The intervention administered in this study was a tele-nursing educational program aimed at improving cancer patients' management of chemotherapy-related symptoms and enhancing their quality of life. The program was delivered via a Telegram group, which provided a platform for regular interaction between the patients and nursing staff. The educational content was designed to address common chemotherapy-related symptoms, such as nausea, fatigue, pain, and loss of appetite, and to provide guidance on managing these symptoms effectively.

The intervention administered in this study was a tele-nursing educational program aimed at improving cancer patients' management of chemotherapy-related symptoms and enhancing their quality of life. The program was delivered via a Telegram group, which provided a platform for regular interaction between the patients and nursing staff. The educational content was designed to address common chemotherapy-related symptoms, such as nausea, fatigue, pain, and loss of appetite, and to provide guidance on managing these symptoms effectively.

The M.D. Anderson Symptom Inventory Arabic Version (MDASI-A), adapted from Nejmi et al. (2010), was utilized to assess the severity of cancer-related and treatment-related symptoms in a manner accessible to Arabic-speaking patients. Designed in straightforward Arabic, the tool evaluates both the intensity of 13 core symptoms commonly experienced by cancer patients and their interference with daily functioning. This makes the MDASI-A comprehensive while remaining brief enough to avoid imposing a burden on respondents.

The MDASI-A employs a 0-2 numerical scale (Never = 0, Sometimes = 1, Always = 2), ensuring its usability even among less-educated individuals. It is also adaptable for telephone, computer, and other electronic methods of administration. Scores were converted to percentages to classify symptom intensity into three categories: low (<50%), average (50% to <75%), and high (≥75%) based on the method proposed by Daisuke and Makoto (2022).

The Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD), adopted from Kurihara et al. (1999), was employed to assess the quality of life (QOL) among patients undergoing anticancer treatment. This questionnaire comprises 22 items distributed across five domains: six items for daily activities, five for physical condition, five for mental and psychological status, five for social activities, and one for general QOL (evaluated via a face scale). Each item was rated on a 5-point scale, with scores ranging from 1 (lowest QOL) to 5 (highest QOL), yielding a total score between 22 and 110; higher scores indicate better QOL.

Patients' responses were classified into three categories based on their scores: good (≤75%), average (50%-<75%), and low (>50%), according to the scoring framework by Saad and Elsayed (2021). Negative statements were reverse scored to align with the Likert scale format, ensuring consistency in the evaluation.