Diagnosis delay of breast cancer and its associated factors in Malaysian women

<p>Abstract</p> <p>Background</p> <p>Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia.</p> <p>Methods</p> <p>This study had a cross-sectional design. Respondents had histologically confirmed breast cancer and were registered at five medical centres between 2005 and 2007. All breast cancer patients who attended hospital clinics at the East Coast were included. Patients at Kuala Lumpur hospitals were selected by systematic sampling. A standardised questionnaire was developed to interview respondents. We measured the time from the first recognition of symptoms to the first general practitioners' consultation and to the histological diagnosis of breast cancer. Diagnosis delay was defined when there was more than 6 months from the recognition of symptoms to the histological diagnosis. Multiple logistic regression was used for analysis.</p> <p>Results</p> <p>In total, 328 respondents were included. The mean (standard deviation) age was 47.9 (9.4) years. Most respondents were of Malay ethnicity, were married housewives with a median family income of RM1500 a month. Most respondents had ductal carcinoma (89.3%) and the stage distribution was as follows: 5.2% stage I, 38.7% stage II, 44.8% stage III and 11.3% stage IV. The median time to consultation was 2 months and the median time to diagnosis was 5.5 months. The frequency of diagnosis delay of more than 3 months was 72.6% and delay of more than 6 months occurred in 45.5% of the cases. The factors associated with diagnosis delay included the use of alternative therapy (odds ratio (OR) 1.77; 95% confidence interval (CI): 1.06, 2.94), breast ulcer (OR 5.71; 95% CI: 1.59, 20.47), palpable axillary lymph nodes (OR 2.19; 95% CI: 1.23, 3.90), false-negative diagnostic test (OR 5.32; 95% CI: 2.32, 12.21), non-cancer interpretation (OR 1.68; 95% CI: 1.01, 2.78) and negative attitude toward treatment (OR 2.09; 95% CI: 1.15, 3.82).</p> <p>Conclusions</p> <p>Delays in consultation and diagnosis are serious problems in Malaysia. Diagnosis delay was influenced by complex interactions between many factors. Breast awareness and education are required to promote early detection, diagnosis and treatment before the tumours enlarge and metastasis.</p

Complementary and alternative medicine in cancer: perspectives of patients and health professionals

Martin Keene investigated Complementary and Alternative Medicines in Oncology in Australia. He found that Health Professionals' limited knowledge negatively impacted discussions with their cancer patients to ensure the safe use of these therapies. This research provides valuable guidance on future education to facilitate integration of these therapies into hospital practice

Fusion, 2021

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1013/thumbnail.jp

META-REGRESSION: PROGNOSTIC MODELS AS OBJECTIVE PREDICTORS OF MORTALITY AMONG ICU CANCER PATIENTS

Cancer patients admitted to the intensive care unit (ICU) may be experiencing complications of disease or treatment-related effects. While acute complications related to disease and/or its therapeutic management vary in severity, the approach to ICU-centered care is complicated by actual versus perceived risks of poor outcomes. Prognostic models that inform clinical judgment of nurses and physicians may prove helpful in this population. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) are ICU-based models predicting 30-day mortality among the general ICU population. Although studies have been published on use of each model, prognostic accuracy for predicting 30-day, all-cause ICU mortality in the cancer population has yielded mixed results. The purpose of this study was to determine which prognostic model demonstrated greatest prognostic accuracy among oncology patients. Framed within a derived Prognostic Framework, a meta-analysis of prospective and retrospective cohort studies using literature searches of CINAHL, Cochrane, PubMed and Web of Science databases spanning 2000 to 2017 timeframe was performed. Meta-regression with a random-effects model was used to summarize area under the receiver-operating characteristic curves (AUCs) to estimate overall predictive accuracy for the APACHE II, SAPS II, and SOFA. After comparing performances, APACHE II demonstrated greatest predictive accuracy

Dietary habits, commensal microbiome, and nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is a malignant disease characterized by unique geographic distribution endemic to southern China, Southeast Asia, and the Middle East/North Africa. It has been widely accepted that the interaction of Epstein-Barr Virus infection, environmental and lifestyle factors, and genetic susceptibility, contributes to NPC carcinogenesis. In the past two decades, extensive application of intensity-modulated radiotherapy and widespread introduction of chemotherapy have significantly contributed to a desirable prognosis: better survival with fewer toxicities. However, there are still numerous knowledge gaps and unsolved questions about NPC risk and prognosis. In this thesis, we investigated whether dietary habits (Study I), and oral commensal microbiome (Study II) were associated with NPC risk, using a population-based case-control study in endemic southern China. We also conducted a longitudinal hospital-based NPC cohort study (Study III) to deliver proof-of-concept data on the commensal microbiome patterns in patients’ nasopharynx during radiotherapy and their role in NPC prognosis. In Study I/Paper I, we analyzed a total of 4398 study participants (2174 NPC cases and 2224 controls) with data about adolescent diet and 4832 participants (2387 NPC cases and 2445 controls) with data about adulthood diet. We demonstrated a strong positive association between higher consumption of the “animal-foods-based diet” and NPC risk and a strong negative association with higher intake of the “plant-based diet”. Following mutual adjustment for adolescence and adulthood dietary patterns, risk estimates for the former were attenuated and no longer statistically significant, whereas associations with adulthood dietary patterns remained virtually unchanged. In Study II/Paper II, we explored the relationship between NPC status and the oral microbiome using 16S rRNA sequencing in a study of 994 participants (499 NPC cases, 494 controls). We observed a significant reduction in community richness in NPC cases compared to that in controls. We also identified a pair of Granulicatella adiacens amplicon sequence variants (ASVs; Gran-7770 and Gran-5a37), which were strongly associated with NPC status and differed by a single nucleotide. We further revealed that Gran-7770 and Gran-5a37 each formed co-occurring nodes with a dozen ASVs, which were exclusive. These results suggest differences in the oral microbiomes between NPC patients and controls, which may be associated with both a loss of microbial diversity and niche specialization among closely related microorganisms. In Study III/Paper III, we analyzed 445 nasopharyngeal samples longitudinally collected from 39 NPC patients during radiotherapy-based treatment. We addressed stable, temporal changes in the nasopharyngeal microbial community structure among NPC patients during treatment. These changes were associated with patients’ short-term clinical outcomes measured three months after the completion of radiotherapy. We also identified 23 out of 73 abundant ASVs that showed statistically significant changes in the ratio of abundance between early and late responders throughout treatment. These results provided evidence of an association between nasopharyngeal commensal microbiome and NPC patients’ short-term clinical outcome. By studying a range of topics, this thesis provides more insights into NPC in terms of risk and prognosis: plant-based and animal-foods-based diets are differentially associated with NPC risk in endemic southern China, suggesting a possibility of primary prevention of NPC through dietary intervention; oral microbiome is associated with NPC risk; the niche specialization among closely related commensals associated with NPC status calls for future culture-based investigations; moreover, stable, temporal changes of the nasopharyngeal microbiome are associated with NPC patients’ short-term clinical outcome, which calls for more extensive longitudinal studies with long-term follow-up for verification and serves as a base of generating new hypotheses for future studies

Predicting Fluid Adherence in Hemodialysis Patients via the Illness Perception Questionaire - Revided

The Illness Perception Questionnaire - Revised (IPQ - R; Moss-Morris, Weinman, Petrie, Horne, Cameron, & Buick, 2002) was utilized in the current research to better understand and predict fluid adherance in hemodialysis patients. A sample of patients was recruited from three hemodialysis centers in the Los Angeles area and 116 participants completed the Illness Perception Questionnaire - Revised

Predicting normal tissue toxicity in radiotherapy : can we improve clinical decision-making?

Variation exists between individuals in the severity of their normal tissue response to radiotherapy. This can broadly be related to radiation dosimetric variables, adjuvant cancer treatments and factors inherent to the patient, including genetics. In this PhD research, factors were identified that influence the development of acute toxicity in breast and prostate cancer patients. In addition, integrated prediction models, including genetics, were developed that are able to predict which cancer patients are most likely to develop late urinary toxicity in prostate cancer patients

A new prognostic scale for the early prediction of ischemic stroke recovery mainly based on traditional Chinese medicine symptoms and NIHSS score: a retrospective cohort study

TCM symptoms & signs with appearance rate no less than 5 %. In practical analysis we selected 57 TCM symptoms with the appearance rate ≥5 % from 157 TCM symptoms& signs except tongue and pulse. (CSV 1 kb