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  • 1.
    Browall, Maria
    et al.
    University of Skövde, School of Life Sciences. Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden / Johns Hopkins University, Baltimore, Maryland, USA.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA.
    Nasic, Salmir
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Wengström, Yvonne
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
    Validity and Reliability of the Swedish Version of the Memorial Symptom Assessment Scale (MSAS): An Instrument for the Evaluation of Symptom Prevalence, Characteristics, and Distress2013In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 46, no 1, p. 131-141Article in journal (Refereed)
  • 2.
    Browall, Maria
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm.
    Kenne Sarenmalm, Elisabeth
    Research and Development Centre, Skaraborg Hospital, Skövde.
    Persson, Lars-Olof
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Wengström, Yvonne
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
    Patient-reported stressful events and coping strategies in post-menopausal women with breast cancer2016In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 2, p. 324-333Article in journal (Refereed)
  • 3.
    Gaston-Johansson, Fannie
    et al.
    Johns Hopkins University, Department of Acute and Chronic Care, School of Nursing, Baltimore, MD, USA.
    Fall-Dickson, Jane M.
    National Institute of Health, Symptom Management Branch, National Institute of Nursing, Research, Bethesda, MD, USA.
    Nanda, Joy P.
    Johns Hopkins Medical Institutions, Baltimore, MD, USA.
    Kenne Sarenmalm, Elisabeth
    Skaraborg Hospital, Department of Research and Development Centre, Skövde, Sweden.
    Browall, Maria
    University of Skövde, School of Life Sciences.
    Goldstein, Nancy
    Johns Hopkins University, Department of Acute and Chronic Care, School of Nursing, Baltimore, MD, USA.
    Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy2012In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 3, p. 530-539Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program (CCSP) on quality of life (QOL) among breast cancer patients 1 year after treatment.

    METHODS: Patients (n = 110) with stage II, III, or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were randomized to either CCSP treatment or control group. The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge. The CCSP components included educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery. Instruments administered at baseline included the following: Quality of Life Index-Cancer Version (QOLI-CV), State-Trait Anxiety Inventory, Beck Depression Inventory, and Coping Strategies Questionnaire. At 1-year follow-up, patients (n = 73) completed and returned the follow-up QOLI-CV.

    RESULTS: Patients were mainly ≥40 years of age, married, Caucasian, and diagnosed with advanced breast cancer. A model measuring effectiveness of CCSP on QOL (total and subscale) at 1-year follow-up showed that the CCSP group (n = 38) had significant improvement in overall QOL (p < 0.01), health and functioning (p < 0.05), and socioeconomic (p < 0.05) and psychological/spiritual well-being (p < 0.01) compared with the control group (n = 35). The CCSP patients frequently used the CCSP to manage psychological (51%) and sleep problems (60%).

    CONCLUSIONS: The CCSP improved QOL for patients at 1-year follow-up. Patients overwhelmingly reported that CCSP was beneficial. The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors.

  • 4.
    Johansson, Yvonne A.
    et al.
    Skaraborg Hospital, Skövde, Sweden / Jönköping University, Jönköping, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ericsson, Iréne
    Jönköping University, Jönköping, Sweden.
    Kenne Sarenmalm, Elisabeth
    Skaraborg Hospital, Skövde, Sweden.
    Delirium in older hospitalized patients—signs and actions: a retrospective patient record review2018In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 18, no 1, p. 1-11, article id 43Article, review/survey (Refereed)
    Abstract [en]

    Background

    Delirium is common in older hospitalized patients, and is associated with negative consequences for the patients, next of kin, healthcare professionals and healthcare costs. It is important to understand its clinical features, as almost 40% of all cases in hospitals may be preventable. Yet, delirium in hospitalized patients is often unrecognized and untreated. Few studies describe thoroughly how delirium manifests itself in older hospitalized patients and what actions healthcare professionals take in relation to these signs. Therefore, the aim of this study was to describe signs of delirium in older hospitalized patients and action taken by healthcare professionals, as reported in patient records.

    Methods

    Patient records from patients aged ≥65 (n = 286) were retrospectively reviewed for signs of delirium, which was found in 78 patient records (27%). Additionally, these records were reviewed for action taken by healthcare professionals in relation to the patients’ signs of delirium. The identified text was analyzed with qualitative content analysis in two steps.

    Results

    Healthcare professionals responded only in part to older hospitalized patients’ needs of care in relation to their signs of delirium. The patients displayed various signs of delirium that led to a reduced ability to participate in their own care and to keep themselves free from harm. Healthcare professionals met these signs with a variation of actions and the care was adapted, deficient and beyond the usual care. A systematic and holistic perspective in the care of older hospitalized patients with signs of delirium was missing.

    Conclusion

    Improved knowledge about delirium in hospitals is needed in order to reduce human suffering, healthcare utilization and costs. It is important to enable older hospitalized patients with signs of delirium to participate in their own care and to protect them from harm. Delirium has to be seen as a preventable adverse event in all hospitals units. To improve the prevention and management of older hospitalized patients with signs of delirium, person-centered care and patient safety may be important issues.

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  • 5.
    Johansson, Yvonne A.
    et al.
    Skaraborg Hospital, Skövde, Sweden ; Jönköping University, Research School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, United States.
    Kenne Sarenmalm, Elisabeth
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Skaraborg Hospital, Skövde, Sweden ; Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden.
    Symptoms and Well-Being in Older Hospitalized Patients with Cognitive Impairment, As Self-Reported and Reported in Patient Records: A Quantitative Exploratory Subgroup Analysis2021In: Dementia and Geriatric Cognitive Disorders Extra, E-ISSN 1664-5464, Vol. 11, no 2, p. 71-77Article in journal (Refereed)
    Abstract [en]

    Introduction: Given the aging population and the high prevalence of cognitive impairment in older hospitalized patients, it is essential to provide good fundamental care to these vulnerable patients, who easily might be affected by poor outcomes as delirium. Risk factors for delirium are, for example, cognitive impairment, old age, pain, and sleep deprivation. Different symptoms are often unidentified in hospitals, and associated with poor well-being, but this is rarely studied in older patients with cognitive impairment. The study aim was to examine symptoms and sense of well-being in older hospitalized patients with cognitive impairment, as self-reported and reported in patient records. Methods: Exploratory quantitative subgroup (n = 25) analysis of a point-prevalence study (n = 210). Inclusion criteria were age ≥65, and cognitive impairment. Data were collected through structured interviews, validated instruments, and patient records. Associations between well-being and symptoms, and concordance between the occurrence of self-reported symptoms and symptoms reported in patient records were analyzed. Results: The patients reported severe and distressing symptoms that were sparsely reported (14%) in their records. As well were cognitive impairment, and the patients' own descriptions of their well-being. Some symptoms and the total symptom burden were associated with poor well-being. Discussion/Conclusion: To our knowledge, this hypothesis-generating study is one of few studies that describe both symptoms and well-being as self-reported and reported in patient records, in vulnerable patients due to old age, cognitive impairment, and hospitalization. Despite the limited sample size, the results indicate that symptoms were more insufficient alleviated in these patients compared to patients with normal cognitive function in other studies. To our knowledge, this has not been shown previously. Additionally, patients' own experiences were sparsely reported in their records. A larger sample size and longitudinal design has the potential to determine if symptom alleviation differs between patients with and without cognitive impairment, and if a total symptom burden increases the risk of poor outcomes as delirium in vulnerable patients. 

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  • 6.
    Johansson, Yvonne A.
    et al.
    Skaraborg Hospital, Skövde, Sweden ; The Research School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Sweden.
    Tsevis, Theofanis
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden ; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Nasic, Salmir
    Skaraborg Hospital, Skövde, Sweden ; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, United States.
    Johansson, Linda
    Institute of Gerontology, Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Bogdanovic, Nenad
    Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden ; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kenne Sarenmalm, Elisabeth
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Skaraborg Hospital, Skövde, Sweden ; Institute of Health and Care Science, Sahlgrenska Academy, Centre for Person-Centred Care Sahlgrenska Academy, University of Gothenburg, Sweden.
    Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting2021In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 21, no 1, article id 568Article in journal (Refereed)
    Abstract [en]

    Background: Delirium is common in older hospitalized patients. It has serious consequences e.g., poor health outcomes, mortality and increased costs. Despite that, many cases are undetected. Early detection of delirium is important in improving outcomes and use of assessment tools improves detection rates. The 4AT is a brief screening tool for delirium detection, which has not previously been translated into Swedish. The study aim was to evaluate diagnostic accuracy and clinical applicability of a Swedish version of the screening tool 4AT for delirium detection. Method: This diagnostic test accuracy study used a quantitative and a qualitative approach and evaluated the patients’ and the health care professionals’ experiences of the tool. Study included 200 patients ≥65 years from a university hospital and a county hospital in two Swedish regions. Medical specialties were geriatric stroke/neurology, geriatric multimorbidity, severe cognitive impairment, orthopaedic, and urology. The translated 4AT was tested against the reference standard DSM-IV-TR criteria, based on the Organic Brain Syndrome scale and patient records. The 4AT was assessed simultaneously and independently by two assessors. Additionally, data was collected through patient record reviews, and questions about applicability to the patients (n = 200) and the assessors (n = 37). Statistical analyses, and qualitative content analyses were conducted. Results: By reference standard 18% had delirium, and by 4AT 19%. The overall percent agreement was 88%, AUROC 0.808, sensitivity 0.70 (95% CI 0.51–0.84) and specificity 0.92 (95% CI 0.87–0.96). In the ward for severe cognitive impairment (n = 63) the 4AT was less sensitive and less specific. In the other wards (n = 132) sensitivity was 0.77 (95% CI 0.50–0.93), specificity 0.93 (95% CI 0.87–0.97), and AUROC 0.848. Interrater reliability (Kappa) was 0.918, p = < 0.001 (n = 144). The 4AT was well tolerated by patients, easy to use for health care professionals, and took a few minutes to conduct. Conclusion: The Swedish version of 4AT is an accurate and applicable tool to use in clinical practice for detecting delirium in hospitalized patients across different medical specialities, and to use by different professionals and levels of seniority. To improve patient outcomes, we recommend the 4AT to be incorporated in clinical practice in health care settings in Sweden. 

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  • 7.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins University, Baltimore, Maryland, USA / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Browall, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Johns Hopkins University, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden / Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA / Institute of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
    Gaston-Johansson, Fannie
    Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA.
    Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer2014In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 47, no 4, p. 731-741Article in journal (Refereed)
    Abstract [en]

    Context: Although there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters. Objectives: To explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer. Methods: In this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups. Results: Three clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with "change in the way food tastes" as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden. Conclusion: This study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients. © 2013 U.S. Cancer Pain Relief Committee.

  • 8.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Browall, Maria
    University of Skövde, School of Life Sciences. Johns Hopkins School of Nursing, Baltimore, MD, USA / Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Persson, L.-O.
    Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Fall-Dickson, Jane M.
    National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
    Gaston-Johansson, Fanny
    Johns Hopkins School of Nursing, Baltimore, MD, USA.
    Relationship of sense of coherence to stressful events, coping strategies, health status, and quality of life in women with breast cancer2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Objective: To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) predicts stressful events, coping strategies, health status, and quality of life (QoL) in a cohort of postmenopausal women (n = 131) with newly diagnosed primary or recurrent breast cancer.

    Methods: Regression analyses of longitudinal data at baseline through 6 months following breast cancer diagnosis examined the relationships between SOC (13-item version), daily assessment of coping with stressful events, health status, and QoL (EORTC QLQ-30).

    Results: The findings support Antonovsky's concept of SOC. Women with strong SOC reported fewer stressful events and more days without stressful events. They used more coping strategies and more frequently used distraction, situation redefinition, direct action, and relaxation, but seldom religion, to cope with stressful events, and reported better health status and QoL. Women with weak SOC experienced more distress and used fewer coping strategies, and they more frequently used coping strategies such as catharsis and seeking social and spiritual support, but seldom acceptance of the situation. They reported worse health status and QoL, regardless of disease stage or treatment. The relationships between SOC and health status and QoL were linear.

    Conclusions: Sense of coherence significantly predicts distress, number and type of coping strategies such as direct action and relaxation, health status, and QoL in women with breast cancer. Our data suggest that the SOC scale may be a useful screening tool to identify individuals particularly vulnerable to distress and unable to cope adequately. Assessing SOC strength may assist health care providers to provide individualized patient interventions.

  • 9.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Bengt A.
    Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlsson, Per
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital,Sweden University of Gothenburg, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mindfulness and its efficacy for psychological and biological responses in women with breast cancer2017In: Cancer Medicine, E-ISSN 2045-7634, Vol. 6, no 5, p. 1108-1122Article in journal (Refereed)
    Abstract [en]

    Many breast cancer survivors have to deal with a variety of psychological andphysiological sequelae including impaired immune responses. The primary purposeof this randomized controlled trial was to determine the efficacy of amindfulness-basedstress reduction (MBSR) intervention for mood disorders inwomen with breast cancer. Secondary outcomes were symptom experience, healthstatus, coping capacity, mindfulness, posttraumatic growth, and immune status.This RTC assigned 166 women with breast cancer to one of three groups: MBSR(8 weekly group sessions of MBSR), active controls (self-instructingMBSR) andnon-MBSR.The primary outcome measure was the Hospital Anxiety and DepressionScale. Secondary outcome measures were: Memorial Symptom AssessmentScale, SF-36,Sense of Coherence, Five Facets of Mindfulness Questionnaire,and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometryfor NK-cellactivity (FANKIA) and lymphocyte phenotyping; concentrationsof cytokines were determined in sera using commercial high sensitivityIL-6and IL-8ELISA (enzyme-linkedimmunosorbent assay) kits. Results provideevidence for beneficial effects of MBSR on psychological and biological responses.Women in the MBSR group experienced significant improvements in depressionscores, with a mean pre-MBSRHAD-scoreof 4.3 and post-MBSRscore of 3.3(P = 0.001), and compared to non-MBSR(P = 0.015). Significant improvementson scores for distress, symptom burden, and mental health were also observed.Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumaticgrowth. Significant benefits in immune response within the MBSRgroup and between groups were observed. MBSR have potential for alleviatingdepression, symptom experience, and for enhancing coping capacity, mindfulnessand posttraumatic growth, which may improve breast cancer survivorship.MBSR also led to beneficial effect on immune function; the clinical implicationsof this finding merit further research.

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  • 10.
    Kenne Sarenmalm, Elisabeth
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden / Institute of Health and Caring Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden / Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Life Sciences.
    Holmberg, Stig B.
    Department of Surgery, SU/Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Bengt A.
    Microbiology and Immunology, Göteborg University, Göteborg, Sweden.
    Odén, Anders
    Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Mindfulness based stress reduction study design of a longitudinal randomized controlled complementary intervention in women with breast cancer2013In: BMC Complementary and Alternative Medicine, E-ISSN 1472-6882, Vol. 13, article id 248Article in journal (Refereed)
    Abstract [en]

    Background: The stress of a breast cancer diagnosis and its treatment can produce a variety of psychosocial sequelae including impaired immune responses. Mindfulness Based Stress Reduction (MBSR) is a structured complementary program that incorporates meditation, yoga and mind-body exercises. Despite promising empirical evidence for the efficacy of MBSR, there is a need for randomized controlled trials (RCT). There is also a need for RCTs investigating the efficacy of psychosocial interventions on mood disorder and immune response in women with breast cancer. Therefore, the overall aim is to determine the efficacy of a Mindfulness Based Stress Reduction (MBSR) intervention on well-being and immune response in women with breast cancer.Methods and design: In this RCT, patients diagnosed with breast cancer, will consecutively be recruited to participate. Participants will be randomized into one of three groups: MBSR Intervention I (weekly group sessions + self-instructing program), MBSR Intervention II (self-instructing program), and Controls (non-MBSR). Data will be collected before start of intervention, and 3, 6, and 12 months and thereafter yearly up to 5 years. This study may contribute to evidence-based knowledge concerning the efficacy of MBSR to support patient empowerment to regain health in breast cancer disease.Discussion: The present study may contribute to evidence-based knowledge concerning the efficacy of mindfulness training to support patient empowerment to regain health in a breast cancer disease. If MBSR is effective for symptom relief and quality of life, the method will have significant clinical relevance that may generate standard of care for patients with breast cancer.Trial registration: ClinicalTrials.gov: NCT01591915. © 2013 Kenne Sarenmalm et al.; licensee BioMed Central Ltd.

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