AccScience Publishing / CP / Online First / DOI: 10.36922/CP025470078
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ORIGINAL RESEARCH ARTICLE

Efficacy of cognitive behavioral therapy and nutritional counseling to improve quality of life in breast cancer patients in south-western Nigeria

Bosede O. Adebayo-Oke1* ,  Chioma C. Asuzu2,3
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1 Department of Human Nutrition and Dietetics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
2 Department of Counseling and Human Development, Faculty of Education, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
3 Department of Radiation Oncology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
CP, 025470078 https://doi.org/10.36922/CP025470078
Received: 19 November 2025 | Revised: 6 March 2026 | Accepted: 20 March 2026 | Published online: 7 April 2026
(This article belongs to the Special Issue Emerging Horizons in Cancer Mechanisms and Therapeutic Innovation)
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

The primary clinical goals of treatment for cancer, other chronic illnesses, and terminal diseases are to manage symptoms and improve the quality of life (QoL). The aim of this study is to investigate the three-way interaction effect of nutritional counselling (NC) and cognitive behavior therapy (CBT) on the QoL of breast cancer patients in south-western Nigeria. This study employed a pre-test–post-test quasi-experimental design with a 3 × 2 × 3 factorial matrix, involving 92 breast cancer patients. The first three levels were CBT, NC, and control, followed by two levels of psychological distress (PD), and three levels of risk of malnutrition (RoM). The instruments used include the European Organisation for Research and Treatment of Cancer QoL Questionnaire (general and breast cancer-specific; α = 0.80), the Hospital Anxiety and Depression Scale (α = 0.83), the Malnutrition Universal Screening Tool (α = 0.81), and the Functional Assessment of Cancer Therapy-Breast for screening. Data were analyzed using analysis of covariance and estimated marginal means at the significance level p < 0.05. There was a significant three-way interaction among treatment, PD, and RoM (F(4,73) = 3.44, partial η2 = 0.16), with the greatest improvement (mean score = 131.52) in participants with low levels of PD and RoM in the NC group. This study underscores the synergistic impact of treatment, PD, and RoM on the QoL of breast cancer patients in south-western Nigeria. Breast cancer patients should be screened for distress and malnutrition risk and have access to appropriate psychological and nutritional care.

Keywords
Cognitive behavior therapy
Nutritional counselling
Multidisciplinary approach
Quality of life
Breast cancer patients
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Scott BC. Multidisciplinary team approach in cancer care: a review of the latest advancements. EMJ Oncol. 2021;9(9). Available from: https://www.emjreviews.com/oncology/article/multidisciplinary-team-approach-in-cancer-care-areview-of-the-latest-advancements-s130921/ [Last accessed on 2026 Apr 01].

 

  1. Borras JM, Albreht T, Audisio R, et al. Policy statement on multidisciplinary cancer care. Eur J Cancer. 2014;50(3):475-480. doi: 10.1016/j.ejca.2013.11.012

 

  1. Valentini V, Boldrini L, Mariani S, Massaccesi M. Role of radiation oncology in modern multidisciplinary cancer treatment. Mol Oncol. 2020;14(7):1431-1441. doi: 10.1002/1878-0261.12712

 

  1. Berghmans T, Lievens Y, Aapro M, et al. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer. 2020;150:221-239. doi: 10.1016/j.lungcan.2020.08.017

 

  1. Hanna N. Leveraging the virtual landscape for effective multidisciplinary care. ASCO Annual Meeting. June 4, 2021.

 

  1. Chang Y, Lin C, Kang C, et al. Association between multidisciplinary team care and the completion of treatment for oral squamous cell carcinoma: A cohort population-based study. Eur J Cancer Care. 2020;30(2). doi: 10.1111/ecc.13367

 

  1. Polański J, Jankowska-Polańska B, Mazur G. Relationship Between Nutritional Status and Quality of Life in Patients with Lung Cancer. CMAR. 2021;13:1407-1416. doi: 10.2147/cmar.s287551

 

  1. Rios TC, de Oliveira LPM, da Costa MLV, et al. A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients. Health Qual Life Outcomes. 2021;19(1). doi: 10.1186/s12955-021-01735-7

 

  1. Taghian NR, Miller CL, Jammallo LS, O’Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: A review. Crit Rev Oncol Hematol. 2014;92(3):227-234. doi: 10.1016/j.critrevonc.2014.06.004

 

  1. Jeffs E, Ream E, Taylor C, Bick D. Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review. JBI Database System Rev Implement Rep. 2018;16(2):453-506. doi: 10.11124/jbisrir-2016-003185

 

  1. Muller M, Klingberg K, Wertli MM, Carreira H. Manual lymphatic drainage and quality of life in patients with lymphoedema and mixed oedema: a systematic review of randomised controlled trials. Qual Life Res. 2018;27(6):1403-1414. doi: 10.1007/s11136-018-1796-5

 

  1. Opadola O, Opadola O, Ojedokun S, Abayomi O. Determinants of Quality of Life in Women living with Breast Cancer in South-west Nigeria. AIR. Published online December 17, 2022:91-99. doi: 10.9734/air/2022/v23i6923

 

  1. Puigpinos-Riera R, Graells-Sans A, Serral G, et al. Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort). Cancer Epidemiol. 2018;55:123-129. doi: 10.1016/j.canep.2018.06.002

 

  1. Tsaras K, Papathanasiou IV, Mitsi D, et al. Assessment of Depression and Anxiety in Breast Cancer Patients: Prevalence and Associated Factors. Asian Pac J Cancer Prev. 2018;19(6). doi: 10.22034/APJCP.2018.19.6.1661

 

  1. D’Egidio V, Sestili C, Mancino M, et al. Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review. Qual Life Res. 2017;26(10):2573-2592. doi: 10.1007/s11136-017-1613-6

 

  1. Rueda JR, Sola I, Pascual A, Subirana Casacuberta M. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. Cochrane Database Syst Rev. 2011;2015(2). doi: 10.1002/14651858.cd004282.pub3

 

  1. Mokhtari-Hessari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes. 2020;18(1). doi: 10.1186/s12955-020-01591-x

 

  1. Engel GL. The Need for a New Medical Model: A Challenge for Biomedicine. Science. 1977;196(4286):129-136. doi: 10.1126/science.847460

 

  1. Borrell-Carrio F. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Ann Fam Med. 2004;2(6):576-582. doi: 10.1370/afm.245

 

  1. Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care. 2018;7(3):497. doi: 10.4103/jfmpc.jfmpc_145_17

 

  1. Adebayo-Oke BO, Asuzu CC. Effects of cognitive behavioral therapy and nutritional counseling on the quality of life of patients with breast cancer in the South West, Nigeria. J Psychosoc Oncol Res Pract. 2025;7(2). doi: 10.1097/or9.0000000000000170

 

  1. Gupta K, Attri J, Singh A, Kaur H, Kaur G. Basic concepts for sample size calculation: Critical step for any clinical trials! Saudi J Anaesth. 2016;10(3):328-331. doi: 10.4103/1658-354x.174918

 

  1. Okoli C, Anyanwu SNC, Ochomma AO, et al. Assessing the Quality of Life of Patients with Breast Cancer Treated in a Tertiary Hospital in a Resource‐Poor Country. World J Surg. 2018;43(1):44-51. doi: 10.1007/s00268-018-4772-x

 

  1. Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast qualityof-life instrument. JCO. 1997;15(3):974-986. doi: 10.1200/jco.1997.15.3.974

 

  1. Kugbey N, Oppong Asante K, Meyer-Weitz A. Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer. S Afr J Psychol. 2018;49(3):364-375. doi: 10.1177/0081246318801159

 

  1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x

 

  1. Wu Y, Levis B, Sun Y, et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: systematic review and individual participant data meta-analysis. BMJ. 2021:n972. doi: 10.1136/bmj.n972

 

  1. Annunziata MA, Muzzatti B, Bidoli E, et al. Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients. Support Care Cancer. 2019;28(8):3921-3926. doi: 10.1007/s00520-019-05244-8

 

  1. Boleo-Tome C, Monteiro-Grillo I, Camilo M, Ravasco P. Validation of the Malnutrition Universal Screening Tool (MUST) in cancer. Br J Nutr. 2011;108(2):343-348. doi: 10.1017/s000711451100571x

 

  1. Hettiarachchi J, Madubhashini P, Miller M. Agreement between the Malnutrition Universal Screening Tool and the Patient-Generated Subjective Global Assessment for Cancer Outpatients Receiving Chemotherapy: A Cross-Sectional Study. Nutr Cancer. 2018;70(8):1275-1282. doi: 10.1080/01635581.2018.1539186

 

  1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQC30: A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology. JNCI J Natl Cancer Inst. 1993;85(5):365-376. doi: 10.1093/jnci/85.5.365

 

  1. Guzelant A, Goksel T, Ozkok S, Tasbakan S, Aysan T, Bottomley A. The European Organization for Research and Treatment of Cancer QLQ-C30: an examination into the cultural validity and reliability of the Turkish version of the EORTC QLQ-C30. Eur J Cancer Care. 2004;13(2):135-144. doi: 10.1111/j.1365-2354.2004.00435.x

 

  1. Cankurtaran ES, Ozalp E, Soygur H, Ozer S, Akbiyik DI, Bottomley A. Understanding the reliability and validity of the EORTC QLQ-C30 in Turkish cancer patients. Eur J Cancer Care. 2008;17(1):98-104. doi: 10.1111/j.1365-2354.2007.00827.x

 

  1. Davda J, Kibet H, Achieng E, Atundo L, Komen T. Assessing the acceptability, reliability, and validity of the EORTC Quality of Life Questionnaire (QLQ-C30) in Kenyan cancer patients: a cross-sectional study. J Patient Rep Outcomes. 2021;5(1). doi: 10.1186/s41687-020-00275-w

 

  1. Claudiu-Cristian P, Anamaria-Gabriela I. Tailoring a Multicomponent–Psychotherapy and Dietary–Intervention to Cancer Patient Needs. Procedia Soc Behav Sci. 2015;187:118-123. doi: 10.1016/j.sbspro.2015.03.023

 

  1. Zhu C, Wang B, Gao Y, Ma X. Prevalence and relationship of malnutrition and distress in patients with Cancer using questionnaires. BMC Cancer. 2018;18(1):1272. doi: 10.1186/s12885-018-5176-x

 

  1. Gordon WA, Freidenbergs I, Diller L, et al. Efficacy of psychosocial intervention with cancer patients. J Consult Clin Psychol. 1980;48(6):743.

 

  1. Ma L, Poulin P, Feldstain A, Chasen MR. The Association between Malnutrition and Psychological Distress in Patients with Advanced Head-and-Neck Cancer. Curr Oncol. 2013;20(6):554-560. doi: 10.3747/co.20.1651

 

  1. Sanchez-Torralvo FJ, Contreras-Bolivar V, Ruiz-Vico M, et al. Relationship between malnutrition and the presence of symptoms of anxiety and depression in hospitalized cancer patients. Support Care Cancer. 2021;30(2):1607-1613. doi: 10.1007/s00520-021-06532-y

 

  1. Adebayo-Oke BO, Asuzu CC. A multidisciplinary approach to the enhancement of quality of life of breast cancer patients in the South-west, Nigeria. Eur J Cancer. 2024;200:113665. doi: 10.1016/j.ejca.2024.113665

 

  1. George Taukeni S. Introductory Chapter: Bio-Psychosocial Model of Health. In: Psychology of Health – Biopsychosocial Approach. IntechOpen; 2019. doi: 10.5772/intechopen.85024
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Cancer Plus, Electronic ISSN: 2661-3840 Print ISSN: 2661-3832, Published by AccScience Publishing
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