Factors Influencing Late Consultation Among Patients with Rectal Bleeding in University Kebangsaan Malaysia Medical Centre

Background: Patients’ delay in the presentation with rectal bleeding had been identified as a factor for latediagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting amedical practitioner and identifying associated factors. Materials and Methods: A cross-sectional study of 80patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 inthe endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaireincluded data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any selftreatment prior to medical consultation and patients’ opinion on causes of their own rectal bleeding. Results:The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6;95% CI 3.3-27.5), who did not seek anyone’s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment beforeseeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logisticregression revealed that less worry of rectal bleeding and not seeking anyone’s advice were important predictors(p < 0.05). The majority of patients attributed their bleeding to benign causes. Conclusion: A high proportion ofpatients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needsto focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.     

Colorectal Carcinoma in Malaysians: DNA Mismatch Repair Pattern in a Multiethnic Population

Background: The interesting preponderance of Chinese with colorectal carcinoma (CRC) amongst the threemajor ethnic groups in Malaysia prompted a study to determine DNA mismatch repair (MMR) status in ourCRC and attempt correlation with patient age, gender and ethnicity as well as location, grade, histological typeand stage of tumour. Histologically re-confirmed CRC, diagnosed between 1st January 2005 and 31st December2007 at the Department of Pathology, University of Malaya Medical Centre, were immunohistochemically stainedwith monoclonal antibodies to MMR proteins, MLH1, MSH2, MSH6 and PMS2 on the Ventana BenchmarkXT autostainer. Of the 142 CRC cases entered into the study, there were 82 males and 60 females (M:F=1.4:1).Ethnically, 81 (57.0%) were Chinese, 32 (22.5%) Malays and 29 (20.4%) Indians. The patient ages rangedbetween 15-87 years (mean=62.4 years) with 21 cases <50-years and 121 ≥50-years of age. 14 (9.9%) CRCshowed deficient MMR (dMMR). Concurrent loss of MLH1 and PMS2 occurred in 10, MSH2 and MSH6 in 2with isolated loss of MSH6 in 1 and PMS2 in 1. dMMR was noted less frequently amongst the Chinese (6.2%)in comparison with their combined Malay and Indian counterparts (14.8%), and was associated with rightsided and poorly differentiated tumours (p<0.05). 3 of the 5 (60.0%) dMMR CRC cases amongst the Chineseand 1 of 9 cases (11.1%) amongst the combined Malay and Indian group were <50-years of age. No significantassociation of dMMR was noted with patient age and gender, tumour stage or mucinous type.     

Relationship between Body Image and Breast Self-examination Intentions and Behaviors among Female University Students in Malaysia

This study aimed to examine the relationship between body image satisfaction and breast self-screening behaviors and intentions. The sample for this cross-sectional study consisted of 842 female university students who were recruited from a number of public and private universities. Data were obtained between the months of November and December, 2013, using multistage random cluster sampling. Main research variables were breast cancer screening behavior and intentions, demographic factors, and the total scores on each of the Multidimensional Body-Self Relations Questionnaire (MBSRQ-Appearance Scales) subscales. Results of multivariate analysis showed that having higher satisfaction and more positive evaluation of appearance were related to having performed breast self-examination more frequently in the last year and intending to perform breast self-examination more frequently in the next year. Longitudinal research can potentially provide detailed information about overall body image satisfaction and breast cancer screening behavior among various communities.     

Improving Safety-Related Knowledge,Attitude and Practices of Nurses Handling Cytotoxic Anticancer Drug: Pharmacists’ Experience in a General Hospital,Malaysia

Background: An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased theoccupational exposure among the nurses. This study aimed to assess the change of nurses’ safety-related knowledgeas well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards aftera series of pharmacist-based interventions. Materials and Methods: This prospective interventional study witha before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy toanswer a self-administered questionnaire. A performance checklist was then used to determine the complianceof all these wards with the recommended safety measures. The first and second assessments took 2 monthsrespectively with a 9-month intervention period. Pharmacist-based interventions included a series of technical,educational and administrative support measures consisting of the initiation of closed-system cytotoxic drugreconstitution (CDR) services, courses, training workshops and guideline updates. Results: The mean age ofnurses was 32.2±6.19 years. Most of them were female (93.8%) and married (72.9%). The mean knowledge scoreof nurses was significantly increased from 45.5±10.52 to 73.4±8.88 out of 100 (p<0.001) at the end of the secondassessment. Overall, the mean practice score among the wards was improved from 7.6±5.51 to 15.3±2.55 outof 20 (p<0.001). Conclusions: The pharmacist-based interventions improved the knowledge, attitude and safepractices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of theimproved practices.     

Challenges in Volunteering from Cancer Care Volunteers Perspectives

The involvement of non-government organizations (NGOs) and support groups has helped strengthen publichealth services in addressing cancer care burden. Owing to the contribution of volunteers in cancer care, thisarticle documents a qualitative study that examined challenges in attracting and retaining cancer care volunteersas part of the effort to develop a volunteer recruitment model. Data were collected through three focus groupdiscussions involving 19 cancer support group members in Malaysia. Findings of the study revealed that mobilityand locality appeared to be significant in Malaysian context, while the need for financial support and timeflexibility are challenges faced by cancer support groups to attract and retain volunteers. The findings implythat cancer care initiatives can benefit from more local volunteers but at the same time these volunteers requireflexibility and financial support to sustain their engagement.     

The Decision-Making Journey of Malaysian Women with Early Breast Cancer: A Qualitative Study

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatmentdecisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early,many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision makingexperiences of women with early breast cancer. Materials and Methods: A qualitative study using individualin-depth interviews was conducted to capture the decision making process of women with early breast cancerin Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eightparticipants consented and were interviewed using a semi-structured interview guide. These women were recruitedfrom a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decisionsupport framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribedand analysed using a thematic approach. Results: We identified four phases in the decision-making process ofwomen with early breast cancer: discovery (pre-diagnosis); confirmatory (‘receiving bad news’); deliberation;and decision (making a decision). These phases ranged from when women first discovered abnormalities in theirbreasts to them making final surgical treatment decisions. Information was vital in guiding these women. Supportfrom family members, friends, healthcare professionals as well as survivors also has an influencing role. However,the final say on treatment decision was from themselves. Conclusions: The treatment decision for women withearly breast cancer in Malaysia is a result of information they gather on their decision making journey. Thisjourney starts with diagnosis. The women’s spouses, friends, family members and healthcare professionals playdifferent roles as information providers and supporters at different stages of treatment decisions. However, thefinal treatment decision is influenced mainly by women’s own experiences, knowledge and understanding.     

Perceived Susceptibility,and Cervical Cancer Screening Benefits and Barriers in Malaysian Women Visiting Outpatient Clinics

Aims: A main reason for increasing incidence of cervical cancer worldwide is the lack of regular cervicalcancer screening. Coverage and uptake remain major challenges and it is crucial to determine the perceivedsusceptibility to cervical cancer, as well as the benefits of, and barriers to, cervical cancer screening among women.Materials and Methods: A cross-sectional survey was conducted among 369 women attending an outpatient centrein Malaysia and data were collected by administering a self-report questionnaire. Results: The majority of theparticipants (265, 71.8%) showed good level of perception of their susceptibility to cervical cancer. Almost allresponded positively to four statements about the perceived benefits of cervical cancer screening (agree, 23.1% orstrongly agree, 52.5%), whereas negative responses were received from most of the participants (agree, 29.9%orstrongly agree, 14.6 %) about the eleven statements on perceived barriers. Significant associations were observedbetween age and perceived susceptibility(x2=9.030, p=0.029); between employment status (p<0.001) as well asethnicity and perceived benefits (p<0.05 [P=0.003]); and between education and perceived barriers to cervicalcancer screening (p<0.001). Conclusions: Perceived susceptibility, including knowledge levels and personal riskassessment, should be emphasized through education and awareness campaigns to improve uptake of cervicalcancer screening in Malaysia.     

Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primaryprophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysisof two antiemetic regimens from the payer perspective. Materials and Methods: This cost evaluation refers to2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drugacquisition, materials and time spent for clinical activities from prescribing to dispensing of home medicationswere evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1%vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfullytreated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness.Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimenthan for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities wereincluded, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47).Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-basedregimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change ofantiemetic effects of granisetron-based regimen. Conclusions: While providing a better efficacy in acute emesiscontrol, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis inLEC controversial.     

Knowledge of colorectal cancer among patients presenting with rectal bleeding and its association with delay in seeking medical advice

Background: Knowledge is believed to be a driving factor for patients’ early presentation for healthcare. This study was conducted to assess knowledge of colorectal cancer among subjects presenting with rectal bleeding and to determine its association with late presentation. Methods: A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The research instruments used in this study was a self-administered questionnaire including data on duration of rectal bleeding, first medical consultation and knowledge of colorectal cancer. Results: Sixty percent of subjects with rectal bleeding delayed seeking medical advice. Subjects were more aware of symptoms of non-colorectal cancers compared to symptoms of colorectal cancer. The majority of subjects (63.8%) correctly identified rectal bleeding as a symptom but were not aware of the best screening method to detect colorectal cancer. Half of the subjects knew increasing age and genetic background to be risk factors for colorectal carcinoma. However, knowledge of colorectal cancer was not found to be significantly associated with delay in seeking help. Conclusion: Findings indicate poor awareness of colorectal cancer among the subjects. Although public education of colorectal cancer is important for early presentation on rectal bleeding, further studies are advocated to evaluate other factors influencing patients’ help seeking behavior other than knowledge.