Introduction
Cancer remains one of the most pressing health challenges
of our era and exerts biological, social, financial,
and psychological impacts. According to the WHO, in
2022, there were 19.9 million new cancer diagnoses
worldwide, with breast cancer being the most prevalent
in women.[] In Türkiye, 240.013 individuals received
their initial cancer diagnosis in 2022, with lung cancer being the most prevalent cancer among men and breast
cancer among women.[,] Based on global data from
2022, there were 2.296.840 new cases of breast cancer,
during that year. In 2022, Türkiye reported a total of
25.249 new cases of breast cancer. Both the global and
local data indicate that the incidence of breast cancer
remains notably high and that there is an expectation
of a continued increase in the number of breast cancer
cases, similar to other cancer types.[r1>,]
Many cancer patients require treatment that may
involve one or more of the following approaches: Chemotherapy,
surgery, radiotherapy, biotherapy (immunotherapy),
and hormone therapy. Chemotherapy can
lead to various side effects, fatigue, nausea, vomiting,
shortness of breath, loss of appetite, and insomnia.
These symptoms can have a detrimental impact on the
patient's quality of life and functional abilities, often
posing challenges to their ability to adhere to the treatment
regimen.[,]
Fatigue is a common symptom of cancer treatment.
[] Most patients with cancer (50%-90%) encounter
CRF, which can manifest as weakness, diminished attention
span, weight loss, reduced engagement in activities,
sleep disturbances, and restlessness.[-] CRF
has a detrimental impact on patients" quality of life and
functional abilities, ultimately resulting in decreased
comfort levels.[,]
Researchers have explored the concept of comfort
by considering various dimensions, including physical,
environmental, psychospiritual, and sociocultural aspects.
Physical comfort is related to bodily sensations.
Environmental comfort is about the impact of external
factors and situations on the individual. Psychospiritual
comfort encompasses the spiritual elements that
provide meaning and purpose to an individual"s life.
Sociocultural comfort encompasses factors such as not
feeling isolated, receiving support from spouses and
relatives, being able to engage in cultural traditions,
having access to information, and fostering positive
interpersonal relationships.[,] Cancer patients who
experience high levels of comfort tend to have fewer
unmet needs, enjoy a higher quality of life, and exhibit
greater adherence to their treatment regimens. Research
has demonstrated that healthcare professionals
who effectively manage symptoms and assess the
quality of life can significantly assist their cancer patients
in addressing physical, psychological, and social
challenges. This approach contributes to an improved
overall quality of life for individuals dealing with cancer.[,] While numerous researchers have explored
symptoms and related factors arising from cancer or
cancer treatment, there has been relatively limited
research attention dedicated to the comfort levels of
cancer patients.[] Hence, it is crucial to assess and
understand the physical, psychological, social, and environmental
comfort levels of cancer patients, particularly
those diagnosed with breast cancer. Such evaluations
can provide valuable insights into the well-being
and support needs of these individuals, ultimately enhancing
the quality of care and life for breast cancer patients and potentially serving as a foundation for future
research and interventions in this area. In this context,
assessing the severity of CRF, understanding how it impacts
the individual, and evaluating the overall comfort
level of cancer patients in a multidimensional manner
are of paramount importance. Such comprehensive
evaluations can aid in improving the quality of life for
these patients by ensuring that treatment is carried out
effectively and addressing the physical, psychological,
social, and environmental aspects that contribute to
their comfort and well-being.[,,,-] Therefore,
this study investigated the cancer-related fatigue and
comfort levels of patients with breast cancer.
Methods
Study Design
This study was a cross-sectional and descriptive.
Sample of the Study
The purpose of this study was to investigate the CRF
and comfort levels of patients with breast cancer. The
study was carried out in the University Hospital"s
Medical Oncology Unit from November 2021 to April
2022. Data were gathered through face-to-face interviews
with patients. The research involved 324 breast
cancer patients. The known sample calculation formula
(5% tolerance and 99% confidence level) was used to
determine the sample size. The sample consisted of
218 breast cancer patients. Inclusion criteria were: Diagnosed
with breast cancer, continuing chemotherapy
and had undergone at least four cycles of chemotherapyhad
an ECOG performance score of ≤2, knew the
diagnosis and expressed it verbally, volunteering and
had no communication problems or any other health
problems that might prevent participation.
Measures and Tools
The data were interviews using a sociodemographic
questionnaire, the Fatigue Severity Scale, and the General
Comfort Questionnaire.
Research Questions
• What is the fatigue and comfort level of patients?
• Do demographic and disease-related characteristics
affect the CRF and comfort levels of patients with
breast cancer?
• Is there a relationship between the CRF and comfort
levels of patients with breast cancer?
Patient Characteristics Information Form: The
sociodemographic characteristics questionnaire consisted of two parts: Personal characteristics and disease
and treatment-related characteristics. The "personal
characteristics" part consisted of items on sociodemographic
characteristics (gender, age, marital status, education,
occupation, tobacco and alcohol use, income,
etc.). The "disease and treatment-related characteristics"
part consisted of items on disease status, year of
diagnosis, ECOG performance score, cancer-related
surgery, radiotherapy, and treatment course, etc.
Fatigue Severity Scale (FSS): Krupp et al.[] developed
FSS, which Armutlu et al.[] adapted to Turkish.
The instrument consists of nine items rated on a sevenpoint
Likert-type scale. The total score is the average of
all items. The mean score ranges from 1 to 7 ("1=strongly
disagree" to "7=strongly agree"). The scale has a cutoff
score of 4. A mean score <2.8 indicates no fatigue. A
mean score of 2.8 to 6.1 indicates mild fatigue. A mean
score of 6.1 indicates chronic fatigue. The total score varies
from 9 to 63, with higher numbers indicating more
acute weariness. The original scale has a Cronbach's alpha
of 0.80.[] The Turkish version has a Cronbach's
alpha of 0.79 which was 0.97 in the present study.[,]
General Comfort Questionnaire (GCQ): GCQ
was developed by Kolbaca.[] This questionnaire
adapted to Turkish by Kuğuoğlu and Karabacak.[]
The questionnaire consists of 48 items and three subscales;
relief 16 items, relaxation 17 items, and overcoming
problems 15 items. The items are rated on a
four-point Likert-type scale. The scale has positive and
negative items. The negative items are reverse-scored.
Higher scores on the positive items indicate higher
comfort levels, while higher scores on the negative
items indicate lower comfort levels. The total score is
the sum of all scores divided by the number of items.
The total score ranges from 48 to 192. A mean score of
0 to 48 indicates low comfort levels. A mean score of 49
to 96 indicates moderate comfort levels. A mean score
of 50 to 144 indicates high comfort levels. A mean score
of 145 to 192 indicates very high comfort levels. The
original questionnaire has a Cronbach's alpha score of
0.88. The Turkish version has a Cronbach's alpha score
of 0.85 which was 0.84 in the present study.[,]
Statistical Analysis
Descriptive, graphical, and statistical methods were
used Normality was tested using the Kolmogorov-
Smirnov test. Percentages, numbers, means, medians,
standard deviations were used for categorical variables.
The independent sample t-test was used to compare
two groups, while the one-way Analysis of Variance
(ANOVA) was used to compare more than two groups.
Scheffe's test was used to make post-hoc comparisons
between the groups to determine significant differences.
Pearson"s correlation coefficients were used to determine
the relationship between two continuous variables. The
dependent variables were comfort and fatigue levels,
while the independent variables were demographic and
disease-related characteristics. A multivariate linear regression
model was used to determine the effect of the
independent variables on the dependent variables. A
multiple linear regression model (enter method) was
constructed to pinpoint independent variables associated
with the overall comfort level. The model included
variables that exhibited statistical significance (p<0.05)
or were nearly significant in the initial univariate analyses.
Durbin Watson (D-W) statistics were used to determine
autocorrelation between variables. The D-W
statistical score was 1.860 (1.5-2.5), indicating no autocorrelation.
Therefore, basic assumptions were thoroughly
examined and confirmed, demonstrating the
model"s viability and reliability. According to the regression
analysis results, the coefficient of determination
of the model (R²) was 0.30, suggesting that 30% of the
variance of the dependent variable was explained by the
independent variables. Since the p-value in the model
(F(11-206)=7.914, p<0.001) was smaller than α, the
model was significant at a 95% confidence level.
Ethical Considerations
The study was approved by the Scientific Research
and Ethics Committee of Trakya University Faculty
of Health Sciences, Faculty of Medicine Dean's Office
(Date: 15.11.2021 and No: TUTF-BAEK 2021/430).
The Trakya University Faculty of Health Sciences and
Application Center provided written consent. All patients
provided informed consent. The research followed
the ethical guidelines specified in the World
Medical Association's Declaration of Helsinki.
Results
Patients had a mean age of 53.93±11.0 years. More
than half of the patients were older than 50 (59.6%).
Most patients were married (90.4%). More than half
of the patients were housewife (61.5%). Only seventeen
patients were employed (7.8%). Half of the patients
had chronic diseases (50.5%). Less than half of
the patients were on medication (48.6%). Twenty-three
patients were smokers (10.6%). More than half of the
patients had primary school (68.6%) degrees. Less than
a quarter of the patients had middle school degrees
(21.1%). Only twenty-two patients had bachelor"s degrees (10.1%). More than half of the patients had neutral
incomes (income = expense) (67.4%). More than a
quarter of the patients had negative incomes (income <
expense). Only fourteen patients had positive incomes
(6.4%). More than half of the patients were diagnosed
with primary breast cancer (57.3%), while less than half
were diagnosed with metastatic breast cancer (47.2%).
Less than a quarter of the patients were diagnosed more
than five years ago (23.9%). Less than half of the patients
received radiotherapy (47.2%), while more than a
quarter of the patients received additional chemotherapy
(26.1%). 28.4 % patients had an ECOG score of 0.
48.2% patients had an ECOG score of I. 23.4% patients
had an ECOG score of II. More than half of the patients
slept less than eight hours (54.6%) (Table 1).
Table 1 Personal, diagnosis and treatment characteristics of patients (n=218)
Patients had a total mean FSS score of 48.29±10.22
(out of 63), while they had a mean significance score of 5.37±1.14 (out of 7). The scale had a Cronbach's
alpha score (α) of 0.97, indicating high reliability
(0.8-1) (Table 2).
Table 2 Patients' fatigue severity scale and general comfort scale scores (n=218)
Patients had a mean GCQ score of 140.61±11.42.
They had mean GCQ "relaxation," "relief," and "overcoming
problems" subscale scores of 49.16±4.83, 44.76±5.46,
and 46.70±3.09, respectively. Given the GCQ subscale
significance scores, patients had the highest score on the
"overcoming problems" subscale (3.11±0.21), while they
had the lowest score on the "relief" subscale (2.80±0.34).
The scale had a Cronbach's alpha score of 0.84, indicating
high reliability (0.8-1) (Table 2).
Employed patients had a lower mean FSS score than
their unemployed counterparts (t=2.888; p=0.004).
Patients with positive incomes had a lower mean FSS
score than those with negative incomes (F=3.391;
p=0.035). Smokers had a higher mean FSS score than non-smokers (F=3.908; p=0.022). Patients with chronic
diseases had a higher mean FSS score than those without
chronic diseases (t=2.725; p=0.007). Patients who
were on medication had a lower mean FSS score than
those who were not (t=2.451; p=0.015). Patients with
primary breast cancer had a lower mean FSS score than
those with metastatic breast cancer (t=2.953; p=0.003).
Patients with an ECOG score of II had a higher mean
FSS score than those with an ECOG score of I. Moreover,
patients with an ECOG score of I had a higher
mean FSS score than those with an ECOG score of 0
(F=39.669; p<0.001). Patients who slept less than eight
hours had a higher mean FSS score than those who slept
more than eight hours (t=2.422; p=0.016) (Table 3).
Table 3 Fatigue severity scale and general comfort scale score averages according to patients' personal, diagnostic and treatment
characteristics (n=218)
Employed patients had significantly higher mean
GCQ total (t=2.988; p=0.003) and GCQ "relief"
(t=2.488; p=0.014), "relaxation" (t=2.616; p=0.010),
and "overcoming problems" (t=2.492; p=0.013) subscale
scores. Patients with positive incomes had significantly
higher mean GCQ total (F=3.898; p=0.022)
and GCQ "relief " (F=5.024; p=0.007) subscale scores
than those with negative incomes. Smokers had significantly
lower mean GCQ total (F=4.950; p=0.008)
and GCQ "relief " (F=3.113; p=0.046) and "relaxation"
(F=6.350; p=0.002) subscale scores than non-smokers.
Patients who were on medication had significantly
lower mean GCQ total (t=2.016; p=0.045) and GCQ
"relaxation" (t=2.195; p=0.029) and "overcoming problems"
(t=2.072; p=0.039) subscale scores than those
who were not. Patients with breast cancer had significantly
higher mean GCQ total (t=2.711; p=0.007) and
GCQ "relief " (t=2.117; p=0.036), "relaxation" (t=2.600;
p=0.010), and "overcoming problems" (t=2.046;
p=0.042) subscale scores than those with metastatic
breast cancer. Patients with an ECOG score of II
had a significantly lower mean GCQ total (F=27.403;
p<0.001) and GCQ "relief " (F=42.078 p<0.001), "relaxation"
(F=5.928; p=0.003), and "overcoming problems"
(F=23.606; p<0.001) subscale scores than those
with an ECOG score of I. Moreover, patients with an
ECOG score of I had a significantly lower mean GCQ
total (F=27.403; p<0.001) and GCQ "relief " (F=42.078
p<0.001), "relaxation" (F=5.928; p=0.003), and "overcoming
problems" (F=23.606; p<0.001) subscale scores
than those with an ECOG performance score of 0. Patients
who received less than eight cycles of chemotherapy
had significantly higher mean GCQ total (t=3.356;
p=0.001) and GCQ "relaxation" (t=4.578; p<0.001) and
"overcoming problems" (t=2.644; p=0.009) subscale
scores than those who received more than eight rounds
of chemotherapy. "Patients who repoted sleeping less
than eight hours had a significantly lower mean GCQ
total (t=2.481; p=0.014) and GCQ "relief " (t=2.893;
p=0.004) and "relaxation" (t=2.158; p=0.039) subscale
scores than those who repoted sleeping more than
eight hours (Table 3).
There was a negative correlation between FSS and
GCQ total scores (r=-0.232;p=0.001). There was also
a negative correlation between FSS total and GCQ "relief
" (r=-0.366; p<0.001) and "overcoming problems"
(r=-0.169; p=0.013) subscale scores. These results suggested
that the more severe the fatigue, the lower the
comfort levels (Table 4).
Table 4 The relationship between patients' fatigue severity
scale and general comfort scale scores
The results showed that tobacco use [B=-0.116(95%
GA: -0.208; -0.023); t=-2.456, p=0.015], ECOG performance scores [B=-0.125(95% GA: -0.172; -0.079),
t=-5.300, p<0.001], the number of chemotherapy cycles
[B=-0.068 (95% GA: -0.129;-0.007), t=-2.185,
p=0.030], and sleep duration [B=0.022(95% GA:
0.003-0.040), t=2.287, p=0.023] affected patients" general
comfort levels. These findings indicated four results.
First, smokers had lower general comfort levels
than non-smokers. Second, patients with higher ECOG
scores had lower general comfort levels than those with
lower ECOG scores. Third, patients who received more
chemotherapy cycles had lower general comfort levels
than those with fewer chemotherapy cycles. Fourth, patients
who slept longer had higher general comfort levels
than those who slept for shorter durations (Table 5).
Table 5 Independent variables related to patients' general comfort level (multivariate linear regression analysis results)
Discussion
Breast cancer patients undergoing chemotherapy often
experience a range of symptoms, which can vary
in intensity and duration depending on the individual
and the specific chemotherapy regimen. Fatigue is a
common symptom and side effect associated with chemotherapy
for breast cancer. Fatigue has physical, psychological,
and social consequences. Fatigue prevents
patients from performing daily activities and diminishes
their comfort level. Poor comfort is also an indicator
of poor quality of life. Poor comfort and quality of life
can also have a negative impact on the treatment regimen.
Nurses should monitor and manage their patients"
fatigue and other related symptoms to improve their
comfort level. Patients with high comfort levels can take
care of their own needs and live independently.[-]
Our results showed that patients, in general, experienced
fatigue (48.29±10.22). Li et al.,[] identified
fatigue as one of the most prevalent and distressing
symptoms among patients with advanced cancer. Süren
et al.[] found that fatigue was among the most common
symptoms in end-stage cancer patients. A study
found that cancer patients had moderate fatigue levels. [] Hinz et al.[] observed that German patients with
cancer experienced more severe fatigue than healthy individuals.
All in all, our results are consistent with the
literature. We think that the experience of fatigue in cancer
patients can vary depending on the type of cancer
and the specific treatment protocol they are undergoing.
Cancer patients often have to cope with a wide range
of symptoms and side effects associated with both the
disease itself and its treatments. Those symptoms and
side effects also affect their comfort levels. Our patients
had a mean GCQ score of 140.61±11.42, indicating high
comfort levels. Patients had the highest score on the
"overcoming problems" subscale (3.11±0.21), while they
had the lowest score on the "relief " subscale (2.80±0.34).
These results indicated that patients were able to cope
with problems but could not experience complete relief.
Kubat Bakır and Yurt discovered that patients who
underwent surgery had a mean general comfort score of
128.91±25.13, indicating that their overall comfort level
was above average.[] This suggests that these patients
experienced a relatively high level of comfort following
their surgical procedures.[] Ertin and Kurt revealed
that cancer patients experienced a moderate quality of
life.[] Research shows that patients with breast cancer
have a high quality of life.[,] While there is a large
body of research on the comfort levels of different patient
groups, no researchers have investigated the comfort levels of patients with cancer. A high quality of life
is also an indicator of high comfort. Researchers have
reported that cancer patients have a moderate-to-high
quality of life. All in all, our results are consistent with
the literature. Our patients had high comfort levels,
probably because they were able to comply with treatment
regimens and overcome their problems.
Our employed patients experienced less fatigue and
higher comfort than their unemployed counterparts.
Kurt and Unsar[] found that unemployed patients
with cancer experienced more fatigue than their employed
counterparts. Bayram reported that breast cancer
patients who were civil servants or self-employed
had a higher quality of life compared to housewives.
[] Schmidt et al.[] observed that patients who quit
their jobs due to breast cancer had a poor quality of
life. These findings may be attributed to the fact that
cancer patients who experience lower levels of fatigue
often report higher levels of comfort, primarily because
they are better able to actively participate in their work
and daily life activities.
Our results showed that patients with positive incomes
had less fatigue and more comfort than those
with negative incomes. Lin et al.[] reported that
cancer patients with low socioeconomic status (SES)
experienced more fatigue than those with high SES.
Ertin and Kurt[] found that cancer patients with SES typically experienced higher levels of fatigue and lower
comfort compared to their counterparts with higher
SES. Kim and Kim also documented that cancer survivors
with low SES had a poorer quality of life than their
counterparts with high SES.[] These findings can be
attributed to the fact that cancer patients with low SES
face a multitude of challenges that impact their quality
of life, including disparities in healthcare access, financial
hardships, limited social support, poor nutrition,
and psychosocial stressors. On the other hand, cancer
patients with high SES have a better quality of life because
they typically have advantages in healthcare access,
treatment options, financial resources, support
systems, education, and living conditions. These factors
collectively contribute to their ability to manage
cancer more effectively and maintain a higher quality
of life throughout their journey.
Our results showed that smokers experienced more
fatigue and less comfort than non-smokers. Vaz-Luis et
al.[] and Zvolensky et al.[] also found that smokers
and e-smokers experienced more fatigue than nonsmokers.
Research shows that smokers have a poorer
quality of life than non-smokers.[,] These results
suggest that smoking is a dangerous addiction that
causes various health problems.
Our results showed that patients with chronic
diseases experienced more fatigue than their counterparts
without chronic diseases. Moreover, patients
who were on medication had lower comfort levels than
those who were not. İzgü et al.[] found that cancer
patients with chronic diseases more severe fatigue
than those without chronic diseases. Ghaderi et al.[]
documented that cancer patients with chronic diseases
(hypertension, diabetes, etc.) experienced higher levels
of fatigue than those without chronic diseases. Önsüz
and Can observed that cancer patients who were on
medication experienced more fatigue than those who
were not.[] Schenker et al.[] focused on patients
with advanced life-limiting diseases and found that
patients who were on medication had a poorer quality
of life than those who were not. Many people with
chronic diseases are on medication. Cancer patients
with chronic illness and polypharmacy experience
lower levels of comfort and higher levels of fatigue.
Our results showed that patients with primary
breast cancer experienced lower levels of fatigue and
higher levels of comfort than those with metastatic
breast cancer. Research shows that patients with advanced
stages of cancer experience more fatigue than
those with earlier stages of cancer.[,] Research, in
general, shows that patients with Stage III breast cancer have a poorer quality of life than those with Stage
I and II breast cancer.[] Hamer et al.[] also found
that patients with metastatic breast cancer had a poorer
quality of life than those with primary breast cancer.
These findings suggest that patients with metastatic
breast cancer typically have a poorer quality of life than
those with primary breast cancer due to the incurable
nature of the disease, aggressive treatments, chronic
symptoms (fatigue), and emotional distress, resulting
in poorer quality of life and low levels of comfort.
Our results showed that patients with higher
ECOG scores experienced higher levels of fatigue and
lower levels of comfort compared to those with lower
ECOG scores. Hinz et al.[] reported a positive correlation
between ECOG scores and fatigue. A study
also found that cancer patients with higher ECOG
scores experienced higher levels of fatigue and lower
levels of comfort than those with lower ECOG scores.
[] Ertin and Kurt[] documented that cancer patients
with higher ECOG scores had a poorer quality of
life than those with lower ECOG scores. Bayram[]
noted that breast cancer patients with lower ECOG
scores enjoyed a better quality of life than those with
higher ECOG scores. All in all, cancer patients with
lower ECOG scores tend to enjoy a better quality of
life due to improved physical functioning, treatment
tolerability, independence, psychological well-being,
reduced symptom burden, social engagement, treatment
options, and overall well-being.
Our results showed that patients who slept less
than eight hours had higher levels of fatigue and lower
levels of comfort than those who slept more than
eight hours. Haque et al.[] found that breast cancer
survivors who experienced sleep deprivation experienced
fatigue six times more frequently than those
without sleep deprivation. Research shows that cancer
patients with a higher quality of sleep enjoy a better
quality of life.[,] All in all, cancer patients with a
higher quality of sleep enjoy a better quality of life due
to improved physical and emotional well-being, enhanced
cognitive function, better pain management,
increased energy levels, reduced stress, higher treatment
adherence, improved social engagement, and an
overall sense of well-being.
Our results showed that patients who had received
less than eight cycles of chemotherapy had higher
comfort levels than those who had received more than
eight cycles of chemotherapy. Moreover, patients who
had received an additional cycle of chemotherapy had
lower comfort levels than those who had not. studies
found that cancer patients who had received fewer cycles of chemotherapy enjoyed a better quality of life.
[,] Cancer patients who undergo more cycles of
chemotherapy may have a poorer quality of life due to
cumulative side effects, physical and emotional distress,
financial strain, disruption of daily life, and potential
long-term health effects associated with the treatment.
Our results showed that patients who experienced
higher levels of fatigue had lower comfort levels. Özkan
and Akın[] and Doğan, Tel, and Özkan found that
cancer patients with higher levels of fatigue had a poorer
functional quality of life than those with lower levels
of fatigue.[] Dağcı reported that lymphoma patients
with high fatigue levels had worse functional status.
[] No researchers have investigated the association
between fatigue and comfort among patients with
cancer. Most researchers have focused only on quality
of life. Therefore, our findings on the relationship between
fatigue and comfort contribute to the literature.
Limitation and Strengths
This study had some limitations. The results cannot be
generalized to all patients with breast cancer. The results
are sample-specific. Although we contacted many
patients, their diagnoses and treatments were variable.
Therefore, many factors that could not be assessed may
have influenced fatigue and comfort levels. Despite
these limitations, our sample was pretty large. Therefore,
our findings represent the data from breast cancer
patients living in northwestern Turkey (Thrace region).
Conclusion
Our results indicate that cancer patients with higher
levels of fatigue have lower comfort levels. Sociodemographic
(employment status, income, etc.) and diseaserelated
characteristics (disease status, the number of
chemotherapy cycles, etc.) affect cancer patients" fatigue
and comfort levels. Smokers have lower comfort
levels than non-smokers. Cancer patients with higher
ECOG scores have lower comfort levels than those
with lower ECOG scores. Cancer patients who have
undergone more cycles of chemotherapy have lower
comfort levels than those with fewer cycles of chemotherapy.
Cancer patients who sleep less than eight
hours have lower comfort levels than those who sleep
more than eight hours. Nurses should also implement
the right interventions to help patients with breast cancer
experience lower levels of fatigue and higher levels
of comfort. Moreover, researchers should evaluate patients
with different types of cancer to investigate the
relationship between comfort and fatigue.
Ethics Committee Approval: The study was approved by
the Scientific Research and Ethics Committee of Trakya
University Faculty of Health Sciences, Faculty of Medicine
Dean"s Office (no: TUTF-BAEK 2021/430, date: 15/11/2021).
Informed Consent: Informed consent was obtained from
all participants.
Conflict of Interest Statement: There are no conflicts and
interest was reported by the authors.
Funding: The authors declared that this study received no
financial support.
Use of AI for Writing Assistance: No AI technologies utilized.
Author Contributions: Concept - S.K.; Design - S.K., R.A.;
Supervision - S.K.; Fundings - S.K., R.A.; Materials - R.A.;
Data collection and/or processing - S.K., R.A.; Data analysis
and/or interpretation - S.K., R.A.; Literature search - S.K.,
R.A.; Writing - S.K., R.A.; Critical review - S.K., R.A.
Peer-review: Externally peer-reviewed.
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