{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T09:15:58Z","timestamp":1783329358047,"version":"3.54.6"},"reference-count":62,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Cancer survivors admitted to inpatient rehabilitation suffer from a complex burden of interrelated physical and psychological symptoms. While mean-level improvements during rehabilitation are well-documented, it remains unknown whether rehabilitation modifies the underlying structure of symptom interconnections\u2014the symptom network\u2014beyond reducing individual symptom scores. This study aimed to characterize symptom network structure at admission and discharge of a 21-day inpatient cancer rehabilitation program based on cancer-related physical symptoms and psychosocial functioning, formally compare network topology across timepoints, identify structurally central treatment targets, and assess the transdiagnostic generalizability of findings. Methods: Secondary analysis of routinely collected, electronic patient-reported outcome (PRO) data from 5066 cancer survivors (mean age 60.3 years, SD 12.2; 64.2% female; most frequent diagnoses: breast cancer = 36.9%, hematological malignancies = 10.4%; prostate cancer = 8.5%) admitted to a single-center inpatient rehabilitation program was performed between January 2017 and November 2022. The EORTC QLQ-C30 and the Hospital Anxiety and Depression Scale (HADS) questionnaires were utilized. Bayesian Gaussian Graphical Models were estimated at admission (T0) and discharge (T1) across 17 symptom and functioning domains using Bayesian Model Averaging (15,000 iterations). Edge-level change was quantified via posterior distributions of pairwise differences with 95% Highest Density Intervals. Node-level changes were assessed using Bayesian paired t-tests. Centrality was quantified by Expected Influence and Bridge Expected Influence. Results: Patients showed clinically meaningful improvements across all 17 domains during rehabilitation (all Bayes Factors &gt;10; posterior probability of direction &gt;99.9%). The largest standardized effects were observed for emotional functioning (Cohen\u2019s d = 0.76), global health status (d = 0.69), and fatigue (d = 0.53). These improvements were clinically meaningful for a substantial proportion of patients: 62% improved by at least the minimal important difference in fatigue and 58% in emotional functioning, and the proportion of patients with probable anxiety fell from 15% to 6% and probable depression from 10% to 4%. Emotional functioning and anxiety were the most central domains in the symptom network\u2014most strongly connected to the rest of patients\u2019 symptom burden\u2014at both admission and discharge. Despite the clinical improvements, the overall architecture of symptom interconnections changed little (83% of connections were unchanged). This indicates that the severity of symptoms was mitigated while the structure linking them together remained largely intact. The one connection that strengthened was that between impaired social functioning and financial difficulties (\u0394 = \u22120.112). Structural findings were consistent across ten cancer types (leave-one-out r &gt; 0.80 in seven of ten). Conclusions: Over the course of inpatient cancer rehabilitation, patients showed large improvements against a background of largely stable symptom network architecture. Emotional functioning and anxiety occupy structurally central positions at both admission and discharge, identifying them as candidate domains warranting further investigation for network-informed rehabilitation. These findings provide a novel structural perspective on oncological rehabilitation and a framework for developing more targeted intervention strategies.<\/jats:p>","DOI":"10.3390\/cancers18132155","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"2155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Symptom Networks During Inpatient Cancer Rehabilitation: A Retrospective Bayesian Gaussian Graphical Model Analysis of Real-World Patient-Reported Outcomes"],"prefix":"10.3390","volume":"18","author":[{"given":"Christina","family":"Kirchhoff","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1846-0331","authenticated-orcid":false,"given":"Thomas","family":"Licht","sequence":"additional","affiliation":[{"name":"Ludwig Boltzman Institute for Rehabilitation Research, Ludwig Boltzmann Society, 1140 Vienna, Austria"},{"name":"Oncological Rehabilitation Center Sankt Veit im Pongau, 5621 St.Veit im Pongau, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4589-9186","authenticated-orcid":false,"given":"Samuel","family":"Eke","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1513-1358","authenticated-orcid":false,"given":"\u0160pela","family":"Matko","sequence":"additional","affiliation":[{"name":"Ludwig Boltzman Institute for Rehabilitation Research, Ludwig Boltzmann Society, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4421-2449","authenticated-orcid":false,"given":"Vincent","family":"Grote","sequence":"additional","affiliation":[{"name":"Ludwig Boltzman Institute for Rehabilitation Research, Ludwig Boltzmann Society, 1140 Vienna, Austria"},{"name":"Department of Orthopedics and Traumatology, Medical University Graz, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6345-0813","authenticated-orcid":false,"given":"Michael J.","family":"Fischer","sequence":"additional","affiliation":[{"name":"Ludwig Boltzman Institute for Rehabilitation Research, Ludwig Boltzmann Society, 1140 Vienna, Austria"},{"name":"VITREA Rehabilitation Center Kitzb\u00fchel, 6370 Kitzb\u00fchel, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5453-8792","authenticated-orcid":false,"given":"Katharina","family":"H\u00fcfner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Riedl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria"},{"name":"Ludwig Boltzman Institute for Rehabilitation Research, Ludwig Boltzmann Society, 1140 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","first-page":"409","article-title":"Cancer treatment and survivorship statistics, 2022","volume":"72","author":"Miller","year":"2022","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/S1470-2045(19)30456-5","article-title":"Progress in cancer survival, mortality, and incidence in seven high-income countries 1995\u20132014 (ICBP SURVMARK-2): A population-based study","volume":"20","author":"Arnold","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S1470-2045(11)70002-X","article-title":"Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies","volume":"12","author":"Mitchell","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1200\/JCO.2001.19.3.895","article-title":"Insomnia in the context of cancer: A review of a neglected problem","volume":"19","author":"Savard","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1002\/cncr.28058","article-title":"Cancer-related fatigue and its impact on functioning","volume":"119","author":"Minton","year":"2013","journal-title":"Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s11764-023-01451-9","article-title":"The association of cancer-related fatigue on the social, vocational and healthcare-related dimensions of cancer survivorship","volume":"19","author":"Jones","year":"2025","journal-title":"J. Cancer Surviv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","article-title":"The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology","volume":"85","author":"Aaronson","year":"1993","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sartori, R.D.G., Dalu, D., De Francesco, D., Biscaldi, V., Cona, M.S., Gambaro, A., Ferrario, S., Ruggieri, L., Filipazzi, V., and Fasola, C. (2026). The impact of bio-psycho-social factors on mental health outcomes in patients with solid tumors. Tumori.","DOI":"10.1177\/03008916261442818"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1080\/0284186X.2016.1266089","article-title":"Quality of life in long-term and very long-term cancer survivors versus population controls in Germany","volume":"56","author":"Arndt","year":"2017","journal-title":"Acta Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jpainsymman.2013.10.027","article-title":"Symptom clusters in patients with advanced cancer: A systematic review of observational studies","volume":"48","author":"Dong","year":"2014","journal-title":"J. Pain Symptom Manag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/jncimonographs\/lgm003","article-title":"Conceptual issues in symptom clusters research and their implications for quality-of-life assessment in patients with cancer","volume":"2007","author":"Miaskowski","year":"2007","journal-title":"J. Natl. Cancer Inst. Monogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.jpainsymman.2018.12.006","article-title":"Comparison of Fatigue, Pain, and Depression in Patients With Advanced Kidney Disease and Cancer-Symptom Burden and Clusters","volume":"57","author":"Jhamb","year":"2019","journal-title":"J. Pain Symptom Manag."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/s43586-021-00055-w","article-title":"Network analysis of multivariate data in psychological science","volume":"1","author":"Borsboom","year":"2021","journal-title":"Nat. Rev. Methods Prim."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/wps.20375","article-title":"A network theory of mental disorders","volume":"16","author":"Borsboom","year":"2017","journal-title":"World Psychiatry"},{"key":"ref_15","first-page":"930","article-title":"Modeling psychopathology: From data models to formal theories","volume":"27","author":"Haslbeck","year":"2022","journal-title":"Psychol. Methods"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1037\/abn0000181","article-title":"Identifying highly influential nodes in the complicated grief network","volume":"125","author":"Robinaugh","year":"2016","journal-title":"J. Abnorm. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1080\/00273171.2019.1614898","article-title":"Bridge Centrality: A Network Approach to Understanding Comorbidity","volume":"56","author":"Jones","year":"2021","journal-title":"Multivar. Behav. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s10354-015-0414-1","article-title":"Cancer rehabilitation in Austria-aspects of Physical Medicine and Rehabilitation","volume":"166","author":"Maehr","year":"2016","journal-title":"Wien. Med. Wochenschr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2340\/16501977-1902","article-title":"What is covered by \u201ccancer rehabilitation\u201d in PubMed? A review of randomized controlled trials 1990-2011","volume":"47","author":"Gudbergsson","year":"2015","journal-title":"J. Rehabil. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Lehmann, J., Riedl, D., Nickels, A., Sanio, G., Hassler, M., Rumpold, G., Holzner, B., and Licht, T. (2023). Associations of Age and Sex with the Efficacy of Inpatient Cancer Rehabilitation: Results from a Longitudinal Observational Study Using Electronic Patient-Reported Outcomes. Cancers, 15.","DOI":"10.3390\/cancers15061637"},{"key":"ref_21","first-page":"5853","article-title":"Evaluation by electronic patient-reported outcomes of cancer survivors\u2019 needs and the efficacy of inpatient cancer rehabilitation in different tumor entities","volume":"29","author":"Licht","year":"2021","journal-title":"Support Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/s10354-018-0619-1","article-title":"Long-term improvement of the bio-psycho-social state of cancer patients after 3 weeks of inpatient oncological rehabilitation: A long-term study at the Humanomed Zentrum Althofen","volume":"168","author":"Klocker","year":"2018","journal-title":"Wiener. Med. Wochenschr."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pergolotti, M., Wood, K.C., Kendig, T.D., and Mayo, S. (2024). Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States. Cancers, 16.","DOI":"10.3390\/cancers16101927"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e66087","DOI":"10.2196\/66087","article-title":"Investigating the Complexity of Multidimensional Symptom Experiences in Patients With Cancer: Systematic Review of the Network Analysis Approach","volume":"11","author":"Richard","year":"2025","journal-title":"JMIR Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e49476","DOI":"10.2196\/49476","article-title":"Usability of Electronic Patient-Reported Outcome Measures for Older Patients With Cancer: Secondary Analysis of Data from an Observational Single Center Study","volume":"25","author":"Riedl","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Holzner, B., Giesinger, J.M., Pinggera, J., Zugal, S., Schopf, F., Oberguggenberger, A.S., Gamper, E.M., Zabernigg, A., Weber, B., and Rumpold, G. (2012). The Computer-based Health Evaluation Software (CHES): A software for electronic patient-reported outcome monitoring. BMC Med. Inform. Decis. Mak., 12.","DOI":"10.1186\/1472-6947-12-126"},{"key":"ref_27","unstructured":"Herrmann, C., Buss, U., and Snaith, R.P. (1995). HADS-D. Hospital Anxiety and Depression Scale\u2014German Version, Huber."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Menard, S. (2002). Applied Logistic Regression Analysis, SAGE Publications.","DOI":"10.4135\/9781412983433"},{"key":"ref_29","unstructured":"Huth, K. (easybgm: Extracting and Visualizing Bayesian Graphical Models [R package], 2025). easybgm: Extracting and Visualizing Bayesian Graphical Models [R package], version 0.3.1."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102441","DOI":"10.1016\/j.jmp.2020.102441","article-title":"Bayesian hypothesis testing for Gaussian graphical models: Conditional independence and order constraints","volume":"99","author":"Williams","year":"2020","journal-title":"J. Math. Psychol."},{"key":"ref_31","first-page":"200","article-title":"A conceptual introduction to Bayesian model averaging","volume":"3","author":"Hinne","year":"2020","journal-title":"Adv. Methods Pract. Psychol. Sci."},{"key":"ref_32","first-page":"667","article-title":"Rank-Normalization, Folding, and Localization: An Improved R\u02c6 for Assessing Convergence of MCMC (with Discussion)","volume":"16","author":"Aki","year":"2021","journal-title":"Bayesian Anal."},{"key":"ref_33","unstructured":"Plummer, M., Best, N., Cowles, K., Vines, K., Sarkar, D., Bates, D., Almond, R., and Magnusson, A. (2024). coda: Output Analysis and Diagnostics for MCMC (R Package Version 0.19-4.1), The R Foundation."},{"key":"ref_34","unstructured":"Jones, P. (2025). networktools: Tools for Identifying Important Nodes in Networks, CRAN."},{"key":"ref_35","unstructured":"Morey, R.D., and Rouder, J.N. (BayesFactor: Computation of Bayes Factors for Common Designs [R package], 2025). BayesFactor: Computation of Bayes Factors for Common Designs [R package], version 0.9.12.4.8."},{"key":"ref_36","unstructured":"Jeffreys, H. (1961). The Theory of Probability, Oxford University Press."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/j.ejca.2012.02.059","article-title":"Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30","volume":"48","author":"Cocks","year":"2012","journal-title":"Eur. J. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/1477-7525-6-46","article-title":"The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease","volume":"6","author":"Puhan","year":"2008","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","article-title":"Estimating psychological networks and their accuracy: A tutorial paper","volume":"50","author":"Epskamp","year":"2018","journal-title":"Behav. Res. Methods"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1002\/pon.4571","article-title":"Cognition, quality-of-life, and symptom clusters in breast cancer: Using Bayesian networks to elucidate complex relationships","volume":"27","author":"Xu","year":"2018","journal-title":"Psychooncology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s00508-017-1266-z","article-title":"Improvement of quality of life and psychological distress after inpatient cancer rehabilitation: Results of a longitudinal observational study","volume":"129","author":"Riedl","year":"2017","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/s11764-013-0272-z","article-title":"Fear of cancer recurrence in adult cancer survivors: A systematic review of quantitative studies","volume":"7","author":"Simard","year":"2013","journal-title":"J. Cancer Surviv."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Maheu, C., Singh, M., Tock, W.L., Eyrenci, A., Galica, J., H\u00e9bert, M., Frati, F., and Estap\u00e9, T. (2021). Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research. Front Psychol., 12.","DOI":"10.3389\/fpsyg.2021.644932"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.21037\/apm-24-54","article-title":"Is cancer back?\u2014psychological issues faced by survivors of breast cancer","volume":"13","author":"Bergerot","year":"2024","journal-title":"Ann. Palliat. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1002\/ijc.34152","article-title":"Late effects, long-term problems and unmet needs of cancer survivors","volume":"151","author":"Schmidt","year":"2022","journal-title":"Int. J. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Guan, N., Guariglia, A., Moore, P., Xu, F., and Al-Janabi, H. (2022). Financial stress and depression in adults: A systematic review. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0264041"},{"key":"ref_47","first-page":"618","article-title":"Financial toxicity among cancer survivors: A conceptual model based on a feedback perspective","volume":"31","author":"Scheidegger","year":"2023","journal-title":"Support. Care Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"100508","DOI":"10.1016\/j.ssmmh.2025.100508","article-title":"Financial factors and depression and anxiety: A symptom-specific approach in the general population","volume":"8","author":"Nes","year":"2025","journal-title":"SSM\u2014Mental Health"},{"key":"ref_49","first-page":"1533","article-title":"Anticipatory nausea and vomiting","volume":"19","author":"Roscoe","year":"2011","journal-title":"Support. Care Cancer"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1007\/s00595-024-02881-3","article-title":"The long-term quality of life after distal and pylorus-preserving gastrectomy for stage I gastric cancer: A prospective multi-institutional study (CCOG1601)","volume":"55","author":"Tanaka","year":"2025","journal-title":"Surg. Today"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"5240","DOI":"10.1245\/s10434-025-17362-1","article-title":"Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies","volume":"33","author":"Bansal","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e14976","DOI":"10.1111\/nmo.14976","article-title":"Chemotherapy-Induced Neuropathy Affecting the Gastrointestinal Tract","volume":"37","author":"Vera","year":"2025","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/S0002-9378(13)90479-8","article-title":"Adhesions after extensive gynecologic surgery: Clinical significance, etiology, and prevention","volume":"170","author":"Monk","year":"1994","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1056\/NEJM198212093072402","article-title":"Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy","volume":"307","author":"Morrow","year":"1982","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/nrclinonc.2014.127","article-title":"Cancer-related fatigue--mechanisms, risk factors, and treatments","volume":"11","author":"Bower","year":"2014","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/S0033-3182(09)70835-7","article-title":"Cancer-related fatigue and its associations with depression and anxiety: A systematic review","volume":"50","author":"Brown","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_58","first-page":"4671419","article-title":"Effect of Endurance Training in COPD Patients Undergoing Pulmonary Rehabilitation: A Meta-Analysis","volume":"2022","author":"Li","year":"2022","journal-title":"Comput. Math. Methods Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1177\/13591053241298752","article-title":"Effect of physical activity on depression, anxiety, and stress in women surviving breast cancer: A systematic review and meta-analysis of randomized clinical trials","volume":"30","author":"Nero","year":"2025","journal-title":"J. Health Psychol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1007\/s11764-024-01696-y","article-title":"The effectiveness of exercise interventions on psychological distress in patients with lung cancer: A systematic review and meta-analysis","volume":"20","author":"Tadsuan","year":"2026","journal-title":"J. Cancer Surviv."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1200\/JCO.2011.40.8922","article-title":"Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: Systematic review and meta-analysis","volume":"31","author":"Faller","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s12955-020-01524-8","article-title":"Normative data for the EORTC QLQ-C30 from the Austrian general population","volume":"18","author":"Lehmann","year":"2020","journal-title":"Health Qual. Life Outcomes"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:26:18Z","timestamp":1783326378000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":62,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["cancers18132155"],"URL":"https:\/\/doi.org\/10.3390\/cancers18132155","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]}}}