Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Study Cohort
2.2. Measures
2.3. Statistical Analysis
3. Results
3.1. Study Cohort
3.2. Psychological Resilience
3.3. Health-Related Quality of Life
3.4. Predictors of the Change in Resilience Score
3.5. Uni- and Multivariable Regression Analyses between Psychological Resilience and Health-Related Quality of Life at One Year Post Diagnosis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ghoncheh, M.; Pournamdar, Z.; Salehiniya, H. Incidence and Mortality and Epidemiology of Breast Cancer in the World. Asian Pac. J. Cancer Prev. 2016, 17, 43–46. [Google Scholar] [CrossRef] [Green Version]
- Olsson Moller, U.; Olsson, I.M.; Sjovall, K.; Beck, I.; Ryden, L.; Malmstrom, M. Barriers and facilitators for individualized rehabilitation during breast cancer treatment—A focus group study exploring health care professionals’ experiences. BMC Health Serv. Res. 2020, 20, 252. [Google Scholar] [CrossRef]
- Alarcón, R.; Cerezo, M.V.; Hevilla, S.; Blanca, M.J. Psychometric properties of the Connor-Davidson Resilience Scale in women with breast cancer. Int. J. Clin. Health Psychol. 2020, 20, 81–89. [Google Scholar] [CrossRef]
- Huang, Y.; Huang, Y.; Bao, M.; Zheng, S.; Du, T.; Wu, K. Psychological resilience of women after breast cancer surgery: A cross-sectional study of associated influencing factors. Psychol. Health Med. 2019, 24, 866–878. [Google Scholar] [CrossRef] [PubMed]
- Fasano, J.; Shao, T.; Huang, H.-H.; Kessler, A.J.; Kolodka, O.P.; Shapiro, C.L. Optimism and coping: Do they influence health outcomes in women with breast cancer? A systemic review and meta-analysis. Breast Cancer Res. Treat. 2020, 183, 495–501. [Google Scholar] [CrossRef]
- Ristevska-Dimitrovska, G.; Stefanovski, P.; Smichkoska, S.; Raleva, M.; Dejanova, B. Depression and Resilience in Breast Cancer Patients. Open Access Maced. J. Med. Sci. 2015, 3, 661–665. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Velickovic, K.; Hallberg, I.R.; Axelsson, U.; Borrebaeck, C.A.K.; Rydén, L.; Johnsson, P.; Månsson, J. Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a non-clinical population in Sweden. Health Qual. Life Outcomes 2020, 18, 1–10. [Google Scholar] [CrossRef] [PubMed]
- Ristevska-Dimitrovska, G.; Filov, I.; Rajchanovska, D.; Stefanovski, P.; Dejanova, B. Resilience and Quality of Life in Breast Cancer Patients. Open Access Maced. J. Med. Sci. 2015, 3, 727–731. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zhang, H.; Zhao, Q.; Cao, P.; Ren, G. Resilience and Quality of Life: Exploring the Mediator Role of Social Support in Patients with Breast Cancer. Med. Sci. Monit. 2017, 23, 5969–5979. [Google Scholar] [CrossRef]
- Izci, F.; Sarsanov, D.; Erdogan, Z.I.; Ilgun, A.S.; Celebi, E.; Alco, G.; Kocaman, N.; Ordu, C.; Ozturk, A.; Duymaz, T.; et al. Impact of Personality Traits, Anxiety, Depression and Hopelessness Levels on Quality of Life in the Patients with Breast Cancer. Eur. J. Breast Health 2018, 14, 105–111. [Google Scholar] [CrossRef] [Green Version]
- Avis, N.E.; Levine, B.; Goyal, N.; Crawford, S.L.; Hess, R.; Colvin, A.; Bromberger, J.T.; Greendale, G.A. Health-related quality of life among breast cancer survivors and noncancer controls over 10 years: Pink SWAN. Cancer 2020, 126, 2296–2304. [Google Scholar] [CrossRef]
- Wu, Z.; Liu, Y.; Li, X.; Li, X. Resilience and Associated Factors among Mainland Chinese Women Newly Diagnosed with Breast Cancer. PLoS ONE 2016, 11, e0167976. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Markovitz, S.E.; Schrooten, W.; Arntz, A.; Peters, M.L. Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients. Psycho-Oncology 2015, 24, 1639–1645. [Google Scholar] [CrossRef] [PubMed]
- Harms, C.A.; Cohen, L.; Pooley, J.A.; Chambers, S.K.; Galvão, D.A.; Newton, R.U. Quality of life and psychological distress in cancer survivors: The role of psycho-social resources for resilience. Psycho-Oncology 2019, 28, 271–277. [Google Scholar] [CrossRef] [Green Version]
- Alizadeh, S.; Khanahmadi, S.; Vedadhir, A.; Barjasteh, S. The Relationship between Resilience with Self- Compassion, Social Support and Sense of Belonging in Women with Breast Cancer. Asian Pac. J. Cancer Prev. 2018, 19, 2469–2474. [Google Scholar]
- Tu, P.C.; Yeh, D.C.; Hsieh, H.C. Positive psychological changes after breast cancer diagnosis and treatment: The role of trait resilience and coping styles. J. Psychosoc. Oncol. 2020, 38, 156–170. [Google Scholar] [CrossRef]
- Fradelos, E.C.; Latsou, D.; Mitsi, D.; Tsaras, K.; Lekka, D.; Lavdaniti, M.; Tzavella, F.; Papathanasiou, I.V. Assessment of the relation between religiosity, mental health, and psychological resilience in breast cancer patients. Współczesna Onkol. 2018, 22, 172–177. [Google Scholar] [CrossRef] [PubMed]
- Fradelos, E.C.; Papathanasiou, I.V.; Veneti, A.; Daglas, A.; Christodoulou, E.; Zyga, S.; Kourakos, M. Psychological Distress and Resilience in Women Diagnosed with Breast Cancer in Greece. Asian Pac. J. Cancer Prev. 2017, 18, 2545–2550. [Google Scholar]
- Padilla-Ruiz, M.; Ruiz-Román, C.; Pérez-Ruiz, E.; Rueda, A.; Redondo, M.; Rivas-Ruiz, F. Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: Cross-sectional study. Support. Care Cancer 2019, 27, 1279–1286. [Google Scholar] [CrossRef]
- Connor, K.M.; Davidson, J.R.T. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress. Anxiety 2003, 18, 76–82. [Google Scholar] [CrossRef]
- The Connor-Davidson Resilience Scale. Available online: http://www.connordavidson-resiliencescale.com/ (accessed on 5 February 2021).
- Windle, G.; Bennett, K.M.; Noyes, J. A methodological review of resilience measurement scales. Health Qual. Life Outcomes 2011, 9, 8. [Google Scholar] [CrossRef] [Green Version]
- Sullivan, M.; Karlsson, J.; Ware, J.J.E. The Swedish SF-36 Health Survey—I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc. Sci. Med. 1995, 41, 1349–1358. [Google Scholar] [CrossRef]
- Sullivan, M.; Karlsson, J.; Taft, C.; Ware, J.E. SF-36 hälsoenkät: Svensk Manual och Tolkningsguide = (Swedish Manual and Interpretation Guide); Sahlgrenska Sjukhuset, Sektionen för Vårdforskning: Göteborg, Sweden, 2002. [Google Scholar]
- Axelsson, U.; Rydén, L.; Johnsson, P.; Edén, P.; Månsson, J.; Hallberg, I.R.; Borrebaeck, C.A.K. A multicenter study investigating the molecular fingerprint of psychological resilience in breast cancer patients: Study protocol of the SCAN-B resilience study. BMC Cancer 2018, 18, 1–7. [Google Scholar] [CrossRef] [Green Version]
- Saal, L.H.; Vallon-Christersson, J.; Hakkinen, J.; Hegardt, C.; Grabau, D.; Winter, C.; Brueffer, C.; Tang, M.-H.E.; Reuterswärd, C.; Schulz, R.; et al. The Sweden Cancerome Analysis Network-Breast (SCAN-B) Initiative: A large-scale multicenter infrastructure towards implementation of breast cancer genomic analyses in the clinical routine. Genome Med. 2015, 7, 20. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rydén, L.; Loman, N.; Larsson, C.; Hegardt, C.; Vallon-Christersson, J.; Malmberg, M.; Lindman, H.; Ehinger, A.; Saal, L.H.; Borg, Å. Minimizing inequality in access to precision medicine in breast cancer by real-time population-based molecular analysis in the SCAN-B initiative. Br. J. Surg. 2018, 105, e158–e168. [Google Scholar] [CrossRef] [Green Version]
- Swedish National Quality Register for Breast Cancer (NKBC). Available online: https://www.cancercentrum.se/samverkan/cancerdiagnoser/brost/kvalitetsregister/ (accessed on 5 February 2021).
- Mohlin, Åsa; Axelsson, U.; Bendahl, P.-O.; Borrebaeck, C.; Hegardt, C.; Johnsson, P.; Hallberg, I.R.; Rydén, L. Psychological Resilience and Health-Related Quality of Life in Swedish Women with Newly Diagnosed Breast Cancer. Cancer Manag. Res. 2020, 12, 12041–12051. [Google Scholar] [CrossRef] [PubMed]
- The Public Health Agency of Sweden. Available online: https://www.who.int/vaccine_safety/initiative/communication/network/smi/en/ (accessed on 5 February 2021).
- Statistics Sweden, Surveys about Living Conditions (ULF/SILC). Available online: https://scb.se/ (accessed on 5 February 2021).
- Steyerberg, E. Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating; Springer: New York, NY, USA, 2009. [Google Scholar]
- Loprinzi, C.E.; Prasad, K.; Schroeder, D.R.; Sood, A. Stress Management and Resilience Training (SMART) Program to Decrease Stress and Enhance Resilience among Breast Cancer Survivors: A Pilot Randomized Clinical Trial. Clin. Breast Cancer 2011, 11, 364–368. [Google Scholar] [CrossRef]
- Tan, W.S.; Beatty, L.; Kemp, E.; Koczwara, B. What contributes to resilience in cancer patients? A principal component analysis of the Connor–Davidson Resilience Scale. Asia-Pac. J. Clin. Oncol. 2019, 15, e115–e119. [Google Scholar]
- Dooley, L.N.; Slavich, G.M.; Moreno, P.I.; Bower, J.E. Strength through adversity: Moderate lifetime stress exposure is associated with psychological resilience in breast cancer survivors. Stress Health 2017, 33, 549–557. [Google Scholar] [CrossRef] [PubMed]
- Fernández de Larrea-Baz, N.; Pérez-Gómez, B.; Guerrero-Zotano, Á.; Casas, A.M.; Bermejo, B.; Baena-Cañada, J.M.; Antolin, S.; Sánchez-Rovira, P.; Vázquez, M.R.; Garcia-Sáenz, J.Á.; et al. Primary breast cancer and health related quality of life in Spanish women: The EpiGEICAM case-control study. Sci. Rep. 2020, 10, 7741. [Google Scholar] [CrossRef] [PubMed]
Variables | n | % | CD-RISC25 at 1 Year Post Diagnosis | delta-CD-RISC25 (Score at 1 Year Post Diagnosis Minus Score at Diagnosis) | |||
---|---|---|---|---|---|---|---|
Mean (SD) | p-Value A | Mean (SD) | p-Value A | ||||
Follow-up cohort | - | 418 | 68.9 (14.0) | - | −1.7 (10.5) | - | |
Study site | Halmstad | 135 | 32 | 68.5 (13.7) | 0.587 | −1.6 (10.6) | 0.961 |
Helsingborg | 20 | 5 | 71.7 (19.2) | −2.4 (9.0) | |||
Karlskrona | 120 | 29 | 69.8 (13.6) | −1.3 (10.6) | |||
Växjö | 143 | 34 | 68.1 (13.8) | −1.9 (10.6) | |||
Age (years) | Mean (SD): 62 (11) | - | - | - | - | - | - |
≤64 (median) | 214 | 51 | 69.9 (12.9) | 0.134 | −1.7 (10.0) | 0.954 | |
>64 (median) | 204 | 49 | 67.8 (15.0) | −1.6 (11.0) | |||
Menstrual status | Premenopausal | 74 | 19 | 72.3 (13.7) | 0.024 | −2.1 (11.2) | 0.699 |
Postmenopausal | 325 | 81 | 68.2 (14.1) | −1.5 (10.4) | |||
Unknown | 19 | ||||||
Mode of detection | Screening | 269 | 65 | 69.0 (13.5) | 0.764 | −0.8 (10.2) | 0.022 |
Symptomatic | 148 | 35 | 68.6 (14.9) | −3.3 (10.9) | |||
Unknown | 1 | ||||||
Stage | 0 | 24 | 6 | 69.9 (13.8) | 0.114 | 0.8 (7.0) | 0.691 |
I | 272 | 65 | 68.0 (14.3) | −1.9 (10.7) | |||
II | 117 | 28 | 70.4 (13.0) | −1.7 (10.7) | |||
III | 3 | 1 | 83.7 (18.3) | 0.3 (2.1) | |||
Unknown | 2 | ||||||
Type of breast surgery | Breast-conserving | 304 | 73 | 68.3 (14.0) | 0.136 | −1.7 (10.7) | 0.949 |
Mastectomy | 114 | 27 | 70.5 (13.9) | −1.6 (10.0) | |||
Unknown | 0 | ||||||
Immediate breast reconstruction | Yes | 25 | 7 | 67.6 (12.7) | 0.540 | −1.9 (7.9) | 0.776 |
No | 333 | 93 | 69.3 (13.9) | −1.1 (10.3) | |||
Unknown | 60 | - | - | - | |||
Type of axillary surgery | Sentinel node | 323 | 79 | 68.3 (14.0) | 0.200 | −1.9 (10.9) | 0.690 |
Axillary dissection | 35 | 9 | 69.5 (13.6) | −1.4 (10.9) | |||
Sentinel node + axillary dissection | 52 | 13 | 72.0 (13.9) | −0.76 (7.7) | |||
Unknown | 8 | - | - | ||||
Neoadjuvant chemotherapy | Yes | 20 | 5 | 69.7 (12.0) | 0.801 | −3.2 (11.2) | 0.505 |
No | 398 | 95 | 68.8 (14.1) | −1.6 (10.5) | |||
Unknown | 0 | ||||||
Adjuvant chemotherapy | Yes | 151 | 36 | 69.6 (14.0) | 0.506 | −2.2 (9.7) | 0.307 |
No | 267 | 64 | 68.6 (14.1) | −1.1 (10.5) | |||
Unknown | 0 | ||||||
Adjuvant endocrine therapy | Yes | 271 | 65 | 69.1 (14.0) | 0.693 | −1.2 (10.6) | 0.186 |
No | 147 | 35 | 68.5 (14.2) | −2.6 (10.3) | |||
Unknown | 0 | ||||||
Adjuvant bisphosphonate therapy | Yes | 57 | 14 | 71.6 (11.7) | 0.074 | −2.1 (8.4) | 0.736 |
No | 361 | 86 | 68.5 (14.8) | −1.6 (10.8) | |||
Unknown | 0 | ||||||
Adjuvant antibody therapy B | Yes | 45 | 11 | 67.6 (12.4) | 0.517 | −4.2 (11.1) | 0.093 |
No | 373 | 89 | 69.0 (14.2) | −1.4 (10.4) | |||
Unknown | 0 | ||||||
Adjuvant radiotherapy | Yes | 334 | 80 | 68.9 (13.7) | 0.946 | −1.6 (10.5) | 0.764 |
No | 84 | 20 | 68.8 (15.0) | −2.0 (10.4) | |||
Unknown | 0 | - | - | - |
Variables | n | % | CD-RISC25 at 1 Year Post Diagnosis | delta-CD-RISC25 (Score at 1 Year Post Diagnosis Minus Score at Diagnosis) | |||
---|---|---|---|---|---|---|---|
Mean (SD) | p-Value A | Mean (SD) | p-Value A | ||||
Follow-up cohort | - | 418 | - | 68.9 (14.0) | - | −1.7 (10.5) | - |
BMI | Underweight (<18.5) | 1 | 0.2 | 80.0 | 0.605 | −2.0 | 0.920 |
Normal-weight (18.5–24.9) | 173 | 42 | 68.4 (13.8) | −1.5 (9.0) | |||
Overweight (25.0–29.9) | 152 | 37 | 69.8 (14.4) | −2.2 (12.2) | |||
Obese (≥30) | 84 | 20 | 68.1 (14.0) | −1.2 (10.5) | |||
Unknown | 8 | ||||||
Cigarette smoker | I smoke every day | 32 | 8 | 69.0 (11.1) | 0.378 | −1.1 (10.5) | 0.705 |
I smoke sometime during the month | 6 | 1 | 78.2 (8.9) | −6.0 (10.3) | |||
I have previously smoked every day but do not smoke on a regular basis today | 134 | 32 | 69.3 (14.5) | −1.3 (11.8) | |||
I have never smoke regularly | 246 | 59 | 68.4 (14.1) | −1.9 (9.8) | |||
Physical activity (at least 30 min) | Every day | 121 | 29 | 71.0 (13.4) | 0.052 | −0.6 (10.1) | 0.259 |
At least 3–4 times a week | 145 | 35 | 69.0 (14.3) | −3.0 (9.4) | |||
At least 1–2 times a week | 102 | 24 | 68.3 (13.6) | −1.0 (11.4) | |||
Less than once a week | 50 | 12 | 64.6 (14.8) | −1.9 (12.5) | |||
Social network | Living alone | 85 | 20 | 68.2 (15.9) | 0.198 | −2.5 (10.2) | 0.092 |
Living with child/children < 18 years old only | 5 | 1 | 76.0 (21.1) | −6.2 (7.0) | |||
Living with adult/adults and child/children < 18 years old | 53 | 13 | 72.1 (13.6) | −4.2 (9.4) | |||
Living with adult/adults only | 275 | 66 | 68.3 (13.2) | −0.8 (10.8) | |||
Educational level | Primary school < 9 years | 55 | 13 | 68.2 (16.6) | 0.213 | −0.9 (12.9) | 0.856 |
Primary school completed | 52 | 12 | 64.9 (15.0) | −2.4 (10.6) | |||
Upper secondary education | 84 | 20 | 68.8 (13.0) | −1.1 (11.2) | |||
Post-secondary education <2 years | 39 | 9 | 68.9 (14.6) | −2.8 (10.7) | |||
Post-secondary education ≥ 2 years | 182 | 44 | 70.4 (12.8) | −1.6 (9.3) | |||
PhD (doctoral education) | 6 | 1 | 65.3 (20.4) | −5.3 (12.4) | |||
Financial situation | Able to pay an unexpected bill of SEK 11,000/EUR 1100 | 378 | 90 | 69.4 (13.6) | 0.050 | −1.3 (10.3) | 0.022 |
Unable to pay an unexpected bill of SEK 11,000/EUR 1100 | 40 | 10 | 63.9 (16.7) | −5.3 (11.9) | |||
Trust in the treatment | Not at all | 5 | 1 | 69.8 (18.9) | <0.001 | −0.4 (5.5) | 0.047 |
To a lesser extent | 1 | 0.2 | 61.0 | −17.0 | |||
To some extent | 19 | 5 | 57.5 (14.0) | −7.5 (9.8) | |||
To a large extent | 151 | 36 | 66.1 (14.4) | −2.1 (11.5) | |||
To a very high extent | 242 | 58 | 71.6 (12.9) | −0.9 (9.9) | |||
Satisfaction with the implementation of the treatment | Not at all | 2 | 0.5 | 58.0 (14.1) | <0.001 | −3.5 (3.5) | 0.174 |
To a lesser extent | 2 | 0.5 | 72.0 (15.6) | −5.0 (17.0) | |||
To some extent | 13 | 3 | 56.5 (16.4) | −6.1 (9.2) | |||
To a large extent | 126 | 30 | 65.4 (14.9) | −3.0 (10.6) | |||
To a very high extent | 275 | 66 | 71.1 (12.8) | −0.8 (10.5) | |||
Satisfaction with the staff–patient encounters | Not at all | 0 | 0 | - | 0.005 | - | 0.181 |
To a lesser extent | 4 | 1 | 69.5 (13.5) | −8.0 (13.6) | |||
To some extent | 15 | 4 | 59.8 (18.6) | −3.1 (12.6) | |||
To a large extent | 83 | 20 | 65.8 (14.6) | −3.4 (9.1) | |||
To a very high extent | 316 | 76 | 70.1 (13.4) | −1.1 (10.7) |
Variables | Baseline (BL) Mean (SD) | Follow-Up (FU)Mean (SD) | Difference between BL Data and FU Data p-Values A | Swedish Norm Data Mean (SD) | Difference between BL Data and Norm Data p-Values B | Difference between FU Data and Norm Data p-Values B |
---|---|---|---|---|---|---|
SF-36 C | ||||||
Physical functioning | 85.9 (17.6) | 80.5 (20.3) | <0.001 | 86.2 (20.4) | 0.771 | <0.001 |
Role—physical | 83.6 (33.3) | 69.6 (40.8) | <0.001 | 81.6 (33.1) | 0.237 | <0.001 |
Bodily pain | 82.3 (20.0) | 70.3 (22.6) | <0.001 | 72.7 (26.5) | <0.001 | 0.073 |
General health | 71.4 (19.1) | 68.6 (20.9) | 0.001 | 75.1 (22.7) | 0.001 | <0.001 |
Vitality | 68.2 (23.0) | 62.0 (24.3) | <0.001 | 66.7 (23.2) | 0.205 | <0.001 |
Social functioning | 85.1 (21.7) | 82.9 (23.5) | 0.062 | 87.5 (20.8) | 0.024 | <0.001 |
Role—emotional | 77.5 (36.1) | 77.2 (37.6) | 0.904 | 84.0 (30.9) | <0.001 | <0.001 |
Mental health | 70.5 (21.5) | 76.7 (18.4) | <0.001 | 79.6 (19.4) | <0.001 | 0.003 |
CD-RISC25 D | 70.6 (13.0) | 68.9 (14.0) | 0.001 | Not available | - | - |
Final Model | β | 95% CI | p-Values |
---|---|---|---|
Constant | −10.908 | −15.872 to −5.934 | - |
Centered baseline CD-RISC25 score | −0.254 | −0.329 to −0.178 | <0.001 |
Greater level of trust in the treatment | 6.415 | 2.292 to 10.538 | 0.002 |
Able to pay an unexpected bill of SEK 11 000/EUR 1100 | 3.649 | 0.278 to 7.019 | 0.034 |
Unadjusted Models | Adjusted Models A | ||||||
---|---|---|---|---|---|---|---|
Variables | CD-RISC25 at 1 Year Post Diagnosis | CD-RISC25 at 1 Year Post Diagnosis | |||||
SF-36 | β | 95% CI | p | R2 | β | 95% CI | p |
Physical functioning | 0.339 | 0.203 to 0.475 | <0.001 | 0.054 | 0.250 | 0.067 to 0.433 | 0.008 |
Role—physical | 0.767 | 0.496 to 1.039 | <0.001 | 0.069 | 0.764 | 0.384 to 1.144 | <0.001 |
Bodily pain | 0.283 | 0.130 to 0.437 | <0.001 | 0.031 | 0.370 | 0.152 to 0.587 | 0.001 |
General health | 0.649 | 0.519 to 0.778 | <0.001 | 0.189 | 0.605 | 0.423 to 0.787 | <0.001 |
Vitality | 0.722 | 0.569 to 0.874 | <0.001 | 0.172 | 0.655 | 0.446 to 0.864 | <0.001 |
Social functioning | 0.503 | 0.349 to 0.658 | <0.001 | 0.090 | 0.374 | 0.157 to 0.592 | 0.001 |
Role—emotional | 0.812 | 0.565 to 1.059 | <0.001 | 0.091 | 0.753 | 0.406 to 1.100 | <0.001 |
Mental health | 0.626 | 0.514 to 0.737 | <0.001 | 0.226 | 0.577 | 0.420 to 0.735 | <0.001 |
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Mohlin, Å.; Bendahl, P.-O.; Hegardt, C.; Richter, C.; Hallberg, I.R.; Rydén, L. Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study. Cancers 2021, 13, 2233. https://doi.org/10.3390/cancers13092233
Mohlin Å, Bendahl P-O, Hegardt C, Richter C, Hallberg IR, Rydén L. Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study. Cancers. 2021; 13(9):2233. https://doi.org/10.3390/cancers13092233
Chicago/Turabian StyleMohlin, Åsa, Pär-Ola Bendahl, Cecilia Hegardt, Corinna Richter, Ingalill Rahm Hallberg, and Lisa Rydén. 2021. "Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study" Cancers 13, no. 9: 2233. https://doi.org/10.3390/cancers13092233
APA StyleMohlin, Å., Bendahl, P.-O., Hegardt, C., Richter, C., Hallberg, I. R., & Rydén, L. (2021). Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study. Cancers, 13(9), 2233. https://doi.org/10.3390/cancers13092233