Table 2.

Characteristics of included studies

Author/Year/Reference	Country and setting	Study design and Population	Main focus	QOL Assessment	Outcome	Comparison	Main finding and effects
El Sharkawi et al. [17]	Egypt Surgery and clinical and nulear Medicine departments, Alexandria Men University Hospital	Cross sectional study 272 women with early Breast cancer who are under treatment	Determine the effects of the treatment on the QOL of Egyptian women with early Breast Cancer	Linear analogue self-assessment (LASA) scales	the four domains of QOL of women having adjuvant therapy were significantly altered compared to those who underwent mastectomy alone triple modality adversely affected global QL the most compared to radiotherapy or chemotherapy radiotherapy had significantly less effect on QL compared to chemotherapy triple modality predicted the worst QOL	Patients were divided into four groups: 1. mastectomy alone, 2. surgery plus radiotherapy, 3. surgery plus chemotherapy 4. triple modality	Quality of life measures should be incorporated in the evaluation of treatment Patients should receive health education on the effects of each therapy
Awad et al. [18]	United Arab Emirates The Breast Cancer Clinic at Tawam Hospital, Al Ain	Cross sectional study 87 women with breast cancer and who are of Arabic origin 3 months after surgical treatment	Assess the psychometric properties of the Arabic version of the EORTC QLQ-C30 and QLQ-BR23 in Arab breast cancer patients	The Arabic version of EORTC QLQ-C30 and QLQ-BR23	Participants had a mean score for global QOL of 74.6 The QLQ-C30 discriminated between mastectomy and lumpectomy patients on the emotional and cognitive function scales and QLQ-BR23 discriminated as well on the function scales and for systemic side effects.	Group I :mastectomy patients Group II:lumpectomy patients	Patients’ perceptions extend beyond the negative physical and functional impact of cancer to the individuals’ perceptions of their general well-being.
Alawadi and Ohaeri [19]	Kuwait The medical oncology department of the Kuwait Cancer Control Center	Cross-sectional a comparative study using the EORTC Quality of Life Questionnaire 348 women with breast cancer receiving chemotherapy	Highlight the HRQOL scale scores for Kuwaiti women in stable clinical condition with breast cancer, in comparison with the international data. Assess the socio-demographic and clinical variables that predict the five functional scales and global QOL (GQOL) scale of the QLQ – C30	The Arabic version of EORTC QLQ-C30 and QLQ-BR23	The mean score of global QOL scale (GQOL) was 45.3 The patients had poor to average functioning and intense symptom experience. Younger women had poorer HRQOL scores The significant associations of disease stage with role functioning, diarrhea and future perspective In regression analysis, social functioning accounted for the highest proportion of variance for GQOL.	-	The biological and treatment side effect factors seemed to be more important than family and institutional supports A longitudinal study is needed to confirm this trend.
Masmoudi et al. [20]	Tunisia Department of Medical Oncology in Sfax University Hospital	Descriptive study 23 women with early breast cancer receiving adjuvant chemotherapy	Assess the feasibility of QOL assessment in a cohort of Tunisian cancer patients	The Arabic version of EORTC QLQ-C30	Participants had a mean score for global QOL of 72.5 pre chemo And 68.5 during chemo. A significant deterioration in physical, cognitive, and social functioning, between the pre-treatment and on-treatment assessments	Group I:pre-treatment Group II:on-treatment	improvement of cancer care infrastructure and public education is still needed before reliable QOL studies can be performed
Mostafa et al. [21]	Egypt El- Minia oncology center	Interventional hospital based study, 180 female breast cancer patients recei-ving treatment	Assess QOL, its relation to different variables related to cancer Trial to improve the QOL of patients and their families through communication, counseling, restorative (rehabilitative) therapy, social and medical support.	The Arabic version of EORTC QLQ-C30 and QLQ-BR23	38.3 % of studied females had poor global health status/QOL 52.8 % had good global health status/QOL There is a significant change in physical, role, emotional, cognitive and social functioning in pre- and post-intervention assessment.	180 female breast cancer patients in pre-intervention 75 patients (with global health status/QOL score value of ≤ 50) in post intervention phase	Need to provide comprehensive care for breast cancer survivors
Al-Naggar et al. [22]	Yemen The outpatient of National Oncology Centre (NOC), Sana’a	Cross-sectional study 106 female breast cancer patients underwent treatment.	Determine the QOL among breast cancer patients in Yemen based on socio-demographic and clinical characteristics	Functional Assessment of Cancer Treatment-Breast (FACT-B) questionnaire	Years after diagnosis, family monthly income and radiotherapy were significantly associated with total QOL of the breast cancer patients	-	Age, occupation, family history of breast cancer, size of tumor, chemotherapy and tamoxifen were not significantly influence QOL
Huijer and Abboud [23]	Lebanon American University of Beirut-Medical Center (AUB-MC)	Cross-sectional descriptive survey 200 Lebanese adult patients with cancer including 89 women with breast cancer who are diagnosed for more than one month	Evaluate the QOL, symptom prevalence and management, functional ability, and quality of care provided to Lebanese women with BC	The Arabic version EORTC-QLQ-C30	Mean score for global QOL: 59.64 High scores were reported on functional ability, medical care, spirituality, and relationships. Factors significantly associated with QOL: Payments per month for medical expenses, presence of metastasis, time since diagnosis, symptoms, and type of treatment received .	-	The impact of clinical characteristics on QOL is far more significant than demographic characteristics
Denewer et al. [24]	Egypt the Oncology Center–Mansoura University	Prospective study 200 Egyptian women within 2 months–2 years from their primary surgery	Evaluate QOL, body image, and patient satisfaction comparing between traditional mastectomy alone and sparing mastectomy with immediate autologous breast reconstruction	Breast impact of treatment scale (BITS) Body satisfaction scale (BSS)	Patient with breast reconstruction had a high mean score of BSS: 14.44 out of total degrees of 20 No difference was found between the two groups as regard the BITS score	Group I :patients underwent sparing mastectomy with immediate autologous breast reconstruction Group II:100 Patients underwent traditional mastectomy	Egyptian women with breast cancer show better QOL and body image satisfaction outcomes following immediate breast reconstruction.
Ba-Khubaira and Al-Kahiry [25]	Yemen Central Public Health Laboratories – Aden branch	Cross-sectional study 58 Yemeni patients with early stage breast cancer. During follow-up for the last 2 years after they finished treatment.	Determine the QOL of Yemeni patients in Aden after treatment of early stage breast cancer below 50 years compared to 50 years and more of age.	FACT-B Questionnaire	The overall QOL reported in this study among breast cancer Yemeni patients in Aden was 77.6 and the breast cancer-specific subscale (BCS) was 21.2. Yemeni patients with early breast cancer are having lower QOL after treatment; this QOL was deteriorated among younger patients when compared to older patients.	Group I: early stage breast cancer below 50 years Group II: 50 years and more of age.	-Evaluation of the post-treatment QOL of cancer patients should be a part of the evaluation criteria of cancer therapy in Aden.
Jassim and Whitford [26]	Bahrain The main governmental Hospital, Salmaniya Medical Complex	Descriptive cross sectional study 239 Bahraini breast cancer survivors	Describe the QOL of Bahraini women with breast cancer and its association with their sociodemographic and clinical data.	The Arabic version of EORTC-QLQ-C30	Participants had a mean score for global QOL of 63.9 Average to good QOL functioning and low to average symptoms experience Factors associated to lower QOL: marital status, menopausal status, metastases, monthly income and type of surgery.	-	Bahraini BC survivors reported favorable overall global quality of life. Special care should be given to women with cancer related symptoms and metastatic lesions
Jassim and Whitford [16]	Bahrain Oncology Center in Salmaniya Medical Complex	Qualitative study 12 Bahraini women diagnosed with breast cancer. Who were deemed to have coped to differing degrees both during and following their initial diagnosis.	Explore the Experiences, beliefs, perceptions and attitudes of Bahraini women with breast cancer towards their quality of life.		Global QOL was expressed in terms of being able to perform every day chores and the ability to function in one’s daily role as a woman, wife, daughter and employee Hair loss was a major side effect of treatment the important role played by the family and husband in treatment decisions the use of traditional clothing (hijab and abaya) to hide hair and body changes the importance of spirituality and religion to cope with the disease	-	The finding aid healthcare professionals in planning appropriate interventions that meet the patients’ needs
El Fakir et al. [27]	Morocco National institute of oncology in Rabat and oncology center of Ibn Rochd hospital in Casablanca	Cross-cultural adaptation of the EORTC QLQ-BR23 105 women with breast cancer	Assess the reliability and validity of this translation for use in Morocco.	Moroccan Arabic version of the EORTC QLQ-BR23	Scores for different scales ranged from 34.0 to 77.8. Body image had the higher score (83.33) Systemic therapy side effects” scale had the lower score (median 57.14)	-	QLQ-BR23 questionnaire could be used in clinical trials that evaluate the impact of specific interventions on the QOL of Moroccan patients with breast cancer
Abu-Helalah et al. [28]	Jordan the Radiation Oncology Department at Al-Bashir	Cross-sectional study 236 Jordanian breast cancer survivors	Obtain such data Quality of Life and Psychological Well-Being of Breast Cancer Survivors in Jordan Assess predictors with calculated scores	EORTC QLQ-C30, the Breast Module QLQ-BR23 the Hospital Anxiety and Depression Scale (HADS).	The mean Global Health score for the QLQ-C30 was 63.7 Social functioning” scored the highest (mean = 78.1) The worest scores were for Emotional functioning, body image and future perspective (respectively 59.0, 52,9, 52,1) Severe depression and severe anxiety were detected among 8 % and 14 % of study participants, respectively Factors associated: the presence of recurrence since baseline, family history of cancer, low educational status, current social problems, extent of the disease and employment status	-	There is an urgent need for psychosocial support programs and psychological screening and consultation for breast cancer patients at hospitals of the Ministry of Health in Jordan