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NCT01772472 · OUTCOME

Change From Baseline in EORTC Quality of Life Questionnaire - Breast Cancer (QLQ-BR23)

A Study of Trastuzumab Emtansine Versus Trastuzumab as Adjuvant Therapy in Patients With HER2-Positive Breast Cancer Who Have Residual Tumor in the Breast or Axillary Lymph Nodes Following Preoperative Therapy (KATHERINE) · Source last updated 2025-07-22

Results reported by the registry submitting party. Population, time horizon, units and missing values must be read together.

Measure: MEAN
Unit: score on a scale
Interval / dispersion: Standard Deviation
Time frame: Baseline, Cycles 5 &11, Follow-up (FU) Month 6, FU Month 12 (1 cycle = 21 days)

What was measured

EORTC-QLQ-BR23 is a 23-item breast cancer-specific companion module to the EORTC-QLQ-C30 and consists of four functional scales (body image, sexual enjoyment, sexual functioning, future perspective \[FP\]) and four symptom scales (systemic side effects \[SE\], upset by hair loss, arm symptoms, breast symptoms). Questions used 4-point scale (1=not at all, 2=a little, 3=quite a bit, 4=very much). Obtained scores are linearly transformed to a score range of 0-100. High score for functional scale indicated high/better level of functioning/healthy functioning. Higher scores for symptom scales represent higher levels of symptoms/problems. For functional scales, positive change from baseline indicated deterioration in QOL and negative change from baseline indicated an improvement in QOL. For symptom scales, positive change from baseline indicated an improvement in QOL and negative change from baseline indicated a deterioration in QOL.

Analysis population: ITT population included all participants who were randomized to the study regardless of whether they received any study treatment. Overall number analyzed is the number of participants with data available for analysis. Number analyzed per timepoint are unique number of participants out of all the assessed participants with data available for analysis at the specified timepoint. Different participants may have contributed data for each timepoint.

Groups in this outcome

Trastuzumab

Participants received trastuzumab, 6 mg/kg, IV, Q3W, as a maintenance dose for 14 cycles (1 cycle = 21 days) or until disease recurrence or unacceptable toxicity which ever occurs first.

Trastuzumab Emtansine

Participants received trastuzumab emtansine, 3.6 mg/kg, IV, Q3W for 14 cycles (1 cycle = 21 days) or until disease recurrence or unacceptable toxicity which ever occurs first.

Group identifiers and denominators belong to this outcome only. They may differ in another outcome or in safety reporting.

Analysis denominator · Participants

Group	Source count
Trastuzumab	743
Trastuzumab Emtansine	743

Reported measurements

Baseline: Body Image

Analysis denominator · Participants

Group	Source count
Trastuzumab	622
Trastuzumab Emtansine	645

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	69.8	28.5	Not reported	Not reported	Not reported
Trastuzumab Emtansine	67.5	28.5	Not reported	Not reported	Not reported

Change at Cycle 5: Body Image

Analysis denominator · Participants

Group	Source count
Trastuzumab	555
Trastuzumab Emtansine	571

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	1.5	20.5	Not reported	Not reported	Not reported
Trastuzumab Emtansine	4.6	22.7	Not reported	Not reported	Not reported

Change at Cycle 11: Body Image

Analysis denominator · Participants

Group	Source count
Trastuzumab	493
Trastuzumab Emtansine	495

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	3.4	24.4	Not reported	Not reported	Not reported
Trastuzumab Emtansine	5.7	23.9	Not reported	Not reported	Not reported

Change at FU Month 6: Body Image

Analysis denominator · Participants

Group	Source count
Trastuzumab	409
Trastuzumab Emtansine	462

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	3.6	25.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	7.8	25.8	Not reported	Not reported	Not reported

Change at FU Month 12: Body Image

Analysis denominator · Participants

Group	Source count
Trastuzumab	383
Trastuzumab Emtansine	428

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	6.2	27.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	6.1	27.2	Not reported	Not reported	Not reported

Baseline: FP

Analysis denominator · Participants

Group	Source count
Trastuzumab	622
Trastuzumab Emtansine	645

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	51.3	31.2	Not reported	Not reported	Not reported
Trastuzumab Emtansine	50.1	31.7	Not reported	Not reported	Not reported

Change at Cycle 5: FP

Analysis denominator · Participants

Group	Source count
Trastuzumab	555
Trastuzumab Emtansine	571

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	2.6	28.3	Not reported	Not reported	Not reported
Trastuzumab Emtansine	6.5	29.9	Not reported	Not reported	Not reported

Change at Cycle 11: FP

Analysis denominator · Participants

Group	Source count
Trastuzumab	493
Trastuzumab Emtansine	495

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	6.3	30.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	6.1	31.4	Not reported	Not reported	Not reported

Change at FU Month 6: FP

Analysis denominator · Participants

Group	Source count
Trastuzumab	409
Trastuzumab Emtansine	462

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	7.7	33.5	Not reported	Not reported	Not reported
Trastuzumab Emtansine	8.1	34.6	Not reported	Not reported	Not reported

Change at FU Month 12: FP

Analysis denominator · Participants

Group	Source count
Trastuzumab	383
Trastuzumab Emtansine	428

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	8.1	31.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	8.2	33.0	Not reported	Not reported	Not reported

Baseline: Sexual Enjoyment

Analysis denominator · Participants

Group	Source count
Trastuzumab	218
Trastuzumab Emtansine	241

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	50.9	28.8	Not reported	Not reported	Not reported
Trastuzumab Emtansine	52.3	28.5	Not reported	Not reported	Not reported

Change at Cycle 5: Sexual Enjoyment

Analysis denominator · Participants

Group	Source count
Trastuzumab	147
Trastuzumab Emtansine	172

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	2.3	26.4	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-1.9	24.6	Not reported	Not reported	Not reported

Change at Cycle 11: Sexual Enjoyment

Analysis denominator · Participants

Group	Source count
Trastuzumab	128
Trastuzumab Emtansine	137

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	4.4	27.5	Not reported	Not reported	Not reported
Trastuzumab Emtansine	4.4	24.5	Not reported	Not reported	Not reported

Change at FU Month 6: Sexual Enjoyment

Analysis denominator · Participants

Group	Source count
Trastuzumab	104
Trastuzumab Emtansine	126

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	3.2	28.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	0.3	27.5	Not reported	Not reported	Not reported

Change at FU Month 12: Sexual Enjoyment

Analysis denominator · Participants

Group	Source count
Trastuzumab	95
Trastuzumab Emtansine	114

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	5.6	26.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	1.8	26.2	Not reported	Not reported	Not reported

Baseline: Sexual Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	550
Trastuzumab Emtansine	564

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	20.2	23.6	Not reported	Not reported	Not reported
Trastuzumab Emtansine	22.0	23.4	Not reported	Not reported	Not reported

Change at Cycle 5: Sexual Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	456
Trastuzumab Emtansine	466

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	3.3	20.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	2.3	20.0	Not reported	Not reported	Not reported

Change at Cycle 11: Sexual Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	393
Trastuzumab Emtansine	382

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	3.1	20.8	Not reported	Not reported	Not reported
Trastuzumab Emtansine	1.9	20.3	Not reported	Not reported	Not reported

Change at FU Month 6: Sexual Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	321
Trastuzumab Emtansine	360

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	5.1	23.9	Not reported	Not reported	Not reported
Trastuzumab Emtansine	4.3	23.1	Not reported	Not reported	Not reported

Change at FU Month 12: Sexual Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	289
Trastuzumab Emtansine	319

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	5.9	23.7	Not reported	Not reported	Not reported
Trastuzumab Emtansine	5.2	22.7	Not reported	Not reported	Not reported

Baseline: Arm Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	622
Trastuzumab Emtansine	645

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	24.6	21.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	24.5	21.0	Not reported	Not reported	Not reported

Change at Cycle 5: Arm Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	555
Trastuzumab Emtansine	571

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-2.8	20.9	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-2.6	23.0	Not reported	Not reported	Not reported

Change at Cycle 11: Arm Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	493
Trastuzumab Emtansine	495

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-2.6	21.2	Not reported	Not reported	Not reported
Trastuzumab Emtansine	0.2	24.2	Not reported	Not reported	Not reported

Change at FU Month 6: Arm Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	409
Trastuzumab Emtansine	462

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-3.0	23.5	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-1.3	24.2	Not reported	Not reported	Not reported

Change at FU Month 12: Arm Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	383
Trastuzumab Emtansine	428

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-5.7	22.8	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-1.5	22.6	Not reported	Not reported	Not reported

Baseline: Breast Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	622
Trastuzumab Emtansine	645

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	22.7	19.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	21.4	17.9	Not reported	Not reported	Not reported

Change at Cycle 5: Breast Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	555
Trastuzumab Emtansine	571

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-1.1	20.3	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-1.1	19.1	Not reported	Not reported	Not reported

Change at Cycle 11: Breast Symptoms

Analysis denominator · Participants

Group	Source count
Trastuzumab	493
Trastuzumab Emtansine	495

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-3.7	19.8	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-0.6	19.5	Not reported	Not reported	Not reported

Change at FU Month 6: Breast Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	409
Trastuzumab Emtansine	462

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-6.5	20.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-2.2	19.7	Not reported	Not reported	Not reported

Change at Follow-up Month 12: Breast Function

Analysis denominator · Participants

Group	Source count
Trastuzumab	383
Trastuzumab Emtansine	428

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-8.3	19.9	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-3.8	19.2	Not reported	Not reported	Not reported

Baseline: Systemic Therapy Side Effects (SE)

Analysis denominator · Participants

Group	Source count
Trastuzumab	622
Trastuzumab Emtansine	645

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	16.7	13.7	Not reported	Not reported	Not reported
Trastuzumab Emtansine	16.9	14.1	Not reported	Not reported	Not reported

Change at Cycle 5: Systemic Therapy SE

Analysis denominator · Participants

Group	Source count
Trastuzumab	555
Trastuzumab Emtansine	571

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	0.7	13.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	5.5	15.3	Not reported	Not reported	Not reported

Change at Cycle 11: Systemic Therapy SE

Analysis denominator · Participants

Group	Source count
Trastuzumab	493
Trastuzumab Emtansine	495

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	1.2	12.2	Not reported	Not reported	Not reported
Trastuzumab Emtansine	4.2	15.4	Not reported	Not reported	Not reported

Change at FU Month 6: Systemic Therapy SE

Analysis denominator · Participants

Group	Source count
Trastuzumab	409
Trastuzumab Emtansine	462

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	1.9	13.9	Not reported	Not reported	Not reported
Trastuzumab Emtansine	1.1	15.3	Not reported	Not reported	Not reported

Change at FU Month 12: Systemic Therapy SE

Analysis denominator · Participants

Group	Source count
Trastuzumab	383
Trastuzumab Emtansine	428

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	1.3	13.9	Not reported	Not reported	Not reported
Trastuzumab Emtansine	1.4	16.3	Not reported	Not reported	Not reported

Baseline: Upset by Hair Loss Item

Analysis denominator · Participants

Group	Source count
Trastuzumab	77
Trastuzumab Emtansine	96

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	40.3	35.6	Not reported	Not reported	Not reported
Trastuzumab Emtansine	50.7	38.4	Not reported	Not reported	Not reported

Change at Cycle 5: Upset by Hair Loss Item

Analysis denominator · Participants

Group	Source count
Trastuzumab	13
Trastuzumab Emtansine	17

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-5.1	38.1	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-17.6	39.3	Not reported	Not reported	Not reported

Change at Cycle 11: Upset by Hair Loss Item

Analysis denominator · Participants

Group	Source count
Trastuzumab	14
Trastuzumab Emtansine	14

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-28.6	45.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-14.3	33.9	Not reported	Not reported	Not reported

Change at FU Month 6: Upset by Hair Loss Item

Analysis denominator · Participants

Group	Source count
Trastuzumab	25
Trastuzumab Emtansine	22

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-12.0	47.0	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-15.2	42.1	Not reported	Not reported	Not reported

Change at FU Month 12: Upset by Hair Loss Item

Analysis denominator · Participants

Group	Source count
Trastuzumab	23
Trastuzumab Emtansine	21

Values in score on a scale · Interval/dispersion: Standard Deviation
Group	Value	Spread	Lower	Upper	Comment
Trastuzumab	-2.9	37.5	Not reported	Not reported	Not reported
Trastuzumab Emtansine	-14.3	41.6	Not reported	Not reported	Not reported

Complete source fields

classes

categories
measurements
group Id
OG000
spread
28.5
value
69.8
group Id
OG001
spread
28.5
value
67.5
denoms
counts
group Id
OG000
value
622
group Id
OG001
value
645
units
Participants
title
Baseline: Body Image
categories
measurements
group Id
OG000
spread
20.5
value
1.5
group Id
OG001
spread
22.7
value
4.6
denoms
counts
group Id
OG000
value
555
group Id
OG001
value
571
units
Participants
title
Change at Cycle 5: Body Image
categories
measurements
group Id
OG000
spread
24.4
value
3.4
group Id
OG001
spread
23.9
value
5.7
denoms
counts
group Id
OG000
value
493
group Id
OG001
value
495
units
Participants
title
Change at Cycle 11: Body Image
categories
measurements
group Id
OG000
spread
25.1
value
3.6
group Id
OG001
spread
25.8
value
7.8
denoms
counts
group Id
OG000
value
409
group Id
OG001
value
462
units
Participants
title
Change at FU Month 6: Body Image
categories
measurements
group Id
OG000
spread
27.1
value
6.2
group Id
OG001
spread
27.2
value
6.1
denoms
counts
group Id
OG000
value
383
group Id
OG001
value
428
units
Participants
title
Change at FU Month 12: Body Image
categories
measurements
group Id
OG000
spread
31.2
value
51.3
group Id
OG001
spread
31.7
value
50.1
denoms
counts
group Id
OG000
value
622
group Id
OG001
value
645
units
Participants
title
Baseline: FP
categories
measurements
group Id
OG000
spread
28.3
value
2.6
group Id
OG001
spread
29.9
value
6.5
denoms
counts
group Id
OG000
value
555
group Id
OG001
value
571
units
Participants
title
Change at Cycle 5: FP
categories
measurements
group Id
OG000
spread
30.0
value
6.3
group Id
OG001
spread
31.4
value
6.1
denoms
counts
group Id
OG000
value
493
group Id
OG001
value
495
units
Participants
title
Change at Cycle 11: FP
categories
measurements
group Id
OG000
spread
33.5
value
7.7
group Id
OG001
spread
34.6
value
8.1
denoms
counts
group Id
OG000
value
409
group Id
OG001
value
462
units
Participants
title
Change at FU Month 6: FP
categories
measurements
group Id
OG000
spread
31.1
value
8.1
group Id
OG001
spread
33.0
value
8.2
denoms
counts
group Id
OG000
value
383
group Id
OG001
value
428
units
Participants
title
Change at FU Month 12: FP
categories
measurements
group Id
OG000
spread
28.8
value
50.9
group Id
OG001
spread
28.5
value
52.3
denoms
counts
group Id
OG000
value
218
group Id
OG001
value
241
units
Participants
title
Baseline: Sexual Enjoyment
categories
measurements
group Id
OG000
spread
26.4
value
2.3
group Id
OG001
spread
24.6
value
-1.9
denoms
counts
group Id
OG000
value
147
group Id
OG001
value
172
units
Participants
title
Change at Cycle 5: Sexual Enjoyment

denoms

counts
group Id
OG000
value
743
group Id
OG001
value
743
units
Participants

description

EORTC-QLQ-BR23 is a 23-item breast cancer-specific companion module to the EORTC-QLQ-C30 and consists of four functional scales (body image, sexual enjoyment, sexual functioning, future perspective \[FP\]) and four symptom scales (systemic side effects \[SE\], upset by hair loss, arm symptoms, breast symptoms). Questions used 4-point scale (1=not at all, 2=a little, 3=quite a bit, 4=very much). Obtained scores are linearly transformed to a score range of 0-100. High score for functional scale indicated high/better level of functioning/healthy functioning. Higher scores for symptom scales represent higher levels of symptoms/problems. For functional scales, positive change from baseline indicated deterioration in QOL and negative change from baseline indicated an improvement in QOL. For symptom scales, positive change from baseline indicated an improvement in QOL and negative change from baseline indicated a deterioration in QOL.

dispersion Type

Standard Deviation

groups

description
Participants received trastuzumab, 6 mg/kg, IV, Q3W, as a maintenance dose for 14 cycles (1 cycle = 21 days) or until disease recurrence or unacceptable toxicity which ever occurs first.
id
OG000
title
Trastuzumab
description
Participants received trastuzumab emtansine, 3.6 mg/kg, IV, Q3W for 14 cycles (1 cycle = 21 days) or until disease recurrence or unacceptable toxicity which ever occurs first.
id
OG001
title
Trastuzumab Emtansine

param Type

MEAN

population Description

ITT population included all participants who were randomized to the study regardless of whether they received any study treatment. Overall number analyzed is the number of participants with data available for analysis. Number analyzed per timepoint are unique number of participants out of all the assessed participants with data available for analysis at the specified timepoint. Different participants may have contributed data for each timepoint.

reporting Status

POSTED

time Frame

Baseline, Cycles 5 &11, Follow-up (FU) Month 6, FU Month 12 (1 cycle = 21 days)

title

Change From Baseline in EORTC Quality of Life Questionnaire - Breast Cancer (QLQ-BR23)

type

SECONDARY

unit Of Measure

score on a scale

Download exact source JSON → · Snapshot ctgov-results-191f4516d4760045304b24a0

Preserved source evidence · Not medical advice