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ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 3  |  Page : 521-526

Breast specific functional and symptom analysis in female breast cancer survivors


1 Department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
2 Department of Anaesthesiology and Critical Care, Division of Anaesthesiology and Pain and Palliative Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
3 District Hospital Pulwama, Directorate of Health Services, Srinagar, Jammu and Kashmir, India

Date of Web Publication12-Jun-2018

Correspondence Address:
Dr. Talib Khan
Department of Anaesthesiology and Critical Care Medicine, Division of Anaesthesiology and Pain and Palliative Care, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir - 190 011
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.165867

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 > Abstract 


Context: The disease and surgery of the breast not only evoke a fear of mutilation and loss of feminity but is also responsible for psychosocial, behavioral, and sexual problems.
Aim: To analyze prospectively the time trends in “breast specific functional and symptom scale scores in female breast cancer survivors.”
Settings and Design: The prospective study was conducted in the Department of Radiation Oncology at Tertiary Referral Hospital.
Materials and Methods: A total of 154 operated (mastectomy) female breast cancer patients who were referred to the Department of Radiation Oncology for chemoradiation ± target therapy (trastuzumab) ± hormonal therapy (tamoxifen) were included in the study. Seven patients were excluded from the final analysis due to their refusal to consent. The patients were assessed by using European Organization for Research and Treatment of Cancer Quality of Life-BR23 questionnaire module (which incorporates five multi-item and three single items scales) at 1st visit (0 month), 6, 12, and 24 months interval, respectively.
Results: The symptom scores and future perspectives scale showed improvement with time, but body image and sexual functioning and enjoyment scales showed the deteriorating trend. P < 0.05 was considered as significant.
Conclusion: The female breast cancer survivors failed to improve their body image, sexual functioning, and sexual enjoyment scales but did well in other BR23 scales. Besides the family and spousal/marital support these patients got closer to their religion which has been seen to influence their psychosocial well-being optimistically and need further studies to establish the role of religious practices/beliefs.

Keywords: Body image, breast cancer, future perspectives, quality of life, sexual enjoyment, sexual functioning, upset by hair loss


How to cite this article:
Wani SQ, Khan T, Wani SY, Teli MA, Khan NA, Mir LR, Lone MM, Afroz F. Breast specific functional and symptom analysis in female breast cancer survivors. J Can Res Ther 2018;14:521-6

How to cite this URL:
Wani SQ, Khan T, Wani SY, Teli MA, Khan NA, Mir LR, Lone MM, Afroz F. Breast specific functional and symptom analysis in female breast cancer survivors. J Can Res Ther [serial online] 2018 [cited 2022 Nov 30];14:521-6. Available from: https://www.cancerjournal.net/text.asp?2018/14/3/521/165867




 > Introduction Top


Female breasts have not only physical and functional value but also have psychological bearing and are symbolic of womanhood and ultimate fertility. As a result, both disease and surgery of the breast evoke a fear of mutilation and loss of feminity besides being responsible for psychosocial behavioral problems.[1] Breast cancer imparts feeling of dread and fear in many women. Breast cancer is a complex disease not yet fully understood, most likely caused by a number of factors interacting with each other, rather than by any single factor.[2]

Breast cancer is the most common type of cancer globally [3],[4] and the most common cause of cancer-related mortality among women worldwide.[4] Breast cancer has been rising steadily over the last decade or so, and is now the most common cancer in women in India, the way ahead of cervical cancer as was previously four decades ago. Both the incidence, as well as deaths, due to the breast cancer are more than cervical cancer due to rapid rise in the number of breast cancer cases followed by actual decrease in the incidence of cervical cancer. For the year 2015, there will be an estimated 1,55,000 new cases of breast cancer and about 76,000 breast cancer deaths in India.[5] There is a need for the aggressive breast cancer awareness and screening programs for early detection and management to improve the breast cancer outcome.[6]

The effective management of patients must be aimed at tumor control vis a vis techniques to maximize the patients sense of well-being or quality of life (QOL),[7] thereby having an opportunity to add life to years, as well as adding years to life.[1] Thus, the primary endpoint nowadays in oncology management is the QOL.[8]

Keeping in view, the increasing burden of breast cancer in females in Kashmir and its impact on various psychosocial aspects in these patients, we planned to study the time trends of breast specific functional and symptom analysis in female breast cancer patients during their treatment and follow-up.


 > Materials and Methods Top


After approval from Institutional Review Board and permission from European Organization for Research and Treatment of Cancer (EORTC), the present prospective hospital-based study titled “breast specific functional and symptom analysis in female breast cancer survivors” was conducted in Department of Radiation Oncology of Tertiary Referral and University Teaching Hospital.

A total of 154 operated (mastectomy + axillary dissection) female breast cancer patients having stages IIB and IIIA disease were included in the study after being referred to the Department of Radiation Oncology for chemoradiation ± target therapy (trastuzumab) ± hormonal therapy (tamoxifen). Seven patients were excluded from the final analysis due to their refusal to consent to follow the study protocol. The patients were assessed by using EORTC Quality of Life-BR23 (QLQ-BR23) questionnaire module at 1st visit (0 month), 6 months, 12 months (1-year), and 24 months follow-up (2 years), respectively.

The breast cancer module QLQ-BR23 comprises 23 questions assessing disease symptoms, side effects of treatment (surgery, chemotherapy, radiotherapy, and hormonal treatment), body image, sexual functioning, and future perspective [Table 1]. The patients were questioned directly about which single factor gave them a feeling of well-being.
Table 1: EORTC QLQ-BR23 questionnaire module

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The QLQ-BR23 module incorporates five multi-item scales to assess systemic therapy side effects, arm symptoms, breast symptoms, body image and sexual functioning, and three single items scales to assess sexual enjoyment, hair loss, and future perspective [Table 2].
Table 2: Questionnaire item used in scoring of the breast cancer module

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The scale scores range from 0 to 100. A high scale score represents a higher response level. Thus, a high score for a symptom scale represents a high level of symptomatology/problems, and the high score for a functional scale represents a high/healthy level of functioning.

Statistical analysis

The data collected were expressed as raw score, standard deviation (SD), and percent mean score (scale score) and were derived as per the EORTC QLQ-C30 scoring manual, scoring procedures.[9],[10] Further intragroup comparison (IGC) was done at four levels, (“α” is IGC between 1st visit (0 month) and 2nd visit (6 months), “β” between 1st and 3rd visit (12 months), “γ” between 1st and 4th (24 months), and “δ” the overall comparison) and was estimated by paired sample t-test, Wilcoxon sign rank test and overall difference were measured by Friedman's test and unstacked ANOVA. The Statistical Package for the Social Sciences version 17.0 (SPSS, Inc., Chicago, IL, USA) was used for making inferences. P < 0.05 was considered as significant.


 > Results Top


The mean age of patients at first visit was 42.90 ± 10.48 years [Table 3]. The majority of patients were premenopausal 80.95% (n = 119) and married 93.87% (n = 138) [Table 3]. Most of the studied patients belong to stage IIB 53.74% (n = 79) followed by IIIA 46.26% (n = 68) [Table 3]. All patients underwent surgery followed by chemoradiation, endocrine/hormone therapy in the form of tamoxifen was received by 72.78% (n = 107) patients, who were estrogen receptor positive cases and target therapy was received by HER2 positive patients 4.08% (n = 6) [Table 3].
Table 3: Characteristics of female breast cancer survivors

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The body image scale score decreased from 45.33 at 1st visit to 43.94, 38.26, and 30.30 at 6, 12, and 24 months follow-up, respectively, with statistically significant P = 0.000 [Table 4] and [Figure 1].
Table 4: Time trend of EORTC QLQ-BR23 functional and symptom scale scores

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Figure 1: Time trend of European Organization for Research and Treatment of Cancer Quality of Life-BR23 functional scale score

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The sexual functioning scale score decreased from 39.39 at 1st visit to 36.11, 27.53, and 23.99 at subsequent follow-up visit at 6, 12, and 24 months, respectively, with statistically significant P = 0.000 [Table 4] and [Figure 1].

The sexual enjoyment score decreased from 39.00 at 1st visit to 35.33, 36.67, and 36.33 at 6, 12, and 24 months follow-up, respectively, with the statistically significant P = 0.013 [Table 4] and [Figure 1].

The future perspective did not show any significant variation over the initial follow-up period of 6 months, the score initially decreased from 28.28 at 1st visit to 26.77, and 20.20 at 6 and 12 months, respectively. The score then increased to 31.31 at 24 months follow-up with overall statistically significant P = 0.000 [Table 4] and [Figure 1].

The upset by hair loss decreased in score from 26.77 at 1st visit to 13.13, 7.58, and 3.54 at 6, 12, and 24 months follow-up visits with statistically significant P = 0.000 [Table 4] and [Figure 2].
Figure 2: Time trend of European Organization for Research and Treatment of Cancer Quality of Life-BR23 symptom scale score

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The systemic therapy side effect score decreased over the study period from 26.55 at 1st visit to 16.67, 13.71, and 9.31 at a subsequent follow-up visit of 6, 12, and 24 months, respectively. The overall change was statistically significant with P = 0.000 [Table 4] and [Figure 2].

The effective score of breast symptoms decreased from the score of 4.17 at 1st visit to 2.90, 1.89, and 1.26 at 6, 12, and 24 months follow-up, respectively with statistically significant P = 0.000 [Table 4] and [Figure 2].

The arm symptoms decreased from 25.08 at 1st visit to 23.74, 18.01, and 13.80 at 6, 12, and 24 months, respectively, with statistically significant P = 0.000 [Table 4] and [Figure 2].


 > Discussion Top


The mean ± SD age of patients was 42.90 ± 10.48 years in our study, however, in other studies the mean age was 46 ± 10.2 years [1],[2]

Body image is an important aspect of QOL, especially in breast cancer patients.[11],[12] The body image is frequently and negatively impacted by surgery on the breast due to our society's strong identification of female breasts as representing sexuality, femininity, and beauty.[13] Women with breast cancer often experience a decrease in satisfaction with body image after surgery, irrespective of the type of surgical treatment.[8] The body image score did not improve and showed a significant decline over the follow-up period in our study, the similar decline in breast related body image score was also seen by other investigators.[12],[14],[15],[16]

Sexual functioning is an important component of QOL. For a variety of cancer types, estimates of sexual dysfunction after treatment range from 40% to 100%, and involves both physical and psychological causes.[17],[18] Sexual dysfunction or difficulties remain a persistent concern of breast cancer survivors.[16],[17],[18],[19] Sexual dysfunction can cause ongoing emotional distress by reinforcing negative body image, disrupting relationships, and reminding patients of their cancer experience.[18] Sexual dysfunction may develop at any point during the disease course, including at diagnosis and during treatment and posttreatment follow-up.[19],[20] Unlike some other side effects of treatment, sexual problems commonly do not resolve in the first 2 years of disease-free survival but may remain constant and relatively severe.[18] Similarly, our study showed a significant decline in sexual functioning scale score (both in sexual interests and sexual activity) over the follow-up period which was in accordance with the results of other investigators.[12],[14],[16],[20],[21],[22],[23],[24],[25],[26],[27]

The breast related sexual enjoyment (BRSEE) scale among the breast cancer patients showed a significant variation over the follow-up period, however, the decline in BRSEE among the breast cancer was initially more, later on slightly improved at 1-year and 2 years follow-up. The patients showed adaptation to this scale over time; the reason may be the strong bond of marital/spousal relationship which may be one of the positive stimuli for the improvement in BRSEE scale score. The improvement in sexual enjoyment was seen in other studies.[12],[14],[15],[16],[21],[22],[27],[28]

The functional scale in terms of future perspective decreased initially up to 1-year and then improved over the long-term follow-up of 2 years' time which was in accordance with other investigators.[14] The patients also felt better after the completion of treatment and its related side effects which made these patients feel better psychologically. The patients return back to normal routine work which also helps them to cope with the future worry. Besides the practicing of religion become more common in these patients who have been seen to influence their psychosocial well-being.

Chemotherapy-induced alopecia (CIA)/hair loss occurs with an estimated incidence of 65%. About 47% of female patients consider hair loss to be the most traumatic aspect of chemotherapy and 8% would decline chemotherapy due to fears of hair loss.[29] Hair is an important aspect of a person's self-image. Unfortunately, during many cancer treatments, hair is adversely affected.[30],[31] Hair loss can be an immense burden psychologically and physically.[30],[31],[32] Currently, there are modalities to help alleviate the physical and emotional issues that are involved with alopecia. The incidence of alopecia is extremely high and is currently ranked third among the most common side effects of chemotherapy, directly behind nausea and vomiting. Hair loss generally begins approximately 2 to 4 weeks after treatment; hair usually begins to return 3 to 6 months later.[32] The incidence and severity of CIA are variable and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with different clinical patterns of hair loss.[33] The upset by hair loss among the breast cancer survivors decreased over the follow-up visits. The improvement in upset by hair loss was significant after 6 months to 2 years due to regrowth after completion of chemotherapy. This was in accordance with the findings of other investigators.[15],[32]

The systemic therapy side effect score decreased over the study period in accordance with the findings of other investigators.[15],[21] The reason for the improvement was the completion of chemotherapy and related side effects which gives patients the sense of well-being.

The breast symptoms scale showed a significant improvement over the follow-up period and was in accordance with the other investigators.[15],[21],[34]

The symptom scale in terms of arm symptoms among the patients showed a significant improvement over the follow-up. Similar improvement was seen by Kulesza-Bronczyk et al.[15] The reason for the improvement in the arm symptoms was the encouragement of patients to go for physiotherapy and rehabilitation protocols (exercise, arm elevation, and use of stockings or stretchable bandages).

The overall improvement in the symptom scale is seen gradually after 1-year due to completion of chemotherapy as seen by Kulesza-Bronczyk et al.,[15] King et al.[35] The other reason for the symptom improvement of these patients, is that, they get more closer to their religious beliefs. There must be some unique religious effects that were beyond the recognized social-psychological factors and could not be accounted by secular mediators. These unique religious effects might be thought as something peculiar to religion only, such as ultimate concern, eternal life after death, spiritual character and significance, spiritual support, religious coping, and the like. They were regarded as unique psychological-spiritual contents. It is possible to accept that religious involvement may exert its positive effects through both the psychosocial and unique psychological-spiritual processes.[36]


 > Conclusion Top


The female breast cancer patients failed to improve body image, sexual functioning, and sexual enjoyment scales but succeeded well in other BR23 scales. The family and spousal/marital support also positively affects the QOL. Besides these patients got closer to a religion which has been seen to influence their psychosocial well-being positively and need further research to establish the influence of religious practices on QOL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Wani SQ, Khan T, Teeli AM, Khan NA, Wani SY, Hassan A. Quality of life assessment in survivors of breast cancer. J Cancer Res Ther 2012;8:272-6.  Back to cited text no. 1
    
2.
Wani SQ, Khan T, Wani SY, Koka AH, Arshad S, Rafiq L, et al. Clinicoepidemiological analysis of female breast cancer patients in Kashmir. J Cancer Res Ther 2012;8:389-93.  Back to cited text no. 2
[PUBMED]    
3.
Zervoudis S, Iatrakis G, Tomara E, Bothou A, Papadopoulos G, Tsakiris G. Main controversies in breast cancer. World J Clin Oncol 2014;5:359-73.  Back to cited text no. 3
[PUBMED]    
4.
Hortobagyi GN, de la Garza Salazar J, Pritchard K, Amadori D, Haidinger R, Hudis CA, et al. The global breast cancer burden: Variations in epidemiology and survival. Clin Breast Cancer 2005;6:391-401.  Back to cited text no. 4
[PUBMED]    
5.
Trends of Breast Cancer in India. Available from: http://www.breastcancerindia.net/bc/statistics/stat_global.htm. [Last accessed on 2015 Apr 20].  Back to cited text no. 5
    
6.
Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, et al. Guideline implementation for breast healthcare in low-income and middle-income countries: Overview of the Breast Health Global Initiative Global Summit 2007. Cancer 2008;113 8 Suppl: 2221-43.  Back to cited text no. 6
    
7.
Donovan K, Sanson-Fisher RW, Redman S. Measuring quality of life in cancer patients. J Clin Oncol 1989;7:959-68.  Back to cited text no. 7
[PUBMED]    
8.
Den Oudsten BL, Van der Steeg AF, Roukema JA, Vries JD. Changes in body image in women with early stage breast cancer. In: Mohan R, editor. Topics in Cancer Survivorship. InTech; 2012. Available from: http://www.intechopen.com/books/topics-in-cancersurvivorship/changes-in-body-image-in-women-with-early-stage-breast-cancer. [Last accessed on 2015 Apr 20].  Back to cited text no. 8
    
9.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365-76.  Back to cited text no. 9
[PUBMED]    
10.
Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curan D, Bottomley A. On Behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels: European Organisation for Research and Treatment of Cancer; 2001.  Back to cited text no. 10
    
11.
Avis NE, Crawford S, Manuel J. Quality of life among younger women with breast cancer. J Clin Oncol 2005;23:3322-30.  Back to cited text no. 11
    
12.
Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S. Quality of life in patients with breast cancer before and after diagnosis: An eighteen months follow-up study. BMC Cancer 2008;8:330.  Back to cited text no. 12
    
13.
Ofman US, Kingsberg SA, Nelson CJ. Sexual problems. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. Devita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2008.  Back to cited text no. 13
    
14.
Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D. Quality of life following breast-conserving therapy or mastectomy: Results of a 5-year prospective study. Breast J 2004;10:223-31.  Back to cited text no. 14
    
15.
Kulesza-Bronczyk B, Dobrzycka B, Piekut K, Terlikowski R, Mackowiak-Matejczyk B, Wojno A, et al. Quality life during first year after breast cancer resection. Prog Health Sci 2014;4:124-9.  Back to cited text no. 15
    
16.
Brandberg Y, Sandelin K, Erikson S, Jurell G, Liljegren A, Lindblom A, et al. Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: A prospective 1-year follow-up study. J Clin Oncol 2008;26:3943-9.  Back to cited text no. 16
    
17.
Boehmer U, Timm A, Ozonoff A, Potter J. Explanatory factors of sexual function in sexual minority women breast cancer survivors. Ann Oncol 2012;23:2873-8.  Back to cited text no. 17
    
18.
Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology 2012;21:594-601.  Back to cited text no. 18
    
19.
McKee AL Jr, Schover LR. Sexuality rehabilitation. Cancer 2001;92 4 Suppl: 1008-12.  Back to cited text no. 19
    
20.
Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: Understanding women's health-related quality of life and sexual functioning. J Clin Oncol 1998;16:501-14.  Back to cited text no. 20
    
21.
Holzner B, Kemmler G, Kopp M, Moschen R, Schweigkofler H, Dünser M, et al. Quality of life in breast cancer patients – Not enough attention for long-term survivors? Psychosomatics 2001;42:117-23.  Back to cited text no. 21
    
22.
Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR. Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. J Natl Cancer Inst 2002;94:39-49.  Back to cited text no. 22
    
23.
Thors CL, Broeckel JA, Jacobsen PB. Sexual functioning in breast cancer survivors. Cancer Control 2001;8:442-8.  Back to cited text no. 23
    
24.
Dorval M, Maunsell E, Deschênes L, Brisson J, Mâsse B. Long-term quality of life after breast cancer: Comparison of 8-year survivors with population controls. J Clin Oncol 1998;16:487-94.  Back to cited text no. 24
    
25.
Bantema-Joppe EJ, de Bock GH, Woltman-van Iersel M, Busz DM, Ranchor AV, Langendijk JA, et al. The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy. Br J Cancer 2015;112:636-43.  Back to cited text no. 25
    
26.
Dizon DS, Suzin D, McIlvenna S. Sexual health as a survivorship issue for female cancer survivors. Oncologist 2014;19:202-10.  Back to cited text no. 26
    
27.
Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health 2014;29:632-50.  Back to cited text no. 27
    
28.
Schover LR. The impact of breast cancer on sexuality, body image, and intimate relationships. CA Cancer J Clin 1991;41:112-20.  Back to cited text no. 28
    
29.
Trüeb RM. Chemotherapy-induced hair loss. Skin Therapy Lett 2010;15:5-7.  Back to cited text no. 29
    
30.
Karakunnel JJ, Berger AM. Hair loss. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. Devita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2008.  Back to cited text no. 30
    
31.
Roe H. Chemotherapy-induced alopecia: Advice and support for hair loss. Br J Nurs 2011;20:S4-11.  Back to cited text no. 31
    
32.
Wang J, Lu Z, Au JL. Protection against chemotherapy-induced alopecia. Pharm Res 2006;23:2505-14.  Back to cited text no. 32
    
33.
Trüeb RM. Chemotherapy-induced alopecia. Semin Cutan Med Surg 2009;28:11-4.  Back to cited text no. 33
    
34.
Dabakuyo TS, Fraisse J, Causeret S, Gouy S, Padeano MM, Loustalot C, et al. A multicenter cohort study to compare quality of life in breast cancer patients according to sentinel lymph node biopsy or axillary lymph node dissection. Ann Oncol 2009;20:1352-61.  Back to cited text no. 34
    
35.
King MT, Kenny P, Shiell A, Hall J, Boyages J. Quality of life three months and one year after first treatment for early stage breast cancer: Influence of treatment and patient characteristics. Qual Life Res 2000;9:789-800.  Back to cited text no. 35
    
36.
Jones JW. Religion, health and the psychology of religion: How the research on religion and health helps us understand religion. J Relig Health 2004;43:317-27.  Back to cited text no. 36
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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