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Acc
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Ob
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ca
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GL
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p
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[
2
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[
4
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T
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[
5
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Du
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[
7
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R
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n
an
d
c
o
m
m
u
n
icatio
n
tech
n
o
lo
g
y
(
I
C
T
)
,
wh
ich
h
as
m
ad
e
it
p
o
s
s
ib
le
f
o
r
p
eo
p
le
to
o
b
tain
m
ed
ical
in
f
o
r
m
atio
n
,
k
ee
p
tr
ac
k
o
f
th
eir
h
ea
lth
,
a
n
d
in
ter
ac
t
with
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
m
o
r
e
s
u
cc
ess
f
u
lly
[
6
]
,
[
1
1
]
.
Ap
p
licatio
n
s
f
o
r
n
u
r
s
es
cr
ea
ted
esp
ec
ially
f
o
r
ca
n
ce
r
p
atien
ts
ca
n
o
f
f
er
i
n
f
o
r
m
atio
n
o
n
th
e
illn
ess
an
d
its
tr
ea
tm
en
t,
h
el
p
m
an
ag
in
g
s
y
m
p
to
m
s
,
p
s
y
ch
o
l
o
g
ical
s
u
p
p
o
r
t,
an
d
r
ec
o
m
m
e
n
d
atio
n
s
f
o
r
r
est
an
d
p
h
y
s
ical
ac
tiv
ity
[
1
2
]
,
[
1
3
]
.
T
o
g
u
a
r
an
tee
th
at
it
is
p
er
tin
e
n
t
an
d
u
s
ef
u
l
in
ass
is
tin
g
p
atien
ts
in
m
an
ag
i
n
g
t
h
eir
d
is
ea
s
e
an
d
en
h
an
cin
g
th
eir
q
u
ality
o
f
life
,
th
e
in
f
o
r
m
atio
n
o
f
f
er
e
d
b
y
th
is
ap
p
n
ee
d
s
to
b
e
p
r
o
p
e
r
ly
cr
a
f
ted
.
Desp
ite
th
e
q
u
ick
r
is
e
in
th
e
cr
ea
tio
n
o
f
d
ig
ital
p
latf
o
r
m
s
an
d
m
o
b
ile
ap
p
licatio
n
s
f
o
r
h
e
alth
ca
r
e,
p
r
io
r
s
tu
d
ies
h
av
e
id
en
tifie
d
a
n
u
m
b
e
r
o
f
is
s
u
es
th
at
r
eq
u
ir
e
atten
tio
n
.
Ma
n
y
o
f
t
h
e
p
r
o
g
r
am
s
th
at
ar
e
n
o
w
ac
ce
s
s
ib
le
wer
e
n
o
t
cr
ea
ted
with
ca
n
ce
r
s
u
f
f
er
er
s
'
p
ar
ticu
lar
r
eq
u
ir
em
en
ts
in
m
in
d
.
T
h
e
m
ajo
r
ity
o
f
th
e
in
f
o
r
m
atio
n
n
o
w
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ailab
le
is
s
till
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en
er
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an
d
d
o
es
n
o
t
a
d
eq
u
ately
tak
e
in
to
ac
c
o
u
n
t
t
h
e
v
ar
io
u
s
u
n
i
q
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e
d
em
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d
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p
s
y
ch
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l
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ic
al
f
ac
to
r
s
at
ev
er
y
s
tag
e
o
f
ca
n
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er
tr
ea
tm
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t,
m
ak
in
g
it
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ef
f
e
ctiv
e
at
en
h
an
cin
g
p
atien
ts
'
q
u
ality
o
f
life
.
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r
th
er
m
o
r
e,
cu
r
r
en
t
r
esear
ch
f
r
eq
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en
tly
ig
n
o
r
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th
e
m
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s
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im
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o
r
tan
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m
p
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n
ts
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f
ass
is
tin
g
p
atien
ts
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ag
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g
th
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is
o
r
d
er
s
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o
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tically
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s
u
ch
as su
itab
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h
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ac
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o
m
m
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d
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s
,
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y
m
p
to
m
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g
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n
d
e
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p
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I
n
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er
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v
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ca
n
ce
r
p
atien
ts
'
co
m
f
o
r
t,
q
u
ality
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f
life
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em
o
tio
n
al
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p
s
y
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h
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lo
g
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u
p
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im
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o
r
tan
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s
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s
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v
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d
o
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ti
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ize
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ts
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u
cc
ess
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u
l
n
u
r
s
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g
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p
s
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t
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at
th
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in
d
in
g
s
o
f
th
is
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y
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tem
atic
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ld
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ased
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g
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esti
o
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r
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a
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th
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ar
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e
p
atien
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-
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esp
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iv
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e
r
h
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s
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n
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ter
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im
p
r
o
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e
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ts
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lth
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tco
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h
e
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r
ch
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s
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tify
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licatio
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n
ten
t
th
at
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im
p
r
o
v
e
t
h
e
q
u
ality
o
f
life
f
o
r
ca
n
ce
r
p
atien
ts
.
2.
M
E
T
H
O
D
2
.
1
.
Sea
rc
h str
a
t
eg
y
a
nd
inclu
s
io
n c
rit
er
ia
f
o
r
s
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t
em
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t
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re
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A
s
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tem
atic
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ev
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co
n
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u
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o
r
d
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ath
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n
d
ex
am
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ata
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r
o
m
d
if
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er
en
t
r
esear
ch
p
r
o
jects
th
at
ar
e
p
er
tin
en
t
to
t
h
is
s
u
b
ject.
Utilizin
g
th
e
J
o
a
n
n
a
B
r
ig
g
s
I
n
s
titu
te
Gu
id
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d
th
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C
en
tr
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f
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r
R
ev
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d
Dis
s
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atio
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,
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lo
y
e
d
th
e
PR
I
SMA
c
h
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k
lis
t
o
f
elem
e
n
ts
to
ass
ess
th
e
s
tu
d
y
'
s
q
u
ality
[
1
3
]
,
[
1
4
]
.
T
h
e
p
r
o
ce
s
s
o
f
co
n
d
u
ctin
g
a
s
tr
ateg
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liter
at
u
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e
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ch
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o
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n
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d
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at
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r
r
esp
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with
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u
ch
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“
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Ap
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elev
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ticles
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y
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r
ch
in
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th
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o
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g
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atab
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lik
e
J
o
u
r
n
al
Sto
r
ag
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(
J
STOR
)
,
Scien
ce
Dir
ec
t,
Pro
Qu
est,
an
d
Sp
r
in
g
er
L
in
k
.
J
o
u
r
n
al
ar
ticles
f
r
o
m
2
0
1
9
to
2
0
2
4
,
th
e
last
f
iv
e
y
ea
r
s
o
f
p
u
b
licatio
n
.
T
h
e
p
o
p
u
latio
n
,
in
ter
v
en
tio
n
,
co
m
p
ar
is
o
n
,
o
u
tc
o
m
e,
s
tu
d
y
d
esig
n
(
PICOS
)
[
1
5
]
cr
iter
ia
(
p
o
p
u
latio
n
,
in
ter
v
e
n
tio
n
,
co
m
p
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o
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out
co
m
e,
a
n
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tu
d
y
d
esig
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ar
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u
s
ed
to
d
e
f
in
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in
cl
u
s
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as sh
o
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n
T
ab
le
1
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ab
le
1
.
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clu
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d
ex
clu
s
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cr
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with
PICOS
C
r
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o
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14
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3
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Sep
tem
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20
25
:
1
2
3
2
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1
2
4
2
1234
p
ar
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an
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with
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clin
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d
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g
n
o
s
is
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ca
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ce
r
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d
iii)
ap
p
l
icatio
n
o
f
in
ter
v
en
tio
n
s
to
en
h
an
ce
th
e
q
u
ality
o
f
life
o
f
ca
n
ce
r
p
atien
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.
T
h
e
w
h
o
le
ar
ticle
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a
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3.
3
.
1
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H
ea
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h e
du
ca
t
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T
h
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tu
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'
s
m
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clu
s
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p
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asize
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tio
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ass
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tan
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,
p
ar
ticu
lar
ly
wh
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it
co
m
es
to
d
ig
ital
s
tr
ateg
ies
lik
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in
s
tr
u
ctio
n
al
v
id
eo
s
an
d
web
-
b
ased
ap
p
licatio
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s
.
Acc
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r
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in
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p
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co
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q
u
ality
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life
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ty
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ch
o
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o
cial
s
u
p
p
o
r
t,
a
n
d
s
cien
ti
f
ic
ac
tiv
ities
[
2
2
]
.
B
y
in
c
r
ea
s
in
g
th
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wled
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e,
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all
q
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ality
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life
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r
ca
n
ce
r
p
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[
3
8
]
.
T
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ac
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[
3
9
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p
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[
4
0
]
.
T
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its
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f
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h
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lth
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ca
tio
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q
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p
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tech
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aid
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Evaluation Warning : The document was created with Spire.PDF for Python.
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20
25
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p
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t
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b
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ac
co
r
d
in
g
to
im
p
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r
tan
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r
esu
lts
[
4
1
]
.
Su
p
p
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tin
g
d
ata
d
em
o
n
s
tr
ates
th
at
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is
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tr
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p
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en
ev
er
th
ey
n
ee
d
it.
Nev
er
th
eless
,
th
i
s
s
tu
d
y
's
g
en
er
aliza
b
ilit
y
is
lim
ited
,
p
ar
ticu
lar
ly
d
u
e
to
its
em
p
h
asis
o
n
y
o
u
n
g
er
p
atien
ts
with
co
l
o
r
ec
tal
ca
n
ce
r
,
wh
ic
h
m
ea
n
s
it
is
n
o
t
y
et
ab
le
to
ac
c
u
r
ately
r
e
f
lect
th
e
e
x
p
er
ien
ce
s
o
f
all
ca
n
ce
r
p
atien
ts
[
4
3
]
.
T
h
e
s
tu
d
y
's
s
u
r
p
r
is
in
g
f
in
d
in
g
is
th
at
C
B
T
-
b
ased
co
p
in
g
tr
ain
in
g
h
el
p
s
y
o
u
n
g
er
a
g
e
g
r
o
u
p
s
h
a
v
e
f
ewe
r
s
y
m
p
to
m
s
,
wh
ich
m
ay
lea
d
to
a
n
o
v
el
m
eth
o
d
o
f
s
y
m
p
to
m
tr
ea
tm
en
t in
th
e
f
u
tu
r
e
.
T
h
ese
r
esu
lts
h
ig
h
lig
h
t
h
o
w
c
r
u
cial
it
is
to
o
f
f
er
p
r
o
g
r
am
s
th
at
h
elp
p
atien
ts
au
to
n
o
m
o
u
s
l
y
m
an
ag
e
th
eir
s
y
m
p
to
m
s
wh
ile
ta
k
in
g
in
to
co
n
s
id
er
atio
n
t
h
eir
u
n
i
q
u
e
r
e
q
u
ir
em
e
n
ts
an
d
f
ea
tu
r
es.
I
n
ad
d
itio
n
to
p
o
ten
tially
im
p
r
o
v
in
g
th
e
ef
f
i
ca
cy
o
f
in
te
r
v
en
tio
n
s
,
th
e
f
in
d
in
g
s
o
f
t
h
is
s
tu
d
y
o
f
f
er
i
m
p
o
r
tan
t
in
s
ig
h
ts
in
to
h
o
w
m
Hea
lth
tech
n
o
lo
g
y
ca
n
b
e
u
s
ed
to
in
cr
ea
s
e
ac
ce
s
s
an
d
cu
s
to
m
ize
ca
r
e
f
o
r
ca
n
ce
r
p
atien
ts
,
th
er
eb
y
im
p
r
o
v
in
g
th
eir
q
u
ality
o
f
life
th
r
o
u
g
h
o
u
t t
h
e
co
u
r
s
e
o
f
tr
ea
t
m
en
t a
n
d
r
ec
u
p
e
r
atio
n
.
3
.
3
.
3
.
P
s
y
cho
s
o
cia
l su
pp
o
rt
I
n
o
r
d
er
to
ass
is
t
ca
n
ce
r
p
atien
ts
in
m
an
ag
i
n
g
th
e
em
o
tio
n
a
l
an
d
s
o
cial
s
tr
ain
s
th
at
f
r
e
q
u
e
n
tly
r
esu
lt
f
r
o
m
th
eir
d
iag
n
o
s
is
an
d
tr
e
atm
en
t,
p
s
y
ch
o
s
o
cial
s
u
p
p
o
r
t
is
cr
u
cial.
T
h
e
s
u
cc
ess
o
f
th
e
n
u
r
s
e
s
u
p
p
o
r
t
p
r
o
g
r
a
m
,
wh
ich
co
n
s
is
ts
o
f
f
o
u
r
in
ter
ac
tiv
e
s
ess
io
n
s
—
lear
n
in
g
,
d
is
cu
s
s
io
n
,
ex
p
er
t
Q
&
A,
an
d
p
er
s
o
n
al
s
to
r
ies
—
as
well
as
p
s
y
ch
o
l
o
g
i
ca
l
m
o
d
u
les
in
ten
d
e
d
t
o
o
f
f
er
p
atien
ts
co
m
p
r
eh
en
s
iv
e
ass
is
t
an
ce
,
is
h
ig
h
lig
h
te
d
in
th
is
s
tu
d
y
[
4
]
.
Acc
o
r
d
in
g
t
o
s
u
p
p
o
r
ti
n
g
d
ata,
th
e
p
r
o
g
r
a
m
en
h
an
ce
s
p
atien
ts
'
m
en
tal
an
d
em
o
tio
n
al
well
-
b
ein
g
,
wh
ich
is
in
lin
e
with
ea
r
lier
r
esear
ch
s
h
o
win
g
th
at
s
o
cial
s
u
p
p
o
r
t
ca
n
less
en
th
e
d
etr
im
en
tal
ef
f
ec
ts
o
f
ca
n
ce
r
o
n
p
atien
ts
'
q
u
ality
o
f
life
[
4
4
]
.
I
n
p
ar
ticu
lar
,
t
h
is
s
tu
d
y
h
ig
h
lig
h
ts
th
e
u
n
d
er
ly
in
g
s
o
cial
an
d
c
u
ltu
r
al
o
b
s
tacle
s
th
at
C
h
in
ese
Au
s
tr
alian
wo
m
en
with
b
r
ea
s
t
ca
n
c
er
m
u
s
t
s
u
r
m
o
u
n
t,
in
clu
d
in
g
d
is
p
ar
ities
in
s
o
cial
s
u
p
p
o
r
t
a
n
d
th
e
n
ee
d
t
o
s
ac
r
i
f
ice
th
em
s
e
lv
es
in
o
r
d
e
r
to
p
r
o
tect
o
th
er
s
,
w
h
ich
m
a
y
b
e
a
r
ef
lectio
n
o
f
th
eir
cu
ltu
r
al
n
o
r
m
s
.
T
h
is
e
m
p
h
asi
ze
s
h
o
w
cr
u
cial
it
is
t
o
co
m
p
r
eh
en
d
cu
ltu
r
al
asp
ec
ts
wh
en
cr
ea
tin
g
s
u
cc
ess
f
u
l
s
u
p
p
o
r
t p
la
n
s
f
o
r
ce
r
tain
p
atie
n
t p
o
p
u
latio
n
s
.
I
n
co
n
tr
ast
to
ea
r
lier
r
esear
ch
,
th
e
r
esu
lts
o
f
th
is
s
tu
d
y
ar
e
i
n
lin
e
with
d
ata
f
r
o
m
o
v
er
3
0
y
ea
r
s
ag
o
th
at
s
h
o
w
p
s
y
ch
o
lo
g
ical
ass
is
tan
ce
ca
n
en
h
an
ce
ca
n
ce
r
p
atien
ts
'
q
u
ality
o
f
life
[
45]
.
B
u
t
th
is
s
tu
d
y
also
p
r
esen
ts
a
n
ew
s
tr
en
g
th
:
th
e
u
s
e
o
f
a
co
m
p
r
eh
en
s
iv
e
s
tr
ateg
y
th
at
in
co
r
p
o
r
ates
p
r
o
b
l
em
-
s
o
lv
in
g
th
er
a
p
y
,
ed
u
ca
tio
n
,
an
d
em
o
tio
n
al
s
u
p
p
o
r
t.
T
h
e
r
esu
lts
m
ay
n
o
t
b
e
en
tire
ly
g
en
er
aliza
b
le
to
a
lar
g
er
p
o
p
u
latio
n
o
f
ca
n
ce
r
p
atien
ts
d
u
e
to
th
e
s
tu
d
y
's
lim
itatio
n
s
,
wh
ich
in
clu
d
e
its
m
ajo
r
f
o
cu
s
b
ein
g
r
estricte
d
to
a
g
r
o
u
p
o
f
C
h
in
ese
-
Au
s
tr
alian
wo
m
en
.
T
h
is
s
tu
d
y
also
r
ev
ea
led
a
n
u
m
b
er
o
f
s
u
r
p
r
is
in
g
f
i
n
d
in
g
s
,
i
n
c
lu
d
in
g
th
e
c
u
ltu
r
al
in
f
lu
en
ce
o
n
C
h
in
ese
im
m
ig
r
an
t
wo
m
en
's
ca
n
ce
r
co
p
i
n
g
m
ec
h
a
n
is
m
s
,
wh
ich
in
clu
d
e
t
h
e
u
r
g
e
to
s
ac
r
if
ice
o
n
eself
in
o
r
d
er
to
p
r
o
tect
o
th
er
s
.
T
h
is
h
ig
h
lig
h
ts
h
o
w
cr
u
ci
al
it
is
to
m
o
d
if
y
s
u
p
p
o
r
t
p
la
n
s
ac
co
r
d
in
g
to
th
e
p
atien
t's
cu
ltu
r
e,
s
o
m
eth
in
g
th
at
h
as b
ee
n
d
is
r
eg
a
r
d
ed
i
n
ea
r
l
ier
r
esear
ch
.
I
n
v
e
s
t
i
g
a
ti
n
g
t
h
e
ef
f
i
c
ac
y
o
f
p
r
o
v
i
d
i
n
g
c
a
n
c
e
r
p
a
ti
e
n
t
s
w
it
h
a
ll
-
e
n
c
o
m
p
a
s
s
i
n
g
p
s
y
c
h
o
s
o
ci
a
l
as
s
i
s
ta
n
c
e
,
e
s
p
e
c
i
al
l
y
t
o
i
m
p
r
o
v
e
t
h
e
i
r
s
o
c
i
a
l
a
n
d
e
m
o
t
i
o
n
a
l
h
e
a
l
t
h
w
h
i
le
u
n
d
e
r
g
o
i
n
g
t
r
e
a
t
m
e
n
t
.
T
h
i
s
s
t
u
d
y
h
i
g
h
l
i
g
h
t
s
t
h
e
v
a
l
u
e
o
f
p
r
o
v
i
d
i
n
g
c
a
n
c
e
r
p
a
t
i
e
n
t
s
w
it
h
a
c
o
m
p
r
e
h
e
n
s
i
v
e
s
t
r
at
e
g
y
t
h
a
t
e
n
c
o
m
p
a
s
s
e
s
n
o
t
j
u
s
t
e
m
o
t
i
o
n
a
l
c
a
r
e
b
u
t
a
l
s
o
s
p
i
r
i
t
u
al
a
n
d
e
d
u
c
at
i
o
n
a
l
e
l
e
m
e
n
ts
.
T
h
i
s
s
t
u
d
y
i
s
s
i
g
n
i
f
i
c
a
n
t
b
e
c
a
u
s
e
i
t
d
e
m
o
n
s
t
r
at
e
s
h
o
w
c
u
l
t
u
r
al
l
y
a
p
p
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o
p
r
i
a
t
e
p
s
y
c
h
o
l
o
g
i
c
a
l
s
u
p
p
o
r
t
m
a
y
e
n
h
a
n
c
e
c
a
n
c
e
r
p
a
t
i
en
t
s
'
q
u
a
l
it
y
o
f
l
i
f
e
a
n
d
o
f
f
e
r
i
n
s
i
g
h
t
f
u
l
i
n
f
o
r
m
a
ti
on
f
o
r
c
r
e
a
t
i
n
g
m
o
r
e
s
u
c
c
es
s
f
u
l
t
h
e
r
a
p
i
e
s
,
p
a
r
ti
c
u
l
a
r
l
y
f
o
r
p
a
ti
e
n
t
p
o
p
u
l
a
t
i
o
n
s
w
it
h
v
a
r
i
e
d
c
u
l
t
u
r
al
o
r
i
g
i
n
s
[
4
6
]
,
[
4
7
]
.
3
.
3
.
4
.
M
ultidis
c
ipl
i
na
ry
inte
rv
ent
io
ns
I
n
o
r
d
er
to
p
r
o
v
id
e
a
h
o
li
s
tic
ap
p
r
o
ac
h
to
p
atien
t
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e
atm
en
t,
m
u
ltid
is
cip
lin
ar
y
in
t
er
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en
tio
n
s
co
m
p
r
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g
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r
s
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g
y
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o
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p
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elo
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s
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p
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e
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r
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s
e
f
u
l
t
o
o
ls
t
o
s
p
e
e
d
u
p
t
h
e
i
r
r
e
c
o
v
e
r
y
a
n
d
e
n
h
a
n
c
e
t
h
e
i
r
g
e
n
e
r
al
w
el
l
-
b
e
in
g
,
s
u
c
h
a
s
t
h
e
E
R
A
S
(
E
n
h
a
n
ce
d
R
e
c
o
v
e
r
y
A
f
t
e
r
S
u
r
g
e
r
y
)
c
o
m
p
o
n
e
n
t
s
u
s
e
d
b
o
th
b
e
f
o
r
e
a
n
d
a
f
t
e
r
s
u
r
g
e
r
y
,
as
we
ll
a
s
t
h
e
u
s
e
o
f
e
-
b
o
o
k
s
w
it
h
d
i
et
a
r
y
a
n
d
r
e
h
a
b
i
l
i
t
at
i
o
n
e
x
e
r
c
is
e
g
u
i
d
e
l
i
n
e
s
[
4
8
]
.
T
h
e
r
esu
lts
o
f
ea
r
lier
s
tu
d
ies
th
at
em
p
h
asize
th
e
v
alu
e
o
f
a
m
u
ltid
is
cip
lin
ar
y
ap
p
r
o
ac
h
in
tr
ea
tin
g
p
atien
ts
with
ch
r
o
n
ic
illn
ess
es,
esp
ec
ially
p
e
r
s
is
ten
t
p
elv
ic
p
ain
,
ar
e
co
n
s
is
ten
t
with
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
.
T
h
er
e
ar
e,
h
o
we
v
er
,
v
ar
iatio
n
s
in
th
is
s
tu
d
y
's
u
s
e
o
f
E
R
A
S
c
o
m
p
o
n
en
ts
an
d
tech
n
o
l
o
g
y
u
ti
lizatio
n
,
in
clu
d
in
g
e
-
b
o
o
k
s
,
wh
ich
h
av
e
n
o
t
b
ee
n
th
o
r
o
u
g
h
ly
c
o
v
er
e
d
in
ea
r
lier
r
esear
ch
.
T
h
is
s
tu
d
y
's
p
r
im
ar
y
s
tr
en
g
th
is
th
e
in
teg
r
atio
n
o
f
a
c
o
m
p
lete
s
tr
at
eg
y
in
cl
u
d
in
g
s
ev
er
al
ex
p
e
r
ts
th
at
tack
les
b
eh
a
v
io
r
al
an
d
p
s
y
ch
o
lo
g
ical
is
s
u
es
th
at
im
p
ac
t
p
atien
ts
'
q
u
ality
o
f
life
i
n
ad
d
itio
n
to
p
h
y
s
ical
t
r
ea
tm
en
t.
T
h
e
lack
o
f
a
lo
n
g
-
t
er
m
ass
ess
m
en
t
o
f
th
e
in
ter
v
e
n
tio
n
's
ef
f
icac
y
in
g
u
ar
an
teein
g
th
e
s
u
s
tain
ab
ilit
y
o
f
p
atie
n
t
r
ec
o
v
er
y
,
h
o
wev
er
,
is
th
e
s
tu
d
y
's
m
ai
n
wea
k
n
ess
.
Sig
n
if
ican
t
p
s
y
ch
o
lo
g
ical
ad
v
an
ta
g
es
f
o
r
p
atien
t
s
ar
e
am
o
n
g
th
e
s
u
r
p
r
is
in
g
f
i
n
d
in
g
s
,
s
u
g
g
esti
n
g
th
at
m
en
tal
s
u
p
p
o
r
t m
ay
b
e
m
o
r
e
im
p
o
r
tan
t th
an
p
r
ev
i
o
u
s
ly
th
o
u
g
h
t
in
th
eir
p
h
y
s
ical
h
ea
li
n
g
p
r
o
ce
s
s
.
I
n
v
esti
g
atin
g
h
o
w
m
u
ltid
is
cip
lin
ar
y
th
er
ap
ies,
esp
ec
ially
th
o
s
e
th
at
ta
k
e
a
h
o
lis
tic
ap
p
r
o
ac
h
th
at
in
co
r
p
o
r
ates
b
eh
av
io
r
al,
p
s
y
c
h
o
lo
g
ical,
an
d
s
o
m
atic
elem
e
n
ts
,
m
ig
h
t
aid
p
atien
ts
with
p
er
s
is
ten
t
p
elv
ic
p
ain
in
th
eir
r
eh
ab
ilit
atio
n
.
T
h
i
s
s
tu
d
y
i
s
s
i
g
n
i
f
ic
a
n
t
b
ec
a
u
s
e
i
t
s
h
o
w
s
t
h
at
t
h
e
r
a
p
i
e
s
t
h
at
a
d
d
r
es
s
m
a
n
y
as
p
e
c
ts
o
f
p
a
t
i
e
n
ts
'
l
i
v
es
c
a
n
e
n
h
a
n
c
e
t
h
ei
r
q
u
a
l
i
t
y
o
f
li
f
e
a
n
d
p
r
o
v
i
d
e
m
o
r
e
p
r
o
o
f
o
f
t
h
e
a
d
v
a
n
t
a
g
e
s
o
f
m
u
l
t
i
d
i
s
c
i
p
l
i
n
a
r
y
t
e
a
m
w
o
r
k
i
n
p
a
t
i
e
n
t
c
a
r
e
.
T
h
is
s
t
u
d
y
'
s
i
m
p
o
r
t
a
n
c
e
t
h
e
r
e
f
o
r
e
r
es
ts
i
n
i
ts
c
a
p
ac
i
t
y
t
o
o
f
f
e
r
f
r
e
s
h
p
e
r
s
p
e
c
t
i
v
es
o
n
t
h
e
t
r
e
a
t
m
e
n
t
o
f
c
h
r
o
n
i
c
p
a
i
n
t
h
r
o
u
g
h
t
h
e
u
s
e
o
f
t
e
c
h
n
o
l
o
g
y
a
n
d
a
m
o
r
e
a
l
l
-
e
n
c
o
m
p
a
s
s
i
n
g
a
p
p
r
o
ac
h
t
o
p
a
t
i
e
n
t
c
a
r
e
.
3
.
3
.
5
.
P
hy
s
ica
l e
x
er
cise a
nd
r
ela
x
a
t
io
n
A
g
o
o
d
d
iet,
ex
er
cise,
an
d
r
e
lax
atio
n
ar
e
all
cr
u
cial
f
o
r
th
e
em
o
tio
n
al
an
d
p
h
y
s
ical
wel
l
-
b
ein
g
o
f
ca
n
ce
r
p
atie
n
ts
.
T
h
e
s
tu
d
y
's
m
ain
co
n
clu
s
io
n
s
s
h
o
w
th
at
a
m
o
d
e
r
ately
in
te
n
s
e
walk
in
g
p
r
o
g
r
am
at
h
o
m
e,
to
g
eth
er
with
s
m
ar
t
b
r
ac
elet
m
o
n
ito
r
in
g
,
n
o
t
o
n
l
y
k
ee
p
s
p
atien
ts
m
o
v
in
g
b
u
t
also
im
p
r
o
v
es
th
eir
g
en
er
al
h
ea
lth
.
Fu
r
th
er
m
o
r
e,
im
m
er
s
iv
e
ex
p
er
ien
c
es
with
s
o
o
th
i
n
g
m
u
s
ic
an
d
f
ilm
s
o
f
f
er
a
u
s
ef
u
l
m
eth
o
d
o
f
r
elax
atio
n
,
w
h
ich
ca
n
l
o
wer
s
tr
ess
an
d
en
h
an
ce
p
atien
ts
'
m
en
tal
h
ea
lth
[
4
9
]
.
T
h
is
d
em
o
n
s
tr
ates
h
o
w
an
in
teg
r
ated
s
tr
ateg
y
th
at
in
co
r
p
o
r
ates
ex
er
cise,
r
ela
x
atio
n
,
an
d
a
n
u
tr
itio
u
s
d
iet
m
ay
ass
is
t
ca
n
ce
r
p
atien
ts
in
m
an
ag
in
g
m
en
tal
h
ea
lth
is
s
u
es lik
e
an
x
iety
a
n
d
d
esp
air
wh
ile
also
en
h
an
cin
g
th
eir
q
u
ality
o
f
life
[
5
0
]
.
T
h
is
r
esu
lt
is
co
n
s
is
ten
t
with
o
th
er
r
esear
ch
th
at
d
em
o
n
s
tr
ates
th
e
b
en
ef
icial
ef
f
ec
ts
o
f
r
elax
atio
n
an
d
p
h
y
s
ical
ex
er
cise
o
n
ca
n
ce
r
p
atien
ts
'
m
en
tal
an
d
p
h
y
s
ical
h
ea
lth
[
5
1
]
.
Nev
er
th
eless
,
in
co
n
tr
ast
to
o
th
er
r
esear
ch
,
th
is
s
tu
d
y
also
h
ig
h
lig
h
ts
th
e
s
ig
n
i
f
ican
ce
o
f
m
o
n
ito
r
in
g
with
cu
ttin
g
-
e
d
g
e
d
ev
ices
lik
e
s
m
ar
t
wr
is
tb
an
d
s
,
wh
ich
o
f
f
er
r
ea
l
-
tim
e
d
ata
to
tr
ac
k
p
h
y
s
ical
ac
tiv
ity
.
T
h
is
s
tu
d
y
's
p
r
im
ar
y
s
tr
en
g
th
is
its
co
m
p
r
eh
e
n
s
iv
e
m
eth
o
d
o
lo
g
y
,
wh
ich
co
m
b
in
es
th
ese
th
r
e
e
cr
u
cial
co
m
p
o
n
en
ts
.
I
ts
d
r
awb
ac
k
s
,
h
o
wev
er
,
in
clu
d
e
th
e
lim
ited
s
am
p
le
s
ize
an
d
th
e
b
r
ief
r
esear
ch
p
er
io
d
,
wh
ich
m
ay
p
r
ev
e
n
t
th
e
co
n
clu
s
io
n
s
f
r
o
m
b
ein
g
b
r
o
ad
ly
a
p
p
licab
le.
Fu
r
th
e
r
m
o
r
e,
d
esp
ite
th
e
ab
s
en
ce
o
f
d
ir
e
ct
p
s
y
ch
o
lo
g
ically
o
r
ien
ted
th
er
ap
ies,
a
s
u
r
p
r
is
in
g
o
u
tco
m
e
was th
e
f
a
v
o
r
a
b
le
in
f
lu
en
ce
s
h
o
wn
in
p
atien
ts
with
r
elatio
n
to
th
e
e
n
h
an
ce
m
en
t o
f
m
en
tal
h
ea
lth
.
I
n
v
esti
g
atin
g
t
h
e
ef
f
ec
ts
o
f
c
alm
,
ex
er
cise,
an
d
a
b
alan
ce
d
d
iet
o
n
ca
n
ce
r
p
ati
en
ts
'
o
v
er
all
h
ea
lth
.
T
h
is
s
tu
d
y
d
em
o
n
s
tr
ates
th
at
a
co
m
p
r
e
h
en
s
iv
e
s
tr
ateg
y
t
h
at
in
co
r
p
o
r
ates
all
th
r
ee
ele
m
en
ts
ca
n
en
h
a
n
ce
q
u
ality
o
f
life
an
d
less
en
th
e
p
s
y
ch
o
l
o
g
ical
s
y
m
p
to
m
s
t
h
at
ca
n
ce
r
p
atien
ts
f
r
eq
u
e
n
tly
ex
p
er
ien
ce
.
T
h
e
s
ig
n
if
ican
ce
o
f
th
is
wo
r
k
r
es
id
es
in
th
e
d
is
co
v
er
y
th
at
wea
r
ab
le
tech
n
o
lo
g
y
ca
n
p
r
o
v
i
d
e
m
o
r
e
ef
f
icien
t
p
h
y
s
ical
ac
tiv
ity
tr
ac
k
i
n
g
,
a
n
d
th
e
in
co
r
p
o
r
ati
o
n
o
f
r
elax
i
n
g
m
u
s
ic
an
d
f
ilm
s
p
r
o
v
i
d
es
m
o
r
e
r
ea
d
ily
a
v
ailab
le
s
tr
ess
-
r
ed
u
ctio
n
s
tr
ateg
ies.
Op
p
o
r
tu
n
ities
f
o
r
a
m
o
r
e
all
-
e
n
c
o
m
p
ass
in
g
a
p
p
r
o
ac
h
to
tr
ea
t
m
en
t
ar
e
cr
ea
ted
b
y
th
is
r
esear
ch
,
wh
ich
o
f
f
er
s
f
r
esh
p
er
s
p
ec
tiv
es
o
n
h
o
lis
tic
ca
r
e
th
at
tak
es
in
to
ac
co
u
n
t
ca
n
ce
r
p
atien
ts
'
em
o
tio
n
al
an
d
p
h
y
s
ical
well
-
b
ein
g
.
3
.
3
.
6
.
Dig
it
a
l int
er
a
ct
i
v
e
pla
t
f
o
rm
Flex
ib
le
ed
u
ca
tio
n
al
s
o
lu
tio
n
s
th
at
m
ay
b
e
cu
s
to
m
ized
to
p
atien
ts
'
r
eq
u
ir
em
en
ts
ar
e
p
r
o
v
id
ed
v
ia
in
ter
ac
tiv
e
d
ig
ital
p
latf
o
r
m
s
s
u
ch
as
iC
ar
e
a
n
d
iNu
tr
itio
n
.
W
ith
ac
ce
s
s
to
a
r
a
n
g
e
o
f
m
at
er
ials
,
s
u
ch
as
tex
tu
al
co
u
r
s
es,
p
o
d
ca
s
ts
,
an
d
v
i
d
eo
s
,
in
ad
d
itio
n
to
co
u
n
s
elin
g
an
d
n
u
tr
itio
n
co
n
s
u
ltatio
n
s
,
th
i
s
p
latf
o
r
m
p
r
o
v
id
es
ca
n
ce
r
p
atien
ts
with
all
-
en
c
o
m
p
ass
in
g
ca
r
e
th
r
o
u
g
h
o
u
t
t
h
e
ir
tr
ea
tm
en
t
p
r
o
ce
s
s
.
Fu
r
th
er
m
o
r
e,
p
atien
ts
m
ay
r
em
ain
m
o
tiv
ated
an
d
f
o
cu
s
ed
o
n
th
eir
m
e
n
tal
h
ea
lth
o
b
jectiv
es
th
an
k
s
to
th
e
p
latf
o
r
m
's
c
ap
ac
ity
to
m
o
n
ito
r
p
atien
t
p
r
o
g
r
ess
an
d
o
f
f
er
tailo
r
ed
f
ee
d
b
ac
k
.
E
v
id
e
n
ce
d
em
o
n
s
tr
ates
th
at
th
ese
d
ig
ital
p
latf
o
r
m
s
ca
n
en
h
an
ce
tr
ea
tm
en
t c
o
m
p
lian
ce
an
d
i
n
cr
ea
s
e
p
atien
t c
o
m
f
o
r
t i
n
lo
n
g
-
te
r
m
ca
r
e
[
5
2
]
,
[
5
3
]
.
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
s
h
o
w
th
at
iC
ar
e
an
d
iNu
tr
itio
n
n
o
t
o
n
ly
o
f
f
er
in
s
tr
u
ctio
n
al
m
ater
ials
b
u
t
also
im
p
r
o
v
e
p
atien
t
in
v
o
lv
em
en
t
in
h
ea
lth
m
a
n
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em
e
n
t,
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co
n
tr
ast
to
o
th
er
r
esear
ch
th
at
ass
es
s
e
d
th
e
u
s
e
o
f
d
ig
ital
p
latf
o
r
m
s
in
ca
n
ce
r
tr
e
atm
en
t
[
3
1
]
.
Alth
o
u
g
h
th
e
r
es
tr
icted
ex
am
in
atio
n
o
f
in
d
iv
id
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als
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m
d
if
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er
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o
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ec
o
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o
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ic
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k
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n
d
s
m
ay
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p
ac
t
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ce
s
s
an
d
th
e
p
latf
o
r
m
's
ef
f
icac
y
,
th
is
s
tu
d
y
af
f
ir
m
s
th
e
s
ig
n
if
ican
ce
o
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o
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f
er
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o
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at
m
ay
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e
cu
s
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m
ized
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o
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ch
in
d
iv
id
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al.
Ho
we
v
er
,
th
e
s
u
r
p
r
is
in
g
f
in
d
in
g
s
s
u
g
g
est
th
at
r
em
o
te
co
u
n
s
elin
g
a
n
d
in
s
tr
u
ctio
n
al
m
ater
ials
m
ig
h
t
h
asten
p
atien
ts
'
m
en
tal
h
ea
lin
g
,
wh
ich
was n
o
t a
d
d
r
ess
ed
in
ea
r
lier
s
tu
d
ies th
at
co
n
ce
n
tr
ate
d
m
o
r
e
o
n
th
e
m
e
d
ical
s
id
e
o
f
tr
ea
tm
en
t.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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6
I
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b
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Hea
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Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
3
2
-
1
2
4
2
1238
I
n
v
esti
g
atin
g
th
e
way
s
in
wh
ich
p
er
s
o
n
alize
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tio
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al
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d
p
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ch
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ical
ass
is
tan
ce
v
ia
in
ter
ac
tiv
e
d
ig
ital
p
latf
o
r
m
s
m
ig
h
t
im
p
r
o
v
e
ca
n
ce
r
p
atien
ts
'
in
v
o
lv
em
en
t
in
th
eir
tr
ea
tm
en
t
p
r
o
ce
s
s
.
T
h
is
s
tu
d
y
h
ig
h
lig
h
ts
th
e
v
alu
e
o
f
ad
ap
tab
ilit
y
an
d
ac
ce
s
s
ib
ilit
y
in
h
ea
lth
ca
r
e
b
y
in
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o
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tin
g
tech
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r
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e
a
m
o
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e
p
atien
t
-
ce
n
ter
ed
ap
p
r
o
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h
.
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h
is
ca
n
r
esu
lt
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im
p
r
o
v
e
d
o
u
tco
m
es,
p
ar
ticu
lar
ly
wh
en
it
co
m
es
to
p
atien
ts
'
m
en
tal
h
ea
lth
.
T
h
e
r
esu
lts
o
f
th
is
s
tu
d
y
o
f
f
er
v
alu
ab
le
in
f
o
r
m
at
io
n
f
o
r
th
e
cr
ea
tio
n
o
f
tech
n
o
lo
g
ically
b
ased
h
ea
lth
s
o
lu
tio
n
s
th
at
ca
n
im
p
r
o
v
e
p
ati
en
ts
'
g
en
er
al
h
ea
lth
.
4.
CO
NCLU
SI
O
N
T
h
is
s
y
s
tem
atic
r
ev
iew
id
en
tifie
d
s
ev
er
al
ap
p
licatio
n
-
b
as
ed
in
ter
v
en
tio
n
s
th
at
ca
n
h
e
lp
ca
n
ce
r
p
atien
ts
liv
e
b
etter
liv
es.
T
h
e
f
in
d
in
g
s
o
f
th
e
s
tu
d
y
d
em
o
n
s
tr
ate
th
at
ap
p
licatio
n
s
cr
ea
ted
f
o
r
ca
n
ce
r
p
atien
ts
o
f
f
er
all
-
en
co
m
p
ass
in
g
ass
is
ta
n
ce
b
y
ad
d
r
ess
in
g
s
ix
k
ey
ar
e
as:
in
ter
ac
tiv
e
d
ig
ital
p
latf
o
r
m
s
,
h
ea
lth
ed
u
ca
tio
n
,
s
y
m
p
to
m
m
an
ag
e
m
en
t,
p
s
y
ch
o
lo
g
ical
s
u
p
p
o
r
t,
m
u
ltid
is
cip
lin
ar
y
tr
ea
tm
en
ts
,
p
h
y
s
ical
ex
er
cise
an
d
r
elax
atio
n
,
an
d
h
ea
lth
ed
u
ca
tio
n
.
A
n
u
m
b
er
o
f
ap
p
licatio
n
k
in
d
s
,
s
u
c
h
as
th
o
s
e
b
ased
o
n
d
i
g
ital
s
to
r
y
tellin
g
,
m
o
b
ile
ed
u
ca
tio
n
,
n
u
r
s
e
-
led
ca
r
e
s
u
p
p
o
r
t
p
r
o
g
r
a
m
s
,
v
ir
tu
al
r
ea
lity
-
b
ased
th
er
ap
ies,
an
d
s
y
m
p
t
o
m
m
o
n
ito
r
i
n
g
a
p
p
s
,
h
av
e
d
em
o
n
s
t
r
ated
ef
f
icac
y
in
en
h
a
n
cin
g
q
u
ality
o
f
life
.
T
h
e
f
in
d
i
n
g
s
o
f
th
is
s
tu
d
y
h
a
v
e
s
ig
n
if
ican
t
r
am
if
icatio
n
s
f
o
r
th
e
ad
v
a
n
ce
m
en
t o
f
m
ed
ical
tech
n
o
l
o
g
y
,
e
s
p
ec
ially
in
ter
m
s
o
f
en
h
an
cin
g
th
e
liv
es o
f
ca
n
ce
r
p
atien
ts
.
Dev
elo
p
in
g
m
o
b
ile
a
p
p
s
with
in
teg
r
ate
d
h
ea
lth
f
ea
tu
r
es
m
ay
b
e
a
p
r
ac
tical
s
o
lu
ti
o
n
f
o
r
p
atien
ts
an
d
ef
f
ec
tiv
e
o
p
tio
n
,
esp
ec
ially
wh
en
it
co
m
es
to
im
p
r
o
v
i
n
g
e
d
u
ca
tio
n
,
m
an
ag
i
n
g
s
y
m
p
to
m
s
,
an
d
o
f
f
er
in
g
th
e
r
eq
u
ir
ed
p
s
y
ch
o
lo
g
ical
s
u
p
p
o
r
t.
Fu
r
th
er
m
o
r
e,
th
e
u
s
e
o
f
cu
ttin
g
-
ed
g
e
tec
h
n
o
lo
g
y
lik
e
v
ir
tu
al
r
ea
lity
an
d
telem
ed
icin
e
-
b
ased
ap
p
licatio
n
s
ca
n
en
h
an
ce
in
ter
d
is
cip
lin
ar
y
ap
p
r
o
ac
h
es
an
d
en
h
an
c
e
lo
n
g
-
ter
m
h
ea
lth
r
esu
lts
.
As
p
ar
t
o
f
a
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
an
d
tech
n
o
lo
g
i
ca
lly
ad
v
an
ce
d
ca
n
ce
r
ca
r
e
s
y
s
tem
,
th
is
s
tu
d
y
p
r
o
m
o
tes th
e
f
u
r
th
e
r
d
ev
el
o
p
m
en
t o
f
th
ese
a
p
p
lic
atio
n
s
.
ACK
NO
WL
E
DG
M
E
N
T
S
Ou
r
s
in
ce
r
e
ap
p
r
ec
iatio
n
g
o
es
o
u
t
to
:
i
)
R
esear
ch
,
T
ec
h
n
o
lo
g
y
,
an
d
C
o
m
m
u
n
ity
Ser
v
ice
Di
r
ec
to
r
ate
;
ii
)
Hig
h
er
E
d
u
ca
tio
n
,
R
esear
ch
,
an
d
T
ec
h
n
o
lo
g
y
Dir
ec
to
r
at
e
Gen
er
al
;
a
n
d
iii
)
.
T
h
e
R
ep
u
b
lic
o
f
I
n
d
o
n
esia'
s
Min
is
tr
y
o
f
E
d
u
ca
tio
n
,
C
u
ltu
r
e,
R
esear
ch
,
an
d
T
ec
h
n
o
lo
g
y
,
f
o
r
t
h
e
g
r
an
t
m
o
n
ey
g
iv
e
n
o
u
t
in
2
0
2
4
.
T
h
e
ex
ec
u
tio
n
o
f
o
u
r
s
tu
d
y
is
g
r
e
atly
aid
ed
b
y
t
h
is
ass
is
tan
ce
,
wh
ich
is
an
ticip
ated
to
h
av
e
a
r
ea
l
im
p
ac
t
o
n
th
e
ad
v
an
ce
m
e
n
t o
f
s
cien
ce
,
tec
h
n
o
lo
g
y
,
an
d
s
o
ciety
.
RE
F
E
R
E
NC
E
S
[
1
]
M
.
C
.
H
u
l
v
a
t
,
“
C
a
n
c
e
r
i
n
c
i
d
e
n
c
e
a
n
d
t
r
e
n
d
s
,
”
S
u
r
g
i
c
a
l
C
l
i
n
i
c
s
o
f
N
o
r
t
h
A
m
e
ri
c
a
,
v
o
l
.
1
0
0
,
n
o
.
3
,
p
p
.
4
6
9
–
4
8
1
,
Ju
n
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
su
c
.
2
0
2
0
.
0
1
.
0
0
2
.
[
2
]
M
.
I
.
F
i
t
c
h
,
I
.
N
i
c
o
l
l
,
a
n
d
G
.
L
o
c
k
w
o
o
d
,
“
C
a
n
c
e
r
s
u
r
v
i
v
o
r
’
s
p
e
r
sp
e
c
t
i
v
e
s o
n
t
h
e
ma
j
o
r
c
h
a
l
l
e
n
g
e
i
n
t
h
e
t
r
a
n
si
t
i
o
n
t
o
su
r
v
i
v
o
r
sh
i
p
,
”
Pa
t
i
e
n
t
E
d
u
c
a
t
i
o
n
a
n
d
C
o
u
n
se
l
i
n
g
,
v
o
l
.
1
0
3
,
n
o
.
1
1
,
p
p
.
2
3
6
1
–
2
3
6
7
,
N
o
v
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
p
e
c
.
2
0
2
0
.
0
4
.
0
1
8
.
[
3
]
H
.
L
i
n
,
M
.
Y
e
,
S
.
W
.
C
h
a
n
,
J.
Z
h
u
,
a
n
d
H
.
H
e
,
“
T
h
e
e
f
f
e
c
t
i
v
e
n
e
ss
o
f
o
n
l
i
n
e
i
n
t
e
r
v
e
n
t
i
o
n
s
f
o
r
p
a
t
i
e
n
t
s
w
i
t
h
g
y
n
e
c
o
l
o
g
i
c
a
l
c
a
n
c
e
r
:
A
n
i
n
t
e
g
r
a
t
i
v
e
r
e
v
i
e
w
,
”
G
y
n
e
c
o
l
o
g
i
c
O
n
c
o
l
o
g
y
,
v
o
l
.
1
5
8
,
n
o
.
1
,
p
p
.
1
4
3
–
1
5
2
,
J
u
l
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
y
g
y
n
o
.
2
0
2
0
.
0
4
.
6
9
0
.
[
4
]
Z.
K
.
S
e
n
g
u
l
a
n
d
E
.
K
.
T
o
r
u
n
e
r
,
“
I
n
t
e
r
v
e
n
t
i
o
n
p
r
o
t
o
c
o
l
:
T
e
c
h
n
o
l
o
g
y
-
b
a
se
d
p
s
y
c
h
o
so
c
i
a
l
m
o
t
i
v
a
t
i
o
n
f
o
r
c
h
i
l
d
r
e
n
w
i
t
h
c
a
n
c
e
r
a
n
d
t
h
e
i
r
p
a
r
e
n
t
s:
A
r
a
n
d
o
mi
z
e
d
t
r
i
a
l
,
”
Asi
a
-
Pa
c
i
f
i
c
J
o
u
rn
a
l
o
f
O
n
c
o
l
o
g
y
N
u
r
si
n
g
,
v
o
l
.
7
,
n
o
.
1
,
p
p
.
5
5
–
6
3
,
Ja
n
.
2
0
2
0
,
d
o
i
:
1
0
.
4
1
0
3
/
a
p
j
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n
.
a
p
j
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n
_
2
5
_
1
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Evaluation Warning : The document was created with Spire.PDF for Python.