AL-NAJAM Journal of Medical and Life Sciences, 1(1): March, 2026

ORIGINAL ARTICLE

Life Beyond the Clinic: Quantifying the Negative Correlation Between Treatment Duration and Survivor Quality of Life in Breast Cancer Patients

Rameesha Ali1 | Maham Khizar1 | Maryam Ehsan2*

1Department of Allied Health Sciences, University of Health Sciences, Lahore, Pakistan | 2Department of Nursing, Shaikh Zayed Medical College, Lahore, Pakistan
*Correspondence: Maryam Ehsan (Maryum.sana.med@gmail.com)

Citation: Ali R, Khizar M, Ehsan M. Life Beyond the Clinic: Quantifying the Negative Correlation Between Treatment Duration and Survivor Quality of Life in Breast Cancer Patients. Al Najam J Med Life Sci. 2026;1(1):33-38. https://doi.org/10.68041/anjmls.v1i1/10
Acknowledgement: None; Competing Interests: The author declared no competing interests; Grant Support and Funding Source: No external funding source; Study Ethical Approval: The authors declared that approval was obtained from the institute prior to the study (Adm-112/2023); Consent for Participation and Publication: Written informed consent was obtained from all participants before they participated in the study; Availability of Data and Materials: Available upon reasonable request from correspondence author; Use of Artificial Intelligence: The corresponding author declared that no artificial intelligence or AI-assisted tools were used in any stage of manuscript preparation and editorial processing; Authors’ Contribution: RA: Conception, study design, literature search, drafting, critical review and approval of the final manuscript. MK: Data collection, interpretation of results, drafting, critical review and approval of the final manuscript. ME: Study supervision, statistical analysis, interpretation of results, drafting, critical review and approval of the final manuscript. All authors agreed to be accountable for all aspects of the work in accordance with ICMJE.

Received: 13 January, 2026; Revised: 27 February, 2026; Accepted: 04 March, 2026; Published: 10 March, 2026

ABSTRACT

Background: Improvements in early diagnosis and treatment have led to significant improvements in breast cancer survival, but long-term survivors may still have reduced quality of life (QoL) affected by physical, psychological and social aspects. The purpose of this study was to explore the quality of life of breast cancer survivors and to evaluate the correlation between treatment duration and quality of life. Methods: This cross sectional study with 120 breast cancer survivors used non-probability consecutive sampling technique with a Structured questionnaire to assess quality of life were used to gather data on physical, emotional, social and functional domains. Descriptive data analysis was performed, and inferential data analysis was done through one-way ANOVA, Pearson correlation, independent t-test, and multiple linear regression (SPSS 20.0, P value <0.05). Results: The average total QoL score was 62.4 ± 13.7. Patients with a shorter treatment duration (<1 year) had significantly higher scores (71.2 ± 10.5) than patients with a longer treatment duration (>3 years) (55.1 ± 12.3), (p < 0.001). Significant negative correlations were observed between treatment duration and overall QoL (r = −0.56, p < 0.001), physical well-being (r = −0.49, p < 0.001), and emotional well-being (r = −0.52, p < 0.001). Multiple linear regression showed that treatment duration (p < 0.001, β = −0.44), cancer stage (p = 0.002, β = −0.23) and chemotherapy exposure (p = 0.044, β = −0.19) were significant factors in the reduction of QoL. The model elucidated 48% of the variance in QoL outcomes (R² = 0.48, p < 0.001). Conclusions: The length of treatment is a significant factor in quality of life among the survivors of breast cancer and is correlated with poor quality of life. New targeted survivorship care programs emphasizing lifelong follow-up, psychological support, and physical rehabilitation are needed to enhance the well-being of this patient population.

Keywords: Breast cancer, quality of life, survivors, treatment duration, oncology, survivorship care

INTRODUCTION

Skin diseases that can be treated over an extended period of time are chronic diseases, such as psoriasis, eczema/atopic dermatitis, hidradenitis suppurativa, vitiligo, and alopecia areata 1. They are not only burdened by skin symptoms, but by pain, pruritus, sleep abnormalities, flares, and the need for treatment, which may be associated with difficulties in daily activities and emotional functioning 2. In a review, pooled prevalence of stress, depression, and anxiety was reported as 39.4%, 27.2%, and 28.8%, respectively, in patients with skin diseases 3. The morbidity experienced by young people and adults with atopic dermatitis is also higher for depression, anxiety, and suicidal ideation 4.

Despite the improvement in screening and treatment, breast cancer is the most common type of cancer and is still the most common cancer in women worldwide 1. Better diagnosis, treatment (multi-modality) and supportive care have made a big difference in improving breast cancer survival rates and a larger number of survivors of breast cancer 2. Survival, however, does not always mean complete recovery, with many patients having ongoing physical, mental and social problems that have a negative impact on their quality of life (QoL) 3. Quality of life of breast cancer survivors is a multidimensional construct that includes physical functioning, emotional health, social relationships, and role functioning 4. Multiple factors affect it such as the stage of the cancer at diagnosis, the type of treatment used, any other health conditions that are present and the length of time that the treatment lasts 5.

Of these, treatment duration is of growing importance for analyzing survivorship outcomes; exposure to treatment over a longer period (surgery, chemotherapy, radiotherapy, or hormonal therapy) could result in accumulative toxic effects, chronic fatigue, psychological distress, and lower functional capacity 6,7. Life satisfaction may also be impacted by cancer treatment in the long term, which can affect daily life, work and social activities 8. Survivors are also likely to have ongoing concerns about the risk of recurrence, the cost of continued treatment, and a changed body image, which can also affect their quality of life 9.

However, there is not much available to demonstrate treatment duration's effect on specific aspects of QoL in breast cancer survivors in the developing healthcare environment. In addition, previous research has emphasized overall survivorship outcomes, with little attention paid to the impact of treatment duration on individual domains of quality of life, including physical, emotional and functional well-being 10.

The existing literature also indicates that long-term effects of extended exposure to treatment are uncertain across a variety of clinical populations calling for additional research 11,12. This is an important relationship to know when creating effective survivorship care plans to address overall patient care and wellness beyond just managing the disease. Hence, the present study aimed to determine the quality of life for patients with breast cancer and to examine its relationship with the length of treatment, and other clinical and demographic parameters. The results will be informative for clinicians and policy makers to refine supportive care for the long-term and improve survivorship outcomes.

The present study evaluated the severity of fatigue in chronic kidney disease and its association with the severity of the disease and some clinical parameters like disease duration, hemoglobin level, and kidney function.

METHODOLOGY

This study used a cross-sectional analytical design to examine the QoL of breast cancer survivors and the relationship between the quality of life and treatment duration. The study was carried out at oncology follow up clinics of affiliated tertiary care hospital during a study period of six months from July 2023 to December 2023 (#Adm-112/2023). The study subjects consisted of adult female breast cancer patients who had been treated and were coming for regular follow-up visits. The number of participants that were enrolled was 120, with a non-probability consecutive sampling technique in order to reach the required sample size.

A histologically established diagnosis of breast cancer in women aged 18 years or older who had undergone at least primary treatment (surgery, chemotherapy, and/or radiotherapy) were included in the study. Critically ill patients, patients with recurrent metastatic disease at the time of data collection, and patients with a history of cognitive impairment or psychiatric illness that may affect the ability to fill out the questionnaires were excluded. Those who did not give informed consent were also excluded. An organized questionnaire was used to gather data, as well as a standardized instrument for assessing quality of life in social, emotional, physical, social, and functional areas.

Clinical and demographic information such as age, level of education, marital status, type of treatment received, cancer stage at diagnosis, and occurrence of comorbidities, hormonal therapy status, and length of treatment was collected from medical records and patient interviews. Quality of life scores were derived based on a standardized scoring system with higher scores representing higher quality of life.

IBM SPSS version 20.0 (Released 2020; IBM Corp., Armonk, NY, USA; RRID:SCR_016479). was used for the data analysis 13. Clinical and demographic variables were summarized using descriptive statistics such as standard deviation, mean, frequency and percentage. One-way analysis of variance (ANOVA) was used to compare quality of life scores between treatment duration groups, independent sample t-tests were used to compare the scores in the different groups, Pearson correlation analysis was used to determine the association between two variables, whereas multiple linear regression analysis was used to conclude independent predictors of quality of life. A p-value of < 0.05 was considered as statistically significant. Relevant institutional ethics committee gave ethical approval before the study was commenced. All participants gave informed consent and confidentiality of all data collected was carefully maintained throughout the research process.

RESULTS

All 120 breast cancer survivors participated in the study. The mean age of the members was 51.6 ± 11.8 years with the majority of the patients in the 40-59 age group. The level of overall quality of life was moderate, 62.4 ± 13.7, and significantly decreased with longer treatment duration. Table I shows the characteristics of survivors of breast cancer in the study. The age was predominantly middle-aged (51.6 ± 11.8 years) and most participants were married and unemployed. There was a wide range of educational status, with the majority having at least a secondary level education. The sampling is based on urban and rural populations, and the sample is representative of the socioeconomic status.

Table I: Detailed Socio-Demographic Characteristics of Participants (n = 120)

Variable Category n %
Age (years) <40 22 18.3
40–49 34 28.3
50–59 32 26.7
≥60 32 26.7
Mean age ± SD — 51.6 ± 11.8 —
Marital Status Married 87 72.5
Single 14 11.7
Widowed/Divorced 19 15.8
Education Level No formal education 18 15.0
Primary 28 23.3
Secondary 46 38.3
Higher education 28 23.3
Employment Status Employed 41 34.2
Unemployed 79 65.8
Residence Urban 68 56.7
Rural 52 43.3

The clinical stage, the treatment modalities and the health-related characteristics of the members are précised in this table. There was a significant proportion of patients diagnosed at Stage II or III, and a combination of treatment was most common. Over half of the patients were treated for 1-3 years. Nearly half were taking hormonal therapy, and a large number of the patients had other medical conditions. Table II shows the clinical and treatment characteristics of breast cancer.

Table II: Clinical and Treatment Characteristics of Breast Cancer Survivors (n = 120)

Variable Category n %
Cancer Stage at Diagnosis Stage I 18 15.0
Stage II 44 36.7
Stage III 38 31.7
Stage IV 20 16.7
Type of Treatment Surgery only 20 16.7
Surgery + Chemotherapy 36 30.0
Surgery + Radiotherapy 25 20.8
Combined (Surgery + Chemo + RT) 39 32.5
Treatment Duration <1 year 18 15.0
1–3 years 70 58.3
>3 years 32 26.7
Ongoing Hormonal Therapy Yes 54 45.0
No 66 55.0
Presence of Comorbidities Yes 49 40.8

Table III compares quality of life scores across different treatment durations and clinical variables. A significant decline in QoL was observed with increasing treatment duration, with the lowest scores seen in patients treated for more than three years. Advanced cancer stage and combined therapy were also associated with poorer QoL. All differences were statistically significant in most comparisons (p < 0.05).

Table III: Quality of Life Scores Across Treatment Duration and Clinical Groups

Variable Category n Mean QoL ± SD F / t value
Treatment Duration <1 year 18 71.2 ± 10.5 18.62
1–3 years 70 64.8 ± 11.6 —
>3 years 32 55.1 ± 12.3 —
Cancer Stage Early (I–II) 62 68.5 ± 11.2 9.41
Advanced (III–IV) 58 57.9 ± 12.8 —
Treatment Type Single modality 45 70.3 ± 10.8 11.27
Combined therapy 75 59.4 ± 12.6 —
Hormonal Therapy Yes 54 60.2 ± 12.4 -2.98
No 66 66.8 ± 12.1 —

Table IV presents mean scores across different quality of life domains consisting of emotional, physical, social, and functional well-being. Social well-being showed relatively higher scores, while functional and symptom-related domains were comparatively lower. Overall QoL was moderately reduced, reflecting ongoing physical and psychological burden among survivors.

Table IV: Quality of Life Domain Scores (EORTC-Based Distribution)

QoL Domain Mean ± SD Minimum Maximum
Physical Well-being 64.1 ± 14.2 30 95
Emotional Well-being 60.3 ± 15.6 25 92
Social Well-being 66.5 ± 13.1 28 98
Functional Well-being 58.7 ± 14.9 20 90
Symptom Burden (reverse scored) 55.2 ± 16.3 18 94
Overall QoL Score 62.4 ± 13.7 25 96

Table V shows the relationship between treatment duration and various QoL domains. A significant negative correlation was observed across all major domains, indicating that longer treatment duration is related with poorer QoL. The strongest associations were seen with emotional and physical well-being. Symptom burden showed a positive correlation with treatment duration.

Table V: Correlation Between Treatment Duration and Quality of Life Domains

Variable r-value p-value
Overall QoL -0.56 <0.001
Physical Well-being -0.49 <0.001
Emotional Well-being -0.52 <0.001
Social Well-being -0.41 0.002
Functional Well-being -0.38 0.004
Symptom Burden 0.47 <0.001

Table VI identifies independent predictors of QoL among survivors of breast cancer. Treatment duration emerged as the strongest negative predictor, followed by cancer stage and chemotherapy exposure. Age also showed a modest negative association with QoL. The model explained 48% of the variance, indicating a strong overall predictive fit.

Table VI: Multiple Linear Regression Analysis for Predictors of Quality of Life

Predictor β SE t-value p-value
Treatment Duration -0.44 0.08 -5.62 <0.001
Age -0.21 0.09 -2.18 0.031
Cancer Stage -0.23 0.07 -3.12 0.002
Chemotherapy Exposure -0.19 0.08 -2.04 0.044
Hormonal Therapy -0.14 0.09 -1.56 0.121
Constant — — — —

Overall, the mean overall quality of life score was 62.4 ± 13.7, indicating a moderate QoL burden among breast cancer survivors. QoL declined significantly with longer treatment duration, advanced cancer stage, and combined treatment modalities. Treatment duration showed the strongest negative association with overall QoL (r = −0.56, p < 0.001) and remained the strongest independent predictor in multivariable analysis (β = −0.44, p < 0.001).

DISCUSSION

The present study assessed the quality of life (QoL) amongst breast cancer survivors and examined their relationship to treatment period. The results showed that survivors had a moderate overall QoL score, with significantly poorer QoL scores in survivors receiving longer treatment durations. Those who were treated for less than a year reported significantly higher QoL than individuals who were treated for more than three years. Survivors of breast cancer often face physical, emotional and social problems that persist after treatment and improve survival, as reported in previous studies 14,15. Examples include increased burden of symptoms and reduced daily functioning with longer duration of exposure to breast cancer treatment 16.

One of the key findings of this research was the high negative correlation between treatment duration and overall QoL, especially in the domains of emotional and physical health. Longer treatment durations have been shown previously to be linked to higher levels of fatigue, pain, sleep problems and emotional distress in breast cancer survivors 17,18 and it is likely that these effects on physical functioning and psychological well-being persist long after diagnosis. The same findings have been seen in studies conducted over time—survivorship research—that showed that treatment effects can last for years and play a significant role in the overall loss of QoL19.

Multiple regression analysis revealed that treatment duration was the most important independent predictor of decreased QoL, followed by cancer stage and chemotherapy treatment. Patients who are treated with more intensive treatment regimens and longer durations of treatment are more likely to have treatment-related functional limitations and complications of treatment, which also contribute to poorer survivorship outcomes 20. Clinical factors also play a substantial role in the well-being of survivors 21 as the regression model accounted for 48% of the variance in the QOL outcomes; other psychosocial and socioeconomic factors may also be important.

The findings of this study have vital clinical implications for survivorship care. With the number of breast cancer survivors on the rise, health care systems need to be concerned with not only survival but quality of life 22. Follow-up programs should include routine evaluation of physical symptoms, emotional status, and functioning, especially for patients who are on long-term treatment 23. Survivorship studies indicate that supportive care, psychological counseling, physical rehabilitation, and symptom management can impact patient reported outcomes and overall survivorship quality of life 24 which may be more likely to happen when a patient is identified early as being at risk of reduced QoL 25.

Since the study is cross-sectional, it is not possible to draw causal inferences between treatment duration and quality of life. Moreover, participants were selected consecutively from one oncology follow-up area, and the findings might not be generalizable. Quality of life was measured at one time and may not capture the full spectrum of changes that can happen over the survivorship continuum. Additional multicenter, longitudinal studies with larger, more diverse patient cohorts are needed to gain better insight into changes in quality of life over time and to identify factors that can be modified to improve survivorship outcomes. Additional studies are required to assess the effectiveness of tailored supportive care interventions intended to minimize the long-term physical and psychological effects of breast cancer therapy.

CONCLUSION

The present research found that survivors of breast cancer who received the treatments for longer periods of time had poorer quality of life especially in physical and emotional health. Chemotherapy, cancer stage and treatment duration were also important factors influencing poor quality of life, and treatment duration was the strongest independent predictor.

The symptoms endured by treatment, emotional distress, decreased physical functioning and trouble getting back to normal social and occupational activities are potential side effects that can become chronic with prolonged treatment. These effects can persist after active treatment and can significantly impact long-term wellbeing.

The results demonstrate that comprehensive survivorship care programs, which encompass psychological support, management of symptoms, rehabilitation, nutrition education and follow-up care are critical. Survivorship care should include regular evaluations of a breast cancer survivor to address any ongoing issues as early as possible, to help arrange timely and supportive interventions, to maximize functional recovery, and to support long-term survivorship and overall health.

References

  1. Aitken LA, Hossan SZ. The Psychological Distress and Quality of Life of Breast Cancer Survivors in Sydney, Australia. Healthcare (Basel). 2022;10(10):2017. https://doi.org/10.1007/s10567-024-00478-3
  2. Muzzatti B, Bomben F, Flaiban C, Piccinin M, Annunziata MA. Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients. BMC Cancer. 2020;20(1):758. https://doi.org/10.1186/s12885-020-07272-8
  3. Zeleke TK, Tamene FB, Geremew GW, Alemayehu TT, Worku MC, Wondm SA, et al. Mental health treatment and its impact on survival outcomes in patients with comorbid mental health and cardiovascular diseases: a retrospective cohort study. BMC Psychiatry. 2025 Jul;25(1):609. https://doi.org/10.1186/s12888-025-07035-4
  4. Ayub F, Khan TM, Baig MR, Amin MU, Tahir H. Quality of life and wellbeing among breast cancer patients in Lahore, Pakistan. Front Oncol. 2023;13:1105411. https://doi.org/10.3389/fonc.2023.1105411
  5. Agarwal S, Garg R, Minhas V, Bhatnagar S, Mishra S, Kumar V, et al. To assess the Prevalence and Predictors of Cancer-related Fatigue and its Impact on Quality of Life in Advanced Cancer Patients Receiving Palliative Care in a Tertiary Care Hospital: A Cross-sectional Descriptive Study. Indian J Palliat Care. 2020;26(4):523-527. https://doi.org/10.4103/IJPC.IJPC_223_19
  6. Kafetzopoulos V, Pittaka M, Ioannidis G, Moniem I. Chronic Fatigue in Cancer Survivorship: Psychiatry Versus Oncology or Psychiatry with Oncology? Curr Oncol Rep. 2025;27(7):883-905. https://doi.org/10.1007/s11912-025-01697-9
  7. Joshy G, Thandrayen J, Koczwara B, Butow P, Laidsaar-Powell R, Rankin N, et al. Disability, psychological distress and quality of life in relation to cancer diagnosis and cancer type: population-based Australian study of 22,505 cancer survivors and 244,000 people without cancer. BMC Med. 2020;18(1):372. https://doi.org/10.1186/s12916-020-01830-4
  8. Sancassiani F, Kalcev G, Agus M, Mulas O, Massa E, Primavera D, et al. The role of satisfaction with care among factors affecting health-related quality of life in people with cancer: a cross-sectional study. Front Oncol. 2026;15:1712478. https://doi.org/10.3389/fonc.2025.1712478
  9. Amini-Tehrani M, Zamanian H, Daryaafzoon M, Andikolaei S, Mohebbi M, Imani A, et al. Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. J Adv Nurs. 2021;77(8):3412-3423. https://doi.org/10.1111/jan.14881
  10. Bates-Fraser LC, Riley S, Stopforth C, Moertl K, Edgar K, Stoner L,et al. Home-based exercise improves quality of life in breast and prostate cancer survivors: A meta-analysis. PLoS One. 2023;18(4):e0284427. https://doi.org/10.1371/journal.pone.0284427
  11. Racz JI, Bialocerkowski A, Calteaux I, Farrell LJ. Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review. Clin Child Fam Psychol Rev. 2024;27(2):317-341. https://doi.org/10.1007/s10567-024-00478-3
  12. Namoos A, Thomson N, Olson C, Sheppard V, Aboutanos M. Physical and Psychological Burdens Among Breast Cancer Survivors: Evaluating Post-Treatment Gait Impairment, Falls, and Depression Using Real-World Data. Eur J Cancer Care (Engl). 2025;2025:10.1155/ecc/5558563. https://doi.org/10.1155/ecc/5558563
  13. IBM Corp. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp; 2020. Available at: https://www.ibm.com/support/pages/spss-statistics-27-now-available
  14. Namoos A, Thomson N, Olson C, Aboutanos M. Physical Injury and Psychological Impact: Understanding the High Risk of Depression on Older Adults with Recurrent Falls. Adv Geriatr Med Res. 2024;6(4):e240008. https://doi.org/10.20900/agmr20240008
  15. Namoos A, Ramadan R, Ramadan D, Liang A, Thomson N. Retrospective Analysis of the Association Between Sarcopenia and Fall Risk in Older Breast Cancer Patients Using Real World Data (TriNetX). Cancer Med. 2025;14(22):e71404. https://doi.org/10.1002/cam4.71404
  16. Hinz A, Friedrich M, Schulte T, Ernst M, Tibubos AN, Petrowski K,et al. Sleep Problems and Quality of Life in Breast Cancer Patients. Curr Oncol. 2025;32(9):508. https://doi.org/10.3390/curroncol32090508
  17. Götze H, Taubenheim S, Dietz A, Lordick F, Mehnert A. Comorbid conditions and health-related quality of life in long-term cancer survivors-associations with demographic and medical characteristics. J Cancer Surviv. 2018;12(5):712-720. https://doi.org/10.1007/s11764-018-0708-6
  18. Firkins J, Hansen L, Driessnack M, Dieckmann N. Quality of life in "chronic" cancer survivors: a meta-analysis. J Cancer Surviv. 2020;14(4):504-517. https://doi.org/10.1007/s11764-020-00869-9
  19. Wagle NS, Nogueira L, Devasia TP, Mariotto AB, Yabroff KR, Islami F,et al. Cancer treatment and survivorship statistics, 2025. CA Cancer J Clin. 2025;75(4):308-340. https://doi.org/10.3322/caac.70011
  20. DeMiglio L, Murdoch V, Ivison J, Fageria S, Voutsadakis IA. Factors influencing psychological wellbeing of early breast cancer patients. Rep Pract Oncol Radiother. 2020;25(6):913-918. https://doi.org/10.1016/j.rpor.2020.09.009
  21. Huang YR, Xing HQ, Yan YR, Wang YC, Feng Y, Smith RD, et al. Quality of Life in Breast Cancer Survivors: A Meta-Analysis of Case-Control Studies. Psychooncology. 2026;35(2):e70398. https://doi.org/10.1002/pon.70398
  22. Kahán Z, Szántó I, Dudás R, Kapitány Z, Molnár M, Koncz Z, et al. Breast Cancer Survivorship Programme: Follow-Up, Rehabilitation, Psychosocial Oncology Care. 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res. 2022;28:1610391. https://doi.org/10.3389/pore.2022.1610391
  23. Baladaniya M, Baldania S. Exploring the Impact of Physical Therapy on Patient Outcomes Across the Cancer Care Continuum: A Narrative Review. Cureus. 2025;17(7):e87144. https://doi.org/10.7759/cureus.87144
  24. O'Hea EL, Creamer S, Flahive JM, Keating BA, Crocker CR, Williamson SR, et al. Survivorship care planning, quality of life, and confidence to transition to survivorship: A randomized controlled trial with women ending treatment for breast cancer. J Psychosoc Oncol. 2022;40(5):574-594. https://doi.org/10.1080/07347332.2021.1936336
  25. Seol KH, Bong SH, Kang DH, Kim JW. Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy. Psychiatry Investig. 2021;18(1):80-87. https://doi.org/10.30773/pi.2020.0286
CC_BY-NC Icon

AL-NAJAM Journal of Medical and Life Sciences, Al Najam J Med Life Sci 2026:1(1), p33-38 (anjmls.org) © 2026 Authors. This work is published by Multidisciplinary Scholarly Advancement and Research MSAR Institute. The full terms of Journal Publishing policy is available at https://anjmls.com/index.php/anjmls/publishing-license and incorporate the Creative Commons Attribution – Non Commercial (CC BY, NC 4.0) License https://creativecommons.org/licenses/by-nc/4.0/. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission, provided the work is properly attributed. Publisher’s Note: MSAR Institute remains neutral with regard to jurisdictional claims in published maps and institutional affiliations, and assumes no liability for the scientific accuracy or clinical efficacy of the content herein, as they rest entirely with the authors.