Quality of life (QoL) is one of the treatment outcome measures in patients with breast cancer. In this study, we measured the QoL of women with breast cancer at Universiti Kebangsaan Malaysia Medical ...Centre (UKMMC) and identified the associated factors.
This cross-sectional study was conducted from October 2017 to December 2017 and involved female patients with breast cancer. The QoL scores and domains were determined using the EuroQol EQ-5D-5L, and were presented as the utility value and visual analog scores, respectively.
We recruited a total of 173 women, aged 33-87 years. The median VA score was 80.00 (interquartile range IQR 70.00-90.00); the median utility value was 0.78 (interquartile range IQR 0.65-1.00. Women who did not take traditional medicine had a higher utility index score of 0.092 (95% CI 0.014-0.171), and women with household income of RM3000-5000 had a higher utility index score of 0.096 (95% CI 0.011-0.180).
Traditional medicine consumption and household income were significantly associated with lower QoL. The pain/discomfort domain was the worst affected QoL domain and was related to traditional medicine use and household income. Addressing pain management in patients with breast cancer and the other factors contributing to lower QoL may improve the QoL of breast cancer survivors in the future.
AbstractCholesteatoma and the ensuing chronic inflammation may promote temporal bone tumorigenesis. Our patient is an 80-year-old female who had undergone left ear surgery 72 years prior. She ...presented with a 3-month history of left facial asymmetry associated with otalgia. Patient had been having intermittent discharge from the left ear since her first ear surgery but worsened in the recent 3 months. The patient underwent mastoid exploration. Histopathological study showed no evidence of dysplasia or malignancy. At one-year post surgery, the patient was noted to have soft tissue swelling in the mastoid region which was reported as squamous cell carcinoma. Scans showed extensive disease with possible extradural involvement. Therefore, she was given radical radiotherapy. Chronic ear infection, especially cholesteatoma, may progress to temporal bone malignancy. If the tumour is advanced or the patient’s condition is unfavourable for the surgery, radiotherapy can be a useful modality of treatment.
Background
Chemotherapy-induced nausea vomiting (CINV) is a common and significant problem in oncology patients and rated as one of cancer chemotherapy’s most distressing side effects. The objectives ...of this study are to describe the incidence of CINV in highly and moderately emetogenic chemotherapy-treated patients and the prescribing pattern of CINV prophylaxis.
Methods
This retrospective, cross-sectional single-center study randomly collected data on demographics, CINV episodes, and prescribing patterns for adult oncology patients receiving intravenous highly or moderately emetogenic chemotherapy (HEC/MEC) between January and December 2019.
Results
A total of 419 randomly selected records of HEC/MEC recipients with 2388 total chemotherapy cycles were included. The mean age was 53.6 ± 12.6 years old. The majority was female (66%), Malay (54.4%), diagnosed with cancer stage IV (47.7%), and with no comorbidities (47%). All patients were prescribed with IV granisetron and dexamethasone before chemotherapy for acute prevention, whereas dexamethasone and metoclopramide were prescribed for delayed prevention. Aprepitant was not routinely prescribed for the prevention of CINV. CINV incidence was 57% in the studied population and 20% in the total cycle. This study found a significant association between CINV incidence with performance status and cisplatin-based chemotherapy (OR = 3.071, CI = 1.515–6.223,
p
= 0.002; OR = 4.587, CI = 1.739–12.099,
p
= 0.02, respectively).
Conclusion
CINV incidence was rather high per patient but relatively low per cycle. Most patients were prescribed with dual regimen antiemetic prophylaxis.
Impact
This study provides evidence that there was suboptimal use of recommended agents for CINV, and there is a clear need for further improvements in CINV management.
Most people with cancer have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. Providing good quality cancer-related information enables patients to be better ...prepared for treatment and improves their adherence. This study aimed to determine the level of information received and the perceived usefulness of the sources of information to cancer patients. A 4-month study was conducted at a day care oncology unit and oncology ward of a tertiary care centre in Malaysia using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Information Module (EORTC QLQ-INFO 25). In total, 103 patients successfully completed the questionnaire. Level of information received was moderate. Patients were well-informed about medical tests (mean ± SD = 74.2 ± 17.8) followed by the disease itself (mean ± SD = 68.0 ± 13.6). Patients received less information on both other services (mean ± SD = 47.6 ± 18.1) and different places of care (mean ± SD = 41.3 ± 22.3). Although the correlation between age and level of information received was poor (
r
= − 0.201;
P = .
042), younger patients (≤ 65 years old) were found to have higher level of information received than older patients (mean ± SD = 61.5 ± 11.2 versus 57.8 ± 6.6;
P = .
046). Doctors (mean ± SD = 88.1 ± 17.1), nurses (mean ± SD = 83.7 ± 20.3), and family members (mean ± SD = 81.1 ± 24.9) were the most useful sources of information by cancer patients. There is still a need for improvement in the provision of information by the healthcare team and prioritisation should depend on patients’ individual characteristics and their needs of information. More attention is needed in delivering required information especially to older patients.
The incidence rate of colorectal cancer (CRC) in Asian countries is increasing. Furthermore, recent studies have shown a concerning rise in the incidence of CRC among younger patients aged less than ...50 years. This study aimed to analyze the incidence trends and clinicopathological features in patients with early-onset CRC (EOCRC) and later-onset CRC (at age ≥ 50 years).
A retrospective analysis was performed on 946 patients with CRC diagnosed from 1997 to 2017 at Universiti Kebangsaan Malaysia Medical Centre. The time trend was assessed by dividing the two decades into four 5-year periods. The mean age-standardized and age-specific incidence rates were calculated by using the 5-year cumulative population of Kuala Lumpur and World Health Organization standard population. The mean incidence was expressed per 100,000 person-years.
After a stable (all age groups) CRC incidence rate during the first decade (3.00 per 100,000 and 3.85 per 100,000), it sharply increased to 6.12 per 100,000 in the 2008-2012 period before decreasing to 4.54 per 100,000 in the 2013-2017 period. The CRC incidence trend in later-onset CRC showed a decrease in the 2013-2017 period. Contrariwise, for age groups of 40-44 and 45-49 years, the trends showed an increase in the latter 15 years of the study period (40-44 years: 1.44 to 1.92 to 2.3 per 100,000; 45-49 years: 2.87 to 2.94 to 4.01 per 100,000). Malays' EOCRC incidence rate increased from 2008-2012 to 2013-2017 for both the age groups 40-44 years (1.46 to 2.89 per 100,000) and 45-49 years (2.73 to 6.51 per 100,000). Nearly one-fifth of EOCRC cases were diagnosed at an advanced stage (Dukes D: 19.9%), and the majority of them had rectal cancer (72.8%).
The incidence of EOCRC increased over the period 1997-2017; the patients were predominantly Malays, diagnosed at a later stage, and with cancer commonly localized in the rectal region. All the relevant stakeholders need to work on the management and prevention of CRC in Malaysia.
When given in conjunction with surgery for treating cancer, radiation therapy may result in impaired wound healing, which, in turn, could cause skin ulcers. In this study, bilayer and monolayer ...autologous skin substitutes were used to treat an irradiated wound.
A single dose of 30 Gy of linear electron beam radiation was applied to the hind limb of nude mice before creating the skin lesion (area of 78.6 mm). Monolayer tissue-engineered skin substitutes (MTESSs) were prepared by entrapping cultured keratinocytes in fibrin matrix, and bilayer tissue-engineered skin substitutes (BTESSs) were prepared by entrapping keratinocytes and fibroblasts in separate layers. Bilayer tissue-engineered skin substitute and MTESS were implanted to the wound area. Gross appearance and wound area were analyzed to evaluate wound healing efficiency. Skin regeneration and morphological appearance were observed via histological and electron microscopy. Protein expressions of transforming growth factor β1 (TGF-β1), platelet-derived growth factor BB (PDGF-BB), and vascular endothelial growth factor (VEGF) in skin regeneration were evaluated by immunohistochemistry (IHC).
Macroscopic observation revealed that at day 13, treatments with BTESS completely healed the irradiated wound, whereas wound sizes of 1.1 ± 0.05 and 6.8 ± 0.14 mm were measured in the MTESS-treated and untreated control groups, respectively. Hematoxylin-eosin (H&E) analysis showed formation of compact and organized epidermal and dermal layers in the BTESS-treated group, as compared with MTESS-treated and untreated control groups. Ultrastructural analysis indicates maturation of skin in BTESS-treated wound evidenced by formation of intermediate filament bundles in the dermal layer and low intercellular space in the epidermal layer. Expressions of TGF-β1, PDGF-BB, and VEGF were also higher in BTESS-treated wounds, compared with MTESS-treated wounds.
These results indicate that BTESS is the preferred treatment for irradiated wound ulcers.
Cancer increases the global disease burden substantially, but it remains a challenge to manage it. The search for novel biomarkers is essential for risk assessment, diagnosis, prognosis, prediction ...of treatment response, and cancer monitoring. This paper examined NEDD8 ultimate buster-1 (NUB1) and F-adjacent transcript 10 (FAT10) proteins as novel biomarkers in cancer. This literature review is based on the search of the electronic database, PubMed. NUB1 is an interferon-inducible protein that mediates apoptotic and anti-proliferative actions in cancer, while FAT10 is a ubiquitin-like modifier that promotes cancer. The upregulated expression of both NUB1 and FAT10 has been observed in various cancers. NUB1 protein binds to FAT10 non-covalently to promote FAT10 degradation. An overexpressed FAT10 stimulates nuclear factor-kappa β, activates the inflammatory pathways, and induces the proliferation of cancer. The FAT10 protein interacts with the mitotic arrest deficient 2 protein, causing chromosomal instability and breast tumourigenesis. FAT10 binds to the proliferating cell nuclear antigen protein and inhibits the DNA damage repair response. In addition, FAT10 involves epithelial–mesenchymal transition, invasion, apoptosis, and multiplication in hepatocellular carcinoma. Our knowledge about them is still limited. There is a need to further develop NUB1 and FAT10 as novel biomarkers.
Tuberculosis and undernutrition are the public health concerns of people living in middle and low-income countries. When patient develops TB, undernutrition is not only a risk factor for progression ...of latent TB infection to active disease, but also intensifies the risk of drug toxicity, relapse and death. Nutritional supplementation in patients with TB is associated with faster sputum conversion, higher cure and treatment completion rates, and body-weight gain.
To find out the magnitude of undernutrition and associated factors among adult tuberculosis patients in jigjiga public health facilities.
A facility-based cross-sectional study design was applied. Data were collected using a structured questionnaire while anthropometric measurements were collected in their scale measurements. The data were entered into an Epi-data version 3.1, then were exported and analyzed using SPSS v20. Bivariate logistic regression was done to assess the association between the outcome variable and the independent variables, value <0.25 was considered as a candidate for multivariate logistic regression at 95% CI. In multivariable logistic regression analysis, the level of statistical significance was declared at a p-value less than 0.05.
The magnitude of undernutrition was 44.3% 95% CI (38.2, 49.7). Sex (female) AOR=1.769, CI=1.035, 3.024, educational status AOR=3.939, CI=2.285, 6.792 and being Bedridden AOR=3.718, CI=1.115, 12.394) were predictors of Undernutrition among adult tuberculosis patients.
The magnitude of undernutrition among adult patients with TB was high in the area. Overall routine appropriate nutrition assessment and support should be given to undernourished patients with TB. The level of education about nutrition should be improved by counseling on a balanced diet to all patients with TB and particularly for female patients. Appropriate nutrition support should be provided to undernourished TB patients, and more focused on those who are bedridden.
Clinical management of Asian BRCA1 and BRCA2 pathogenic variants (PV) carriers remains challenging due to imprecise age-specific breast (BC) and ovarian cancer (OC) risks estimates. We aimed to ...refine these estimates using six multi-ethnic studies in Asia.
Data were collected on 271 BRCA1 and 301 BRCA2 families from Malaysia and Singapore, ascertained through population/hospital-based case-series (88%) and genetic clinics (12%). Age-specific cancer risks were estimated using a modified segregation analysis method, adjusted for ascertainment.
BC and OC relative risks (RRs) varied across age groups for both BRCA1 and BRCA2. The age-specific RR estimates were similar across ethnicities and country of residence. For BRCA1 carriers of Malay, Indian and Chinese ancestry born between 1950 and 1959 in Malaysia, the cumulative risk (95% CI) of BC by age 80 was 40% (36%–44%), 49% (44%–53%) and 55% (51%–60%), respectively. The corresponding estimates for BRCA2 were 29% (26–32%), 36% (33%–40%) and 42% (38%–45%). The corresponding cumulative BC risks for Singapore residents from the same birth cohort, where the underlying population cancer incidences are higher compared to Malaysia, were higher, varying by ancestry group between 57 and 61% for BRCA1, and between 43 and 47% for BRCA2 carriers. The cumulative risk of OC by age 80 was 31% (27–36%) for BRCA1 and 12% (10%–15%) for BRCA2 carriers in Malaysia born between 1950 and 1959; and 42% (34–50%) for BRCA1 and 20% (14–27%) for BRCA2 carriers of the same birth cohort in Singapore. There was evidence of increased BC and OC risks for women from >1960 birth cohorts (p-value = 3.6 × 10−5 for BRCA1 and 0.018 for BRCA2).
The absolute age-specific cancer risks of Asian carriers vary depending on the underlying population-specific cancer incidences, and hence should be customised to allow for more accurate cancer risk management.
Wellcome Trust grant no: v203477/Z/16/Z; CRUK (PPRPGM-Nov20∖100002).
This study investigated breast cancer patients' involvement level in the treatment decision-making process and the concordance between patients' and physician's perspectives in decision-making.
A ...cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients' involvement in treatment decision-making, and patients' preference for behavioral involvement and information related to their disease.
The majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient-physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range IQR =3-5) and 2 (IQR =2-3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients' preferred role in the process of treatment decision-making and the patients' preference for information seeking (
>0.05). However, only educational qualification (
=0.004) was significantly associated with patients' preference for information seeking in multivariate analysis.
Physicians failed to understand patients' perspectives and preferences in treatment decision-making. The concordance between physicians' perception and patients' perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.
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