C., Paice, J. A., Stubblefield, M. D., & Syrjala, K. L. (2014). Pain in Cancer Survivors. Journal of Clinical Oncology, 32(16), 1739–1747. https://doi.org/10.1200/jco.2013.52.4629

Glare, P., Aubrey, K., Gulati, A., Lee, Y. C., Moryl, N., & Overton, S. (2022). Pharmacologic management of persistent pain in cancer survivors. Drugs, 82(3), 275–291. https://doi.org/10.1007/s40265-022-01675-6

Go, J., Park, S., Kim, K. S., Kang, M. C., Ihn, M. H., Yun, S., Kim, S. H., Hong, S. H., Lee, J. E., Han, S. W., Kim, S. Y., Kim, Z., Hur, S. M., & Lee, J. (2020). Risk of osteoporosis and fracture in long-term breast cancer survivors. Korean Journal of Clinical Oncology, 16(1), 39–45. https://doi.org/10.14216/kjco.20007

Gobbo, M., Rico, V., Marta, G. N., Caini, S., Ryan Wolf, J., van den Hurk, C., Beveridge, M., Lam, H., Bonomo, P., Chow, E., & Behroozian, T. (2023). Photobiomodulation therapy for the prevention of acute radiation dermatitis: a systematic review and meta-analysis. Supportive Care in Cancer, 31(4). https://doi.org/10.1007/s00520-023-07673-y

Gonzalez, A. A., Jimenez-Torres, G. J., Rozman de Moraes, A., Geng, Y., Pawate, V., Khan, R., Narayanan, S., & Yennurajalingam, S. (2024). Psychological interventions for insomnia in patients with cancer: A scoping review. Cancers, 16(22), 3850. https://doi.org/10.3390/cancers16223850

Gordon, K. D., & Mortimer, P. S. (2007). A guide to lymphedema. Expert Review of Dermatology, 2(6), 741–752. https://doi.org/10.1586/17469872.2.6.741

Gowin, K., Muminovic, M., Zick, S. M., Lee, R. T., Lacchetti, C., & Mehta, A. (2024). Integrative therapies in cancer care: An update on the guidelines. American Society of Clinical Oncology Educational Book/Educational Book, 44(3). https://doi.org/10.1200/edbk_431554

Graffeo, R., Rana, H. Q., Conforti, F., Bonanni, B., Cardoso, M. J., Paluch-Shimon, S., Pagani, O., Goldhirsch, A., Partridge, A. H., Lambertini, M., & Garber, J. E. (2022). Moderate penetrance genes complicate genetic testing for breast cancer diagnosis: ATM, CHEK2, BARD1 and RAD51D. The Breast : Official Journal of the European Society of Mastology, 65, 32–40. https://doi.org/10.1016/j.breast.2022.06.003

Grassi, L., R. Zachariae, Caruso, R., L. Palagini, R. Campos-Ródenas, Riba, M. B., M. Lloyd-Williams, Kissane, D., Rodin, G., McFarland, D., C.I. Ripamonti, & Santini, D. (2023). Insomnia in adult patients with cancer: ESMO clinical practice guideline. ESMO Open, 8(6), 102047–102047. https://doi.org/10.1016/j.esmoop.2023.102047

Gray, L. J., Sindall, P., & Pearson, S. (2023). Does resistance training ameliorate cancer-related fatigue in cancer survivors? A systematic review with meta-analysis. Disability and Rehabilitation, 46(11), 1–10. https://doi.org/10.1080/09638288.2023.2226408

Grover, S., Avasthi, A., & Jagiwala, M. (2020). Clinical practice guidelines for practice of supportive psychotherapy. Indian Journal of Psychiatry, 62(8), 173. https://doi.org/10.4103/psychiatry.indianjpsychiatry_768_19

Guo, S., Han, W., Wang, P., Wang, X., & Fang, X. (2022). Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. Journal of Cancer Survivorship, 17. https://doi.org/10.1007/s11764-022-01182-3

Haenen, V., Evenepoel, M., De Baerdemaecker, T., Meeus, M., Devoogdt, N., Morlion, B., Dams, L., Van Dijck, S., Van der Gucht, E., De Vrieze, T., Vyvere, T. V., & De Groef, A. (2022). Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Supportive Care in Cancer, 31(1). https://doi.org/10.1007/s00520-022-07491-8

Hansen, J. L., Juckett, M. B., Foster, M. A., Rumble, M. E., Morris, K. E., Hematti, P., & Costanzo, E. S. (2023). Psychological and physical function in allogeneic hematopoietic cell transplant survivors with chronic graft-versus-host disease. Journal of Cancer Survivorship, 17(3), 646–656. https://doi.org/10.1007/s11764-023-01354-9

Harper-Harrison, G., Shanahan, M. M., & Carlson, K. (2023). Hormone Replacement Therapy. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493191/

Haussmann, A., Schmidt, M., Illmann, M., Schröter, M., Hielscher, T., Cramer, H., Maatouk, I., Horneber, M., & Steindorf, K. (2022). Meta-Analysis of randomized controlled trials on yoga, psychosocial, and mindfulness-based interventions for cancer-related fatigue: What intervention characteristics are related to higher efficacy? Cancers, 14(8), 2016. https://doi.org/10.3390/cancers14082016

He, T., Yang, W., Zhang, X., Li, P., Yang, D., Wu, Y., Fan, Y., Xiang, M., Huang, Q., Chen, J., Zhou, R., Lv, Q., & Chen, J. (2020). Comparative effectiveness of tamoxifen, toremifene, letrozole, anastrozole, and exemestane on lipid profiles in breast cancer patients. Medicine, 99(2), e18550. https://doi.org/10.1097/md.0000000000018550

Hemming, L., S. F. A. Duijts, N. Zomerdijk, Cockburn, C., Yuen, E., Hardman, R., J. Van Vuuren, Farrugia, T., Wilson, C., & E. Spelten. (2024). A systematic review of peer support interventions to improve psychosocial functioning among cancer survivors: can findings be translated to survivors with a rare cancer living rurally? Orphanet Journal of Rare Diseases, 19(1). https://doi.org/10.1186/s13023-024-03477-3

Hickey, M., Basu, P., Sassarini, J., Stegmann, M. E., Elisabete Weiderpass, Karen Nakawala Chilowa, Yip, C.-H., Partridge, A. H., & Brennan, D. J. (2024). Managing menopause after cancer. The Lancet, 403(10430). https://doi.org/10.1016/s0140-6736(23)02802-7

Hill‐Kayser, C., Yorke, E., Jackson, A., Gracia, C. R., Ginsberg, J. P., Keene, K. S., Ronckers, C. M., Metzger, M. L., Li, Z., Constine, L. S., & Hua, C. (2023). Effects of radiation therapy on the female reproductive tract in childhood cancer survivors: A PENTEC comprehensive review. International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2023.08.013

Hindocha, P., Lyon, A. R., Bhaskaran, K., & Strongman, H. (2025). Cardioprotective drugs and heart failure/cardiomyopathy incidence in chemotherapy-treated cancer survivors of breast cancer and non-Hodgkin lymphoma: a retrospective cohort study in England. European Heart Journal Open, 5(3). https://doi.org/10.1093/ehjopen/oeaf039

Hong, Y., Yuhan, L., Youhui, G., Zhanying, W., Shili, Z., Xiaoting, H., & Wenhua, Y. (2022). Death anxiety among advanced cancer patients: a cross-sectional survey. Supportive Care in Cancer, 30(4). https://doi.org/10.1007/s00520-022-06795-z

Hou, S., Li, Y., Lu, W., Zhang, X., Luo, H., Qiu, J., & Lu, Z. (2024). Efficacy of intermittent pneumatic compression on breast cancer-related upper limb lymphedema: a systematic review and meta-analysis in clinical studies. Gland Surgery, 13(8), 1358–1369. https://doi.org/10.21037/gs-24-123

Howell, D., Oliver, T. K., Keller-Olaman, S., Davidson, J., Garland, S., Samuels, C., Savard, J., Harris, C., Aubin, M., Olson, K., Sussman, J., MacFarlane, J., & Taylor, C. (2013). A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer. Supportive Care in Cancer, 21(10), 2695–2706. https://doi.org/10.1007/s00520-013-1823-6

Hrelic, D. A., Wax, E. M., & Saccomano, S. J. (2023). Dyspareunia: Etiology, presentation, and management. The Nurse Practitioner, 48(11), 27–34. https://doi.org/10.1097/01.NPR.0000000000000111

Huang, A. J., Faubion, S., & Grady, D. (2025). Nonhormonal treatment of menopausal vasomotor symptoms. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.0990

Huang, H., Zhao, Y., Yi, J., Chen, W., Li, J., Song, X., Ni, Y., Zhu, S., Zhang, Z., Xia, L., Zhang, J., Yang, S., Ni, J., Lu, H., Wang, Z., Nie, S., & Liu, L. (2024). Post-diagnostic lifestyle and mortality of cancer survivors: Results from a prospective cohort study. Preventive Medicine, 185, 108021–108021. https://doi.org/10.1016/j.ypmed.2024.108021

Huang, S.-T., Ke, X., Yu, X.-Y., Wu, Y.-X., Huang, Y.-X., & Liu, D. (2022). Risk factors for cancer-related fatigue in patients with colorectal cancer: a systematic review and meta-analysis. Supportive Care in Cancer, 30(12), 10311–10322. https://doi.org/10.1007/s00520-022-07432-5

Hull, S. C., Mszar, R., Ostfeld, R. J., Ferrucci, L. M., Mucci, L. A., Giovannucci, E., & Loeb, S. (2025). Diet and prevention of cardiovascular disease and cancer. JACC CardioOncology. https://doi.org/10.1016/j.jaccao.2025.07.008

Huynh, N. T. T., Fan, S.-Y., & Kao, C.-Y. (2022). Nurse-led educational interventions for anxiety management in cancer survivors: a systematic review and meta-analysis. Supportive Care in Cancer. https://doi.org/10.1007/s00520-022-07085-4

Iannopollo, L., Cristaldi, G., Borgese, C., Sommacal, S., Silvestri, G., & Serpentini, S. (2022). Mindfulness meditation as psychosocial support in the breast cancer experience: A case report. Behavioral Sciences, 12(7), 216. https://doi.org/10.3390/bs12070216

Ikhile, D., Ford, E., Glass, D., Gremesty, G., & Harm van Marwijk. (2024). A systematic review of risk factors associated with depression and anxiety in cancer patients. PloS One, 19(3), e0296892–e0296892. https://doi.org/10.1371/journal.pone.0296892

Institute for Quality and Efficiency in Health Care. (2022). Cognitive behavioral therapy. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK279297/

Jang, A., Brown, C., Lamoury, G., Morgia, M., Boyle, F., Marr, I., Clarke, S., Back, M., & Oh, B. (2020). The effects of acupuncture on cancer-related fatigue: Updated systematic review and meta-analysis. Integrative Cancer Therapies, 19, 1534735420949679. https://doi.org/10.1177/1534735420949679

Jia, T., Liu, Y., Fan, Y., Wang, L., & Jiang, E. (2022). Association of healthy diet and physical activity with breast cancer: Lifestyle interventions and oncology education. Frontiers in Public Health, 10, 797794. https://doi.org/10.3389/fpubh.2022.797794

Jolien Robijns, Aquilano, M., Banerjee, S., Saverio Caini, Wolf, J. R., Corina, Beveridge, M., Lam, H., Bonomo, P., Chow, E., & Behroozian, T. (2023). Barrier films and dressings for the prevention of acute radiation dermatitis: A systematic review and meta-analysis. Supportive Care in Cancer, 31(4). https://doi.org/10.1007/s00520-023-07671-0

Jolien Robijns, Becherini, C., Saverio Caini, Wolf, J. R., Corina, Beveridge, M., Lam, H., Bonomo, P., Chow, E., & Behroozian, T. (2023). Natural and miscellaneous agents for the prevention of acute radiation dermatitis: a systematic review and meta-analysis. Supportive Care in Cancer, 31(3). https://doi.org/10.1007/s00520-023-07656-z

Jones, J. K., Evans, J. F., & Barfield, R. C. (2021). The utility of verbal therapy for pediatric cancer patients and survivors: Expressive writing, video narratives, and bibliotherapy exercises. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.579003

Jones, N. G., & Presno, D. H. (2024). The role of rehabilitation in optimizing bone health in cancer survivors. Current Physical Medicine and Rehabilitation Reports, 12(4), 442–454. https://doi.org/10.1007/s40141-024-00471-5

Judith, Winkels, R. M., Kampman, E., & Laura H.H. Winkens. (2023). Behaviour change techniques used in lifestyle interventions that aim to reduce cancer-related fatigue in cancer survivors: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 20(1). https://doi.org/10.1186/s12966-023-01524-z

Kane, D., Rajacich, D., & Andary, C. (2020). Experiences of cancer patients’ return to work. Canadian Oncology Nursing Journal, 30(2), 113–118. https://doi.org/10.5737/23688076302113118

Kang, Y.-E., Yoon, J.-H., Park, N.-H., Ahn, Y.-C., Lee, E.-J., & Son, C.-G. (2023). Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis. Scientific Reports, 13(1), 12815. https://doi.org/10.1038/s41598-023-39046-0

Katta, M. R., Valisekka, S. S., Agarwal, P., Hameed, M., Shivam, S., Kaur, J., Prasad, S., Bethineedi, L. D., Lavu, D. V., & Katamreddy, Y. (2022). Non-pharmacological integrative therapies for chronic cancer pain. Journal of Oncology Pharmacy Practice, 28(8), 1859–1868. https://doi.org/10.1177/10781552221098437

Katz, A., Agrawal, L. S., & Sirohi, B. (2022). Sexuality after cancer as an unmet need: Addressing disparities, achieving equality. American Society of Clinical Oncology Educational Book, 42(42), 11–17. https://doi.org/10.1200/edbk_100032

Kavita Renduchintala, Arevalo, M., Fonseca, G., Haver, M. K., Gwede, C. K., Smitha Pabbathi, & Christy, S. M. (2024). Vaccination uptake among post-treatment cancer survivors: A multi-vaccine scoping review. Vaccine, 42(22), 125995–125995. https://doi.org/10.1016/j.vaccine.2024.05.043

Kawasaki, N., Ishiki, H., Arakawa, S., Satomi, E., Matsuoka, H., & Hasuo, H. (2024). Myofascial pain syndrome in patients with cancer: a narrative review. BMJ Supportive & Palliative Care, spcare-2024-005064. https://doi.org/10.1136/spcare-2024-005064

Keane, K. F., Wickstrom, J., Livinski, A. A., Blumhorst, C., Wang, T., & Saligan, L. N. (2024). The definitions, assessment, and dimensions of cancer-related fatigue: A scoping review. Supportive Care in Cancer, 32(7). https://doi.org/10.1007/s00520-024-08615-y

Kędzia, G., Martyna Woźniak, Samborski, W., & Bogna Grygiel-Górniak. (2023). Impact of dietary protein on osteoporosis development. Nutrients, 15(21), 4581–4581. https://doi.org/10.3390/nu15214581

Kennard, A., Lindo, F. M., Ring, M., Alli, B., Khan, N., Dineasha Potter-McQuilkin, Papia, G., Teng, R., McKendree, R., Thompson-Olson, M., & Tollefson, M. (2024). Lifestyle medicine and vasomotor symptoms: An analytic review. American Journal of Lifestyle Medicine. https://doi.org/10.1177/15598276241232359

Khan, S. J., Kapoor, E., Faubion, S. S., & Kling, J. M. (2023). Vasomotor symptoms during menopause: A practical guide on current treatments and future perspectives. International Journal of Women’s Health, Volume 15(15), 273–287. https://doi.org/10.2147/ijwh.s365808

Kim, J. Y., Kim, M. J., Lee, E. B., Kim, T.-Y., Lee, K.-H., Im, S.-A., & Park, J. K. (2022). Musculoskeletal pain and the prevalence of rheumatoid arthritis in breast cancer patients during cancer treatment: A retrospective study. Journal of Breast Cancer, 25(5), 404. https://doi.org/10.4048/jbc.2022.25.e40

Kuszaj, O., Day, M., Tse, S. S. W., Lee, S. F., Wang, A. J., Bayrakdarian, S., Vesprini, D., Corbin, K., Karam, I., Choi, J. I., Marta, G. N., Cao, J. Q., Hijal, T., Hill, R., Gallant, F., Chan, A. W., Chow, E., & Wong, H. C. Y. (2025). A critical review of randomized controlled trials on topical corticosteroids for the prevention of radiation dermatitis in breast cancer. Supportive Care in Cancer, 33(2). https://doi.org/10.1007/s00520-025-09178-2

Lavafian, A., Pezeshki, P. S., & Rezaei, N. (2023). Investigation of the female infertility risk associated with anti-cancer therapy. Clinical and Translational Oncology. https://doi.org/10.1007/s12094-023-03087-8

Lee, K. T., Bulls, H. W., Hoogland, A. I., James, B. W., Colon-Echevarria, C. B., & Heather. (2024). Chemotherapy-Induced peripheral neuropathy (CIPN): A narrative review and proposed theoretical model. Cancers, 16(14), 2571–2571. https://doi.org/10.3390/cancers16142571

Lee, S. (2022, June). Osteoporosis. Canadian Cancer Society. https://cancer.ca/en/treatments/side-effects/osteoporosis

Lee, Y.-H., Chang, Y.-P., Lee, J.-T., Lee, D.-C., Huang, E.-Y., & Lai, L.-J. T. (2022). Heart rate variability as an indicator of the beneficial effects of Qigong and mindfulness training on the mind–body well-being of cancer survivors. Supportive Care in Cancer, 31(1). https://doi.org/10.1007/s00520-022-07476-7

Lehmann, V., Laan, E. T. M., & den Oudsten, B. L. (2021). Sexual health-related care needs among young adult cancer patients and survivors: a systematic literature review. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-021-01084-w

Li, Q., Zhang, G., Li, X., Xu, S., Wang, H., Deng, J., Cheng, Z., Fan, F., Chen, S., Yang, M., Tang, L. V., & Hu, Y. (2025). Risk of cardiovascular disease among cancer survivors: systematic review and meta-analysis. EClinicalMedicine, 84, 103274–103274. https://doi.org/10.1016/j.eclinm.2025.103274

Li, Y.-R., Fang, Y., Lyu, Z., Zhu, Y., & Yang, L. (2023). Exploring the dynamic interplay between cancer stem cells and the tumor microenvironment: implications for novel therapeutic strategies. Journal of Translational Medicine, 21, 686. https://doi.org/10.1186/s12967-023-04575-9

Ligibel, J. A., Basen-Engquist, K., & Bea, J. W. (2019). Weight management and physical activity for breast cancer prevention and control. American Society of Clinical Oncology Educational Book, 39(39), e22–e33. https://doi.org/10.1200/edbk_237423

Lin, Y., Yang, Y., Zhang, X., Li, W., Li, H., & Mu, D. (2022). Manual lymphatic drainage for breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials. Clinical Breast Cancer, 22(5). https://doi.org/10.1016/j.clbc.2022.01.013

Lingens, S. P., Schulz, H., & Bleich, C. (2021). Evaluations of psychosocial cancer support services: A scoping review. PLOS ONE, 16(5), e0251126. https://doi.org/10.1371/journal.pone.0251126

Liu, B., Zhou, H., Tan, L., Siu, K. T. H., & Guan, X.-Y. (2024). Exploring treatment options in cancer: Tumor treatment strategies. Signal Transduction and Targeted Therapy, 9(1), 1–44. https://doi.org/10.1038/s41392-024-01856-7

Liu, J., Xiao, J., Ou, S., Chen, J., & Tang, S. (2025). Facilitators and barriers associated with returning to work for cancer survivors: A systematic review. Asia-Pacific Journal of Oncology Nursing, 12, 100734. https://doi.org/10.1016/j.apjon.2025.100734

Liu, M., Juravic, M., Mazza, G., & Krychman, M. L. (2021). Vaginal dilators: Issues and answers. Sexual Medicine Reviews, 9(2), 212–220. https://doi.org/10.1016/j.sxmr.2019.11.005

López, D. M. L. (2022). Management of genitourinary syndrome of menopause in breast cancer survivors: An update. World Journal of Clinical Oncology, 13(2), 71–100. https://doi.org/10.5306/wjco.v13.i2.71

Lyu, M., Siah, R. C., Lam, A. S. L., & Cheng, K. F. (2022). The effect of psychological interventions on fear of cancer recurrence in breast cancer survivors: A systematic review and meta‐analysis. Journal of Advanced Nursing, 78(10). https://doi.org/10.1111/jan.15321

Ma, X., Li, S. N., & Chan, D. N. S. (2023). Effects of yoga on cancer-related fatigue, psychological distress, and quality of life among patients with cancer undergoing chemotherapy and/or radiotherapy: A systematic review and meta-analysis. Cancer Nursing. https://doi.org/10.1097/ncc.0000000000001293

Ma, Y., He, B., Jiang, M., Yang, Y., Wang, C., Huang, C., & Han, L. (2020). Prevalence and risk factors of cancer-related fatigue: A systematic review and meta-analysis. International Journal of Nursing Studies, 111(103707), 103707. https://doi.org/10.1016/j.ijnurstu.2020.103707

Maddock, A., & Blair, C. (2021). How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review. Current Psychology, 42(42). https://doi.org/10.1007/s12144-021-02082-y

Mardadni, A., Maleki, M., Hanifi, N., Turunen, H., & Vaismoradi, M. (2025). Coping strategies for fear of cancer recurrence among breast cancer survivors: a systematic review and thematic synthesis of qualitative studies. Supportive Care in Cancer, 33(6). https://doi.org/10.1007/s00520-025-09503-9

Matteo Lambertini, Luca Arecco, Woodard, T. L., Messelt, A., & Rojas, K. E. (2023). Advances in the management of menopausal symptoms, fertility preservation, and bone health for women with breast cancer on endocrine therapy. Breast Cancer, 43. https://doi.org/10.1200/edbk_390442

Maxwell, C., Adam, S., Bergman, L., Nanda, S., Guinto, V. T., Noa Popovits‐Hadari, Maisah Al‐Bakri, Ifeyinwa Nwokoro, McAuliffe, F., Peters, I., Nelson‐Piercy, C., Amant, F., Nana, M., Smith, G., Berek, J., McNally, O., Nguyen‐Hoang, L., Medina‐Palmezano, V. P., O’Reilly, S., & Ruiloba, F. (2025). Pregnancy after cancer: FIGO Best practice advice. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.70139

McGrady, M. E., Willard, V. W., Williams, A. M., & Brinkman, T. M. (2024). Psychological Outcomes in Adolescent and Young Adult Cancer Survivors. Journal of Clinical Oncology, 42(6), 707–716. https://doi.org/10.1200/jco.23.01465

McLaughlin, S. A., Brunelle, C. L., & Taghian, A. (2020). Breast cancer–related lymphedema: Risk factors, screening, management, and the impact of locoregional treatment. Journal of Clinical Oncology, 38(20), 2341–2350. https://doi.org/10.1200/jco.19.02896

McLaughlin, S. A., Stout, N. L., & Schaverien, M. V. (2020). Avoiding the Swell: Advances in Lymphedema Prevention, Detection, and Management. American Society of Clinical Oncology Educational Book, 40, e17–e26. https://doi.org/10.1200/edbk_280471

McNeely, M. L., Shallwani, S. M., Onazi, A., & Lurie, F. (2024). The effect of compression therapies and therapeutic modalities on lymphedema secondary to cancer: a rapid review and evidence map. Medical Oncology, 41(11). https://doi.org/10.1007/s12032-024-02447-w

Mentink, M., Verbeek, D., Noordman, J., Timmer-Bonte, A., von Rosenstiel, I., & van Dulmen, S. (2023). The effects of complementary therapies on patient-reported outcomes: An overview of recent systematic reviews in oncology. Cancers, 15(18), 4513. https://doi.org/10.3390/cancers15184513

Merkison, J., Malcom, C. A., & DeCherney, A. H. (2022). Use of gonadotropin-releasing hormone (GnRH) agonist trigger in fertility preservation for patients with inherited genetic disorders. Sec. Cellular Endocrinology, 13. https://doi.org/10.3389/fendo.2022.826419

Mery, B., Fouilloux, A., Rowinski, E., Catella-Chatron, J., Guichard, J.-B., Costa, A. D., Fabien Tinquaut, N. Magné, & Laurent Bertoletti. (2020). Cardiovascular disease events within 5 years after a diagnosis of breast cancer. BMC Cancer, 20(1). https://doi.org/10.1186/s12885-020-06838-w

Mighton, C., & Lerner‐Ellis, J. (2022). Principles of molecular testing for hereditary cancer. Genes, Chromosomes and Cancer. https://doi.org/10.1002/gcc.23048

Mir, A., Badi, Y., Bugazia, S., Nourelden, A. Z., Fathallah, A. H., Ragab, K. M., Alsillak, M., Elsayed, S. M., Hagrass, A. I., Bawek, S., Kalot, M., & Brumberger, Z. L. (2023). Efficacy and safety of cardioprotective drugs in chemotherapy-induced cardiotoxicity: an updated systematic review & network meta-analysis. Cardio-Oncology, 9(1). https://doi.org/10.1186/s40959-023-00159-0

Miro-Rivera, D., Norris, R. A., Osazuwa-Peters, O. L., Hurst, J. H., Barnes, J. M., & Osazuwa-Peters, N. (2025). Differential use of depression and anxiety medications in adults with a history of cancer. JAMA Network Open, 8(8), e2527585. https://doi.org/10.1001/jamanetworkopen.2025.27585

Mitchell, H.-R., Kirshenbaum, A. P., Zimmer, S., & Sofis, M. J. (2025). Posttraumatic stress symptoms and unmet needs in cancer survivorship. Journal of Psychosocial Oncology, 1–14. https://doi.org/10.1080/07347332.2025.2509985

Mitra, S., Lami, M. S., Ghosh, A., Das, R., Tallei, T. E., Fatimawali, Islam, F., Dhama, K., Begum, M. Y., Aldahish, A., Chidambaram, K., & Emran, T. B. (2022). Hormonal therapy for gynecological cancers: How far has science progressed toward clinical applications? Cancers, 14(3), 759. https://doi.org/10.3390/cancers14030759

Molinares, D., Kurtevski, S., & Zhu, Y. (2023). Chemotherapy-Induced peripheral neuropathy: Diagnosis, agents, general clinical presentation, and treatments. Current Oncology Reports, 25(11), 1227–1235. https://doi.org/10.1007/s11912-023-01449-7

Molinelli, C., Jacobs, F., Guilherme Nader-Marta, Borea, R., Scavone, G., Ottonello, S., Piero Fregatti, Villarreal-Garza, C., Bajpai, J., Hee Jeong Kim, Puglisi, S., Evandro de Azambuja, & Matteo Lambertini. (2024). Ovarian suppression: Early menopause and late effects. Current Treatment Options in Oncology. https://doi.org/10.1007/s11864-024-01190-8

Mungalov, R. V., Mushenkova, N. V., Chudakov, D. M., & Turchaninova, M. A. (2025). Engaging T cells for cleanup. Frontiers in Immunology, 16, 1551424–1551424. https://doi.org/10.3389/fimmu.2025.1551424

Musto, J. A., Brown, R., & Lucey, M. R. (2025). Is there a safe limit for consumption of alcohol? Journal of Hepatology. https://doi.org/10.1016/j.jhep.2024.10.024

National Cancer Institute. (2014, December 2). Coping – new normal - national cancer institute. Www.cancer.gov. https://www.cancer.gov/about-cancer/coping/survivorship/new-normal

National Cancer Institute. (2022, August 23). Hormone therapy to treat cancer. National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/treatment/types/hormone-therapy

National Cancer Institute. (2023a, May 9). Vitamin D and Cancer Prevention. National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/vitamin-d-fact-sheet

National Cancer Institute. (2023b, December 21). Types of Radiation Therapy | SEER Training. Training.seer.cancer.gov. https://training.seer.cancer.gov/treatment/radiation/radiation-types.html

National Cancer Institute. (2024a, April 18). Genetic testing for hereditary cancer syndromes. National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet

National Cancer Institute. (2024b, October 31). Complementary and Alternative Medicine. National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/cam

National Cancer Institute. (2025, May 14). Cancer-Related Post-traumatic Stress (PDQ®)–Patient Version - National Cancer Institute. Www.cancer.gov. https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq

National Cancer institute. (2024, March 6). Lymphedema and cancer treatment - side effects. National Cancer Institute; Cancer.gov. https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema

National Heart, Lung, and Blood Institute. (2023). Calculate your body mass index. Nih.gov; U.S. Department of Health & Human Services. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

National Institute of Biomedical imaging and Bioengineering. (2025). Magnetic Resonance Imaging (MRI). National Institute of Biomedical Imaging and Bioengineering. https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri

National Institute on Alcohol Abuse and Alcoholism. (2024, December). What is A standard drink? | national institute on alcohol abuse and alcoholism (NIAAA). Nih.gov. https://www.niaaa.nih.gov/alcohols-effects-health/what-standard-drink

Nazari, A. M., Zare-Kaseb, A., Arbabi, Z., Gholampour, M. H., Emami Zeydi, A., & Ghazanfari, M. J. (2023). The effect of benson relaxation technique on cancer patients: A systematic review. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 31(12), 681. https://doi.org/10.1007/s00520-023-08142-2

NCI Dictionary of Cancer Terms. (n.d.). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/thorax. Www.cancer.gov. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/thorax

NCCN. (2025, February). Survivorship. NCCN. https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf

Nebahat Özerdoğan, Ayşe Özkaraman, Burcu Tuncer Yılmaz, Tufan Öge, & Ömer Tarık Yalçın. (2022). The effect of bright white light on fatigue levels in patients with gynecological cancer: A randomized control trial. Journal of Palliative Care, 38(4), 416–423. https://doi.org/10.1177/08258597221127795

O’Brien, K., Ried, K., Binjemain, T., & Sali, A. (2022). Integrative approaches to the treatment of cancer. Cancers, 14(23), 5933. https://doi.org/10.3390/cancers14235933

Oldacres, L., Hegarty, J., O’Regan, P., Murphy‐Coakley, N. M., & Saab, M. M. (2022). Interventions promoting cognitive function in patients experiencing cancer related cognitive impairment: A systematic review. Psycho-Oncology. https://doi.org/10.1002/pon.6073

Pati, S., Irfan, W., Jameel, A., Ahmed, S., & Shahid, R. K. (2023). Obesity and Cancer: a Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management. Cancers, 15(2), 485. https://doi.org/10.3390/cancers15020485

Perry, M., & Srivastava, S. B. (2025). Lifestyle medicine in cardio-oncology—addressing cardiovascular risks from the 3 c’s: Cancer, cancer therapies, and conventional risk factors. American Journal of Lifestyle Medicine. https://doi.org/10.1177/15598276251381627

Philippe Arvis, Rongières, C., Pirrello, O., & Philippe Lehert. (2022). Reliability of AMH and AFC measurements and their correlation: A large multicenter study. Journal of Assisted Reproduction and Genetics, 39(5), 1045–1053. https://doi.org/10.1007/s10815-022-02449-5

Plinsinga, M., Singh, B., Bloomquist, K., Bernas, M., Geyer, D., Nele Devoogdt, Koelmeyer, L., Piller, N., Reul-Hirche, H., Rockson, S., & Hayes, S. (2024). Incidence of cancer-related lymphoedema: a protocol for a living systematic review with meta-analysis. BMJ Open, 14(12), e086293–e086293. https://doi.org/10.1136/bmjopen-2024-086293

Qiu, J. M., Fu, M. R., Finlayson, C. S., Tilley, C. P., Martín Payo, R., Korth, S., Kremer, H. L., & Russell Lippincott, C. L. (2024). Lymphatic pain in breast cancer survivors: An overview of the current evidence and recommendations. Women and Children Nursing, 2(2), 33–38. https://doi.org/10.1016/j.wcn.2024.04.001

Rahman, N., Sukumar, J., & Lustberg, M. B. (2025). Chronic chemotherapy-induced peripheral neuropathy: living with neuropathy during and after cancer treatments. Annals of Palliative Medicine, 14(2), 196–216. https://doi.org/10.21037/apm-24-154

Rees-Punia, E., Newton, C. C., Parsons, H. M., Leach, C. R., Diver, W. R., Grant, A. C., Masters, M., Patel, A. V., & Teras, L. R. (2023). Fracture risk among older cancer survivors compared with older adults without a history of cancer. JAMA Oncology, 9(1), 79. https://doi.org/10.1001/jamaoncol.2022.5153

Rick, O., Gerhardt, A., & Schilling, G. (2024). Cancer-Related cognitive dysfunction: A narrative review for clinical practice. Oncology Research and Treatment, 47(5), 218–223. https://doi.org/10.1159/000538277

Rock, C. L., Thomson, C. A., Sullivan, K. R., Howe, C. L., Kushi, L. H., Caan, B. J., Neuhouser, M. L., Bandera, E. V., Wang, Y., Robien, K., Basen-Engquist, K. M., Brown, J. C., Courneya, K. S., Crane, T. E., Garcia, D. O., Grant, B. L., Hamilton, K. K., Hartman, S. J., Kenfield, S. A., & Martinez, M. E. (2022). American Cancer Society nutrition and physical activity guideline for cancer survivors. CA: A Cancer Journal for Clinicians, 72(3), 230–262. https://doi.org/10.3322/caac.21719

Rock, C. L., Thomson, C., Gansler, T., Gapstur, S. M., McCullough, M. L., Patel, A. V., Andrews, K. S., Bandera, E. V., Spees, C. K., Robien, K., Hartman, S., Sullivan, K., Grant, B. L., Hamilton, K. K., Kushi, L. H., Caan, B. J., Kibbe, D., Black, J. D., Wiedt, T.

​

​

​

Rodriguez-Wallberg, K. A., Jiang, Y., Lekberg, T., & Nilsson, H. P. (2023). The late effects of cancer treatment on female fertility and the current status of fertility preservation—a narrative review. Life, 13(5), 1195. https://doi.org/10.3390/life13051195Rossi, F., Tortora, C., Paoletta, M., Marrapodi, M. M., Argenziano, M., Di Paola, A., Pota, E., Di Pinto, D., Di Martino, M., & Iolascon, G. (2022). Osteoporosis in childhood cancer survivors: Physiopathology, prevention, therapy and future perspectives. Cancers, 14(18), 4349. https://doi.org/10.3390/cancers14184349Ryding, H. G., Mitchell, L. J., Rigby, R. R., Ball, L., Hobby, J., & Williams, L. T. (2024). Effectiveness of dietetic care for cancer survivors in the primary care setting: A systematic review and meta-analysis of randomized controlled trials. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-024-01583-6Saeki, Y., Sumi, Y., Ozaki, Y., Hosonaga, M., Yoshiyuki Kenmotsu, Takuma Onoe, Yamaguchi, K., & Matsumoto, Y. (2024). Proposal for managing cancer‐related insomnia: A systematic literature review of associated factors and a narrative review of treatment. Cancer Medicine, 13(22). https://doi.org/10.1002/cam4.70365Salam, A., Woodman, A., Chu, A., Al-Jamea, L. H., Islam, M., Sagher, M., Sager, M., & Akhtar, M. (2022). Effect of post-diagnosis exercise on depression symptoms, physical functioning and mortality in breast cancer survivors: A systematic review and meta-analysis of randomized control trials. Cancer Epidemiology, 77, 102111. https://doi.org/10.1016/j.canep.2022.102111Schoener, B., & Borger, J. (2024, July 14). Erythropoietin Stimulating Agents. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536997/Setyowibowo, H., Yudiana, W., Hunfeld, J. A. M., Iskandarsyah, A., Passchier, J., Arzomand, H., Sadarjoen, S. S., de Vries, R., & Sijbrandij, M. (2022). Psychoeducation for breast cancer: A systematic review and meta-analysis. The Breast, 62, 36–51. https://doi.org/10.1016/j.breast.2022.01.005Shah, C., Whitworth, P., Valente, S., Schwarz, G. S., Kruse, M., Kohli, M., Brownson, K., Lawson, L., Dupree, B., & Vicini, F. A. (2022). Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines. Breast Cancer Research and Treatment, 198(1), 1–9. https://doi.org/10.1007/s10549-022-06850-7Shan, S., Lin, L., Fang, Q., Tian, F., Guo, D., Zhou, Y., & Tian, L. (2023). Massage therapy significantly improves cancer-related fatigue in cancer patients: a meta-analysis of randomized controlled trials. Supportive Care in Cancer, 31(8). https://doi.org/10.1007/s00520-023-07926-wShapiro, C. L., Van Poznak, C., Lacchetti, C., Kirshner, J., Eastell, R., Gagel, R., Smith, S., Edwards, B. J., Frank, E., Lyman, G. H., Smith, M. R., Mhaskar, R., Henderson, T., & Neuner, J. (2019). Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO clinical practice guideline. Journal of Clinical Oncology, 37(31), 2916–2946. https://doi.org/10.1200/jco.19.01696Sharifi, N., & Ahmad, S. (2024). Breast cancer-related lymphedema: A critical review on recent progress. Surgical Oncology, 56, 102124–102124. https://doi.org/10.1016/j.suronc.2024.102124

Sharman, R., Harris, Z., Ernst, B., Mussallem, D., Larsen, A., & Gowin, K. (2024). Lifestyle factors and cancer: A narrative review. Mayo Clinic Proceedings. Innovations, Quality & Outcomes, 8(2), 166–183. https://doi.org/10.1016/j.mayocpiqo.2024.01.004

Sheikh-Wu, S. F., Kauffman, M. A., Anglade, D., Shamsaldeen, F., Ahn, S., & Downs, C. A. (2021). Effectiveness of different music interventions on managing symptoms in cancer survivors: A meta-analysis. European Journal of Oncology Nursing, 52, 101968. https://doi.org/10.1016/j.ejon.2021.101968

Shin, J.-W., Lee, B.-J., Chung, S., Lee, K. S., Kim, K., & Hwang, J.-I. (2023). Understanding experiences of cancer-related fatigue in patients with lung cancer after their cancer treatment: a qualitative content analysis. Quality of Life Research, 33(4), 975–987. https://doi.org/10.1007/s11136-023-03578-9

Sinai Health. (2025). Nutrition and Cancer. Sinai Health. https://www.sinaihealth.ca/areas-of-care/cancer/nutrition-and-cancer

Singh, B., & Toohey, K. (2021). The effect of exercise for improving bone health in cancer survivors — A systematic review and meta-analysis. Journal of Science and Medicine in Sport, 25(1). https://doi.org/10.1016/j.jsams.2021.08.008

Siotos, C., Arnold, S. H., Seu, M., Lunt, L., Ferraro, J., Najafali, D., Damoulakis, G., Vorstenbosch, J., Mehrara, B. J., Antony, A. K., Shenaq, D. S., & Kokosis, G. (2024). Breast cancer‐related lymphedema: A comprehensive analysis of risk factors. Journal of Surgical Oncology. https://doi.org/10.1002/jso.27841

Sleigh, B. C., & Manna, B. (2023, April 19). Lymphedema. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537239/

Song, Y., Sun, X., Shen, L., Qu, Z., Yin, J., Wang, Z., & Zhang, H. (2024). Genes of cancer-related fatigue: a scoping review. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1446321

Streckmann, F., Balke, M., Cavaletti, G., Toscanelli, A., Bloch, W., Décard, B. F., Lehmann, H. C., & Faude, O. (2021). Exercise and Neuropathy: Systematic Review with Meta-Analysis. Sports Medicine, 52(5), 1043–1065. https://doi.org/10.1007/s40279-021-01596-6

Su, H. I., Lacchetti, C., Letourneau, J., Partridge, A. H., Qamar, R., Quinn, G. P., Reinecke, J., Smith, J. F., Tesch, M., Wallace, W. H., Wang, E. T., & Loren, A. W. (2025). Fertility preservation in people with cancer: ASCO guideline update. Journal of Clinical Oncology, 43(12). https://doi.org/10.1200/jco-24-02782

Su, L., Huang, H., Tong, Y., Dong, L., Gu, C., Zhuang, S., Bai, S., & Jin, Y. (2025). Intermittent pneumatic compression devices for the prevention and treatment of breast cancer-related lymphedema—a systematic review and meta-analysis. Supportive Care in Cancer, 33(12), 1113–1113. https://doi.org/10.1007/s00520-025-10159-8

Sundaresan, S., Lavanya, S. K., & Manickam, M. (2024). Emerging molecular technology in cancer testing. EJIFCC, 35(3), 142. https://pmc.ncbi.nlm.nih.gov/articles/PMC11536271/

Suzuki, K., Morishita, S., Nakano, J., Okayama, T., Inoue, J., Tanaka, T., & Fukushima, T. (2023). Neurological outcomes of chemotherapy-induced peripheral neuropathy in patients with cancer: A systematic review and meta-analysis. Integrative Cancer Therapies, 22. https://doi.org/10.1177/15347354231185110

Tam, S., Zhou, G., Trombetta, M., Saverio Caini, Julie Ryan Wolf, Corina, Beveridge, M., Lam, H., Bonomo, P., Chow, E., & Behroozian, T. (2023). Topical corticosteroids for the 

prevention of severe radiation dermatitis: a systematic review and meta-analysis. Supportive Care in Cancer, 31(7). https://doi.org/10.1007/s00520-023-07820-5

Tanda, N., Tada, H., Washio, J., Takahashi, N., Ishida, T., & Koseki, T. (2022). Influence of alcohol sensitivity on bone metastases and skeletal-related events in primary operable breast cancer: A retrospective cohort study. PLOS ONE, 17(6), e0269335. https://doi.org/10.1371/journal.pone.0269335

Taylor, M., Westvold, S. J., Long, J. B., Hyslop, T., Silber, A., Forman, R., Yasin, F., Kwaramba, T., Wang, S.-Y., Leapman, M. S., Cecchini, M., Leeds, I., Spees, L., Wheeler, S. B., Gross, C. P., Oeffinger, K., & Dinan, M. A. (2025). Risk of late-onset depression in long-term survivors of breast, prostate, and colorectal cancer. JAMA Network Open, 8(11), e2544812. https://doi.org/10.1001/jamanetworkopen.2025.44812

To, J., Magid, R., Cleland, J., Panier, V., & Wu, J. (2025). The landscape for radioligand therapies in oncology. Nature Reviews Drug Discovery. https://doi.org/10.1038/d41573-025-00096-w

Tran Thu Ngan, Tien, T., Donnelly, M., & Ciaran O'Neill. (2023). Financial toxicity among cancer patients, survivors and their families in the United Kingdom: a scoping review. Journal of Public Health, 45(4). https://doi.org/10.1093/pubmed/fdad143

UHN. (2023). How to do self lymphatic massage on your upper body. https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/How_to_Do_Self_Lymphatic_Massage_Upper_Body_One_Side.pdf

Ünal, E., & Erdoğan Yüce, G. (2024). The effectiveness of art-based interventions for cancer patients: A systematic review and meta-analysis. European Journal of Oncology Nursing, 74, 102755. https://doi.org/10.1016/j.ejon.2024.102755

van de Donk, N. W. C. J., & Zweegman, S. (2023). T-cell-engaging bispecific antibodies in cancer. The Lancet. https://doi.org/10.1016/S0140-6736(23)00521-4

Van Leeuwen, M. T., Luu, S., Gurney, H., Brown, M. R., Pearson, S.-A., Webber, K., Hunt, L., Hong, S., Delaney, G. P., & Vajdic, C. M. (2020). Cardiovascular toxicity of targeted therapies for cancer: An overview of systematic reviews. JNCI Cancer Spectrum, 4(6). https://doi.org/10.1093/jncics/pkaa076

Vasbinder, A., & Hayek, S. S. (2022). Biomarkers for monitoring and prevention in cancer/heart disease: Traditional and innovative perspectives. American Heart Journal Plus: Cardiology Research and Practice, 17, 100161. https://doi.org/10.1016/j.ahjo.2022.100161

Vu, P. D., Mach, S., & Javed, S. (2025). Neurostimulation for the treatment of cancer-induced pain: A scoping review. Neuromodulation : Journal of the International Neuromodulation Society, 28(2), 191–203. https://doi.org/10.1016/j.neurom.2024.10.006

Wagner, L. I., Tooze, J. A., Hall, D. L., Levine, B. J., Beaumont, J. L., Duffecy, J., Victorson, D., Gradishar, W. J., Leach, J. W., Thomas James Saphner, Sturtz, K., Mary Lou Smith, Penedo, F. J., Mohr, D. C., & Cella, D. (2021). Targeted eHealth intervention to reduce breast cancer survivors’ fear of recurrence: Results from the fortitude randomized trial. Journal of National Cancer Institute, 113(11), 1495–1505. https://doi.org/10.1093/jnci/djab100

Walker, J., Tanna, S., Roake, J., & Lyons, O. (2022). A systematic review of pharmacologic and cell-based therapies for treatment of lymphedema (2010-2021). Journal of Vascular Surgery: Venous and Lymphatic Disorders. https://doi.org/10.1016/j.jvsv.2021.09.004

Wang, K., & Tepper, J. E. (2021). Radiation therapy‐associated toxicity: Etiology, management, and prevention. CA: A Cancer Journal for Clinicians, 71(5), 437–454. https://doi.org/10.3322/caac.21689

Webster, M., Podgorsak, A., Li, F., Zhou, Y., Jung, H., Yoon, J., Lemus, O. D., & Zheng, D. (2025). New approaches in radiotherapy. Cancers, 17(12), 1980–1980. https://doi.org/10.3390/cancers17121980

Wibawa, Y. A., Huang, T.-W., Prajoko, Y. W., Gautama, M. S. N., Setyowati, S., Purnaningsih, E., Ekowati, S. I., Fatmawati, E., Indriyani, Aini, N., & Janitra, F. E. (2026). Non-pharmacological palliative interventions for cancer-related pain and fatigue: A network meta-analysis. Journal of Psychosomatic Research, 201, 112501. https://doi.org/10.1016/j.jpsychores.2025.112501

Wilcox, N. S., Amit, U., Reibel, J. B., Berlin, E., Howell, K., & Ky, B. (2024). Cardiovascular disease and cancer: shared risk factors and mechanisms. Nature Reviews Cardiology, 1–15. https://doi.org/10.1038/s41569-024-01017-x

Willner, D. A., Goyal, A., Grigorova, Y., & Kiel, J. (2023, February 20). Pericardial Effusion. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431089/

Witten, T., Staszkiewicz, J., Gold, L., Granier, M. A., Klapper, R. J., Lavespere, G., Dorius, B., Allampalli, V., Ahmadzadeh, S., Shekoohi, S., Kaye, A. D., & Varrassi, G. (2024). Nonhormonal pharmacotherapies for the treatment of postmenopausal vasomotor symptoms. Cureus, 16(1). https://doi.org/10.7759/cureus.52467

Wolfman, W., Krakowsky, Y., & Fortier, M. (2021). Guideline no. 422d: Menopause and sexuality. Journal of Obstetrics and Gynaecology Canada, 43(11), 1334-1341.e1. https://doi.org/10.1016/j.jogc.2021.09.005

Wong, H. C. Y., Lee, S. F., Caini, S., Chan, A. W., Kwan, J. Y. Y., Waddle, M., Sonis, S., Herst, P., Alcorn, S., Bonomo, P., Wong, C., Corbin, K., Choi, J. I., Rembielak, A., AlKhaifi, M., Marta, G. N., Rades, D., van den Hurk, C., Wolf, J. R., & Chan, R. J. (2024). Barrier films or dressings for the prevention of acute radiation dermatitis in breast cancer: a systematic review and network meta-analysis. Breast Cancer Research and Treatment, 207(3), 477–496. https://doi.org/10.1007/s10549-024-07435-2

Wong, W. M., Chan, D. N. S., He, X., & So, W. K. W. (2022). Effectiveness of pharmacological and nonpharmacological interventions for managing the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients undergoing chemotherapy. Cancer Nursing, Publish Ahead of Print(46). https://doi.org/10.1097/ncc.0000000000001048

Xia, W., Zheng, Y., Guo, D., Zhu, Y., & Tian, L. (2024). Effects of cognitive behavioral therapy on anxiety and depressive symptoms in advanced cancer patients: A meta-analysis. General Hospital Psychiatry, 87, 20–32. https://doi.org/10.1016/j.genhosppsych.2024.01.006

Xiao, P., Ding, S., Duan, Y., Li, L., Zhou, Y., Luo, X., Xie, J., & Cheng, A. S. (2021). Effect of light therapy on cancer-related fatigue: A systematic review and meta-analysis. Journal of Pain and Symptom Management. https://doi.org/10.1016/j.jpainsymman.2021.09.010

Xu, Z., Ibrahim, S. A., Burdett, S., Larysa Rydzewska, Wattar, A., & Davies, M. C. (2023). Long term pregnancy outcomes of women with cancer following fertility preservation: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 281, 41–48. https://doi.org/10.1016/j.ejogrb.2022.12.016

Yao, M., Peng, P., Ding, X., Sun, Q., & Chen, L. (2024). Comparison of intermittent pneumatic compression pump as adjunct to decongestive lymphatic therapy against decongestive therapy alone for upper limb lymphedema after breast cancer surgery: A systematic review and meta-analysis. Breast Care, 19(3), 155–164. https://doi.org/10.1159/000538940

Yennurajalingam, S., Konopleva, M., Carmack, C. L., Dinardo, C. D., Gaffney, M., Michener, H. K., Lu, Z., Stanton, P., Ning, J., Qiao, W., & Bruera, E. (2023). Treatment of cancer-related-fatigue in acute hematological malignancies: Results of a feasibility study of using cognitive behavioral therapy. Journal of Pain and Symptom Management, 65(3), e189–e197. https://doi.org/10.1016/j.jpainsymman.2022.11.003

Zafar, A., Khatoon, S., Khan, M. J., Abu, J., & Naeem, A. (2025). Advancements and limitations in traditional anti-cancer therapies: a comprehensive review of surgery, chemotherapy, radiation therapy, and hormonal therapy. Discover Oncology, 16(1). https://doi.org/10.1007/s12672-025-02198-8

Zhang, J., Zhang, Z., Huang, S., Qiu, X., Lao, L., Huang, Y., & Zhang, Z.-J. (2022). Acupuncture for cancer-related insomnia: a systematic review and meta-analysis. Phytomedicine, 154160. https://doi.org/10.1016/j.phymed.2022.154160

Zhang, L., Liu, X., Tong, F., Zou, R., Peng, W., Yang, H., Liu, F., Yang, D., Huang, X., Yi, L., Wen, M., & Jiang, L. (2022). Cognitive behavioral therapy for anxiety and depression in cancer survivors: a meta-analysis. Scientific Reports, 12(1), 21466. https://doi.org/10.1038/s41598-022-25068-7

Zhang, Y., Kesler, S. R., Dietrich, J., & Chao, H. H. (2025). Cancer-Related cognitive impairment: A practical guide for oncologists. JCO Oncology Practice. https://doi.org/10.1200/op-24-00953

Zhang, Z., Guo, L., Zhou, L., Hao, X., Fan, Y., Li, H., Xu, H., Hu, J., Du, A., & Wang, Y. (2025). Preventive effects of progressive resistance training of different intensities on breast cancer–related lymphedema. Supportive Care in Cancer, 33(3). https://doi.org/10.1007/s00520-025-09256-5

Zhu, L., Hshieh, T. T., Iyer, T. K., Morgans, A. K., & Hamnvik, O.-P. R. (2025). Management of vasomotor symptoms in cancer patients. The Oncologist, 30(2). https://doi.org/10.1093/oncolo/oyaf002

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