Abstract
Background
Physical functional impairments are common among cancer survivors and have a substantial impact on quality of life (QoL). However, evidence remains limited regarding which specific impairments are independently associated with QoL, particularly in non-Western populations.
Objective
To determine the prevalence of physical functional impairments and to identify impairments independently associated with QoL among Chinese cancer survivors, in order to inform nursing-sensitive assessment and rehabilitation care.
Methods
A nationwide online cross-sectional survey was conducted in China between 17 and 24 November 2025, with 365 adult cancer survivors included in the final analysis. Physical functional impairments and QoL were assessed using validated patient-reported instruments. Participants were stratified according to the impairment severity. Between-group comparisons were performed using univariate analyses. Associations between impairments and QoL were explored using Spearman correlation, and hierarchical regression analyses were used to identify impairments independently associated with QoL.
Results
Over 72.13% of participants reported at least one physical functional impairment, and 22.47% met criteria for clinically significant physical dysfunction. The most prevalent impairments were weakness (48.22%), less able to perform daily activities (43.84%), persistent fatigue (38.90%), and pain/aching (33.97%). There were 230 (63.01%) participants who anticipated difficulties attending therapy sessions in hospital. The most commonly perceived barriers to therapy attendance included lack of accompaniment, financial burden, poor physical condition for travel, and transportation difficulties. In regression analyses, advanced disease stage was consistently associated with poorer QoL, whereas completed treatment was associated with better QoL in Model 1. After adjustment for physical functional impairment variables in Model 2, and in Model 3 adjusted only for disease stage and recurrence status, pain/aching, weakness, difficulty in opening the mouth, swallowing or chewing, and easily breathless were consistently independently associated with poorer QoL (all p < 0.05).
Conclusions
Physical functional impairments are highly prevalent among Chinese cancer survivors and are strongly associated with reduced QoL. Identifying specific impairments independently associated with QoL offers clinically relevant insights for nursing-sensitive assessment and prioritisation of functional needs, with implications for QoL outcomes in cancer survivorship.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12912-026-04848-w.
Keywords: Nursing assessment, Physical functional impairments, Quality of life, Cancer survivorship, Patient-reported outcomes, Cross-sectional study
Introduction
With rapid advances in cancer detection and treatment, survival rates have improved steadily, transforming cancer from a predominantly acute, life-threatening condition into a chronic disease requiring long-term management [1, 2]. A “cancer survivor” refers to an individual from the time of cancer diagnosis through the remainder of life, including those undergoing active treatment as well as those who have completed treatment [3]. Consequently, the objectives of oncology care have expanded beyond merely prolonging survival to encompass the preservation and restoration of post-treatment functional capacity and overall well-being [4]. Nevertheless, a substantial proportion of individuals living with and beyond a cancer diagnosis, including those undergoing active treatment, experience persistent physical impairments during or after treatment, including pain, fatigue, weakness, dyspnea, lymphedema, and mobility limitations [5]. These symptoms can severely restrict daily activities and independence, while also exacerbating psychological distress and compromising health-related quality of life (HRQoL) [6]. A comprehensive understanding of the prevalence, distribution, and correlates of these functional impairments is therefore critical for improving survivorship care and QoL outcomes among cancer survivors [7].
Physical functional impairments are highly prevalent among cancer survivors and often persist long after the completion of treatment. In Western populations, up to 36.7% of survivors report ongoing physical limitations [8], whereas in South Korea, 87% of patients experience at least one physical problem during or after treatment [9]. Despite this substantial burden, engagement in supportive and rehabilitative services remains low, reflecting a gap between patients’ functional needs and available care [10]. Commonly reported barriers include limited service availability, transportation challenges, and financial constraint [11]. Understanding these barriers is important for contextualizing disparities in functional outcomes and QoL, particularly from a nursing perspective, where early identification of functional needs and care barriers is essential across rehabilitation settings.
However, most existing studies have focused on high-income countries [10] or specific cancer types, such as breast cancer [12] and colorectal cancer [13]. This limits the generalizability of findings to more heterogeneous cancer populations and to health systems with different resource constraints. Although cancer-type-specific studies provide important insights into disease-specific functional outcomes, they often fail to capture the shared and cross-cutting burden of physical functional impairments across different malignancies, particularly in real-world survivorship settings where multimorbidity, mixed treatment histories, and overlapping symptom profiles are common [14, 15]. From a clinical nursing and rehabilitation perspective, cross-cancer population studies are particularly valuable for identifying shared functional impairment patterns that can inform universal screening strategies and early rehabilitation triage systems [4]. Additionally, in low-and middle-income countries (LMICs), where approximately 70% of global cancer deaths occur, survivorship care is often underdeveloped, rehabilitation services are unevenly distributed, and systematic screening for functional impairments is not routinely implemented. In China, which has one of the largest and fastest-growing cancer burdens worldwide [16, 17], these challenges are further amplified by regional disparities in healthcare resources, limited rehabilitation workforce capacity, and a lack of standardized assessment pathways for functional impairment detection [18]. Moreover, evidence regarding the prevalence of physical functional impairments across multiple cancer types and their associations with HRQoL in Chinese populations remains scarce.
Therefore, this study aimed to investigate the prevalence and anatomical distribution of physical functional impairments among Chinese cancer survivors experiencing physical dysfunction, to compare survivors with and without clinically important physical dysfunction, and to examine the associations between physical functional impairments and HRQoL.
Methods
Study design, setting, and participants
A national cross-sectional online survey was conducted in China from November 17 to November 24, 2025, guided by the Professional Committee of Integrative Nursing for Cancer Rehabilitation, Chinese Anti-Cancer Association. Data were collected using Questionnaire Star (Wenjuanxing), a widely used online survey platform integrated into WeChat, which is a ubiquitous social media application in China. Participants were recruited through snowball sampling by disseminating the survey link via WeChat networks to reach cancer survivors nationwide.
Eligible participants were required to meet the following inclusion criteria: (1) Chinese nationals (2) aged ≥ 18 years; (3) diagnosed with any type of cancer by a certified oncologist; (4) aware of their diagnosis and disease status; (5) able to read Chinese and complete the online questionnaire independently; and (6) willing to provide informed consent. Individuals were excluded if they: (1) had severe systemic comorbidities such as psychiatric, or physical conditions that could interfere with survey completion, or (2) had a history of severe cognitive impairment or mental illness.
Measures
Demographic and clinical characteristics
A self-designed form was used to collect demographic and clinical data, including age, gender, height, weight, educational level, employment status, marital status, residence, average personal monthly income, primary cancer type, time since diagnosis, disease stage, recurrence status, and treatment status.
Cancer rehabilitation
Cancer Rehabilitation was assessed using an adapted version of the Cancer Rehabilitation Questionnaire (CRQ) originally developed and validated by Yen et al. [11]. In the current study, this instrument was culturally adapted to improve relevance and applicability for Chinese cancer survivors following expert review for content validity. Prior to the formal survey, the adapted CRQ was pilot tested in a small sample of cancer survivors (n = 20), who were not included in the final analysis. The pilot testing aimed to assess clarity, comprehensibility, and feasibility of the questionnaire in the target population. Based on participant feedback, minor revisions were made to item wording and response clarity to enhance readability and cultural appropriateness. Content validity was further evaluated by an expert panel consisting of ten oncology nursing and rehabilitation specialists, ensuring conceptual relevance and appropriateness for the Chinese cancer survivorship context.
The adapted instrument comprised three domains: (1) physical functional impairments (change in posture, persistent fatigue, pain/aching, stiffness, weakness, swelling, numbness/tingling sensation) and their locations; (2) functional difficulties (difficulty in opening mouth, swallowing or chewing, less able to perform everyday activities, unsteady walking, having falls/near falls in the last year, easily breathless); and (3) treatment-seeking behaviors and attendance barriers (current treatment-seeking behaviors, awareness of treatment resources, ability/willingness to attend therapy sessions, and perceived barriers to therapy attendance). Each item was dichotomously scored as “Yes” (1 point) or “No” (0 points). A total score of ≥ 4 indicates clinically important physical dysfunction [11]. The English-language version of the adapted questionnaire used in this study is provided in Supplementary File 1.
In this study, the adapted CRQ demonstrated modest internal consistency, with a Cronbach’s α of 0.6. Given that the instrument comprises multiple heterogeneous domains, including physical symptoms, functional difficulties, and rehabilitation-related barriers, a moderate alpha coefficient was considered acceptable for this exploratory cross-cultural adaptation study. Previous methodological literature has noted that Cronbach’s α values may be influenced by scale dimensionality, item heterogeneity, and dichotomous response formats, and that coefficients around 0.60 can be acceptable in early-stage exploratory research and newly adapted instruments [19–21].
Health-related quality of life
HRQoL and functional outcomes were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30, version 3.0) [22]. The EORTC QLQ-C30 is one of the most widely validated and internationally applied instruments for evaluating HRQoL among cancer populations [23]. It comprises 30 items encompassing five multi-item functional scales (physical, role, emotional, cognitive, and social functioning), nine symptom-specific scales (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties), and two global items assessing overall health and QoL. All items are rated on a four-point Likert scale, except for the global health status/QoL items, which use a seven-point response format [22]. In accordance with the EORTC QLQ-C30 Scoring Manual [24], all raw scores were linearly transformed to a standardized 0-100 scale. Higher scores on the functional and global health status/QoL (uniformly described as QoL for clarity) scales indicate better functioning and overall well-being, whereas higher scores on the symptom scales reflect greater symptom burden [25].
Data analysis
All statistical analyses were performed using IBM SPSS Statistics version 24.0 (IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05 (two-tailed). Categorical variables were summarized as frequencies (n) and percentages (%). The normality of continuous variables was assessed using the Kolmogorov–Smirnov test, which indicated a non-normal distribution. Accordingly, continuous variables were expressed as median (interquartile range, IQR).
Participants reporting at least one CRQ-related physical functional impairment symptom were included in the analyses and categorized into two groups according to the CRQ score: “important physical dysfunction (IPD)” (CRQ ≥ 4) and “non-important physical dysfunction (NIPD)” (CRQ < 4) [11]. Between-group comparisons were conducted using the Chi-square test for categorical variables, and the Mann-Whitney U test for continuous variables. Spearman correlation analysis was used to assess the associations between CRQ total scores, functional scales, and QoL scores derived from the EORTC QLQ-C30. To improve the robustness and clinical interpretability of the regression analyses, hierarchical regression models were constructed. Model 1 included demographic and clinical covariates selected based on univariate analyses, prior literature, and clinical relevance [23, 26], including disease stage, recurrence status, age, gender, treatment status, and time since diagnosis. Model 2 additionally incorporated CRQ-related physical functional impairment variables. Model 3 included only physical functional impairment variables and covariates with p < 0.1 in the univariate analyses. The variance inflation factor (VIF) was used to assess multicollinearity, with VIF values > 10 indicating significant collinearity.
Ethical consideration
This study was conducted after obtaining approval from the Research Ethics Review Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, China (Approval No. TJ-IRB202511054). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the principles of the Declaration of Helsinki. All participants were provided electronic written informed consent and informed that they could withdraw from the study at any time without any consequences.
Results
Basic information of participants
A total of 506 participants completed the survey. Among them, 141 participants did not report any physical functional impairments on the CRQ and were therefore excluded from analyses related to physical dysfunction and QoL. Consequently, 365 (72.1%) who reported at least one physical functional impaired symptom were included in the final analysis. Of these, 82 participants (22.5%, 95% CI: 18.2% − 26.8%) met the criterion for IPD (CRQ ≥ 4).
Of 365 participants, the median age was 57.00 years (IQR: 51.00–66.00), and the median QoL score was 58.33 (IQR: 41.67–75.00). Regarding educational background, 36.71% had completed junior high school, 29.59% had primary school or below, 21.37% had senior high school education, and 12.33% held a bachelor’s degree or above. Detailed information was presented in Table 1.
Table 1.
Demographic and clinical characteristics of cancer survivors between IPD and NIPD (N = 365)
| Demographic Characteristics | Median (IQR) or n (%) | Physical dysfunction | χ2/Z | p | |
|---|---|---|---|---|---|
| IPD (CRQ ≥ 4) n = 82 |
NIPD (CRQ<4) n = 283 |
||||
| Gender | 0.003 | 0.957 | |||
| Male | 186(50.96%) | 42(51.22%) | 144(50.88%) | ||
| Female | 179(49.04%) | 40(48.78%) | 139(49.12%) | ||
| Education background | 1.871 | 0.600 | |||
| Primary school or below | 108(29.59%) | 29(35.37%) | 79(27.92%) | ||
| Junior high school | 134(36.71%) | 29(35.37%) | 105(37.10%) | ||
| Senior high school | 78(21.37%) | 15(18.29%) | 63(22.26%) | ||
| Bachelor’s degree or above | 45(12.33%) | 9(10.98%) | 36(12.72%) | ||
| Occupation Status | 0.217 | 0.641 | |||
| Employment | 78(21.37%) | 16(19.51%) | 62(21.91%) | ||
| Unemployment | 287(78.63%) | 66(80.49%) | 221(78.09%) | ||
| Have a steady partner | 0.505 | 0.477 | |||
| No | 41(11.23%) | 11(13.41%) | 30(10.60%) | ||
| Yes | 324(88.77%) | 71(86.59%) | 253(89.40%) | ||
| Residence | 0.480 | 0.488 | |||
| Urban | 233(63.84%) | 55(67.07%) | 178(62.90%) | ||
| Rural | 132(36.16%) | 27(32.93%) | 105(37.10%) | ||
| Average personal monthly income | 0.0001 | 0.992 | |||
| ≤ 3999 Yuan | 258(70.68%) | 58(70.73%) | 200(70.67%) | ||
| ≥ 4000Yuan | 107(29.32%) | 24(29.27%) | 83(29.33%) | ||
| Stage of disease | 4.868 | 0.088* | |||
| early | 78(21.37%) | 13(15.85%) | 65(22.97%) | ||
| intermediate | 112(30.68%) | 21(25.61%) | 91(32.16%) | ||
| advanced | 175(47.95%) | 48(58.54%) | 127(44.88%) | ||
| Recurrence status | 13.250 | <0.001** | |||
| No | 274(75.07%) | 49(59.76%) | 225(79.51%) | ||
| Yes | 91(24.93%) | 33(40.24%) | 58(20.49%) | ||
| Completed treatment | 1.971 | 0.160 | |||
| No | 317(86.85%) | 75(91.46%) | 242(85.51%) | ||
| Yes | 48(13.15%) | 7(8.54%) | 41(14.49%) | ||
| Age | 57.00(51.00, 66.00) | 57.00(50.00, 68.00) | 57.00(51.00, 63.00) | -1.023 | 0.306 |
| Time since diagnosis (months) | 8.0 (4.0, 24.0) | 8.0 (4.0, 24.0) | 8.5 (4.0, 24.0) | -0.085 | 0.932 |
| Global health status/QoL | 58.33(41.67, 75.00) | 50.00(33.33, 68.75) | 58.33(50.00, 75.00) | -2.792 | 0.005 |
Notes: **p<0.05, *p<0.1
As presented in Table 2, the most prevalent symptoms were weakness (48.22%), less able to perform everyday activities (43.84%), persistent fatigue (38.90%), and pain/aching (33.97%). Regarding treatment-seeking and attendance barriers, the majority (94.79%) expressed willingness to seek medical care and 230 (63.01%) participants who anticipated difficulties attending therapy sessions in hospital. The most commonly perceived barriers to therapy attendance included lack of accompaniment (58.70%), financial burden (56.09%), poor physical condition for travel (49.13%), and transportation difficulties (41.74%).
Table 2.
Prevalence of physical symptoms, willingness, and barriers to seeking medical care (N = 365)
| Domain | n | Percentage |
|---|---|---|
| Physical functional impairments | ||
| Change in posture | 62 | 16.99% |
| Persistent fatigue | 142 | 38.90% |
| Pain/aching | 124 | 33.97% |
| Stiffness | 7 | 1.92% |
| Weakness | 176 | 48.22% |
| Swelling | 46 | 12.60% |
| Numbness/tingling sensation | 73 | 20.00% |
| Functional difficulties | ||
| Difficulty in opening mouth, swallowing or chewing | 46 | 12.60% |
| Having falls/near falls in the last year | 16 | 4.38% |
| Unsteady walking | 52 | 14.25% |
| Less able to perform everyday activities | 160 | 43.84% |
| Easily breathless | 49 | 13.42% |
| Treatment-seeking behaviors and attendance barriers | ||
| Current treatment-seeking behaviors | 346 | 94.79% |
| Awareness of treatment resources | 297 | 81.37% |
| Ability/willingness to attend therapy sessions | ||
| Once a week | 62 | 16.99% |
| Once every two weeks | 93 | 25.48% |
| Once a month | 189 | 51.78% |
| Not at all | 21 | 5.75% |
| Foresee difficulties attending therapy sessions in hospital | 230 | 63.01% |
| Transportation problems | 96 | 41.74% |
| Need someone to accompany me to hospital | 135 | 58.70% |
| Too busy | 39 | 16.96% |
| Too tired / do not feel well enough to travel | 113 | 49.13% |
| Too expensive | 129 | 56.09% |
| Other difficulties | 9 | 3.91% |
Notes: Percentages may exceed 100% because multiple difficulties could be anticipated
Univariate analysis of physical dysfunction (IPD vs. NIPD)
Univariate analyses demonstrated that recurrence status (p < 0.001) differed significantly between the two groups, whereas no significant differences were observed for other demographic variables. Patients with IPD exhibited significantly lower QoL scores compared with those in NIPD (p = 0.005). See details in Table 1.
Distribution of physical dysfunction by anatomical site and cancer type
As displayed in Table 3, the lower limbs were the most frequently affected region across all symptoms, particularly for weakness (80.68%) and swelling (63.04%). Pain/aching was reported across multiple body regions, most often involving the lower limbs (18.55%), upper limbs (15.32%), and other body parts (59.68%). In contrast, numbness/tingling sensation were mainly concentrated in the upper (57.53%) and lower limbs (52.05%), indicating predominant peripheral nerve involvement. Additionally, pain/aching in the “Other parts” category was most commonly reported in the upper abdomen (31.08%), chest (21.62%), lower abdomen (14.86%), and lower back/waist (9.46%), while weakness was primarily located in the lower back/waist (64.70%) and chest (35.30%). Swelling mainly involved the chest (57.10%) and perineal region (42.90%), stiffness was concentrated in the lower back/waist (100%), and numbness/tingling sensation was most frequently reported in the chest (42.86%), oral cavity (28.57%), and upper abdomen (28.57%). Detailed distributions of the “Other parts” category are provided in Supplementary File 2.
Table 3.
Anatomical distribution of reported physical functional impairments (N = 365)
| Symptom/Location | Head(n/%) | Neck(n/%) | Upper limbs (n/%) |
Lower limbs (n/%) |
Other parts # (n/%) |
|---|---|---|---|---|---|
| Pain/aching (n = 124) | 16 / 12.90% | 9 / 7.26% | 19 / 15.32% | 23 / 18.55% | 74 / 59.68% |
| Stiffness (n = 7) | 0 / 0.0% | 0 / 0.0% | 2 / 28.57% | 4 / 57.14% | 2 / 28.57% |
| Weakness (n = 176) | 10 / 5.68% | 4 / 2.27% | 47 / 26.70% | 142 / 80.68% | 17 / 9.66% |
| Swelling (n = 46) | 3 / 6.52% | 2 / 4.35% | 13 / 28.26% | 29 / 63.04% | 7 / 15.22% |
| Numbness/tingling sensation (n = 73) | 0 / 0.0% | 2 / 2.74% | 42 / 57.53% | 38 / 52.05% | 7 / 9.59% |
Notes: # Detailed anatomical locations classified as “Other parts” are presented in Supplementary File 2 to improve clarity and readability. Percentages may exceed 100% because multiple anatomical locations could be reported for each symptom
Table 4 presents the distribution of physical dysfunction by cancer type. Among patients with IPD, lung cancer accounted for the largest proportion (24.39%), followed by colorectal cancer (13.41%).
Table 4.
Distribution of physical function impaired symptoms by cancer type (N = 365)
| Cancer Type | Total | IPD (CRQ ≥ 4) n = 82 |
NIPD (CRQ<4) n = 283 |
||
|---|---|---|---|---|---|
| n | Percentage | n | Percentage | ||
| Lung cancer | 77 | 20 | 24.39% | 57 | 20.14% |
| Breast cancer | 42 | 7 | 8.54% | 35 | 12.37% |
| Colorectal cancer | 57 | 11 | 13.41% | 46 | 16.25% |
| Stomach cancer | 29 | 6 | 7.32% | 23 | 8.13% |
| Esophageal cancer | 23 | 8 | 9.76% | 15 | 5.30% |
| Pancreatic cancer | 18 | 8 | 9.76% | 10 | 3.53% |
| Head and neck tumors (Thyroid, Laryngeal cancer) | 7 | 0 | 0.00% | 7 | 2.47% |
| Hepatobiliary tumors | 17 | 6 | 7.32% | 11 | 3.89% |
| Ovarian cancer | 12 | 4 | 4.88% | 8 | 2.83% |
| Cervical cancer | 19 | 3 | 3.66% | 16 | 5.65% |
| Endometrial cancer | 7 | 0 | 0.00% | 7 | 2.47% |
| Urinary system tumors | 23 | 4 | 4.88% | 19 | 6.71% |
| Nervous system tumors | 3 | 0 | 0.00% | 3 | 1.06% |
| Hematological system tumors | 13 | 3 | 3.66% | 10 | 3.53% |
| Skeletal system tumors | 11 | 2 | 2.44% | 9 | 3.18% |
| Others | 7 | 0 | 0.00% | 7 | 2.47% |
Associations between cancer rehabilitation and health-related quality of life
Spearman correlation analyses revealed that higher CRQ scores were significantly associated with poorer QoL and all functional domains (all p < 0.01), with correlation coefficients generally indicating weak-to-moderate associations [27]. Among these, the strongest association was observed for the overall functional score (rₛ = −0.455, p < 0.01) followed by physical functioning (rₛ = −0.411, p < 0.01), role functioning (rₛ = −0.349, p < 0.01), social functioning (rₛ = −0.347, p < 0.01), cognitive functioning (rₛ = −0.325, p < 0.01), and emotional functioning (rₛ = −0.324, p < 0.01), whereas the weakest correlation was with Global health status/QoL (rₛ = −0.269, p < 0.01).
Regression analysis of factors independently associated with global health status/QoL
As shown in Table 5, Model 1 included demographic and clinical variables. Advanced disease stage was independently associated with poorer QoL (B = − 9.66, p < 0.001), whereas completion of treatment was associated with higher QoL (B = 7.51, p = 0.03). No significant associations were observed for age, gender, recurrence status, or time since diagnosis.
Table 5.
Hierarchical regression analyses of factors associated with global health status/QoL
| Models | B | p | 95% CI | VIF |
|---|---|---|---|---|
| Model 1 | ||||
| Age | -0.15 | 0.12 | (-0.33, 0.04) | 1.05 |
| Gender | 3.20 | 0.16 | (-1.28, 7.67) | 1.07 |
| Stage of disease | -9.66 | <0.001*** | (-12.59, -6.73) | 1.14 |
| Recurrence status | 4.77 | 0.10 | (-0.86, 10.40) | 1.27 |
| Completed treatment | 7.51 | 0.03** | (0.74, 14.29) | 1.12 |
| Time since diagnosis (months) | 0.95 | 0.08 | (-0.11, 2.02) | 1.27 |
| Model 2 | ||||
| Change in posture | 3.87 | 0.19 | (-1.88, 9.63) | 1.10 |
| Persistent fatigue | -3.80 | 0.10 | (-8.30, 0.71) | 1.14 |
| Pain/aching | -8.93 | <0.001*** | (-13.47, -4.38) | 1.10 |
| Stiffness | 6.07 | 0.44 | (-9.44, 21.58) | 1.07 |
| Weakness | -6.03 | 0.01** | (-10.44, -1.63) | 1.14 |
| Swelling | -3.20 | 0.33 | (-9.66, 3.27) | 1.09 |
| Numbness/tingling sensation | 2.40 | 0.37 | (-2.87, 7.66) | 1.05 |
| Difficulty in opening mouth, swallowing or chewing | -6.80 | 0.04** | (-13.33, -0.28) | 1.11 |
| Having falls/near falls in the last year | 14.87 | 0.01** | (4.29, 25.45) | 1.11 |
| Unsteady walking | -1.56 | 0.63 | (-8.01, 4.88) | 1.20 |
| Less able to perform everyday activities | -3.45 | 0.12 | (-7.85, 0.95) | 1.13 |
| Easily breathless | -10.94 | <0.001*** | (-17.11, -4.77) | 1.04 |
| Age | -0.11 | 0.22 | (-0.29, 0.07) | 1.11 |
| Gender | 3.13 | 0.16 | (-1.20, 7.46) | 1.11 |
| Time since diagnosis (months) | 0.78 | 0.14 | (-0.25, 1.80) | 1.31 |
| Stage of disease | -8.36 | <0.001*** | (-11.22, -5.49) | 1.20 |
| Recurrence status | 3.05 | 0.29 | (-2.55, 8.65) | 1.39 |
| Completed treatment | 5.13 | 0.12 | (-1.42, 11.69) | 1.16 |
| Model 3 | ||||
| Change in posture | 4.07 | 0.16 | (-1.67, 9.82) | 1.08 |
| Persistent fatigue | -4.11 | 0.07 | (-8.62, 0.41) | 1.12 |
| Pain/aching | -9.51 | <0.001*** | (-14.06, -4.95) | 1.08 |
| Stiffness | 7.14 | 0.37 | (-8.43, 22.72) | 1.06 |
| Weakness | -6.08 | 0.01** | (-10.51, -1.66) | 1.14 |
| Swelling | -1.85 | 0.57 | (-8.29, 4.60) | 1.06 |
| Numbness/tingling sensation | 2.17 | 0.42 | (-3.14, 7.47) | 1.04 |
| Difficulty in opening mouth, swallowing or chewing | -7.16 | 0.03** | (-13.74, -0.57) | 1.11 |
| Having falls/near falls in the last year | 14.79 | 0.01** | (4.14, 25.45) | 1.10 |
| Unsteady walking | -2.38 | 0.47 | (-8.79, 4.04) | 1.16 |
| Less able to perform everyday activities | -3.65 | 0.11 | (-8.08, 0.78) | 1.12 |
| Easily breathless | -12.03 | <0.001*** | (-18.20, -5.86) | 1.03 |
| Stage of disease | -9.08 | <0.001*** | (-11.88, -6.29) | 1.13 |
| Recurrence status | 1.22 | 0.65 | (-3.99, 6.42) | 1.17 |
Notes: **p<0.05. *** p<0.001. Model 1 included age, gender, disease stage, recurrence status, treatment status, and time since diagnosis; Model 2 additionally incorporated CRQ-related physical functional impairment variables; and Model 3 represented the original model adjusted only for covariates with p < 0.1 in the univariate analyses (recurrence status and disease stage)
In Model 2, after additionally adjusting for CRQ-related physical functional impairment variables, pain/aching (B = − 8.93, p < 0.001), weakness (B = − 6.03, p = 0.01), difficulty in opening the mouth, swallowing or chewing (B = − 6.80, p = 0.04), having falls/near falls in the past year (B = 14.87, p = 0.01), and easily breathless (B = − 10.94, p < 0.001) remained independently associated with QoL. Stage of disease also remained significantly associated with poorer QoL (B = − 8.36, p < 0.001). Model 3, which adjusted only for disease stage and recurrence status, yielded broadly consistent findings, supporting the robustness of the findings.
Discussion
This nationwide study is among the first to investigate physical dysfunction and its associations with QoL among Chinese cancer survivors with physical functional impairments. Weakness, persistent fatigue, and pain/aching were the most commonly reported dysfunctions, and greater dysfunction was significantly but modestly associated with poorer QoL. These findings provide novel evidence on symptom-specific factors associated with reduced QoL and highlight the need for targeted rehabilitation strategies in cancer care.
High prevalence of physical function impairments
Our study revealed a high prevalence of physical functional impairments, with 72.1% of participants reporting at least one impairment, which is broadly consistent with previous reports, including 87.3% in Singapore [11], 87% in Korea [9]. Weakness, less able to perform daily activities, persistent fatigue, and pain/aching were the most common impairments, aligning with global evidence from large-scale symptom-surveillance studies that documented high prevalence of functional limitations, clinically significant fatigue, and moderate-to-severe pain across diverse tumor types and treatment settings [28, 29].
Several factors may underlie the high burden of physical dysfunction observed in this study. Persistent fatigue and weakness are frequently exacerbated in cancer survivors undergoing chemotherapy or multimodal treatment [30]. Pain/aching remains a pervasive symptom despite advances in supportive care, with recent meta-analyses estimating that approximately 45% of cancer survivors continue to experience pain across all disease stages [31]. These major physical dysfunctions are closely associated with limitations in daily activities, reported by 43.84% of participants [32]. Moreover, by including patients across diverse disease stages and treatment phases, this study captures both early-treatment effects and long-term survivorship issues, which may together contribute to the high overall prevalence of functional impairment.
Distribution and rehabilitation implications of physical functional impairments across anatomical sites and cancer types
The lower limbs were the most frequently affected region across nearly all evaluated symptoms, with over 80% of patients reporting weakness, over 60% swelling, and 57.14% stiffness. These impairments may stem from decreased muscular strength and lymphedema from cancer treatments [33]. In contrast, pain exhibited a more diffuse distribution, reported in “other body parts” by 60.16% of patients, and in the lower (18.70%) and upper limbs (15.45%). This pattern is consistent with the multifactorial etiology of cancer pain, including bone metastases, nerve compression, musculoskeletal strain, or treatment-related toxicities such as mucositis [34]. Similarly, numbness and tingling were primarily localized to the upper (56.94%) and lower limbs (52.78%), reflecting chemotherapy-induced peripheral neuropathy or postsurgical complications [35].
Notably, several symptoms were also concentrated in anatomically specific “other parts”, including pain in the upper abdomen and chest, weakness in the lower back/waist, swelling in the chest and perineal region, and numbness/tingling in the oral cavity. These patterns may reflect treatment- or tumor-specific complications, such as thoracic surgery, abdominal tumor burden, lymphatic disruption, or treatment-related neurotoxicity, highlighting the heterogeneous and site-specific nature of physical dysfunction among cancer survivors [36].
Regarding dysfunction across cancer types, we observed that lung and colorectal cancer were the most represented cancer types among patients with clinically IPD. This finding is consistent with clinical expectations: lung cancer survivors frequently experience severe shortness of breath and profound weakness [37], whereas colorectal cancer survivors, particularly those undergoing major pelvic surgery or radiation, are at high risk of lower limb lymphedema, neuropathy, and core muscle weakness [38]. Such condition-specific impairments likely explain the elevated dysfunction in these populations.
These findings highlight the importance of targeted rehabilitation. The high prevalence of lower limb weakness and swelling necessitates routine screening and early interventions like strength training, gait and balance exercises, and lymphedema management. Moreover, the substantial functional challenges in lung and colorectal cancer survivors suggest that they should be prioritized for proactive, integrated rehabilitation programs, with plans tailored to the specific functional risks associated with different cancer types and treatments.
In addition, more than half of the participants anticipated difficulties attending hospital-based therapy for physical functional impairments, highlighting the importance of identifying potential barriers and facilitating participation in rehabilitation care among cancer survivors.
Associations between physical functional impairments and QoL
Our results showed that higher levels of physical functional impairments were significantly associated with lower QoL. This finding is consistent with previous studies suggesting that physical functioning is an important component of QoL in cancer survivors [3]. Notably, these associations extended across multiple functional domains, indicating the broad influence of physical limitations on daily functioning and well-being [38]. These observations suggest that physical functional impairments should be considered an important target in survivorship care, influencing overall well-being rather than being viewed solely as isolated symptoms [38].
Physical dysfunction factors independently associated with QoL
Regression analyses consistently identified pain/aching, weakness, difficulty in opening mouth, swallowing or chewing, and being easily breathless as independently associated with poorer QoL. These symptoms may represent critical targets for rehabilitation interventions. Pain/aching is well established to disrupt daily functioning and emotional well-being in cancer survivors, with a strong documented impact on QoL [32, 39]. Similarly, weakness, and persistent fatigue are often interrelated, limiting patients’ independence and physical activity [40]. Easily breathless emerged as an independently associated factor, reflecting its high burden and direct link to reduced QoL and poorer prognosis [41]. Difficulty in opening mouth, swallowing or chewing, although less emphasized in prior studies, was a significant estimator in this research, which may reflect tumor location, treatment-related side effects, or unmet rehabilitation needs [42]. These findings extend the traditional focus on pain/aching and persistent fatigue by highlighting breathlessness and oral functional difficulties as clinically important drivers of QoL, stressing the need for comprehensive, symptom-specific rehabilitation strategies in cancer care. An unexpected positive association was observed between a history of falls/near-falls and QoL, which should be interpreted with caution. The positive direction of this association was contrary to clinical expectations. This finding may be influenced by the low prevalence of this event (4.38%), leading to unstable estimates and potential random error. It may also reflect that more physically active individuals have greater exposure to fall risk compared with less mobile patients [43]. Further validation in larger prospective studies is needed.
Importantly, these associations remained significant after adjustment for demographic and clinical characteristics, including age, disease stage, recurrence status, treatment status, and time since diagnosis. This suggests that specific physical functional impairments may independently contribute to poorer QoL beyond disease severity alone. From a rehabilitation nursing perspective, these findings may help identify high-risk subgroups requiring targeted supportive care, particularly survivors with advanced-stage disease and those experiencing pain, weakness, breathlessness, or oral functional difficulties. Future prospective studies are warranted to examine whether early rehabilitation interventions targeting these impairments can improve long-term QoL outcomes.
Limitations
Several limitations should be acknowledged. First, the cross-sectional design precludes causal inference between physical functional impairments and HRQoL. Second, all data were self-reported and may therefore be subject to recall and reporting bias. Third, convenience sampling and online survey administration, together with the exclusion of participants without CRQ-related physical functional impairments from the final analyses, may have limited the representativeness and generalizability of the findings. Fourth, some cancer-specific clinical variables, such as detailed treatment regimens and comorbidities, were not comprehensively assessed and may have resulted in residual confounding. Finally, the low prevalence of certain symptoms, such as falls/near falls, may have contributed to unstable regression estimates and should be interpreted cautiously.
Conclusion
This nationwide study demonstrates that physical functional impairments are highly prevalent among Chinese cancer survivors. Pain or aching, weakness, difficulty opening the mouth, swallowing or chewing, and being easily breathless were independently associated with poorer QoL. These findings highlight specific functional impairments that are strongly linked to reduced QoL and may represent clinically relevant and potentially modifiable targets for nursing-sensitive assessment and supportive care to improve QoL in cancer survivorship.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors would like to express their sincere gratitude to all the cancer survivors who participated in this survey. We are also thankful to the members of the Integrative Nursing Care Professional Committee of the Chinese Anti-Cancer Association for their support in participant recruitment and questionnaires distribution.
Abbreviations
- CRQ
Cancer Rehabilitation Questionnaire
- EORTC QLQ-C30
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30
- HRQoL
Health-related quality of life
- IPD
Important physical dysfunction
- LMICs
Low- and middle-income countries
- NIPD
Non-important physical dysfunction
- QoL
Quality of life
Author contributions
Ji Lu and Qin Huang wrote the main manuscript text. Yi-mei Du, Fei Liu and Xiao-meng Dou collected and analyzed the data and designed tables. All authors reviewed the manuscript. All authors read and approved the final manuscript.
Funding
This research was supported by the Nursing Special Program (General Project) (2023) of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Grant No. 2023D21); the Nursing Special Program (General Project) (2024) of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Grant No. 2024D43); and the PI Project of the Nursing Discipline Development Fund (2024) of Peking University First Hospital, Beijing, China (Grant No. 2024PI003).
Data availability
Due to privacy and ethical restrictions, the datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethical approval and consent to participate
This study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, China (Approval No. TJ-IRB202511054). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Ji Lu and Qin Huang contributed equally to this work.
References
- 1.Schwartz SM. Epidemiology of Cancer. Clin Chem. 2024;70(1):140–9. 10.1093/clinchem/hvad202. [DOI] [PubMed] [Google Scholar]
- 2.Wagle NS, Nogueira L, Devasia TP, Mariotto AB, Yabroff KR, Islami F, Siegel RL. Cancer treatment and survivorship statistics, 2025. Cancer J Clin. 2025;75(4):308–40. 10.3322/caac.70011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Muhandiramge J, Orchard SG, Warner ET, van Londen GJ, Zalcberg JR. Functional Decline in the Cancer Patient: A Review. Cancers. 2022;14(6):1368. 10.3390/cancers14061368. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Mayer RS, Engle J. Rehabilitation of Individuals With Cancer. Annals Rehabilitation Med. 2022;46(2):60–70. 10.5535/arm.22036. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Csontos JK, Roche D, Watts T. Exploring what influences the uptake of cancer rehabilitation services: a realist informed mixed-methods study. BMJ open. 2024;14(11):e87812. 10.1136/bmjopen-2024-087812. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Wu H, Harden JK. Symptom Burden and Quality of Life in Survivorship. Cancer Nurs. 2015;38(1):E29–54. 10.1097/NCC.0000000000000135. [DOI] [PubMed] [Google Scholar]
- 7.Khan F, Amatya B, Elmalik A, Song K, Diaz D, Dickinson M. Embedding rehabilitation into cancer care continuum: an implementation study. J Rehabil Med. 2024;56:jrm40855. 10.2340/jrm.v56.40855. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Neo J, Fettes L, Gao W, Higginson IJ, Maddocks M. Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis. Cancer Treat Rev. 2017;61:94–106. 10.1016/j.ctrv.2017.10.006. [DOI] [PubMed] [Google Scholar]
- 9.Yoon JA, Hong BY. Cancer Rehabilitation Fact Sheet in Korea. Annals Rehabilitation Med. 2022;46(4):155–62. 10.5535/arm.22102. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Gupta E, Lopez G, Narayanan S, Tennison JM, Elahi I, De Moraes R, Bruera A, E. Frequency and Characteristics of Integrative Oncology Referrals for Patients With Cancer Receiving Inpatient Rehabilitation. Integr Cancer Ther. 2024;23:1573611946. 10.1177/15347354241296810. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Yen JM, Tang N, Tong SI, Chew E. Identifying Clinically Important Functional Impairments and Rehabilitation Needs in Cancer Survivors and a Pilot Validation of the Cancer Rehabilitation Questionnaire. J Rehabil Med. 2022;54:jrm354. 10.2340/jrm.v54.1379. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Chen D, Li L, Jiang L, Jia J. The prevalence and risk factors for physical impairments in Chinese post-cancer treated breast cancer survivors: a 4 years’ cross-sectional study at a single center. Sci Rep. 2023;13(1):18458. 10.1038/s41598-023-45731-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin. 2013;63(5):295–317. 10.3322/caac.21186. [DOI] [PubMed] [Google Scholar]
- 14.Mast IH, Bongers CCWG, Gootjes EC, de Wilt JHW, Hopman MTE, Buffart LM. Potential mechanisms underlying the effect of walking exercise on cancer-related fatigue in cancer survivors. J Cancer Surviv. 2025;19(4):1132–42. 10.1007/s11764-024-01537-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Lavín-Pérez AM, Collado-Mateo D, Mayo X, Liguori G, Humphreys L, Jiménez A. Can Exercise Reduce the Autonomic Dysfunction of Patients With Cancer and Its Survivors? A Systematic Review and Meta-Analysis. Front Psychol. 2021;12:712823. 10.3389/fpsyg.2021.712823. Epub 2021/09/11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Han B, Zheng R, Zeng H, Wang S, Sun K, Chen R, He J. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent. 2024;4(1):47–53. 10.1016/j.jncc.2024.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.He S, Xia C, Li H, Cao M, Yang F, Yan X, Chen W. Cancer profiles in China and comparisons with the USA: a comprehensive analysis in the incidence, mortality, survival, staging, and attribution to risk factors. Sci China Life Sci. 2024;67(1):122–31. 10.1007/s11427-023-2423-1. [DOI] [PubMed] [Google Scholar]
- 18.Branch CSOR. Expert Consensus on Function-Centered Exercise Rehabilitation for Cancer Patients in China. Chin J Rehabilitation Med. 2023;1(38):1–7. 10.3969/j.issn.1001-1242.2023.01.001. [Google Scholar]
- 19.Streiner DL. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003;80(1):99–103. 10.1207/s15327752jpa8001_18. Epub 2003/02/14. [DOI] [PubMed] [Google Scholar]
- 20.Taber KS. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res Sci Educ. 2018;48(6):1273–96. 10.1007/s11165-016-9602-2. [Google Scholar]
- 21.Nunnally JC, Bernstein IH. Psychometric Theory. 3rd ed. New York: McGraw-Hill; 1994. [Google Scholar]
- 22.Rogge AA, Liegl G, Snyder C, Rose M, Nolte S, On BOTE,… EORTC, Q. O. L. G. EORTC QLQ-C30 general population normative data for the United States. Eur J cancer (1990). 2024;202:114030. 10.1016/j.ejca.2024.114030. [DOI] [PubMed] [Google Scholar]
- 23.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Et A. 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(5):365–76. 10.1093/jnci/85.5.365. [DOI] [PubMed] [Google Scholar]
- 24.Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 scoring manual (3rd Edition). Brussels: European Organisation for Research and Treatment of Cancer. 2001.
- 25.Young T, Velikova G, Liegl G, Rose M, Nolte S, on behalf of the EORTC Quality of Life Group. EORTC QLQ-C30 normative data for the United Kingdom: Results of a cross-sectional survey of the general population. European Journal of Cancer (1990). 2024;204:113927. 10.1016/j.ejca.2024.113927. [DOI] [PubMed]
- 26.Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41(17):2613–9. 10.1016/j.ejca.2005.05.017. Epub 2005/10/18. [DOI] [PubMed] [Google Scholar]
- 27.Cohen J. Statistical power analysis for the behavioral sciences (2nd ed.). Routledge. 1988. 10.4324/9780203771587.
- 28.Boselli D, Meadors PL, Walsh D. Functional impairments, fatigue, and pain in newly diagnosed solid-tumors: Retrospective path analysis. J Clin Oncol. 2024;42(16suppl):12066. 10.1200/JCO.2024.42.16_suppl.12066. [Google Scholar]
- 29.Ruddy KJ, Grzegorczyk V, Kroenke K, Griffin JM, Ridgeway J, Chlan LL, … Cheville AL. SPPADE symptom prevalence and severity in a diverse sample of patients living with metastatic cancers. J Clin Oncol. 2024;42(16_suppl):11108. 10.1200/JCO.2024.42.16_suppl.11108.
- 30.Koornstra RHT, Peters M, Donofrio S, van den Borne B, de Jong FA. Management of fatigue in patients with cancer – A practical overview. Cancer Treat Rev. 2014;40(6):791–9. 10.1016/j.ctrv.2014.01.004. [DOI] [PubMed] [Google Scholar]
- 31.Snijders R, Brom L, Theunissen M, van den Beuken-van Everdingen M. Update on Prevalence of pain in patients with cancer 2022: a systematic literature review and meta-analysis. Cancers. 2023;15(3):591. 10.3390/cancers15030591. [DOI] [PMC free article] [PubMed]
- 32.Joshy G, Khalatbari-Soltani S, Soga K, Butow P, Laidsaar-Powell R, Koczwara B, … Banks E. Pain and its interference with daily living in relation to cancer: a comparative population-based study of 16,053 cancer survivors and 106,345 people without cancer. BMC Cancer. 2023;23(1):774. 10.1186/s12885-023-11214-5. [DOI] [PMC free article] [PubMed]
- 33.Decorte T, Cerckel M, Kheir GB, Monten C, Vandecasteele K, Vanden Bossche L, et al. Risk factors for lower limb lymphedema after gynecological cancer treatment: a systematic review. Front Oncol. 2025;15:1561836. 10.3389/fonc.2025.1561836. Epub 2025/06/04. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Bolton L. Managing Oral Mucositis in Patients With Cancer. Wounds. 2021;33(5):136–8. Epub 2021/08/10. [PubMed] [Google Scholar]
- 35.Klafke N, Bossert J, Kröger B, Neuberger P, Heyder U, Layer M, Stolz R. Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy(CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process. Med Sci. 2023;11(1):15. 10.3390/medsci11010015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Qiu JM, Fu MR, Finlayson CS, Tilley CP, Payo RM, Korth S, et al. Lymphatic pain in breast cancer survivors: An overview of the current evidence and recommendations. Women Child Nurs. 2024;2(2):33–8. 10.1016/j.wcn.2024.04.001. Epub 2024/10/18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Luo Y, Zhang L, Mao D, Yang Z, Zhu B, Miao J, Zhang L. Symptom clusters and impact on quality of life in lung cancer patients undergoing chemotherapy. Qual Life Res. 2024;33(12):3363–75. 10.1007/s11136-024-03778-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Hardcastle SJ, Leyton-Román M, Maxwell-Smith C, Hince D. Impact of the Promoting Physical Activity in Regional and Remote Cancer Survivors intervention on health-related quality of life in breast and colorectal cancer survivors. Front Oncol. 2024;14:1368119. 10.3389/fonc.2024.1368119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Poço Gonçalves J, Veiga D, Araújo A. Chronic pain, functionality and quality of life in cancer survivors. Br J Pain. 2021;15(4):401–10. 10.1177/2049463720972730. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Mast IH, Bongers CCWG, Gootjes EC, de Wilt JHW, Hopman MTE, … Buffart LM. Potential mechanisms underlying the effect of walking exercise on cancer-related fatigue in cancer survivors. J Cancer Surviv. 2025;19(4):1132–1142. 10.1007/s11764-024-01537-y. [DOI] [PMC free article] [PubMed]
- 41.Hui D, Maddocks M, Johnson MJ, Ekström M, Simon ST, Ogliari AC, … Ripamonti CI. Management of breathlessness in patients with cancer: ESMO clinical practice guidelines. ESMO Open. 2020;5(6):e1038. 10.1136/esmoopen-2020-001038. [DOI] [PMC free article] [PubMed]
- 42.Bulbul MG, Wu M, Lin D, Emerick K, Deschler D, Richmon J, et al. Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study. Laryngoscope. 2021;131(11):2497–504. 10.1002/lary.29573. Epub 2021/04/22. [DOI] [PubMed] [Google Scholar]
- 43.Tinetti ME, Kumar C. The patient who falls: It’s always a trade-off. JAMA. 2010;303(3):258–66. 10.1001/jama.2009.2024. Epub 2010/01/21. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Citations
- Snijders R, Brom L, Theunissen M, van den Beuken-van Everdingen M. Update on Prevalence of pain in patients with cancer 2022: a systematic literature review and meta-analysis. Cancers. 2023;15(3):591. 10.3390/cancers15030591. [DOI] [PMC free article] [PubMed]
Supplementary Materials
Data Availability Statement
Due to privacy and ethical restrictions, the datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.