Reliability and validatidity of Hospital Anxiety and Depression Scale (HADS) on breast cancer survivors: Malaysia case study

Objective: Cancer survivors may experience psychiatric or psychological disturbances during or after medical treatment, but most of it was under-reported or unrecognized by the health care professionals. Hospital Anxiety and Depression Scale (HADS) is a common and widely used tool for determining psychological distress among cancer population. This study determined the reliability and validity of both Malay and Chinese translated English version of HADS. Method: Malay and Chinese versions of HADS were administered to 150 breast cancer survivors Cronbach’s alpha coefficient and convergent validity was assessed to determine the internal consistency and the validity of the questionnaire. Result: The prevalence of anxiety was 7.3% whereas the prevalence of depression was 4.7%. The internal consistency for the full scale on Malay version was 0.87, for the anxiety subscale was 0.81 and for depression subscale was 0.73. For the scales on Chinese version, the Cronbach’s alpha (α) was 0.81, for the anxiety subscale was 0.67 and for the depression subscale was 0.70. The internal consistency of this study was found to be satisfactory with the α coefficient values of above 0.70, as the recommended values. The correlation coefficient ranged from 0.40 to 0.78 for the anxiety and depression sub- scale for both Malay and Chinese version of HADS, which showed that the correlations between the items of each subscale with its subscale were moderate. Conclusion: The Malay and Chinese version of HADS were reliable and valid instrument in assessing anxiety and depres- sion among breast cancer survivors

Diet and physical activity in relation to weight change among breast cancer patients

Background: This study aimed to provide an overview of lifestyle changes after breast cancer diagnosis and to examine the relationship between dietary and physical activity changes with weight changes in breast cancer patients. Women with breast carcinomas (n=368) were recruited from eight hospitals and four breast cancer support groups in peninsular Malaysia. Dietary and physical activity changes were measured from a year preceding breast cancer diagnosis to study entry. Mean duration since diagnosis was 4.86±3.46 years. Dietary changes showed that majority of the respondents had decreased their intake of high fat foods (18.8-65.5%), added fat foods (28.3-48.9%), low fat foods (46.8-80.7%), red meat (39.7%), pork and poultry (20.1-39.7%) and high sugar foods (42.1-60.9%) but increased their intake of fish (42.7%), fruits and vegetables (62.8%) and whole grains (28.5%). Intake of other food groups remained unchanged. Only a small percentage of the women (22.6%) had increased their physical activity since diagnosis where most of them (16.0%) had increased recreational activities. Age at diagnosis (β= -0.20, p= 0.001), and change in whole grain (β= -0.15, p= 0.003) and fish intakes (β= 0.13, p= 0.013) were associated with weight changes after breast cancer diagnosis. In summary, the majority of the women with breast cancer had changed their diets to a healthier one. However, many did not increase their physical activity levels which could improve their health and lower risk of breast cancer recurrence

Pattern of weight changes in women with breast cancer.

This study describes weight changes experienced by Malaysian women with breast cancer. Women with breast cancer (n=368) were recruited from eight hospitals and four breast cancer support groups in Peninsular Malaysia. Current weight was measured and weight at the time of diagnosis and a year preceding diagnosis were based on self-reports. Change in weight was determined from the year preceding breast cancer diagnosis to study entry (time 1), at the time of diagnosis to study entry (time 2) and from a year preceding breast cancer diagnosis to the time of diagnosis (time 3). Current body mass index, at a year preceding diagnosis and at the time of diagnosis were determined. Waist circumference was also measured. The sample comprised 57% Malay, 34% Chinese and 9.8% Indian women. The mean age of the women was 54 ∓ 9.04 years and over 80% were post-menopausal. Majority of the women were in stage I and stage II breast cancer at the time of diagnosis. The most common treatments received by these women were chemotherapy followed by radiotherapy and mastectomy. Overweight and obesity were prevalent in over 40% of the survivors at all three periods. Significant weight changes were observed during time 1 (-0.74 ∓ 4.78kg, p< 0.001), time 2 (2.73 ∓ 8.06kg, p< 0.001) and time 3 (3.47 ∓ 7.53kg, p< 0.001). At time 1, almost 50% showed no changes in their weight. At time 2, nearly two-thirds had gained weight and at time 3, 69% had gained weight, abdominal obesity was observed in nearly two-thirds of the women at study entry. A significant difference in weight change among age groups was observed in time 2 and time 3. All ethnic groups had significant weight change in time 1 and time 2. Significant weight gain was observed in relation to body mass index prior to diagnosis, at diagnosis and at study entry. However, no significant difference in weight change by educational level, family history of cancer and cancer stages were observed in all 3 periods. In conclusion, significant weight gain was evident in this sample of women after diagnosis of breast cancer and treatment. Women with breast cancer should be encouraged to maintain normal body mass index and waist circumference through appropriate diet and regular physical activity which may help to reduce their risk of recurrence, secondary cancer and metastasis

Weight changes and lifestyle behaviors in women after breast cancer diagnosis: a cross-sectional study

Background: Weight gain rather than weight loss often occurs after breast cancer diagnosis despite breast cancer survivors frequently reported making healthful lifestyle changes. This study describes the prevalence and magnitude of changes in weight before and after breast cancer diagnosis and examines lifestyle behaviors of breast cancer survivors with stable weight, weight gain or weight loss. Methods. Respondents were 368 women with breast cancer characterized by stages I, II and III. All were recruited from hospitals or breast cancer support groups and had completed conventional treatment. Current weight and height were measured while weight at cancer diagnosis and 1 year before diagnosis were self-reported. Weight change was calculated as the difference between current weight and weight a year preceding breast cancer diagnosis. A 24-hour diet recall and Global Physical Activity Questionnaire assessed dietary intake and physical activity, respectively. Differences in lifestyle behaviors among weight change groups were examined using Analysis of Covariance (ANCOVA). Results: Mean weight change from a year preceding diagnosis to study entry was 2.73 kg (95% CI: 1.90-3.55). Most women (63.3%) experienced weight gain rather than weight loss (36.7%) with a higher percentage (47.8%) having at least 5% weight gain (47.8%) rather than weight loss (22%), respectively. Compared to other weight change groups, women in >10% weight gain group had the lowest fruit and vegetable servings (1.58 servings/day; 95% CI: 1.36-1.82) and highest servings of dairy products (0.41 servings/day; 95% CI: 0.30-0.52). Conclusions: Weight gain was evident in this sample of women after breast cancer diagnosis. Information on magnitude of weight change after breast cancer diagnosis and lifestyle behaviors of breast cancer survivors with varying degrees of weight change could facilitate the development and targeting of effective intervention strategies to achieve healthy weight and optimal health for better survival

Psychological distress and associated personal and workplace stressors among breast cancer survivors

The number of women employed at the time of breast cancer diagnosis has risen gradually and most of the survivors were younger than 65 years and the majority would most likely return to work. Working survivors might face social and economic hardship, workplace stress and psychological burdens either individually or with their coworkers or their superiors. Thus, this study will promote a better understanding of the psychological distress experienced by working breast cancer survivors, and to determine associated workplace and personal factors contributing to the psychological distress. Objective: To determine personal and workplace stressors and their associations with psychological distress of working breast cancer survivors. Methodology: This cross-sectional study was conducted at 2 hospitals and 4 support groups. One hundred and fifty breast cancer survivors were recruited. Personal Stress Inventory (PSI) and Job Content Questionnaire (JCQ) were used to determine personal and workplace stressors, respectively. Psychological distress was determined using the Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). Salivary a-amylase assay kit was used to analyze the salivary a-amylase levels, are indicator of psychological distress. Results: The Cronbach's alpha coefficient for the Malay translated version of HADS subscales were better (a = 0.81 for anxiety and a= 0.73 for depression) compared to the Chinese version (a = 0.67 for anxiety and a= 0.70 for depression). The cut-off point of 5 on DT had maximized the balance between sensitivity and specificity rates in detecting the caseness of anxiety, depression and distress. In personal, family and household stressors were significantly associated with anxiety (OR =1.42, p<O.OOl), depression (OR =1.18, p<O.OOl) and distress on both HADS (OR =1.24, p<O.OOl) and DT (OR =1.20, p<O.OOl). For workplace stressors, only job strain was significantly association with anxiety (OR=4.74, p<O.OOl). Psychological job demand was significantly associated with depression (OR =8.08, p<O.OOl) and social support was a protective factor for depression (OR =0.39, p=0.041). Psychological job demand and job strain showed significant associations with distress on both HADS (OR =4.40, p=0.012; OR=6.09, p=0.032) and DT (OR =5.49, p=0.052; OR =3.17, p=0.037). For stress-related symptoms, musculoskeletal system related symptoms (OR =4.21, p=0.003) and sleeping habit and pattern problem (OR =5.24, p=0.002) showed significant association with anxiety. While, work load and task delivery problem is the only stress¬related symptom that showed significant association with depression (OR =3.45, p=0.030). Memory and attention span problem (OR =5.42, p=0.037) and work load and task delivery problem (OR =4.38, p=0.008) showed significant association with distress HADS while musculoskeletal system related symptoms (OR =4.63, p=O.Oll) and rk load and task delivery problem (OR =8.03, p=0.007) showed significant association h distress on DT. Salivary a-amylase showed significant association with anxiety (OR 21, p=0.032), depression (OR =7.78, p=0.002) and distress on HADS (OR =6.48, l.002). Therefore, salivary a-amylase was found to be a potential indicator of chological distress. Conclusion: The Malay and Chinese version of HADS and DT 'e reliable and validated measures. It is clear that most distressed survivors ,experienced anxiety, depression and distress due to both workplace and personal factors. Among all stressors, psychological job demand, job strain and family and household factors, symptoms of musculoskeletal system, sleeping habit and pattern problem, memory and attention span problem and work load and task delivery problem were significant predictors of psychological distress whereas social support served as a protective factor. The salivary a-amylase level was a reliable indicator of psychological distress

Psychological distress among breast cancer survivors: a preliminary study

An estimated of more than 30% of the cancer deaths can be prevented and about 80% of the cancer was due to environmental and lifestyle factors. Many of the study had successfully revealed the association between genetic, lifestyle and nutritional factors with breast cancer. The survivor may also face with some of the psychological distress (e.g., stress, anxiety, fatigue and depression) in their lifetime. The objective of this study was to investigate the association between psychological factors with breast cancer survivorship. DASS questionnaire was used to determine the depression, anxiety and stress level of the respondents. A total of 75 respondents who fulfilled the inclusive criteria were interviewed. They were randomly selected as the intervention and comparative group. The case made up of 35 intervention group while the comparative group made up of 34 survivors. The psychological variables (depression, anxiety and stress) were gathering by using self-reported DASS questionnaire. The majority of respondents were Chinese then followed by Malay and Indian. Majority have education until secondary school. A large number of were married, followed by, single, divorced and divorce. Majority of the respondents were also unemployed (62.2%), diagnose at stage II and had mastectomy, chemotherapy and radiation as a form of treatment. The prevalence of stress was about 44.7 % for the intervention group while only 27.7% for the comparison group. The study showed the existence of depression, stress and anxiety experienced by the respondents. For most of the respondents, they were faced with coexistence of these psychological syndromes. This result will provide some baseline information before the intervention program proceed