الفهرس 
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Abstract
Breast cancer is the most common invasive cancer in women, and the second main cause of cancer death among them, after lung cancer. Chemotherapy is the cancer treatment which is most likely to weaken the immune system. The immune system helps to fight cancer and its activation strengthen the effect of chemotherapy. The aim of this study was to evaluate the effect of educational immune enhancement guidelines on clinical outcomes of mastectomy patients undergoing chemotherapy. A quasi-experimental research design was used in this study. It was conducted at the Oncology Center - Mansoura University Hospital. The study sample was a purposive sample of 60 adult female patients, age ranged from ≥20-60 years old, with cancer and scheduled to be treated with adjuvant chemotherapy for the first time after curative surgery and met the sampling criteria. It was divided into 30 subjects in the study group and 30 subjects in the control group, the study group received chemotherapy while having nursing management of chemotherapy side effects and immune enhancement through (diet, exercise, and life style modification as good night sleeping for 6-8 hours, relaxation technique for relieving worry and tension) in addition to the routine hospital care, while the control group received the routine hospital care. The data collected through the following tools: Ι- knowledge assessment structured interview questionnaire, ΙΙ- the Australia – modified Karnofsky performance status scale by Abernethy et al., (2005), III- Piper Fatigue scale by Piper et al., (1998), IV- The quality of life scale by brady et al., (1997) and V- Nutritional and laboratory investigation assessment sheet. The results of this study revealed that after implementing the immune enhancement guidelines for the mastectomy patients undergoing chemotherapy, there was greatly improvement on the study sample quality of life, performance status of usual daily activities, fatigue level, nutritional status and laboratory investigations rather than the control group. This study concluded that, immune enhancement through (diet, exercise, and life style modifications) is effective on the clinical outcomes of mastectomy patients undergoing adjuvant chemotherapy. The study recommends that, providing the mastectomy patients with counseling, periodical educational guidelines, and booklet with all information about immune enhancement is efficient on their clinical outcomes. Also further researches are needed with large sample size for generalization of the results.