This study is one of the few studies exploring the QoL of Emirati women with BC, and it revealed that Emirati women survivors of BC have good QoL and functioning but worse symptom experience. The most worrying symptoms for Emirati women were sleep disturbance, fatigue, and pain. A history of metastases and chemotherapy had a major effect across the domains of QoL in Emirati women.
Similarly, on the specific disease tool QLQ-BR23, the Emirati women seemed to perform above average to very good on the functional domains and poorly on the symptom scales. The most worrying symptoms were upset by hair loss and arm symptoms.
4.1 Comparison with Previous Literature
The mean global health/QoL of Emirati women with BC was higher (74.73) than that of other women in the Gulf Corporate Council (GCC). For example, the mean global health score was 63.9 in Bahrain , 64 and 67.45 in the KSA [24, 25], and 45.3 in Kuwait . This variability could be attributed to different study populations, different tools used to measure the outcome, different sampling techniques and different times elapsed since diagnosis.
Emirati women seemed to perform well on the five functional scales, with means ranging from 68.43 to 82.33, showing mostly a good level of functional health status. Social functioning scored the highest among Emirati women, which was similar to Bahraini, Saudi, and Kuwaiti women. Emotional functioning scored the lowest among Emirati women, which was similar to Bahraini women , but different from Kuwaiti and Saudi women, who scored lowest in physical functioning [25, 26]. Emirati women had good functioning, with only 5.6–12.4% having problematic functioning on the functional scales, which was similar to Kuwaiti women (5.8–11.8%)  but better than Bahraini women (3.8–21.8%) .
Emirati women did worse on the symptom scales, as they scored higher on all symptom scales except financial impact. Indeed, while 1.7–17% of Bahraini women  were found to have had bad symptom experience, this figure was 8.8–45.6% for Emirati women.
Regarding financial impact, Emirati women were much better off than other Arab women in the region, with a score of 9.2, which is much lower than the scores of Bahraini women (34.58), Kuwaiti women (31.2), and Saudi women (17.13). This could be attributed to the fact that healthcare in the UAE is known to be among some of the finest in the world, offering a high standard of medical care in state-of-the art facilities. Healthcare facilities are run by the Dubai Health Authority (DHA), which oversees both public and private healthcare and replaces the Department of Health and Medical Services . Health insurance is mandatory for all nationals and UAE residents. For UAE nationals, public hospitals and clinics are low-cost to free.
The most worrying symptom for Emirati women was sleep disturbance, followed by fatigue and pain, which was similar to studies on women in Bahrain, Kuwait and Saudi Arabia [23, 25, 26].
In accordance with the results from the QoL general scale, on the disease-specific scales (QLQ-BR23), Emirati women were above average to very good on the functional scales and poor on the symptom scales, as 12.4–40% had bad experience with BC symptoms, which was slightly similar to Kuwaiti women (6.7–40.8%),  but worse than Bahraini women (1.7–14.2%)  and Saudi women (9.5–26.8%) 
Among functional scales, sexual functioning scored the highest among Emirati women, which indicates better functioning. This was similar to Kuwaiti women but contrary to Bahraini and Saudi women, who scored the lowest. This finding should be interpreted with caution, as sexual functioning and enjoyment were perceived and approached differently in various studies due to the sensitivity of the topic and the conservative nature of the community. This scale showed the lowest reliability in a study investigating the reliability and validity of the Arabic versions of the EORTC QLQ-C30 and QLQ-BR23 questionnaires and had to be removed from the reliability analysis because of the very low coefficient values .
For Emirati women with BC, the most worrying symptom was upset by hair loss, followed by arm symptoms, which was similar to all other Arab women in the region [23–26, 29, 30]. These topics should be given special care and attention. Physiotherapy and hair care options should be discussed and included in the comprehensive rehabilitation care provided to patients.
4.2 Factors Associated with Quality-of-Life Scores
The results of the study indicated associations between global health/QoL and monthly income, physical activity, history of metastases, and chemotherapy. Emirati women who had regular physical activity, had high income, had no history of metastases, and were not treated with chemotherapy seemed to have better global health-related QoL. Age was not associated with global health/QoL, which was similar to what was found in Bahraini , Kuwaiti , and Saudi women .
Women who were younger, were employed, were premenopausal, were single, had low income, had undergone chemotherapy or dissection and were highly educated seemed to have poorer body image. Therefore, although doing better on the physical side, younger women did worse on the emotional and body image scales. This is in line with the literature illustrating body image and sexuality issues as disturbing potential consequences of treatment for younger women with BC in particular . Furthermore, monthly income was the only predictor that had a significant effect on global health/QoL given the other predictors in the regression model.
Our study indicated that Emirati women with BC experience problems in some of the QOL domains, and further research in this direction is recommended, especially in the emotional domain, to understand how better this domain could be evaluated and managed among Emirati women with special consideration of cultural sensitivity.
The study highlighted important aspects of the disease, such as side effects of the treatment and the need to explain them to patients along with ways of coping and adjustment.
Furthermore, we recommend that special attention be given to women with metastatic history, as the impact on their QoL is substantial.
This study has several strengths, such as the random sampling method, the use of validated tools to measure the outcome, and the use of a standardized score for analysis; most importantly, it is one of the few studies that included Emirati women with BC as participants. This study also has few limitations, such as that the generalization of the results is limited to patients attending the two hospitals of the study population and that the response rate among the two study locations was variable.