exudates and Neoplasms

Historically, the majority of oncology clinical trials are conducted in Western Europe and North America. Globalization of drug development has resulted in sponsors shifting their focus to the Asia-Pacific region. In Malaysia, implementation of various government policies to promote clinical trials has been initiated over a decade ago and includes the establishment of Clinical Research Malaysia, which functions as a facilitator and enabler of industry-sponsored clinical trials on a nationwide basis. Although oncology clinical trials in Malaysia have seen promising growth, there are still only a limited number of early phase oncology studies being conducted. Hence, the Phase 1 Realization Project was initiated to develop Malaysia's early phase clinical trial capabilities. In addition, the adaptation of good practices from other countries contribute to the effective implementation of existing initiatives to drive progress in the development of early phase drug development set up in Malaysia. Furthermore, holistic approaches with emphasis in training and education, infrastructure capacities, strategic alliances, reinforcement of upstream activities in the value chain of drug development, enhanced patient advocacy, coupled with continued commitment from policy makers are imperative in nurturing a resilient clinical research ecosystem in Malaysia.

Topics: Asia; Developing Countries; Ecosystem; Humans; Malaysia; Neoplasms

Palliative care in Malaysia developed in the 1990s to improve the quality of life of people with advanced cancer. Like many other countries, Malaysia faces its own challenges in providing palliative care to patients and their families. In Malaysian culture, families play a significant part in providing care to the dying. Connecting with families in patient care is therefore important. This paper reports a focused literature review evaluating studies on the care of the families of terminally ill people in palliative care environments in Malaysia.. The search engines CINAHL, Medline, PsycINFO, and Google Scholar were searched for literature published from January 2000 to April 2010 relating to family care in palliative care environments. Due to a paucity of research on family care in Malaysia, the search was broadened to include relevant studies on family care internationally.. Four themes were identified: delivering palliative care in Malaysia, communicating with families, crossing cultural boundaries, and the caring experience of nurses.. The studies indicate the importance of the nurse-family interaction in providing optimal and culturally appropriate palliative care. This paper emphasizes the need for research into the nurse's role in family care and for developing a theory appropriate to the Malaysian culture and other countries with cultural diversity.

Topics: Cultural Competency; Empathy; Humans; Malaysia; Neoplasms; Nursing Care; Palliative Care; Professional-Family Relations

Cancer is a major morbidity and mortality concern in Malaysia. Based on National Cancer Registry data, the Malaysian population is estimated to bear a cancer burden of about 40,000 new cases per year, and a cumulative lifetime risk of about 1:4. Cancer research in Malaysia has to consider needs relevant to our population, and resources constraints. Hence, funding bodies prioritise cancers of high prevalence, unique to our community and posing specific clinical problems. Cancer diagnosis is crucial to cancer management. While cancer diagnosis research largely aims at improvements in diagnostic information towards more appropriate therapy, it also impacts upon policy development and other areas of cancer management. The scope of cancer diagnosis upon which this paper is based, and their possible impact on other R&D areas, has been broadly categorized into: (1) identification of aetiological agents and their linkages to the development of precancer and cancer (impact on policy development, cancer prevention and treatment), (2) cancer biology and pathogenesis (impact on cancer prevention, treatment strategies and product development), (3) improvements in accuracy, sensitivity and specificity in cancer detection, monitoring and classification (impact on technology development) and (4) prognostic and predictive parameters (impact on treatment strategies). This paper is based on data collected by the Working Group on Cancer Diagnosis Research for the First National Conference on Cancer Research Coordination in April 2004. Data was collated from the databases of Institutions/Universities where the authors are employed, the Ministry of Science, Technology and Innovation (MOSTI) and targeted survey feedback from key cancer researchers. Under the 7th Malaysia Plan, 76 cancer projects were funded through the Intensified Research in Priority Areas (IRPA) scheme of MOSTI, amounting to almost RM15 million of grant money. 47(61.8%) of these projects were substantially in cancer diagnosis, accounting for 65.6% (RM 9.7 million) of cancer project funds. The 8th Malaysia Plan saw a change in research strategy. The IRPA agency fielded several top-down projects which encouraged a multicentre and multidisciplinary approach. This resulted in larger funding per project i.e. RM32 million for 49 projects. There was also a surge of interest in drug development and natural products. Because of this shift in direction, cancer diagnosis projects constituted only 51% of IRPA-funded canc

Topics: Humans; Malaysia; Neoplasms; Prevalence; Research; Research Support as Topic

The problem of cancer in Malaysia is a growing one. It is now the fourth leading cause of death among medically certified deaths. Cancer of the lung is the most common killer among malignancies. It is estimated that the annual incidence of cancer is 30 000. The majority of patients are found at a late stage of the disease. The National Cancer Control Program aims to reduce the incidence and mortality of cancer and to improve the quality of life of cancer patients. Policies encompass prevention, early diagnosis, treatment, palliative care and rehabilitation. The program for prevention includes an anti-smoking campaign and immunization of babies against hepatitis B. Papanicolaou's smear and breast self-examination are among efforts for the early detection of cancer. Public education and the promotion of healthy lifestyles have been actively carried out. Facilities for treatment and palliative care are being developed further. Networks between the public and private sectors and non-governmental organizations have been on-going. Apart from the establishment and upgrading of treatment facilities, the need for training of skilled staff in the treatment of cancer is highlighted.

Topics: Combined Modality Therapy; Female; Humans; Incidence; Malaysia; Male; Neoplasms; Quality Assurance, Health Care; Quality of Life; Registries; Survival Rate

Significant advances in diagnosis and management have cured the majority of children with cancer. In the leukaemias, the commonest childhood malignancy, intensive induction-consolidation is important to ensure a lasting cure in about 65-80% and to eliminate the traditionally bad prognostic risk factors associated with less intensive treatment. Bone marrow transplantation (BMT) has a curative role in the minority who relapse particularly while on treatment. With few exceptions, most paediatric solid tumours are curable. Although the multimodal approach is responsible for the progress made, chemotherapy has emerged to play a dominant role. It has, in several tumours, obviated or reduced the need for radiotherapy and/or surgery. In Wilms' tumour and Hodgkin's disease, refinement of treatment is now in progress to reduce therapy-related morbidity while not sacrificing efficacy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cause of Death; Child; Child, Preschool; Combined Modality Therapy; Humans; Incidence; Infant; Infant, Newborn; Malaysia; Neoplasms; Prognosis; Radiotherapy; Registries; Risk Factors; Treatment Outcome

Topics: beta Carotene; Carotenoids; Coronary Disease; Dietary Fats, Unsaturated; Humans; Malaysia; Neoplasms; Nutritional Physiological Phenomena; Palm Oil; Plant Oils

Three cases of muscular sarcocystosis from West Malaysia are reported. The morphological features of the parasites from these three cases are similar to the eight cases previously reported from this country. A review of this total of eleven cases of muscular sarcocystosis showed that they were all incidental findings, where man acted as intermediate hosts of as yet unknown Sarcocystis spp. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals) thus permitting the contamination of food and drink with sporocysts shed by these definitive hosts. These infections were probably acquired locally as most of the subjects were born in Malaysia and none had ever left the country to stay elsewhere. Eight of the eleven cases reported were associated with malignancies, especially of the tongue and nasopharynx.

Topics: Adult; Aged; Child; Female; Humans; Incidence; Life Style; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Risk Factors; Sarcocystosis; Zoonoses

Immunology is a discipline that traverses all branches of clinical medicine. Thus since about ten years ago major hospitals in Malaysia established routine clinical immunology services particularly in the diagnosis of autoimmune/connective tissue disorders. More recently these laboratories have ventured into basic research in Dengue Haemorrhagic Fever, Leukaemia Immunology, Nasopharyngeal Cancer and Leprosy. The rationale for these projects together with early results from them are discussed.

Topics: Allergy and Immunology; Autoimmune Diseases; Communicable Diseases; Forecasting; Humans; Malaysia; Neoplasms

Acceptance and action questionnaire (AAQ II) is a scale used to assess psychological inflexibility. The aim of this study is to translate AAQ II into Malay language and evaluate the psychometric properties of AAQ II Malay version.. The AAQ II which has been translated into Malay language via back translation procedure was distributed to 101 cancer patients and 100 non-cancer patients. The evaluation of psychometric properties in this study included content validity index, internal consistency, parallel reliability, exploratory factor analysis, concurrent validity, sensitivity and specificity of AAQ II Malay version.. AAQ II Malay version has established good content validity index, acceptable internal consistency with Cronbach's alpha value of 0.91, excellent parallel reliability and adequate concurrent validity. Exploratory factor analysis (EFA) results demonstrated AAQ II Malay version is a unidimensional factor instrument. The result of sensitivity and specificity of AAQ II Malay version indicated cancer patients who scored more than 17.5 were having significant psychological inflexibility.. AAQ II Malay version is a reliable and valid instrument to measure psychological inflexibility among cancer patient in Malaysia.

Topics: Adult; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Psychometrics; Quality of Life; Surveys and Questionnaires

The aim of this study was to implement and evaluate the outcomes of chemotherapy counselling based on the "Managing Patients on Chemotherapy" module on self-esteem and psychological affect (anxiety, depression) of cancer patients by pharmacists in ten selected government hospitals in Peninsular Malaysia.. A randomized control trial was conducted among 2120 cancer patients from April 2016 to January 2017 in ten selected government hospitals in Peninsular Malaysia. Cancer patients were randomly assigned to intervention and control groups. The intervention group received chemotherapy counselling by pharmacists based on the "Managing Patients on Chemotherapy" module. The outcomes were assessed at baseline, 1st, 2nd and 3rd follow-ups after counselling. In the course of data analysis; independent sample t-test, chi-square and two-way repeated measures ANOVA were conducted.. Mean scores of self-esteem in the intervention group had significant difference in comparison with those of the control group in the 1st, 2nd and 3rd follow-ups after counselling (P < 0.0001). Also, among those with depression and anxiety at baseline, there was reduction in depression and anxiety scores after the 1st, 2nd and 3rd follow-ups after counselling (p < 0.05).. Repetitive counselling by pharmacists based on the "Managing Patients on Chemotherapy" module had positive effect on improving self-esteem and psychological affect of cancer patients undergoing chemotherapy in Peninsular Malaysia.. This module can be used for all Malaysian cancer patients undergoing chemotherapy to improving self-esteem and psychological affect.

Topics: Adult; Antineoplastic Agents; Anxiety; Counseling; Depression; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Outcome Assessment, Health Care; Pharmacists; Quality of Life; Self Concept

Objective: To determine the perceived risk of developing cancer in a suburban community in Malaysia. Methods:\ A cross sectional study using a simple random sampling was conducted among residents aged 18 years old and above\ (n=520) who had never been diagnosed with cancer, in selected households in a suburban area of Pahang state in\ Malaysia. The study instruments were a validated questionnaire on risk perception, an automatic blood pressure monitor,\ a weighing scale and a measuring tape. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 and\ the p value was taken at p <0.05 as significant. Result: This study revealed that only 5.0 percent individuals perceived\ they were at risk cancer, whilst the perceived severity was 41.3 percent. Multivariable analysis showed a significant\ association only for a family history of cancer (adjusted OR of 4.80; 95% CI = 1.45-15.82) (p=0.010) among this\ population. Conclusion: The perceived risk of developing cancer in the selected suburban community of Pahang state in\ Malaysia is low as compared to that for other non-communicable diseases in this country, whilst the perceived severity\ was higher than for other diseases. Thus, considering the importance of correct perceptions for behavioral changes,\ more health education and promotion is needed to make the community better aware of the actual threat of cancer.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Neoplasms; Perception; Prognosis; Risk Factors; Suburban Population; Surveys and Questionnaires; Young Adult

Cancer is now becoming a leading cause of death. Chemotherapy is an important treatment for cancer patients. These patients also need consultation during their treatment to improve quality of life and decrease psychological disorders. The objectives of the study were to develop, implement and evaluate the effectiveness of a chemotherapy counseling module by pharmacists among oncology patients on their quality of life and psychological outcomes in Malaysia.. A single-blind randomized controlled trial was carried out among 162 oncology patients undergoing chemotherapy from July 2013 to February 2014 in a government hospital with oncology facilities in Malaysia. Participants were randomized to either the intervention group or the control group. Chemotherapy counseling using the module on 'Managing Patients on Chemotherapy' by Pharmacists was delivered to the intervention group. The outcome measures were assessed at baseline, first follow-up and second follow-up and third follow-up post-intervention. Chi-square, independent samples t-test and two-way repeated measures ANOVA were conducted in the course of the data analyses.. The module on 'Managing Patients on Chemotherapy' along with repetitive counseling by pharmacists has been shown to be effective in improving quality of life and decreasing anxiety and depression among oncology patients undergoing chemotherapy.. National Medical Research Register (NMRR) of Malaysia and given a registration number NMRR-12-1057-12,363 on 21 December 2012.

Topics: Aged; Analysis of Variance; Anxiety; Counseling; Depression; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Outcome Assessment, Health Care; Pharmacists; Quality of Life; Single-Blind Method; Surveys and Questionnaires

This is a 4 week, randomized, double-blind, placebo-controlled study to examine the effects of methylphenidate as add-on therapy to mirtazapine compared to placebo for treatment of depression in terminally ill cancer patients. It involved 88 terminally ill cancer patients from University of Malaya Medical Centre, Kuala Lumpur, Malaysia. They were randomized and treated with either methylphenidate or placebo as add on to mirtazapine. The change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to day 3 was analyzed by linear regression. Changes of MADRS and Clinical Global Impression-Severity Scale (CGI-S) over 28 days were analyzed using mixed model repeated measures (MMRM). Secondary analysis of MADRS response rates, defined as 50% or more reduction from baseline score. A significantly larger reduction of Montgomery-Åsberg Depression Rating Scale (MADRS) score in the methylphenidate group was observed from day 3 (B=4.14; 95% CI=1.83-6.45). Response rate (defined as 50% or more reduction from baseline MADRS score) in the methylphenidate treated group was superior from day 14. Improvement in Clinical Global Impression-Severity Scale (CGI-S) was greater in the methylphenidate treated group from day 3 until day 28. The drop-out rates were 52.3% in the methylphenidate group and 59.1% in the placebo group (relative risk=0.86, 95%CI=0.54-1.37) due to cancer progression. Nervous system adverse events were more common in methylphenidate treated subjects (20.5% vs 9.1%, p=0.13). In conclusions, methylphenidate as add on therapy to mirtazapine demonstrated an earlier antidepressant response in terminally ill cancer patients, although at an increased risk of the nervous system side effects.

Topics: Academic Medical Centers; Aged; Antidepressive Agents; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; Female; Humans; Malaysia; Male; Methylphenidate; Mianserin; Middle Aged; Mirtazapine; Neoplasms; Palliative Care; Patient Dropouts; Psychiatric Status Rating Scales; Terminally Ill

An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational exposure among the nurses. This study aimed to assess the change of nurses' safety-related knowledge as well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards after a series of pharmacist-based interventions.. This prospective interventional study with a before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy to answer a self-administered questionnaire. A performance checklist was then used to determine the compliance of all these wards with the recommended safety measures. The first and second assessments took 2 months respectively 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 drug reconstitution (CDR) services, courses, training workshops and guideline updates.. The mean age of nurses was 32.2∓6.19 years. Most of them were female (93.8%) and married (72.9%). The mean knowledge score of 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 second assessment. Overall, the mean practice score among the wards was improved from 7.6∓5.51 to 15.3∓2.55 out of 20 (p<0.001).. The pharmacist-based interventions improved the knowledge, attitude and safe practices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of the improved practices.

Topics: Adult; Antineoplastic Agents; Attitude of Health Personnel; Female; Guideline Adherence; Hazardous Substances; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Neoplasms; Occupational Exposure; Occupational Health; Oncology Nursing; Pharmacy Service, Hospital; Practice Guidelines as Topic; Practice Patterns, Nurses'; Statistics, Nonparametric; Workplace

It is well established that a healthy lifestyle is of benefit in the prevention of diseases such as cancer and promotion of well-being. Therefore, the objective of this study was to determine lifestyle practice and associated factors among university students in Malaysia.. A cross sectional study was conducted over six months from November 2011 until May 2012 among the students from the Management and Science University. This study was approved by its ethical committee , the students being explained the objective and invited to participate. A consent form was signed by all study participants. Questionnaire was distributed randomly to the students of the five faculties through their lecturers in different faculty. For univariate analysis t-test and ANOVA test were performed. Multiple linear regression used for multivariate analysis using SPSS 13.0.. A total number of 1100 students participated with a mean age of 22.1±2.21 (SD) years. The majority were 22 years or younger (56.3%), female (54%), Malay (61.5%), single (92.3%), with family monthly income ≥5000 Ringgit Malaysia (41.2%). Regarding lifestyle, about were 31.6% smokers, 75.6% never drank alcohol and 53.7% never exercised. Multivariate analysis showed that age, sex, race, parent marital status, participant marital status, type of faculty, living status, smoking status, exercise, residency, brushing teeth, fiber intake and avoid fatty food significantly influenced the practice of drinking alcohol among university students (p=0.006, p=0.042, p<0.001, p=0.003, p=0.002, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.003, p<0.001; respectively). It similarly showed that sex, race, parent marital status, participant marital status, monthly family income, exercise, residency, brushing teeth and fiber intake significantly influenced the practice of sun protection (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.017, p<0.001, p<0.001, p<0.001; respectively) and that age, sex, parent marital status, participant marital status, type of faculty, living status, exercise, taking non- prescribed medication, brushing the teeth, coffee consumption and fiber intake were significantly influenced the practice of fruits consumption (p=0.008, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p=0.002, p<0.001, P<0.001; respectively).. This study showed a poor practice of healthy lifestyle among university students. Therefore universities should emphasize a healthy lifestyle in all faculties as a required subject. Socio-demographic characteristics significantly influenced practice and thus should be considered when planning preventive measures among university students. Frequent campaigns and educational seminars are to be encouraged.

Topics: Adult; Alcohol Drinking; Cross-Sectional Studies; Exercise; Faculty; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Life Style; Malaysia; Male; Neoplasms; Prognosis; Risk Factors; Smoking; Students; Surveys and Questionnaires; Universities; Young Adult

The use of email and website as channels for workplace health information delivery is not fully explored. This study aims to describe the rationale, design, and baseline findings of an email-linked website intervention to improve modifiable cancer risk factors.. Employees of a Malaysian public university were recruited by systematic random sampling and randomised into an intervention (n = 174) or control group (n = 165). A website was developed for the intervention and educational modules were uploaded onto the website. The intervention group received ten consecutive weekly emails with hypertext links to the website for downloading the modules and two individual phone calls as motivational support whilst the control group received none. Diet, lifestyle, anthropometric measurements, psychosocial factors and stages of change related to dietary fat, fruit and vegetable intake, and physical activity were assessed.. Participants were predominantly female and in non-academic positions. Obesity was prevalent in 15% and 37% were at risk of co-morbidities. Mean intake of fats was 31%, fruit was -1 serving/day and vegetable was < 1 serving/day. Less than 20% smoked and drank alcohol and about 40% were physically inactive. The majority of the participants fell into the Preparation stage for decreasing fat intake, eating more fruit and vegetables, and increasing physical activity. Self-efficacy and perceived benefits were lowest among participants in the Precontemplation/Contemplation stage compared to the Preparation and Action/Maintenance stages.. Baseline data show that dietary and lifestyle practices among the employees did not meet the international guidelines for cancer prevention. Hence the findings warrant the intervention planned.

Topics: Adult; Analysis of Variance; Dietary Fats; Electronic Mail; Feeding Behavior; Female; Fruit; Health Education; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Internet; Life Style; Malaysia; Male; Motor Activity; Neoplasms; Obesity; Risk Factors; Vegetables; Workplace; Young Adult

Empirical therapy for children with febrile neutropenia has traditionally consisted of combination antibiotics, usually a beta-lactam and an aminoglycoside. However, recent trends and international guidelines have now made monotherapy a feasible option in the management of this group of patients. We prospectively evaluated the efficacy and safety of cefepime monotherapy in our population of paediatric cancer patients with febrile neutropenia.. An audit was performed on children aged 16 years and younger presenting with fever and neutropenia who were managed with empirical single-agent cefepime. The patients were analysed for clinical outcome, documented infections and side-effects of the study drug. Success was defined as clinical improvement without treatment modification. Death or any change to the empirical antibiotic was considered as failure.. In this study 79 children (median age 5.2 years) with 133 episodes of febrile neutropenia were prospectively studied between August 2004 and August 2005. A microbiologically documented infection was seen in 26 episodes. The success rate of cefepime monotherapy was 60%. The rate of survival through neutropenia (with or without modification) was 98%. No significant adverse effects were seen.. Cefepime monotherapy is a safe and feasible option for treatment of childhood cancer patients with febrile neutropenia.

Topics: Adolescent; Anti-Bacterial Agents; Cefepime; Cephalosporins; Child; Child, Preschool; Female; Fever; Humans; Infant; Malaysia; Male; Neoplasms; Neutropenia; Prospective Studies; Treatment Outcome; Vancomycin

Topics: Aged, 80 and over; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Palliative Care; Referral and Consultation; Retrospective Studies; Terminal Care

Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care.. Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach.. The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients' lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care.. Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.

Topics: Family; Humans; Malaysia; Neoplasms; Qualitative Research; Quality of Life; Spirituality

Rice is a predominant staple food in many countries. It is a great source of energy but can also accumulate toxic and trace metal(loid)s from the environment and pose serious health hazards to consumers if overdosed. This study aims to determine the concentration of toxic metal(loid)s [arsenic (As), cadmium (Cd), nickel (Ni)] and essential metal(loid)s [iron (Fe), selenium (Se), copper (Cu), chromium (Cr), cobalt (Co)] in various types of commercially available rice (basmati, glutinous, brown, local whites, and fragrant rice) in Malaysia, and to assess the potential human health risk. Rice samples were digested following the USEPA 3050B acid digestion method and the concentrations of metal(loid)s were analyzed using an inductively coupled plasma mass spectrometry (ICP-MS). Mean concentrations (mg/kg as dry weight) of metal(loid)s (n=45) across all rice types were found in the order of Fe (41.37)>Cu (6.51)>Cr (1.91)>Ni (0.38)>As (0.35)>Se (0.07)>Cd (0.03)>Co (0.02). Thirty-three percent and none of the rice samples surpassed, respectively, the FAO/WHO recommended limits of As and Cd. This study revealed that rice could be a primary exposure pathway to toxic metal(loid)s, leading to either noncarcinogenic or carcinogenic health problems. The non-carcinogenic health risk was mainly associated with As which contributed 63% to the hazard index followed by Cr (34%), Cd (2%), and Ni (1%). The carcinogenic risk to adults was high (>10

Topics: Adult; Arsenic; Cadmium; China; Chromium; Cobalt; Environmental Monitoring; Heavy Metal Poisoning; Humans; Malaysia; Metals, Heavy; Neoplasms; Nickel; Oryza; Risk Assessment; Selenium; Soil Pollutants

To conduct a cultural adaptation and validation of the Champion Health Belief Model Scale (CHBMS) for colorectal cancer (CRC) screening (CHBMS-CRC-M) in order to assess and investigate perceptions and beliefs about CRC screening in Malaysia.. The results from an evidence synthesis and the outcomes from an expert panel discussion were used to shape CHBMS scale content into an assessment of beliefs about CRC screening (CHBMS-CRC). This questionnaire assessment was translated into the official language of Malaysia. An initial study tested the face validity of the new scale or questionnaire with 30 men and women from various ethnic groups. Factorial or structural validity was investigated in a community sample of 954 multiethnic Malaysians.. Selangor state, Malaysia.. The new scale was culturally acceptable to the three main ethnic groups in Malaysia and achieved good face validity. Cronbach's alpha coefficients ranged from 0.66 to 0.93, indicating moderate to good internal consistency. Items relating to perceived susceptibility to CRC 'loaded' on Factor 1 (with loadings scoring above 0.90); perceived benefits of CRC screening items loaded on factor 2 and were correlated strongly (loadings ranged between 0.63 and 0.83) and perceived barriers (PBA) to CRC screening (PBA) items loaded on factor 3 (range 0.30-0.72).. The newly developed CHBMS-CRC-M fills an important gap by providing a robust scale with which to investigate and assess CRC screening beliefs and contribute to efforts to enhance CRC screening uptake and early detection of CRC in Malaysia and in other Malay-speaking communities in the region.

Topics: Asian People; Early Detection of Cancer; Female; Humans; Malaysia; Male; Neoplasms; Principal Component Analysis

This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time.. A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay.. One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost.. As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.

Topics: Choice Behavior; Humans; Malaysia; Neoplasms; Pain; Patient Preference; Quality of Life; Surveys and Questionnaires

The well-being and adaptive functioning of patients with cancer depend on their perception of social support. To accurately assess and understand the impact of social support in a diverse population, validated measurement tools are essential. This study aimed to adapt and validate the Malay version of the Multidimensional Scale of Perceived Social Support (MSPSS-M) among patients with cancer in Malaysia.. A total of 346 cancer patients with mixed disease types were recruited and completed the socio-demographic and clinical characteristics questionnaire and the MSPSS-M. The MSPSS-M was assessed for internal consistency, construct validity, face, content, convergent, discriminant validity, and confirmatory factor analyses.. The MSPSS-M and its three domains demonstrated good internal consistency with Cronbach's α ranging from 0.900 to 0.932. Confirmatory factor analysis (CFA) of the MSPSS-M supported the three-factor model of the original English version of the MSPSS. The MSPSS-M also exhibited good convergent validity and discriminant validity.. The MSPSS-M demonstrates favorable psychometric properties among patients with cancer in Malaysia. The validation of the MSPSS-M provides a culturally adapted and linguistically valid instrument to assess perceived social support among Malay-speaking patients with cancer in Malaysia.

Topics: Humans; Malaysia; Neoplasms; Psychometrics; Reproducibility of Results; Social Support; Surveys and Questionnaires

Prognostication of myeloproliferative neoplasm (MPN) has always been challenging, even with the advent of Janus kinase 2 (JAK2 V617F) molecular studies. The survival pattern of patients diagnosed with MPN in developing countries is still undetermined.. The national MPN registry conducted from 2009 to 2015 in Malaysia provided a comprehensive insight into the demographics, clinical characteristics and laboratory parameters of patients diagnosed with MPN nationwide. The study analysed the survival patterns and mortality outcomes and risk among 671 patients diagnosed with essential thrombocythaemia (ET), polycythaemia vera (PV), primary myelofibrosis (PMF) and unclassified MPN (MPN-U). Mortality status was traced and confirmed until the end of December 2018, with right censoring applied to patients alive beyond that.. The analysed cohort consisted of 283 (42.2%) ET, 269 (40.1%) PV, 62 (9.2%) PMF and 57 (8.5%) MPN-U incident cases with diagnosis made between 2007 and 2015. The majority of patients were male (52.3%) and Malay (48.9%), except for ET, in which the majority of patients were female (60.1%) and of Chinese origin (47.0%). Female patients were found to have significantly better overall survival (OS) rates in ET (p = 0.0285) and MPN-U (p = 0.0070). Patients with JAK2 V617F mutation were found to have marginally inferior OS over time. Multivariable Cox regression identified patients with increased age [hazard ratio (HR) 1.055, 95% CI 1.031; 1.064], reduced haemoglobin (HB) level (HR 0.886, 95% CI 0.831; 0.945, p = 0.0002), being male (HR 1.545, 95% CI 1.077; 2.217, p = 0.0182), and having MPN-U (HR 2.383, 95% CI 1.261; 4.503, p = 0.0075) and PMF (HR 1.975, 95% CI 1.054; 3.701, p = 0.0335) at increased risk for worse mortality outcomes.. Myeloproliferative neoplasm reduces patient survival. The degree of impact on survival varies according to sub-type, sex, bone marrow fibrosis and HB levels. The JAK2 V617F mutation was not found to affect the survival pattern or mortality outcome significantly.

Topics: Asian People; Female; Humans; Malaysia; Male; Myeloproliferative Disorders; Neoplasms; Thrombocythemia, Essential

We aim to discuss the hematological cancer cases that opted for ovarian tissue cryopreservation (OTC) as fertility preservation before the gonadotoxic chemotherapy agent.. The ovarian tissue cryopreservation (OTC) was started in August 2020 in our center. Up to now, there were four cases have been performed and included in this report. The ovarian tissue cortex was cryopreserved with cryoprotectant using Kitazato™ (Tokyo, Japan) media and fit in the closed system devices. A total of four post-OTC patients were included. The mean age was 24 years old, whereas the mean serum AMH level was 30.43 pmol/L. Most of them were diagnosed with lymphoma, except one was leukemia. All of them received additional GnRH analog following OTC as a chemoprotective agent before cancer treatment. Currently, they are recovering well and on regular follow-up with the hematological department.. Although The OTC is an ultimate option for prepubertal girls, it can be proposed as a good strategy for adult cancer women who could not delay cancer therapy.

Topics: Adult; Cryopreservation; Female; Fertility Preservation; Humans; Malaysia; Neoplasms; Ovary; Young Adult

The assessment of stigma among cancer patients is of the utmost importance as stigma may lead to various psychological sequelae and a lower quality of life. This study aimed to translate the English version of the Shame and Stigma Scale (SSS) into Malay and validate the Malay version of the SSS (SSS-M) to assess the degree of stigma among cancer patients in Malaysia. Initially, the concurrent translation and back translation of the SSS-M were performed, and the face and content validity were assessed. Subsequently, the SSS-M was administered to a total of 234 patients with mixed types of cancer to assess its reliability (internal consistency and test-retest reliability), construct validity (convergent and discriminant validity), and conduct an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The SSS-M total score registered a good internal consistency (a Cronbach's α of 0.881) and test-retest reliability (an intraclass correlation coefficient of 0.876,

Topics: Humans; Malaysia; Neoplasms; Psychometrics; Quality of Life; Reproducibility of Results; Shame; Surveys and Questionnaires

In health news production, sourcing and framing are two critical mechanisms that influence how newsreaders think about and perceive the severity of a health issue. Understanding how local media covers the cancer control continuum is vital. However, very limited studies have looked at the effect of sourcing and framing in cancer news coverage, and it is still unknown how sources and news frames shape cancer coverage, especially in non-Western countries.. This study examines framing and sourcing patterns in news stories reporting on cancer control in Malaysian mainstream (English) and ethnicity (Chinese) online news sites, uncovering underlining associations between essential news components, source, and framing.. We used a predesigned code book to conduct a quantitative content analysis on cancer news stories (. Two logistic regression models demonstrated the internal relationships between sourcing, framing, and different elements in cancer coverage. In terms of news sources, the results revealed that medical journals were the most likely to be cited when the news focused on medical research, followed by primary cancer prevention. When the news concentrated on statistical cancer reports and environmental/occupational risk factors, government agencies were more likely to be interviewed. Of news frames, when the news articles engaged with medical institutions and mentioned medical publications, the lifestyle frame was very likely to be shown, but the environmental frame was more likely to be portrayed when interviewing medical practitioners.. This study is the first comprehensive assessment to analyze and compare Malaysian English and Chinese online cancer news coverages and uncover underlying associations between news components, sourcing, and framing paradigms. We contributed to the scholarly understanding of cancer news coverage. This study can serve as a model for future health promotion researchers, journalists, and policymakers. Implications for cancer risk communication research, health journalist practices, and health policymaking were discussed.

Topics: Attitude to Health; Health Promotion; Humans; Malaysia; Neoplasms; Newspapers as Topic

Cancer is a life-threatening disease, and the challenges in accepting the diagnosis can bring a devastating emotional impact on the patient's mental and psychological wellbeing. Issues related to illness acceptance among cancer patients are not well studied in Malaysia. To date, the Acceptance of Illness Scale has not been translated to the Malay language (Bahasa Malaysia) nor validated for use in the oncology setting. The objective of the study is to translate, validate and determine the reliability of the Bahasa Malaysia version of the Acceptance of Illness Scale among Malaysian patients with cancer. A total of 129 patients newly diagnosed with cancer were consecutively sampled and the scale was administered via face-to-face interviews. A pilot test (n = 30) was conducted and test-retest reliability was determined. The Bartlett Test of Sphericity was statistically significantly (p<0.001), while the Kaiser-Mayer-Olkin (KMO) measure of sampling adequacy was adequate at 0.84. Scale item mean scores ranged between 3.02 and 4.33, while the item-total correlation ranged between 0.50 to 0.66 (p<0.05). The internal reliability coefficient was 0.84. The test-retest reliability indicated a high correlation, r = 0.94 with p = 0.001. The Bahasa Malaysia version of the Acceptance of Illness Scale is a valid and reliable instrument that is appropriate for use in Malaysian patients with cancer. Use of this scale to assess illness acceptance among the Malay-speaking patients with cancer can act as a guide for delivery of psycho-oncological services to help patients have a better mental wellbeing and life adjustment in living with cancer.

Topics: Adolescent; Adult; Aged; Female; Humans; Language; Malaysia; Male; Middle Aged; Neoplasms; Psychometrics; Quality of Life; Reproducibility of Results; Severity of Illness Index; Surveys and Questionnaires; Translations; Young Adult

Cancer-associated venous thromboembolism (CAT) is a common disease or complication which is associated with reduced survival and incurring a substantial health-care cost. Low molecular weight heparin (LMWH) remained the gold standard treatment option available. Direct oral anticoagulants (DOACs) have recently become more popular in the guidelines, they are still few and inconsistent across the current literature. The aim of this study was to evaluate rivaroxaban in treatment of CAT.. In this prospective real-world study, we recruited and followed up patients diagnosed with CAT treated with rivaroxaban or standard of care as a control for 12 months or until death. Baseline characteristics were collected at the study entry. The primary outcomes were recurrent DVT or PE and death within 12 months after treatment initiation. Safety outcomes were composite outcomes of major and minor bleeding.    Results: A total of 80 patients confirm CAT with radiological imaging were recruited; 39 patients were evaluated in the control arm and 41 patients in the rivaroxaban arm. The 12 months cumulative CAT recurrence rate was 46.2% in control and 39% in rivaroxaban (p=0.519). The 12-month death was not a statistically significant difference between both arms (20.5% vs. 31.7%, p=0.255). The cumulative rate of composite safety outcomes was similar in both groups (17.9% vs. 12.2%, p=0.471).. The result of this small but important real-world evidence proofs that rivaroxaban is an effective and safe alternative to the standard of care for CAT in Malaysia's cancer population.

Topics: Anticoagulants; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Prospective Studies; Recurrence; Rivaroxaban; Tertiary Healthcare; Treatment Outcome; Venous Thromboembolism

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.

Topics: Aged; Humans; Malaysia; Neoplasms; Quality of Life; Surveys and Questionnaires; Tertiary Care Centers

Cancer pain prevalence is high despite well-established international guidelines on pain management and improved accessibility to treatment. Inadequate cancer pain management can be attributed to barriers related to patients, health care professionals, and health care system.. To identify patient-related barriers to effective cancer pain management in a diverse multicultural developing country.. A cross-sectional survey study was carried out using Brief Pain Inventory-Short Form to measure effectiveness of pain management and Barriers Questionnaire II to explore patient-related barriers to effective pain management.. Patients on strong opioids treated in a comprehensive cancer unit of a public hospital in Sarawak, Malaysia.. Among 133 subjects surveyed, 66% reported no pain or mild pain, 34% moderate pain, and 10% severe pain. Despite good pain control, 71% of patients still reported moderate-to-severe interference with daily activities. Fatalism scored the highest median Barriers Questionnaire II score among the four domains of patient-related barriers followed by harmful effects, physiological effects, and communication factor.. Cancer pain is generally well controlled with more than half of patients reporting mild pain. However, degree of interference with daily activities is still high despite good cancer pain control. Fatalistic mentality need to be addressed for effective cancer pain management. Further studies on health care professional-related barriers and health system-related barriers are urgently needed to provide a comprehensive approach of holistic pain management.

Topics: Cancer Pain; Cross-Sectional Studies; Developing Countries; Humans; Malaysia; Neoplasms; Pain Management

To investigate the relationship between anticipated delay in help-seeking and cancer symptom recognition and the extent to which this relationship varied according to socio-demographic and health-related characteristics.. A cross-sectional telephone survey was conducted of 1895 adults aged ≥40 years who were randomly selected across Malaysia and interviewed using the Awareness and Beliefs about Cancer questionnaire, which was previously validated and culturally adapted by the research team. Logistic regression analysis was used to test the associations between anticipated delay for help seeking >2 weeks and socio-demographic and health-related variables.. Anticipated delay in help-seeking was reported for persistent cough (19.3 %), rectal bleeding (6.1 %) and breast changes (2.5 %). Difficulty in accessing a doctor was associated with anticipated delayed help-seeking for breast changes and rectal bleeding (adjusted ORs 7.58; 95 % CI 1.98, 28.94 and 2.37; 95 % CI 1.21, 4.66, respectively); not recognising the symptom 'unexplained bleeding' as a colorectal cancer warning sign was associated with anticipated delayed help-seeking for rectal bleeding (adjusted OR 1.54; 95 % CI 1.03, 2.31); and ethnicity was associated with anticipated delay for rectal bleeding and persistent cough.. Generally, anticipated delay to help-seeking for cancer symptoms in Malaysia (a middle-income country) appeared to be a less significant problem compared to other countries including high-income countries. There appeared to be a significant association between social variation indicators in Malaysia and anticipated delay in help-seeking.

Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Patient Acceptance of Health Care; Surveys and Questionnaires; Time-to-Treatment

This is a systematic assessment of the burden of cancers in Malaysia in 2018 using epidemiologic approach. The purpose of this study was to identify the proportion of cancers in Malaysia that were attributable to the modifiable risk factors of excess weight, alcohol intake, physical inactivity, tobacco smoking and to estimate the number of cancer cases that could be prevented if the exposure to the modifiable risk factor was reduced.. We estimated the Population Attributable Fraction (PAF) of the modifiable risk factors to cancers incidences in Malaysia. The two parameters used for the estimation were exposure prevalence from national representative surveys and the relative risk of getting the cancers from worldwide literature review.. Among 38,426 cancer incidences in 2018 from Globocan data, we estimated that 22.2% (95% confidence interval (CI):14.9 to 29.6%) of the cancer incidences included in this study were attributable to the investigated modifiable risk factors. 39.1% (95% CI:27.2 to 49.7%) and 10.5% (95% CI:5.8 to 15.7%) of cancers in male and female respectively, were attributable to the studied modifiable risk factors. The top main cancers attributed by the risk factors were lung cancer (65.1%; 95% CI:56.4 to 72.9%), laryngeal cancer (63.6%; 95% CI:39.9 to 80.5%), and oesophageal cancer (51.5%; 95% CI:39.9 to 62.0%). For each risk factor studied across genders, tobacco smoking contributed the most (14.3%; 95% CI:9.9 to 17.3%), followed by excess weight (7.0%; 95% CI:4.1 to 10.2%), physical inactivity (1.0%; 95% CI:0.4 to 1.7%) and alcohol intake (0.6%; 95% CI:0.2 to 1.0%).. Findings from this study suggests that tobacco smoking and excess weight are the two predominant factors out of the four studied risk factors for cancer cases in Malaysia. Nationwide public health prevention campaigns tailored to these risk factors are recommended. However, the other risk factors such as physical inactivity and alcohol intake shall not be neglected. PAFs are estimated based on the best available data that we have currently. Regular collection of other risk factor exposure prevalence data is vital for future analyses.

Topics: Female; Humans; Incidence; Malaysia; Male; Neoplasms; Prevalence; Risk Factors; Sedentary Behavior

Topics: Anti-Bacterial Agents; Cough; Diagnosis, Differential; Fever; Humans; Lung Neoplasms; Malaysia; Male; Melioidosis; Middle Aged; Neoplasms; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Weight Loss

This study aimed to assess the association of exposure to particle-bound (PM

Topics: Air Pollutants; Child; DNA Damage; Environmental Monitoring; Humans; Malaysia; Mouth Mucosa; Neoplasms; Particulate Matter; Polycyclic Aromatic Hydrocarbons; Risk Assessment; Schools; Seasons

Fertility preservation is significant for oncology patients to maintain their ability to start a family when they are ready. Onco-fertility, as a discipline, exists at the intersection of oncology and reproductive medicine that safeguards and expands the fertility options for cancer survivors, by facilitating early intervention and suitable treatment with favourable outcomes. Successful fertility preservation requires a comprehensive networking among the gynaecologists, oncologists, pathologists, imaging and other specialists, involved in diagnosing and treating cancer in the reproductive age group. There are several ways in which fertility can be preserved, like role of gonadotrophin releasing hormone analogues, in vitro maturation, and cryopreservation.

Topics: Cryopreservation; Fertility; Fertility Preservation; Humans; Malaysia; Neoplasms

To investigate the impact of herbal therapy on the quality of life (QoL) among cancer patients and to evaluate the relationship of QoL with age, gender, cancer stage, cancer type, and history of conventional treatment.. A prospective study was targeted on cancer patients receiving herbal therapy from a Traditional and Complementary Medicine (T&CM) clinic in a public hospital from 1st January 2016 to 31st August 2018. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTCQLQ-C30) was distributed to the patients prior to herbal therapy (baseline) and after the sixth and twelfth week of herbal therapy. Socio-demographic and clinical data were collected and analyzed using SPSS version 16.. The majority of the patients were females (60.0%) and were from the Chinese ethnic group (77.4%) with a mean age of 58.72 ± 12.17 years. Approximately 42.4% of patients were in advanced cancer stages at the time of study and 60.7% of patients had undergone radiotherapy before receiving herbal therapy. The most commonly prescribed herbs were Bai Hua She She Cao (90.6%) and Zhen Ren Huo Ming Yin (57.6%). Significant differences in mean score were observed in global health status, overall functional scales, and symptom scales after the sixth and twelfth week of receiving herbal therapy. QoL in terms of global health status and overall functional scales improved with higher scores while symptom scales recorded a lower score after twelve weeks of receiving herbal therapy in the T&CM clinic. Herbal therapy has a significant effect (p < 0.05) on the improvement of QoL of cancer patients. However, gender, cancer stage, cancer type, age, history of radiotherapy, and history of chemotherapy has no effect (p > 0.05).. Herbal therapy did improve the QoL of cancer patients in the southern region of Peninsular Malaysia.

Topics: Female; Hospitals, Public; Humans; Malaysia; Male; Middle Aged; Neoplasm Staging; Neoplasms; Phytotherapy; Prospective Studies; Quality of Life

This study sought to determine the prevalence of pathogenic and non-pathogenic bacteria in the oral cavities of children with cancer. There were 68 paediatric patients with cancer who were included in this study. Oral swab samples from the dorsum of tongues and mouth floors of these patients were subjected to culture, staining, and molecular methods to detect the bacteria. The overall prevalence of gram-positive and gram-negative bacteria was 79.4% (54/68; 95% CI = 68.4 - 87.3) and 25% (17/68; 95% CI = 16.2 - 36.4), respectively. Streptococcus salivarius and Streptococcus parasanguinis were the predominant pathogenic grampositive bacteria, while Neisseria subflava and Neisseria perflava were the most common pathogenic gram-negative bacteria. The results revealed that the number of bacteria isolates recovered in patients receiving cancer treatment was higher (55.9%) than those who had not received treatment (16.2%). Therefore, more isolated pathogenic bacteria were observed post-therapy (54.4%). Pathogenic organisms can have significant implications on patient health. Awareness of the types of bacteria inhabiting the oral cavity is essential to predict and prevent dental problems, and their associated systemic complications. Findings on the diversity of oral microflora can also provide a better understanding of the aetiology of oral diseases in paediatric patients receiving cancer treatment.

Topics: Child; Gram-Negative Bacteria; Gram-Positive Bacteria; Hospitals, Teaching; Humans; Malaysia; Mouth; Neisseria; Neoplasms; Streptococcus

Single-nucleotide polymorphisms (SNPs) are the most common genetic variations for various complex human diseases, including cancers. Genome-wide association studies (GWAS) have identified numerous SNPs that increase cancer risks, such as breast cancer, colorectal cancer, and leukemia. These SNPs were cataloged for scientific use. However, GWAS are often conducted on certain populations in which the Orang Asli and Malays were not included. Therefore, we have developed a bioinformatic pipeline to mine the whole-genome sequence databases of the Orang Asli and Malays to determine the presence of pathogenic SNPs that might increase the risks of cancers among them. Five different in silico tools, SIFT, PROVEAN, Poly-Phen-2, Condel, and PANTHER, were used to predict and assess the functional impacts of the SNPs. Out of the 80 cancer-related nsSNPs from the GWAS dataset, 52 nsSNPs were found among the Orang Asli and Malays. They were further analyzed using the bioinformatic pipeline to identify the pathogenic variants. Three nsSNPs; rs1126809 (TYR), rs10936600 (LRRC34), and rs757978 (FARP2), were found as the most damaging cancer pathogenic variants. These mutations alter the protein interface and change the allosteric sites of the respective proteins. As TYR, LRRC34, and FARP2 genes play important roles in numerous cellular processes such as cell proliferation, differentiation, growth, and cell survival; therefore, any impairment on the protein function could be involved in the development of cancer. rs1126809, rs10936600, and rs757978 are the important pathogenic variants that increase the risks of cancers among the Orang Asli and Malays. The roles and impacts of these variants in cancers will require further investigations using in vitro cancer models.

Topics: Computational Biology; Computer Simulation; Conserved Sequence; Databases, Genetic; Ethnicity; Exome Sequencing; Female; Genetic Predisposition to Disease; Genome-Wide Association Study; Guanine Nucleotide Exchange Factors; Humans; Malaysia; Male; Models, Molecular; Molecular Docking Simulation; Monophenol Monooxygenase; Mutant Proteins; Mutation; Neoplasms; Polymorphism, Single Nucleotide; Protein Interaction Domains and Motifs; Protein Stability; Structural Homology, Protein

The main purpose of this study was to identify the psychometric properties and validate   the Bahasa Malaysia version of the Brief Illness Perception Questionnaire among patients with cancer.. A total of 129 newly diagnosed patients with cancer were consecutively sampled. Reliability and validity of the questionnaire were tested using translation validity, test-retest reliability, Principal Component Analysis, Cronbach's alpha coefficient for domains and item-total correlation.. The questionnaire indicates excellent test-retest reliability. The Principal Component Analysis (PCA) revealed that Kaiser-Meyer-Olkin (KMO) is 0.60 for the two-factor structure of the Brief Illness Perception Questionnaire of the Bahasa Malaysia version which consists of cognitive illness representation and emotional illness representation.. The Brief Illness Perception Questionnaire in the Bahasa Malaysia version is a useful tool to use among patients with cancer in Malaysia context despite moderate psychometric properties. This is based on the premise that the questionnaire can be used as a quick tool to assess illness perceptions among Malaysian with cancer in routine oncology practice.

Topics: Adolescent; Adult; Aged; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Neoplasms; Perception; Prognosis; Psychometrics; Quality of Life; Reproducibility of Results; Severity of Illness Index; Surveys and Questionnaires; Translations; Young Adult

The main aims of the study were to identify barriers to seeking help for cancer, appraise demographic and socio-economic differences in relation to barriers and evaluate the association between barriers and cancer symptoms awareness and delayed help-seeking.. A total of 2,360 adults (18 years and above) from randomly selected households in metropolitan Kuala Lumpur completed face-to-face interviews with trained research assistants that incorporated the validated Malay version of the Cancer Awareness Measure (CAM). Logistic regression was the main statistical technique that was used to investigate the study objectives and relationships (noted above).. The most commonly reported barriers to help-seeking were emotional barriers. The probability of delaying seeking help was 49% higher in participants who reported emotional barriers (OR = 1.49; CI: 1.32-1.68; p < .001); and each unit rise in the cancer symptom awareness score was associated with a reduced likelihood of 29% in help-seeking delay (OR = 0.71; 95% CI: 0.68-0.74; p < .001).. Our study presents clear evidence of the relationship between cancer awareness and help-seeking; and the need for, and potential positive impact of, providing cancer awareness-raising programmes. Cancer health education campaigns or programme should address emotional barriers and encourage early seeking help.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Embarrassment; Emotions; Fear; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Logistic Models; Malaysia; Male; Middle Aged; Neoplasms; Patient Acceptance of Health Care; Time Factors; Urban Population; Young Adult

Our primary objective was to identify predictors associated with preferences for patient-centered care among cancer survivors and the association between cancer health literacy and patient-centered care preferences.. Cross sectional analyses of N = 345 adult cancer survivors (5 years post cancer diagnosis) attending follow-ups at University Malaya Medical Centre, Malaysia. Face-to face-interviews were conducted using the 30-item Cancer Health Literacy Test and the Patient-Practitioner Orientation Scale to determine preference for patient-centered care.. Findings from this study provide insights into preferences for patient-centered care among cancer survivors during receipt of follow-up care, which remains an understudied phase of cancer care delivery.. Efforts are needed to ensure different preferences for care are taken into account particularly in the setting of variable cancer health literacy.

Topics: Adolescent; Adult; Aftercare; Aged; Aged, 80 and over; Cancer Survivors; Cross-Sectional Studies; Female; Health Literacy; Humans; Malaysia; Male; Middle Aged; Neoplasms; Patient Preference; Patient-Centered Care; Psychological Distress; Social Support; Young Adult

Cancer incidence in Malaysia is expected to double by 2040. Understanding cancer awareness is important in order to tailor preventative efforts and reduce the cancer burden. The objective of this research was to assess nationwide awareness about the signs and symptoms as well as risk factors for various cancers in Malaysia and identify socio-demographic factors associated with awareness.. This cross-sectional study was conducted from March-November 2014 in the form of a telephone survey. Participants aged 40 years and above were randomly selected across Malaysia and interviewed using the validated Awareness Beliefs about Cancer (ABC) measurement tool. Linear regression was conducted to test the association between symptom and risk factor recognition and socio-demographic variables.. A sample of 1895 participants completed the survey. On average, participants recognised 5.8 (SD 3.2) out of 11 symptoms and 7.5 (SD 2.7) out of 12 risk factors. The most commonly recognised symptom was 'lump or swelling' (74.5%) and the most commonly recognised risk factor was 'smoking' (88.7%). Factors associated with prompted awareness were age, ethnicity, education and smoking status.. Recognition of symptom and risk factors for most cancers was relatively low across Malaysia compared to previous studies in high-income countries and to studies conducted in Malaysia. There is a need to conduct regular public health campaigns and interventions designed to improve cancer awareness and knowledge as a first step towards increasing the early detection of cancer.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Incidence; Linear Models; Malaysia; Male; Middle Aged; Neoplasms; Risk Factors; Surveys and Questionnaires; Symptom Assessment

Complementary and alternative medicine (CAM) use among cancer patients is increasing over the years. Some types of CAM may interact with conventional cancer therapy or may cause serious adverse effects. This study was designed to determine the prevalence of CAM use among cancer patients during cancer therapy and to identify CAM users' characteristics, perception, reasoning, expectation and disclosure of CAM use.. This cross-sectional study was conducted between July 2017 to October 2017, on 121 cancer patients in oncology and hematology clinics and daycare of a tertiary hospital in Kuala Lumpur, Malaysia. Study data was collected using a self-administered questionnaire.. The prevalence of CAM use among cancer patients was found to be 61.2 %. Multivariate logistic regression analysis showed that CAM use was associated with change in outlook on life after development of cancer. The most frequently used types of CAM were vitamins and Islamic medical practices. Majority of patients were guided by family and friends' suggestions towards using CAM. Most patients expected CAM to cure their disease. The percentage of patients who disclosed CAM use to the doctors was slightly higher than those who did not disclose CAM use.. The use of CAM was found to be remarkably high. Rate of non-disclosure of CAM use was high indicating the need for enhancement of doctor- patient relationship for effective patient's care. Future research is needed with large sample of patients to provide better representation of the population and to help understand patients' beliefs and perception more.

Topics: Adult; Aged; Complementary Therapies; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Surveys and Questionnaires; Tertiary Care Centers

To assess sales of anti-cancer medicines in the 2017 World Health Organization's. We extracted sales volume data for 39 anti-cancer medicines from the IQVIA database. We divided the total quantity sold by the reference defined daily dose to estimate the total number of defined daily doses sold, per country per year, for three types of anti-cancer therapies (traditional chemotherapy, targeted therapy and endocrine therapy). We adjusted these data by the number of new cancer cases in each country for each year.. We observed an increase in sales across all types of anti-cancer therapies in all countries. The largest number of defined daily doses of traditional chemotherapy per new cancer case was sold in Thailand; however, the largest relative increase per new cancer case occurred in Indonesia (9.48-fold). The largest absolute and relative increases in sales of defined daily doses of targeted therapies per new cancer case occurred in Kazakhstan. Malaysia sold the largest number of adjusted defined daily doses of endocrine therapies in 2017, while China and Indonesia more than doubled their adjusted sales volumes between 2007 and 2017.. The use of sales data can fill an important knowledge gap in the use of anti-cancer medicines, particularly during periods of insurance coverage expansion. Combined with other data, sales volume data can help to monitor efforts to improve equitable access to essential medicines.. Évaluer la vente de médicaments contre le cancer figurant dans l'édition 2017 de la. Nous avons extrait de la base de données IQVIA les informations relatives au volume de vente pour 39 médicaments contre le cancer. Nous avons divisé le nombre total de médicaments vendus par la dose quotidienne déterminée de référence, afin d'estimer le nombre total de doses quotidiennes déterminées vendues par pays et par an, pour trois types de traitements contre le cancer (chimiothérapie conventionnelle, thérapie ciblée et endocrinothérapie). Nous avons ajusté ces données en tenant compte du nombre de nouveaux cas de cancer diagnostiqués chaque année dans chaque pays.. Nous avons observé une hausse des ventes pour tous les types de traitements contre le cancer dans tous les pays. C'est la Thaïlande qui vend le plus grand nombre de doses quotidiennes déterminées en chimiothérapie conventionnelle pour chaque nouveau cas de cancer; néanmoins, c'est en Indonésie que nous avons constaté la plus grande augmentation relative pour chaque nouveau cas de cancer (nombre multiplié par 9,48). En termes d'augmentation absolue et relative des ventes de doses quotidiennes déterminées pour lathérapie ciblée, c'est au Kazakhstan qu'elle était la plus élevée. La Malaisie est le pays ayant vendu le plus grand nombre de doses quotidiennes déterminées pour l'endocrinothérapie, tandis que la Chine et l'Indonésie ont plus que doublé leur volume de vente ajusté entre 2007 et 2017.. L'exploitation des données de vente peut combler un manque de connaissances dans l'utilisation de médicaments contre le cancer, surtout pendant les périodes d'élargissement de la couverture maladie. En les associant à d'autres informations, les données sur le volume de vente permettent de suivre les efforts fournis pour garantir un accès de plus en plus équitable aux médicaments essentiels.. Evaluar las ventas de los medicamentos contra el cáncer que aparecen en la. Los datos sobre el volumen de ventas de 39 medicamentos contra el cáncer se obtuvieron de la base de datos IQVIA. Se dividió la cantidad total que se vendió por la dosis diaria definida de referencia para estimar el número total de dosis diarias definidas que se vendieron, por país y por año, para tres tipos de tratamientos anticancerosos (quimioterapia tradicional, terapia dirigida y tratamiento endocrino). Se adaptaron estos datos por el número de nuevos casos de cáncer en cada país para cada año.. Se observó un incremento en las ventas de todos los tipos de tratamientos anticancerosos en todos los países. El mayor número de dosis diarias definidas de quimioterapia tradicional por cada nuevo caso de cáncer se vendió en Tailandia; sin embargo, el mayor incremento relativo por cada nuevo caso de cáncer se registró en Indonesia (9,48 veces). Los mayores incrementos absolutos y relativos de las ventas de dosis diarias definidas de las terapias dirigidas por cada nuevo caso de cáncer se registraron en Kazajstán. Malasia vendió el mayor número de dosis diarias definidas adaptadas de los tratamientos endocrinos en 2017, mientras que China e Indonesia duplicaron con creces sus volúmenes de ventas ajustadas entre 2007 y 2017.. El empleo de los datos de ventas puede llenar un importante vacío de conocimientos sobre el uso de los medicamentos contra el cáncer, en particular durante los periodos de la ampliación de la cobertura de los seguros. Los datos sobre el volumen de ventas, junto con otros datos, pueden ayudar a supervisar los esfuerzos por mejorar el acceso equitativo a los medicamentos esenciales.. الغرض تقييم مبيعات أدوية مكافحة السرطان في القائمة النموذجية للأدوية الأساسية لمنظمة الصحة العالمية (WHO) لعام 2017 في كل من الصين وإندونيسيا وكازاخستان وماليزيا والفلبين وتايلند، من عام 2007 (2008 بالنسبة لكازاخستان وماليزيا) حتى عام 2017. الطريقة قمنا باستخلاص بيانات حجم المبيعات لعدد 39 دواءً مكافحاً للسرطان من قاعدة بيانات IQVIA. قمنا بتقسيم إجمالي الكمية المباعة بالجرعة اليومية المرجعية المحددة، وذلك لتقدير إجمالي عدد الجرعات اليومية المحددة المباعة، لكل بلد سنوياً، لثلاثة أنواع من العلاجات المكافحة للسرطان (العلاج الكيميائي التقليدي، والعلاج الموجه، والعلاج بالغدد الصماء). قمنا بتعديل هذه البيانات حسب عدد حالات السرطان الجديدة في كل دولة لكل عام. النتائج لاحظنا زيادة في مبيعات كل أنواع العلاجات المكافحة للسرطان في كل الدول. تم بيع أكبر عدد من الجرعات اليومية المحددة من العلاج الكيميائي التقليدي، لكل حالة سرطان جديدة، في تايلند؛ ومع ذلك، حدثت أكبر زيادة نسبية لكل حالة سرطان جديدة في إندونيسيا (9.48 ضعفاً). حدثت أكبر زيادات مطلقة ونسبية في مبيعات الجرعات اليومية المحددة من العلاجات المستهدفة لكل حالة سرطان جديدة، في كازاخستان. باعت ماليزيا أكبر عدد من الجرعات اليومية المعدلة من علاجات الغدد الصماء في عام 2017، بينما باعت الصين وإندونيسيا أكثر من ضعف حجم مبيعاتهما المعدلة بين عامي 2007 و2017. الاستنتاج إن استخدام بيانات المبيعات يمكنه أن يسد فجوة معرفية هامة في استخدام أدوية مكافحة السرطان، وخاصة خلال فترات تمديد التغطية التأمينية. يمكن لبيانات حجم المبيعات، إلى جانب بيانات أخرى، أن تساعد في مراقبة الجهود لتحسين الوصول العادل إلى الأدوية الأساسية.. 旨在评估世界卫生组织发布的. 我们从 IQVIA 数据库中选取了 39 种抗癌药物的销量数据。我们用销售总量除以此参考清单中的限定日剂量来估算每个国家三种抗癌疗法（传统化疗、靶向治疗和内分泌疗法）每年的限定日剂量总销量。我们根据每个国家每年新增癌症病例数调整了这些数据。.. 我们观察到所有国家各种类型的抗癌疗法的销售额都有所增长。泰国每例新增癌症患者购买传统化疗药物的限定日剂量最大；然而，印度尼西亚每例新增癌症患者的相对增幅最大（9.48 倍）。哈萨克斯坦的新增癌症患者中，靶向治疗的限定日剂量销售额呈现最大的绝对增幅和相对增幅。2017 年，马来西亚调整后的内分泌疗法限定日剂量销量最大，而中国和印度尼西亚的调整后销售量在 2007 年至 2017 年增加了一倍以上。.. 销售数据的使用可以填补抗癌药物使用方面的重要认知缺口，尤其是在扩大保险覆盖范围期间。结合其他数据，销量数据有助于监测改善患者平等获取基本药物方面的工作。.. Оценить уровень продаж противораковых препаратов из изданного Всемирной организацией здравоохранения в 2017 году. Авторы получили данные о продажах 39 противораковых препаратов из базы данных IQVIA. Общее количество проданных единиц было разделено на эталонную условную суточную дозу для оценки общего количества условных суточных доз, проданных в конкретной стране за год. Рассматривались три типа противораковых препаратов: традиционная химиотерапия, таргетная и гормональная терапия. Данные затем были скорректированы по количеству новых случаев рака в каждой стране за каждый год.. Наблюдался рост продаж по всем типам противораковых препаратов в каждой из стран. Максимальное количество условных суточных доз традиционной химиотерапии на новый случай рака было продано в Таиланде, однако максимальный относительный прирост по каждому новому случаю продемонстрировала Индонезия (рост в 9,48 раза). Максимальный абсолютный и относительный прирост продаж условных суточных доз препаратов для таргетной терапии на новый случай рака продемонстрировал Казахстан. Малайзия стала лидером по продажам скорректированных условных суточных доз препаратов для гормональной терапии в 2017 году, а в период с 2007 по 2017 год Индонезия и Китай увеличили скорректированные объемы продаж более чем вдвое.. Использование данных продаж поможет восполнить значительный пробел в знаниях о применении противораковых препаратов, в частности в периоды расширения страхового покрытия. В сочетании с другими данными показатели объемов продаж помогут отслеживать усилия по обеспечению равного доступа населения к основным лекарственным средствам.

Topics: Antineoplastic Agents; China; Commerce; Databases, Factual; Drug Utilization; Humans; Indonesia; Kazakhstan; Malaysia; Neoplasms; Philippines; Thailand

Topics: COVID-19; Fertility; Humans; Malaysia; Neoplasms

The rapid growth of industrial and agricultural activities in Malaysia are leading to the impairment of most of the rivers in recent years through realising various trace metals. This leads to toxicity, particularly when the toxic has entered the food chain. Perak River is one of the most dynamic rivers for the Malaysian population. Therefore, in consideration of the safety issue, this study was conducted to assess the concentration of such metals (Cd, Cu, Zn, Fe, and Pb) in the muscles of most widely consumed fish species (Barbonymus schwanenfeldii, Puntius bulum, Puntius daruphani, Hexanematichthys sagor, Channa striatus, Mystacoleucus marginatus, and Devario regina) from different locations of Perak River, Malaysia by employing inductively coupled plasma optical emission spectroscopy (ICP-OES). Among the trace metals, Fe and Cd were found to be the highest (29.33-148.01 μg/g) and lowest (0.16-0.49 μg/g) concentration in all of the studied species, respectively. Although the estimated daily intakes (μg/kg/day) of Cd (0.65-0.85), Fe (79.27-352.00) and Pb (0.95-12.17) were higher than their reference, the total target hazard quotients values suggested that the local residents would not experience any adverse health effects from its consumption. In contrast, the target cancer risk value suggested that all fish species posed a potential cancer risk due to Cd and cumulative cancer risk values, strongly implying that continuous consumption of studied fish species would cause cancer development to its consumers.

Topics: Animals; Bioaccumulation; Cyprinidae; Ecosystem; Feeding Behavior; Fresh Water; Geography; Geologic Sediments; Malaysia; Neoplasms; Risk Assessment; Risk Factors; Rivers; Seafood; Species Specificity; Trace Elements; Water Pollutants, Chemical

Patient's financial ability is always the most critical imputes to treatment choice and adherence; as it translates into health outcomes such as survival rate and quality of life. Cancer care is likely to affect the patient's financial well-being, putting huge financial pressure to the families. Therefore, it is imperative to understand the confounding factors of financial toxicity among cancer survivors along the course of survivorship.. This study was designed in the form of cross-sectional analysis, in which, cancer survivors were recruited from the Sarawak General Hospital, the largest tertiary and referral public hospital in Sarawak. To capture the financial toxicity of the cancer survivors, the Comprehensive Score for Financial Toxicity (COST) instrument in its validated form was adopted. Multivariable logistic regression analysis was applied to determine the relationship between financial toxicity (FT) and its predictors.. The median age of the 461 cancer survivors was 56 while the median score of COST was 22.0. Besides, finding from multivariable logistic regression revealed that low income households (OR: 6.893, 95% CI, 3.109-15.281) were susceptible to higher risk of financial toxicity, while elderly survivors above 50 years old reported a lower risk in financial toxicity. Also, survivors with secondary schooling (OR:0.240; 95%CI, 0.110-0.519) and above [College or university (OR: 0.242; 95% CI, 0.090-0.646)] suffer a lower risk of FT.. Financial toxicity was found to be associated with survivors age, household income and educational level. In the context of cancer treatment within public health facility, younger survivors, households from B40 group and individual with educational attainment below the first level schooling in the Malaysian system of education are prone to greater financial toxicity. Therefore, it is crucial for healthcare policymakers and clinicians to deliberate the plausible risk of financial toxicity borne by the patient amidst the treatment process.

Topics: Aged; Cancer Survivors; Cost of Illness; Cross-Sectional Studies; Female; Follow-Up Studies; Health Expenditures; Humans; Income; Malaysia; Male; Middle Aged; Neoplasms; Prognosis; Quality of Life; Socioeconomic Factors; Surveys and Questionnaires; Survival Rate

The number of cancer cases in Malaysia has increased from 32,000 cases in 2008 with to 37,000 in 2012 (check figures in text). This number is expected to rise to 56,932 by 2025. Cancer patients undergoing chemotherapy experience low to moderate level of self-esteem.. To determine the self-esteem among oncology patients receiving chemotherapy in selected government state hospitals, Peninsular Malaysia.. A cross-sectional study was conducted using selfadministered questionnaires. 953 respondents were given questionnaires which included socio-demographic profile, physical effect, depression, anxiety, quality of life and self esteem. Inferential analysis was done by using Independent T-test or Pearson's Correlation and the level of significance was p<0.05. Multivariate logistic regression was then used to determine the predictors using Statistical Package for Social Sciences software version 22.0 RESULTS: All 953 respondents selected participated in this study. The overall mean self-esteem in this study was 22.67, SD=4.98. The significant predictors of self-esteem where pvalue was <0.05 were age; gender; marital status; working status; anxiety; depression; nausea; anemia; hair loss; skin and nail changes; overall quality of life and psychological domain of quality of life. The finding of this study indicates that predictors of selfesteem among patients undergoing chemotherapy should be taken into account to improve their quality of life. Guidelines on how to manage self-esteem in a chemotherapy patient can be done using this study as the baseline.

Topics: Antineoplastic Agents; Cross-Sectional Studies; Female; Hospitals, State; Humans; Incidence; Malaysia; Male; Middle Aged; Neoplasms; Quality of Life; Retrospective Studies; Self Concept; Surveys and Questionnaires

The present study aimed to explore the use of meaning-making coping mechanisms (existential, spiritual and religious coping) among ethnic Malay cancer patients in Malaysia and to investigate the impact of culture on their choice of coping methods. Twenty-nine participants with various kinds of cancer were interviewed. Four kinds of coping resources emerged from analyses of the interview transcripts: (1) relying on transcendent power, (2) supernatural or mystical beliefs, (3) finding oneself in relationships with others and (4) nature. In this article, the two first resources are in focus. The present findings suggest that Malay culture, which is imbued with Islamic belief, strongly influences cancer patients' coping methods and ways of looking at their experience of being cancer patients.

Topics: Adaptation, Psychological; Adult; Culture; Existentialism; Female; Humans; Interviews as Topic; Islam; Malaysia; Male; Middle Aged; Neoplasms; Qualitative Research; Religion and Medicine; Religion and Psychology; Social Support; Spirituality

The extensive biodiversity of plants in Southeast Asia and inadequate research hitherto warrant a continued investigation into medicinal plants. On the basis of a careful review of fresh medicinal plant usage to treat cancer from previous ethnobotanical interviews in Singapore and from the traditional uses of the indigenous plants, fresh leaves of seven locally grown medicinal plant species were evaluated for anti-proliferative activity.. To evaluate the anti-proliferative activity of local medicinal plant species Clausena lansium Skeels, Clinacanthus nutans (Burm. f.) Lindau, Leea indica (Burm. f.) Merr., Pereskia bleo (Kunth) DC., Strobilanthes crispus (L.) Blume, Vernonia amygdalina Delile and Vitex trifolia L.. Fresh, healthy and mature leaves of the seven medicinal plants were harvested from various locations in Singapore and Malaysia for Soxhlet, ultrasonication and maceration extractions in three different solvents (water, ethanol and methanol). Cell proliferation assay using water soluble tetrazolium salt (WST-1) assay was performed on twelve human cancer cell lines derived from breast (MDA-MB-231, T47D), cervical (C33A), colon (HCT116), leukemia (U937), liver (HepG2, SNU-182, SNU-449), ovarian (OVCAR-5, PA-1, SK-OV-3) and uterine (MES-SA/DX5) cancer.. The results of this study provide new scientific evidence for the traditional use of local medicinal plant species C. lansium, L . indica, P. bleo, S. crispus, V. amygdalina and V. trifolia in cancer treatment. These results highlight the importance of the upkeep of these indigenous plants in modern society and their relevance as resources for drug discovery.

Topics: Antineoplastic Agents, Phytogenic; Cell Line, Tumor; Ethnobotany; Humans; Malaysia; Medicine, East Asian Traditional; Neoplasms; Plant Extracts; Plants, Medicinal; Singapore

Topics: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Fatigue; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Pain; Public Health Surveillance; Sleep; Stress, Psychological; Surveys and Questionnaires

Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage.. Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable analyses.. One fifth of patients had private health insurance. Incidence of FC at 1 year was 51% (MOH hospitals, 33%; public university hospital, 65%; private hospitals, 72%). Thirty-three percent of households were impoverished at 1 year. Economic hardship was reported by 47% of families. Risk of FC attributed to conventional medical care alone was 18% (MOH hospitals, 5%; public university hospital, 24%; private hospitals, 67%). Inclusion of expenditures on nonmedical goods and services inflated the risk of financial toxicity in public hospitals. Low-income status, type of hospital, and lack of health insurance were strong predictors of FC.. Patients with cancer may not be fully protected against financial hardships, even in settings with universal health coverage. Nonmedical costs also contribute as important drivers of financial toxicity in these settings.

Topics: Family Characteristics; Female; Health Expenditures; Hospitals, Public; Humans; Income; Insurance, Health; Longitudinal Studies; Malaysia; Male; Middle Aged; Neoplasms; Poverty; Prospective Studies; Quality of Life; Socioeconomic Factors; Universal Health Insurance

Poor dietary habits have been identified as one of the cancer risks factors in various epidemiological studies. Consumption of healthy and balance diet is crucial to reduce cancer risk. Cancer prevention food plan should consist of all the right amounts of macronutrients and micronutrients. Although dietary habits could be changed, affordability of healthy foods has been a major concern, as the price of healthy foods are more expensive the unhealthy counterparts.. Therefore, using linear programming, this study is aimed to develop a healthy and balanced menu with minimal cost in accordance to individual needs that could in return help to prevent cancer. A cross sectional study involving 100 adults from a local university in Kuala Lumpur was conducted in 3 phases. The first phase is the data collection for the subjects, which includes their socio demographic, anthropometry and diet recall. The second phase was the creation of a balanced diet model at a minimum cost. The third and final phase was the finalization of the cancer prevention menu. Optimal and balanced menus were produced based on respective guidelines of WCRF/AICR (World Cancer Research Fund/ American Institute for Cancer Research) 2007, MDG (Malaysian Dietary Guidelines) 2010 and RNI (Recommended Nutrient Intake) 2017, with minimum cost.. Based on the diet recall, most of subjects did not achieve the recommended micronutrient intake for fiber, calcium, potassium, iron, B12, folate, vitamin A, vitamin E, vitamin K, and beta-carotene. While, the intake of sugar (51 ± 19.8 g), (13% ± 2%) and sodium (2585 ± 544 g) was more than recommended. From the optimization model, three menus, which met the dietary guidelines for cancer prevention by WCRF/AICR 2007, MDG 2010 and RNI 2017, with minimum cost of RM7.8, RM9.2 and RM9.7 per day were created.. Linear programming can be used to translate nutritional requirements based on selected Dietary Guidelines to achieve a healthy, well-balanced menu for cancer prevention at minimal cost. Furthermore, the models could help to shape consumer food choice decision to prevent cancer especially for those in low income group where high cost for health food has been the main deterrent for healthy eating.

Topics: Adult; Cross-Sectional Studies; Diet; Diet, Healthy; Dietary Fiber; Feeding Behavior; Female; Food Preferences; Humans; Malaysia; Male; Micronutrients; Middle Aged; Neoplasms; Nutrition Policy; Nutritional Requirements; Nutritional Status; Programming, Linear; Young Adult

Objectives Ageing is often associated with deteriorating mental and physical health and the need for long-term care, creating a fear of ageing. We investigated what people fear most in terms of disabling chronic diseases and their concerns regarding having long-term illnesses. Methods Data were obtained from an online survey of 518 respondents aged 40 years and older residing in Malaysia, which was based on a convenience sample collected in May 2015 to January 2016. Data were analyzed using chi-squared tests and multinomial logistic regression. Results Of the most dreaded diseases, heart disease and cancer are life-threatening; however, dementia, diabetes, and hypertension persist and have a disabling effect for a long time. While there were variations in the diseases feared most across sex, ethnicity, and place of residence, the biggest worry for all respondents with regard to having a long-term illness was that they would become a burden to their family, a concern that superseded fear of dying. Conclusions We found our survey respondents had a fear of chronic diseases and placing a burden on others. Thus, there is a need to provide motivation for people to adopt a healthy lifestyle, to remain healthy.

Topics: Aged; Aging; Anticipation, Psychological; Anxiety; Chronic Disease; Dementia; Diabetes Mellitus; Fear; Female; Heart Diseases; Humans; Hypertension; Malaysia; Male; Neoplasms; Surveys and Questionnaires

Quality of life and psychological well-being are important patient-centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low-income and middle-income countries remains scarce. We assessed health-related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle-income setting.. Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed-up in Malaysia for 1 year. Health-related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EuroQol-5 (EQ-5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses.. One year after diagnosis, the mean EORTC QLQ-C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty-four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high-income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type.. Cancer survivors in this middle-income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well-being is urgently needed in our settings.

Topics: Adult; Aged; Anxiety; Cancer Survivors; Depression; Female; Humans; Income; Malaysia; Male; Middle Aged; Neoplasms; Poverty; Prevalence; Quality of Life; Stress, Psychological; Surveys and Questionnaires

No abstract provided.

Topics: Female; Humans; Incidence; Malaysia; Male; Neoplasms

Cancer is a serious public health problem not only in Malaysia, also worldwide. The aim of this study was to determine the determinants of quality of life (QOL) among cancer patients in Peninsular Malaysia.. A cross sectional study was conducted among 2120 cancer patients in Peninsular Malaysia, between April 2016 to January 2017. All cancer patients aged 18 years old and above, Malaysian citizens and undergoing cancer treatment at government hospitals were approached to participate in this study and requested to complete a set of validated questionnaires. Inferential statistical tests such as t-test and one-way ANOVA were used to determine the differences between demographic variables, physical effects, clinical factors, psychological effects and self-esteem with the quality of life of cancer patients. Predictor(s) of quality of life were determined by using Multivariate linear regression models.. A total 1620 out of 2120 cancer patients participated in this study, giving a response rate of 92%. The majority of cancer patients were female 922 (56.9%), Malays 1031 (63.6%), Muslim 1031 (63.6%), received chemotherapy treatment 1483 (91.5%). Overall, 1138 (70.2%) of the patients had depression and 1500 (92.6%) had anxiety. Statistically significant associations were found between QOL and clinical factors, physical side effects of cancer, psychological effects and self-esteem (p < 0.05). However, among socio-demographics only age, race, religion, working status were significantly associated with QOL. Based on the multivariate regression analysis, the main predictors of QOL among cancer patients in Malaysia were age, self-esteem as positive predictors, and Indian race, nausea, fatigue, hair loss, bleeding as negative predictors.. The findings of this study provide a scientific basis to develop a comprehensive program for improving quality of life of cancer patients in Malaysia.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Middle Aged; Multivariate Analysis; Neoplasms; Quality of Life; Socioeconomic Factors; Surveys and Questionnaires

Microsporidia are obligate intracellular parasitic fungi causing chronic diarrhea, particularly among immunocompromised patients. The current method used for diagnosis is based on conventional microscopy, which does not differentiate parasites at the species level. The present study was carried out to identify microsporidian species in immunocompromised patients. From March 2016 to March 2017, a total of 289 archived stool samples were examined microscopically for microsporidian spores using Gram-chromotrope Kinyoun (GCK) stain. Positive stool samples by microscopy were subjected to polymerase chain reaction and sequencing for species identification. Based on microscopy examination, the overall prevalence of microsporidian infections was 32.2% (93/289; 95% CI = 27.1-37.8). Of these stool samples, 45 samples were successfully amplified and confirmed as

Topics: Adolescent; Adult; Animals; Child; Diarrhea; DNA, Fungal; Enterocytozoon; Feces; Female; HIV Infections; Humans; Immunocompromised Host; Malaysia; Microsporidiosis; Middle Aged; Neoplasms; Prevalence; Spores, Fungal

Background: Malignancies are among the leading causes of death in Systemic Lupus Erythematosus (SLE)\ patients with studies reporting a higher prevalence of malignancy in SLE patients compared to the general population.\ We wanted to determine the frequency of cancer in a cohort of SLE patients and identify its associated risk factors.\ Methods: Cross-sectional study involving SLE patients attending the nephrology outpatient clinic, Universiti\ Kebangsaan Malaysia Medical Centre between January and June 2014. Results: We recruited 228 patients (207 female,\ 21 male), aged 40.48 ± 12.86 years with mean SLE duration of 11.65 ± 6.46 years. Majority (87%) had lupus nephritis\ and were in remission with a median SLEDAI score 2 (0, 14). Majority (89%) were on corticosteroid with either a\ steroid sparing agent like mycophenolate mofetil (15.4%), azathioprine (36.8%) or ciclosporin (15.4%). One hundred\ and sixty (70.2%) patients were either receiving or had received intravenous cyclophosphamide with median dose\ of 5,173.6 ± 3,242.4 mg. Seven female patients were diagnosed with cancer during the course of their SLE with 56\ (34-78) years being median age at malignancy and SLE duration of 4 (0-12) years. Majority (5/7) had lupus nephritis\ and all patients a median dose of prednisolone 10 (2.5, 10) mg with 10 (4-24) years of steroids. Two patients had a\ family history of cancer with majority developing cancer after the diagnosis of SLE. Two patients received intravenous\ cyclophosphamide prior to the development of cancer for their SLE compared to overall cohort of 160. Three patients\ had colorectal cancer, 2 had cervical cancer, 1 had breast cancer, and one patient had germ cell tumour and one thyroid\ cancer. All patients had their cancer successful treated with no signs of recurrence. Conclusion: We found a lower\ occurrence of cancer in our SLE patients as compared with the reported literature.

Topics: Adrenal Cortex Hormones; Adult; Cohort Studies; Cross-Sectional Studies; Female; Humans; Lupus Erythematosus, Systemic; Lupus Nephritis; Malaysia; Male; Neoplasm Recurrence, Local; Neoplasms; Prevalence; Risk Factors; Severity of Illness Index; Steroids; Time Factors

A rapid epidemiological transition in developing countries in Southeast Asia has been accompanied by major shifts in the health status of children and adolescents. In this article, mortality estimates in Malaysian children and adolescents from 1990 to 2013 are used to illustrate these changes.. All-cause and cause-specific mortality estimates were obtained from the 2013 Global Burden of Disease Study. Data were extracted from 1990 to 2013 for the developmental age range from 1 to 24 years, for both sexes. Trends in all-cause and cause-specific mortality for the major epidemiological causes were estimated.. From 1990 to 2013, all-cause mortality decreased in all age groups. Reduction of all-cause mortality was greatest in 1- to 4-year-olds (2.4% per year reduction) and least in 20- to 24-year-olds (.9% per year reduction). Accordingly, in 2013, all-cause mortality was highest in 20- to 24-year-old males (129 per 100,000 per year). In 1990, the principal cause of death for 1- to 9-year boys and girls was vaccine preventable diseases. By 2013, neoplasms had become the major cause of death in 1-9 year olds of both sexes. The major cause of death in 10- to 24-year-old females was typhoid in 1990 and neoplasms in 2013, whereas the major cause of death in 10- to 24-year-old males remained road traffic injuries.. The reduction in mortality across the epidemiological transition in Malaysia has been much less pronounced for adolescents than younger children. The contribution of injuries and noncommunicable diseases to adolescent mortality suggests where public health strategies should focus.

Topics: Accidents, Traffic; Adolescent; Adult; Age Factors; Cause of Death; Child; Child, Preschool; Communicable Diseases; Developing Countries; Female; Global Burden of Disease; Global Health; Humans; Infant; Infant Mortality; Malaysia; Male; Neoplasms; Risk Factors; Sex Factors; Wounds and Injuries; Young Adult

There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain.. This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups.. A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of < 50 mg morphine equivalents. The chronic use of opioids (> 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group.. The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Cancer Pain; Cross-Sectional Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fentanyl; Humans; Malaysia; Male; Middle Aged; Morphine; Neoplasms; Outpatient Clinics, Hospital; Oxycodone; Pain; Retrospective Studies; Young Adult

Malnutrition is common among patients with cancer, but little attention is given to its risks and consequences.. The aim of this study is to assess the nutritional status and identify the factors associated with malnutrition among newly diagnosed patients with cancer.. Patients admitted with newly diagnosed cancer at a teaching hospital in Malaysia were recruited from January to April 2015. Nutritional status was assessed before treatment initiation, and patients were classified into three categories.. A total of 132 pretreatment patients were recruited into the study. About half were severely malnourished. Patients with stage III cancer had the highest prevalence of severe malnourishment. Clinical parameters and disease characteristics were significantly associated with nutritional status. Demographic variables were also statistically significantly associated with severe nutritional status.

Topics: Adult; Age Factors; Aged; Body Weight; Cross-Sectional Studies; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Malaysia; Male; Malnutrition; Middle Aged; Monitoring, Physiologic; Neoplasm Invasiveness; Neoplasm Staging; Neoplasms; Nutrition Assessment; Nutritional Status; Risk Assessment; Sex Factors; Surveys and Questionnaires; Young Adult

Awareness for paediatric palliative care has resulted in the impetus for paediatrician-led palliative care services across Malaysia. However, there is paucity of local data on patients receiving hospital-based paediatric palliative care. We aim to review the clinical spectrum of patients referred to these services.. An observational study of children aged between 0-18 years receiving palliative care at 13 hospitals between 1st January and 31st December 2014 was carried out.. There were 315 patients analysed, 90 (28.6%) and 46 (14.6%) were neonates and adolescents respectively. The main ICD-10 diagnostic categories for all patients were identified to be 'Congenital malformations, deformations and chromosomal abnormalities' 117 (37.1%), 'Diseases of nervous system' 76 (24.1%) and 'Neoplasms' 60 (19.0%). At referral 156 (50%) patients had holistic needs assessments. Patients with 'Diseases of nervous system' were assessed to have significantly more physical needs than the other two diagnostic categories. Majority of patients who knew of their diagnosis and prognosis were those with malignancy. Over a fifth of referrals were at their terminal admission. Of 144 who died, 111 (77.1%) had advanced care plans. There was bereavement follow-up in 98 (68.1%) patients.. Patients referred for palliative care have varied diagnoses and needs. To ensure all paediatricians are competent to deliver quality care to all children, further education and training initiatives is imperative.

Topics: Adolescent; Child; Child, Preschool; Congenital Abnormalities; Female; Hospitals; Humans; Infant; Infant, Newborn; Malaysia; Male; Neoplasms; Palliative Care

Much has been done to examine the psychological impact of cancer treatment, but it remains unclear to what extent anxiety and depression is related to symptom prevalence. The present study concerned the characteristics and frequency of distress as related to symptom prevalence in cancer patients undergoing chemotherapy in Malaysia.. Participants were 303 consecutive adult cancer patients undergoing chemotherapy in an academic medical center. The short form Memorial Symptom Assessment Scale (MSAS-SF), which covers three domains of symptoms (global distress, physical- and psychological symptoms) was used to cross-sectionally measure symptom frequency and associated distress via self-reporting. One-way ANOVA and t-tests were used to test mean differences among MSAS-SF subscale scores.. Complete data were available for 303 patients. The mean number of symptoms was 14.5. The five most prevalent were fatigue, dry mouth, hair loss, drowsiness and lack of appetite. Overall, symptom burden and frequency were higher than in other published MSAS-SF studies. Higher symptom frequency was also found to be significantly related to greater distress in cancer patients undergoing chemotherapy.. Patients undergoing chemotherapy suffer from multiple physical and psychological symptoms. Better symptom control or palliative care is needed. Greater frequency of reported symptoms may also indicate a subconscious bid by patients for care and reassurance - thus tailored intervention to manage distress should be offered.

Topics: Antineoplastic Agents; Anxiety; Depression; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Stress, Psychological; Symptom Assessment

There is increased awareness of paediatric palliative care in Malaysia, but no local published data on home care services. We aimed to describe the paediatric experience at Hospis Malaysia, a community-based palliative care provider in Malaysia.. We conducted a retrospective case note review of patients aged up to 21 years who were referred to Hospis Malaysia from 2009 to 2013.. A total of 137 patients (92 male, 45 female) with a median age of 140 (3-250) months were included in this study. The majority (71.5%) had malignancies. At referral, 62 patients were still in hospital and 17 died prior to discharge. A total of 108 patients received home visits. At the first home visit, 89.8% of patients had at least one physical symptom. Pain was the most common (52.5%) symptom. Patients had various supportive devices: 39 were on feeding tubes, ten had tracheostomies, five were on bilevel positive airway pressure and ten had urinary catheters. 66 families discussed the preferred location of care at end-of-life. Among those who died, 78.9% died at home, as they preferred (p < 0.001). Regression analysis showed no statistically significant association between a home death and age, diagnosis and number of home visits. Bereavement follow-up occurred for 93.3% of families.. Community care referrals tend to occur late, with 25.5% of patients dying within two weeks of referral. At referral, patients often had untreated physical symptoms. The majority of families preferred and had a home death.

Topics: Cause of Death; Child, Preschool; Female; Follow-Up Studies; Home Care Services; Humans; Infant; Malaysia; Male; Neoplasms; Palliative Care; Retrospective Studies; Survival Rate

Topics: Animals; Humans; Hydrolases; Inflammation; Malaysia; Metabolic Networks and Pathways; Neoplasms; Neurodegenerative Diseases; Proteolysis; Systems Biology

Cancer is the fourth leading cause of death in Sabah Malaysia with a reported agestandardized incidence rate was 104.9 per 100,000 in 2007. The incidence rate depends on nonmandatory notification in the registry. Underreporting will provide the false picture of cancer control program effectiveness. The present study was to evaluate the performance of the cancer registry system in terms of representativeness, data quality, simplicity, acceptability and timeliness and provision of recommendations for improvement.. The evaluation was conducted among key informants in the National Cancer Registry (NCR) and reporting facilities from FebMay 2012 and was based on US CDC guidelines. Representativeness was assessed by matching cancer case in the Health Information System (HIS) and state pathology records with those in NCR. Data quality was measured through case finding and reabstracting of medical records by independent auditors. The reabstracting portion comprised 15 data items. Selfadministered questionnaires were used to assess simplicity and acceptability. Timeliness was measured from date of diagnosis to date of notification received and data dissemination.. Of 4613 cancer cases reported in HIS, 83.3% were matched with cancer registry. In the state pathology centre, 99.8% was notified to registry. Duplication of notification was 3%. Data completeness calculated for 104 samples was 63.4%. Registrars perceived simplicity in coding diagnosis as moderate. Notification process was moderately acceptable. Median duration of interval 1 was 5.7 months.. The performances of registry's attributes are fairly positive in terms of simplicity, case reporting sensitivity, and predictive value positive. It is moderately acceptable, data completeness and inflexible. The usefulness of registry is the area of concern to achieve registry objectives. Timeliness of reporting is within international standard, whereas timeliness to data dissemination was longer up to 4 years. Integration between existing HIS and national registration department will improve data quality.

Topics: Female; Humans; Malaysia; Male; Neoplasms; Population Surveillance; Program Evaluation; Registries; Surveys and Questionnaires; Time Factors

Background Drugs listed on formularies are often subjected to a variety of utilization restriction measures. However, the degree of restriction is influenced by multiple factors, including the characteristics and attributes of the listed drugs. Objective To identify the factors that are associated with the levels of prescribing restriction on oncology formulary drugs in Malaysia. Setting Oncology formulary in Malaysia. Method The Malaysia Drug Code assigned to each of the drug products on the Malaysia Ministry of Health (MOH) drug formulary was used to identify oncology drugs belonging to WHO ATC class L (antineoplastic and immunomodulating agents). Main outcome measures Categories of prescribing restrictions, therapeutic class, drug type, administration mode, number of sources and the post-approval use period. Results Oncology drugs having a shorter post-approval use period (p < 0.001), biologic oncology drugs (p = 0.01) and oncology drugs belonging to immunosuppressant therapeutic class (p = 0.03) were all significantly associated with a greater likelihood of being subjected to a higher level of prescribing restriction. Conclusion This study suggests that safety concerns, costs and potentials for inappropriate use were the important considerations influencing a higher level of prescribing restriction placement on oncology drugs in the Malaysia MOH drug formulary.

Topics: Antineoplastic Agents; Drug Prescriptions; Female; Health Personnel; Humans; Malaysia; Male; Neoplasms; Pharmacopoeias as Topic

Currently very little is known about the prevalence or magnitude of caregiver dependence in Singapore and thus, there is a need to fill this gap in this multiethnic ageing population. This study aims to determine the prevalence and risk factors of caregiver dependence among older adults in Singapore.. Data were used from the Well-being of the Singapore Elderly (WiSE) study, a nationally representative, cross-sectional survey among Singapore residents aged 60 years and above. Caregiver dependence was ascertained by asking the informant (the person who knows the older person best) a series of open-ended questions about the older person's care needs.. The older adult sample comprised 57.1% females and the majority were aged 60 to 74 years (74.8%), while 19.5% were 75 to 84 years, and 5.7% were 85 years and above. The prevalence of caregiver dependence was 17.2% among older adults. Significant sociodemographic risk factors of caregiver dependence included older age (75 to 84 years, and 85 years and above,. Various sociodemographic and health-related conditions were significantly associated with caregiver dependence. Dependent older adults will put greater demands on health and social services, resulting in greater healthcare expenditures. Hence, effective planning, services and support are crucial to meet the needs of dependent older adults and their caregivers.

Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Asthma; Caregivers; Cough; Cross-Sectional Studies; Dementia; Depression; Educational Status; Ethnicity; Female; Humans; India; Logistic Models; Malaysia; Male; Marital Status; Middle Aged; Multivariate Analysis; Neoplasms; Occupations; Paralysis; Prevalence; Retirement; Risk Factors; Singapore; Stroke; Vision Disorders

The Malaysian Cohort study was initiated in 2005 by the Malaysian government. The top-down approach to this population-based cohort study ensured the allocation of sufficient funding for the project which aimed to recruit 100,000 individuals aged 35-70 years. Participants were recruited from rural and urban areas as well as from various socioeconomic groups. The main objectives of the study were to identify risk factors, to study gene-environment interaction and to discover biomarkers for the early detection of cancers and other diseases. At recruitment, a questionnaire-based interview was conducted, biophysical measurements were performed and biospecimens were collected, processed and stored. Baseline investigations included fasting blood sugar, fasting lipid profile, renal profile and full blood count. From April 2006 to the end of September 2012 we recruited a total of 106,527 participants. The baseline prevalence data showed 16.6% participants with diabetes, 46.5% with hypertension, 44.9% with hypercholesterolaemia and 17.7% with obesity. The follow-up phase commenced in June 2013. This is the most comprehensive and biggest cohort study in Malaysia, and has become a valuable resource for epidemiological and biological research. For information on collaboration and also data access, investigators can contact the project leader at (rahmanj@ppukm.ukm.edu.my).

Topics: Adult; Age Distribution; Aged; Cause of Death; Chronic Disease; Diabetes Mellitus; Female; Gene-Environment Interaction; Humans; Hypercholesterolemia; Hypertension; Malaysia; Male; Middle Aged; Neoplasms; Obesity; Prevalence; Prospective Studies; Residence Characteristics; Rural Health; Sex Distribution; Socioeconomic Factors; Urban Health

Distress and psychiatric morbidity in cancer patients are associated with poorer outcomes including mortality. In this study, we examined the prevalence of psychiatric morbidity and its association with cancer survival over time.. Participants were 467 consecutive adult cancer patients attending oncology follow-ups at a single academic medical centre. Assessment consisted of the Hospital Anxiety and Depression Scale and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Comparison between co-morbid psychiatric cases and non-cases was made in follow-ups of up to 24 months.. Of the 467 patients, 217 of 220 patients with elevated total Hospital Anxiety and Depression Scale scores (≥16) met the criteria for an Axis I disorder at 6 months follow-up, with 102 of the follow-up sample having a persistent diagnosable psychiatric disorder after 1 year. The most frequent initial diagnoses were minor depression (17.6%), major depressive disorder (15.8%) and adjustment disorder (15.8%). Cancer patients without psychiatric morbidity had a survival benefit of 2.24 months or 67 days. Mean survival at 24 months was 20.87 months (95% CI 20.06-21.69) for cancer patients with psychiatric morbidity versus 23.11 months (95% CI 22.78-23.43) for those without (p < 0.001 for log rank). After adjusting for demographics and cancer stage on a Cox proportional hazards model, psychiatric morbidity remained associated with worse survival (hazard ratio 4.13, 95% CI 1.32-12.92, p = 0.015).. This study contributes to the growing body of evidence linking psychiatric morbidity to cancer mortality. Treating underlying psychiatric conditions in cancer may therefore improve not just quality of life but also survival.

Topics: Adjustment Disorders; Adolescent; Adult; Aged; Anxiety; Anxiety Disorders; Depression; Depressive Disorder; Depressive Disorder, Major; Female; Humans; Interview, Psychological; Longitudinal Studies; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Proportional Hazards Models; Young Adult

This study was performed to assess patient symptoms prevalence, frequency and severity, as well as distress and coping strategies used, and to identify the relationships between coping strategies and psychological and physical symptoms distress and demographic data of cancer patients. This cross-sectional descriptive study involved a total of 268 cancer patients with various types of cancer and chemotherapy identified in the oncology unit of an urban tertiary hospital.. Data were collected using questionnaires (demographic questionnaire, Medical characteristics, Memorial Symptom Assessment Scale (MSAS) and Brief COPE scales and analyzed for demographic, and disease-related variable effects on symptom prevalence, severity, distress and coping strategies.. Symptom prevalence was relatively high and ranged from 14.9% for swelling of arms and legs to 88.1% for lack of energy. This latter was the highest rated symptom in the study. The level of distress was found to be low in three domains. Problem-focused coping strategies were found to be more commonly employed compared to emotion-focused strategies, demonstrating significant associations with sex, age group, educational levels and race. However, there was a positive correlation between emotion-focused strategies and physical and psychological distress, indicating that patients would choose emotion-focused strategies when symptom distress increased.. These findings demonstrate that high symptom prevalence rates and coping strategies used render an improvement in current nursing management. Therefore development of symptoms management groups, encouraging the use of self-care diaries and enhancing the quality of psycho- oncology services provided are to be recommended.

Topics: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cross-Sectional Studies; Ethnicity; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Neoplasm Staging; Neoplasms; Prognosis; Self Care; Stress, Psychological; Surveys and Questionnaires; Symptom Assessment; Young Adult

Few studies have explored the knowledge and attitudes of adolescents toward cancer prevention and treatment. This lack of research and its potential utility in the development of new educational initiatives and screening methods, or the reconstruction of existing ones, provided the impetus for this study. The primary research aim was to assess secondary school student knowledge of cancer and determine whether or not they possessed basic knowledge of cancer symptoms, risk factors, and treatments and to determine the relationship between cancer knowledge and key demographic factors.. The Management and Science University conducted a cross-sectional study analyzing responses through cross-tabulation with the socio-demographic data collected.. The findings of our quantitative analysis suggest that Malaysian youth generally possess a moderate knowledge about cancer. Quantitative analyses found that socioeconomic inequalities and bias in education present as important factors contributing to cancer awareness, prevention, and treatment among Malaysian adolescents.. The findings indicate that Malaysian youth generally possess a moderate knowledge about cancer but the current deficiencies in initiatives directed to cancer awareness continue to hinder the improvement in prevention of cancer among Malaysian adolescents.

Topics: Adolescent; Adult; Attitude to Health; Child; Cross-Sectional Studies; Culture; Early Detection of Cancer; Female; Follow-Up Studies; Health Education; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Neoplasms; Surveys and Questionnaires; Universities; Young Adult

Usage of traditional, complementary and alternative medicine (TCAM) has gained popularity over the past few years. However, very little is known about TCAM use among Malaysian cancer patients. This study aimed to identify the determinants of TCAM usage among cancer patients with determination of relationships between demographic factors, patient satisfaction with conventional treatment, knowledge on TCAM and healthcare professional influence. Patient's perceptions towards TCAM were also determined. A simple random convenient sampling method was used to recruit 354 patients from Hospital Kuala Lumpur between February to April 2013. All were directly interviewed with a structured questionnaire. In this study, 172 respondents were TCAM users. There was no significant differences between demographic background of respondents in the usage of TCAM. Minimal correlation was found between patient satisfaction with the conventional treatment and usage of TCAM (r=0.091). A poor correlation was found between healthcare professional's influence and TCAM usage (r=-0.213) but the results suggested that increase in influence would decrease TCAM usage. Patient TCAM knowledge correlated negatively with the TCAM usage (r=-0.555) indicated that cancer patients are less likely to use TCAM when they have more TCAM knowledge. Healthcare professionals should be fully equipped with the necessary TCAM knowledge while maintaining patient satisfaction with the conventional treatment. They should also intervene on patient TCAM usage where a potential drug interaction or a harmful adverse event can occur.

Topics: Adult; Aged; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Medicine, Traditional; Middle Aged; Neoplasms; Patient Satisfaction; Professional-Patient Relations

Anxiety is the most common mental health disorders in the general population. This study aimed to determine the prevalence of anxiety, its associated factors and the predictors of anxiety among adults in the community of Selangor, Malaysia.. A cross sectional study was carried out in three districts in Selangor, Malaysia. The inclusion criteria of this study were Malaysian citizens, adults aged 18 years and above, and living in the selected living quarters based on the list provided by the Department of Statistics Malaysia (DOS). Participants completed a set of questionnaires, including the validated Malay version of Generalized Anxiety Disorder 7 (GAD 7) to detect anxiety.. Of the 2512 participants who were approached, 1556 of them participated in the study (61.90%). Based on the cut-off point of 8 and above in the GAD-7, the prevalence of anxiety was 8.2%. Based on the initial multiple logistic regression analysis, the predictors of anxiety were depression, serious problems at work, domestic violence and high perceived stress. When reanalyzed again after removing depression, low self-esteem and high perceived stress, six predictors that were identified are cancer, serious problems at work, domestic violence, unhappy relationship with family, non-organizational religious activity and intrinsic religiosity.. This study reports the prevalence of anxiety among adults in the community of Selangor, Malaysia and also the magnitude of the associations between various factors and anxiety.

Topics: Adolescent; Adult; Aged; Anxiety Disorders; China; Cross-Sectional Studies; Depression; Domestic Violence; Employment; Female; Humans; India; Interpersonal Relations; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Stress, Psychological; Surveys and Questionnaires; Young Adult

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the quality of life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliative treatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliative treatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlations with patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form) tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment, recruited into the study after informed consent using convenient sampling. Results showed that highest satisfaction were observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). The Mental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary (42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of life among cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation was found in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poor negative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feeling at peace and having a sense of meaning in life were more important to patients than being active or achieving good physical comfort. More studyis needed to investigate patients who score poorly on physical and mental component aspects to understand their needs in order to achieve better cancer care.

Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Neoplasms; Palliative Care; Patient Satisfaction; Prognosis; Quality of Life; Tertiary Care Centers; Young Adult

To examine the prescription rates in cancer patients of three common psychotropic drugs: anxiolytic/ hypnotic, antidepressant and antipsychotic.. In this retrospective cohort study, data were extracted from the pharmacy database of University Malaya Medical Center (UMMC) responsible for dispensing records of patients stored in the pharmacy's Medication Management and Use System (Ascribe). We analyzed the use of psychotropics in patients from the oncology ward and cardiology from 2008 to 2012. Odds ratios (ORs) were adjusted for age, gender and ethnicity.. A total of 3,345 oncology patients and 8,980 cardiology patients were included. Oncology patients were significantly more often prescribed psychotropic drugs (adjusted OR: anxiolytic/hypnotic=5.55 (CI: 4.64-6.63); antidepressants=6.08 (CI: 4.83-7.64) and antipsychotics=5.41 (CI: 4.17-7.02). Non-Malay female cancer patients were at significantly higher risk of anxiolytic/hypnotic use.. Psychotropic drugs prescription is common in cancer patients. Anxiolytic/hypnotic prescription rates are significantly higher in non-Malay female patients in Malaysia.

Topics: Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Cohort Studies; Databases, Pharmaceutical; Depressive Disorder, Major; Drug Prescriptions; Drug Utilization; Female; Heart Diseases; Hospitals, Teaching; Humans; Malaysia; Male; Middle Aged; Neoplasms; Practice Patterns, Physicians'; Psychotic Disorders; Psychotropic Drugs; Retrospective Studies

Successful implementation of pain management procedures and guidelines in an institution depends very much on the acceptance of many levels of healthcare providers.. The main purpose of this study was to determine the level of knowledge and attitudes regarding pain among nurses working in tertiary care in a local setting and the factors that may be associated with this.. This cross-sectional research study used a modified version of the Nurses' Knowledge and Attitudes Survey (NKAS) regarding pain. Basic demographic data were obtained for further correlation with the level of pain knowledge.. A total of 566 nurses, 34 male and 532 female, volunteered to participate in this study. The response rate (RR) was 76%, with an overall mean percentage score of 42.7±10.9 (range: 5-92.5). The majority of participants were younger nurses below 40 years of age and more than 70% had worked for less than 10 years (6.6±4.45). Up to 92% had never had any formal education in pain management in general. The total mean score of correct answers was 58.6±9.58, with oncology nursing staff scoring a higher percentage when compared with nurses from other general and critical care wards (63.52±9.27, p<0.045). Only 2.5% out of all participants obtained a score of 80% or greater. The majority of the oncology nurses achieved the expected competency level (p<0.03).. The present findings give further support for the universal concern about poor knowledge and attitudes among nurses related to the optimal management of pain. The results indicated that neither number of years working nor age influenced the level of knowledge or attitudes of the practising nurses. Oncology nursing staff consistently scored better than the rest of the cohort. This reflects that clinical experience helps to improve attitudes and knowledge concerning better pain management.

Topics: Adult; Attitude of Health Personnel; Clinical Competence; Cross-Sectional Studies; Data Collection; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Neoplasms; Nursing Staff, Hospital; Oncology Nursing; Pain; Pain Management; Surveys and Questionnaires; Tertiary Healthcare; Young Adult

This study aimed to assess the most common physical side effects experienced by local chemotherapy patients. Their perceptions of these side effects and informational needs from clinical pharmacists were also evaluated.. This was a single-center, cross-sectional study. A face-to-face interview guided by a structured questionnaire with cancer patients admitted to receive repeated cycles of chemotherapy was conducted. Information collected included chemotherapy-related side effects after last chemotherapy experience, the most worrisome side effects, the side effects overlooked by healthcare professionals and the preferred method, amount and source of receiving related information.. Of 99 patients recruited, 90 participated in this survey (response rate: 90.9%). The majority were in the age range of 45-64 years (73.3%) and female (93.3%). Seventy-five (83.3%) and seventy-one (78.9%) experienced nausea and vomiting, respectively. Both symptoms were selected as two of the most worrisome side effects (16.7% vs. 33.3%). Other common and worrisome side effects were hair loss and loss of appetite. Symptoms caused by peripheral neuropathies were perceived as the major symptoms being overlooked (6.7%). Most patients demanded information about side effects (60.0%) and they would like to receive as much information as possible (86.7%). Oral conversation (83.3%) remained as the preferred method and the clinical pharmacist was preferred by 46.7% of patients as the educator in this aspect.. The high prevalence of chemotherapy-related side effects among local patients is of concern. Findings of their perceptions and informational needs may serve as a valuable guide for clinical pharmacists to help in side effect management in Malaysia.

Topics: Adult; Antineoplastic Agents; Cross-Sectional Studies; Data Collection; Drug-Related Side Effects and Adverse Reactions; Female; Hospitals, General; Humans; Malaysia; Male; Middle Aged; Neoplasms; Pharmacists; Pharmacy Service, Hospital; Young Adult

Strongyloidiasis is one of the most commonly neglected but clinically important parasitic infections worldwide, especially among immunocompromised patients. Evidence of infection among immunocompromised patients in Malaysia is, however, lacking. In this study, microscopy, real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISAs) were used to detect Strongyloides stercoralis (S. stercoralis) infection among cancer patients in a Malaysian hospital.. A total of 192 stool and serum samples were collected from cancer patients who were receiving chemotherapy with or without steroid treatment at a hospital in northeastern Malaysia. Stool samples were examined for S. stercoralis using parasitological methods and real-time PCR. Serology by ELISA was performed to detect parasite-specific immunoglobulin G (IgG), IgG4 and immunoglobulin E (IgE) antibodies. For comparison, IgG4- and IgG-ELISAs were also performed on the sera of 150 healthy individuals from the same area.. Of the 192 samples examined, 1 (0.5%) sample was positive for S. stercoralis by microscopy, 3 (1.6%) by real-time PCR, 8 (4.2%) by IgG-ELISA, 6 (3.1%) by IgG4-ELISA, and none was positive by IgE-ELISA. In comparison, healthy blood donors had significantly lower prevalence of parasite-specific IgG (2.67%, p < 0.05) and IgG4 (2.67%, p < 0.05) responses.. This study showed that laboratory testing may be considered as a diagnostic investigation for S. stercoralis among immunocompromised cancer patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Antibodies, Helminth; Child; Child, Preschool; Cross-Sectional Studies; Enzyme-Linked Immunosorbent Assay; Female; Healthy Volunteers; Hospitalization; Humans; Immunocompromised Host; Immunoglobulin E; Immunoglobulin G; Malaysia; Male; Middle Aged; Neoplasms; Real-Time Polymerase Chain Reaction; Strongyloides stercoralis; Strongyloidiasis; Young Adult

Cancer therapy in Malaysia primarily focuses on the clinical management of patients with cancer and malnutrition continues to be one of the major causes of death in these patients. There is a dearth of information on the nutrient intake and status of newly diagnosed patients with cancer prior to the initiation of treatment. The present study aims to assess the nutrient intake and status of newly diagnosed patients with cancer from the East Coast of Peninsular Malaysia.. A cross-sectional study was conducted using a convenient sample of newly diagnosed adult patients with cancer (n = 70) attending the Oncology clinic, Hospital Universiti Sains Malaysia in the East Coast of Peninsular Malaysia. Information on socio-demographic characteristics, clinical status, anthropometry, dietary intake and biochemical data including blood samples was obtained.. The mean (SD) age, triceps skin fold (TSF), mid upper arm circumference (MUAC) and body mass index (BMI) of participants was 21.1(3.9) years, 17.6(7.9) mm, 24.1(5.5) cm, and 21.1(3.9) Kg/m(2), respectively; 39% participants had BMI <18.5 Kg/m(2). One-third of newly diagnosed patients with cancer were undernourished (i.e. women: MUAC <220 mm; men: <230 mm). The proportion (%) of participants with low haemoglobin (<120 g/L) and serum albumin (<38 g/dL) were 62% and 26%, respectively. The older women had significantly lower macro and micro nutrient intakes compared to men in the same age group (P <0.05).. At the time of diagnosis, greater than one-third of patients with cancer from the East Coast of Peninsular Malaysia were underweight and undernourished. The majority of patients with cancer had poor micronutrient intakes; the older women had a poor macro and micronutrient intakes. Before the initiation of rigorous clinical management of patients with cancer, screening for nutritional status, subsequent nutrition counseling, and interventions are essential to improve their nutritional status; consequently, response to cancer therapy, survival and quality of life.

Topics: Adult; Aged; Cross-Sectional Studies; Diet; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Nutritional Status; Young Adult

Ensuring adherence to chemotherapy is important to prevent disease progression, prolong survival and sustain good quality of life. Capecitabine is a complex chemotherapeutic agent with many side effects that might affect patient adherence to treatment. This cross sectional study aimed to determine adherence to capecitabine and its contributing factors among cancer outpatients in Malaysia. One hundred and thirteen patients on single regime capecitabine were recruited from Hospital Sultan Ismail and Hospital Kuala Lumpur from October 2013 to March 2014. Adherence was determined based on adherence score using validated Medication Compliance Questionnaire. Patient socio-demographics, disease, and treatment characteristics were obtained from medical records. Satisfaction score was measured using the validated Patient Satisfaction with Healthcare questionnaire. The mean adherence score was 96.1% (standard deviation: 3.29%). The significant contributing factors of adherence to capecitabine were Malay ethnicity [β=1.3; 95% confidence interval (CI): 0.21, 2.43; p value=0.020], being female [β=1.8; 95%CI: 0.61, 2.99; p value=0.003]), satisfaction score [β=0.08; 95%CI: 0.06, 1.46; p value=0.035], presence of nausea or vomiting [β=2.3; 95%CI: 1.12, 3.48; p value <0.001] and other side effects [β=1.45; 95%CI: 0.24, 2.65; p value=0.019]. Adherence to capecitabine was generally high in our local population. Attention should be given to non-Malay males and patients having nausea, vomiting or other side effects. Sufficient information, proactive assessment and appropriate management of side effects would improve patient satisfaction and thus create motivation to adhere to treatment plans.

Topics: Administration, Oral; Aged; Antimetabolites, Antineoplastic; Capecitabine; Cross-Sectional Studies; Deoxycytidine; Female; Fluorouracil; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Nausea; Neoplasms; Patient Satisfaction; Sex Factors; Vomiting

The National Health & Morbidity Survey (NHMS) IV (2011) observed that the prevalence of obese children aged less than 18 years in Malaysia is 6.1% compared to 5.4% overweight and obese in NHMS III (2006). As such, this observation is of public health importance as obesity is a forewarning risk factor for chronic diseases such as type-2 diabetes, cardiovascular diseases (CVD) and certain types of cancers. This MyHeART (Malaysian Health and Adolescents longitudinal Research Team) study aims to examine risk factors of non-communicable diseases (NCD) among adolescents.. The MyHeART study is longitudinal cohort study of 1361 schoolchildren (13-years old) attending 15 public secondary schools from the central (Kuala Lumpur and Selangor) and northern (Perak) regions of Peninsular Malaysia. The study used a stratified sampling design to select the study participants. Data collected at baseline included socio-economic, lifestyle (e.g. smoking, physical activity assessment, fitness assessment, seven-day diet history), and environmental information, anthropometric measurements, blood pressure, handgrip strength and bone mineral density. Blood samples for fasting blood glucose and lipid profiles, full blood count, renal profile, as well as bone profile and serum vitamin D were taken. This study cohort will be followed up again when participants turn 15, 17 and lastly, after a period of ten years (around the age of 27).. Nine percent of the adolescents from this study were obese. More male participants smoked compared to female participants (15.4% vs. 4.7%). Adolescent males had higher fasting blood glucose but the female participants had lower high density lipoprotein (HDL-cholesterol) and higher low density lipoprotein (LDL-cholesterol). In addition, adolescents from the rural area had higher fasting blood glucose, diastolic blood pressure, total cholesterol and LDL-cholesterol.. Our results demonstrated that adolescents from the rural area are at higher risk of NCDs compared to their urban counterpart. Tailor made public health interventions are highly recommended for adolescents as this may minimise the dreadful NCD burden in adulthood and health disparity between the rural and urban in the near future.

Topics: Adolescent; Blood Glucose; Blood Pressure; Cardiovascular Diseases; Cholesterol, HDL; Cholesterol, LDL; Diabetes Mellitus, Type 2; Fasting; Female; Health Surveys; Humans; Longitudinal Studies; Malaysia; Male; Neoplasms; Pediatric Obesity; Prevalence; Risk Factors; Rural Population; Sex Distribution; Smoking

This paper reports on part of a large study to identify competencies of oncology nurses in Malaysia. It focuses on oncology nurses' communications-related competency. As an important cancer care team member, oncology nurses need to communicate effectively with cancer patients. Literature shows that poor communication can make patients feel anxious, uncertain and generally not satisfied with their nurses' care. This paper deliberates on the importance of effective communication by oncology nurses in the context of a public hospital. Four focus group discussions were used in this study with 17 oncology/cancer care nurses from Malaysian public hospitals. The main inclusion criterion was that the nurses had to have undergone a post-basic course in oncology, or have work experience as a cancer care nurse. The findings indicated that nurses do communicate with their patients, patients' families and doctors to provide information about the disease, cancer treatment, disease recurrence and side effects. Nurses should have good communication skills in order to build relationships as well as to provide quality services to their patients. The paper concludes by recommending how oncology nursing competencies can be improved.

Topics: Adult; Clinical Competence; Communication; Female; Focus Groups; Hospitals, Public; Humans; Malaysia; Middle Aged; Neoplasms; Nurse-Patient Relations; Oncology Nursing; Physician-Nurse Relations

To describe the development and validation of a cancer awareness questionnaire (CAQ) based on a literature review of previous studies, focusing on cancer awareness and prevention.. A total of 388 Chinese undergraduate students in a private university in Kuala Lumpur, Malaysia, were recruited to evaluate the developed self-administered questionnaire. The CAQ consisted of four sections: awareness of cancer warning signs and screening tests; knowledge of cancer risk factors; barriers in seeking medical advice; and attitudes towards cancer and cancer prevention. The questionnaire was evaluated for construct validity using principal component analysis and internal consistency using Cronbach's alpha (α) coefficient. Test-retest reliability was assessed with a 10-14 days interval and measured using Pearson product-moment correlation.. The initial 77-item CAQ was reduced to 63 items, with satisfactory construct validity, and a high total internal consistency (Cronbach's α=0.77). A total of 143 students completed the questionnaire for the test-retest reliability obtaining a correlation of 0.72 (p<0.001) overall.. The CAQ could provide a reliable and valid measure that can be used to assess cancer awareness among local Chinese undergraduate students. However, further studies among students from different backgrounds (e.g. ethnicity) are required in order to facilitate the use of the cancer awareness questionnaire among all university students.

Topics: Adult; Asian People; Cultural Diversity; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Neoplasms; Reproducibility of Results; Risk Factors; Students; Surveys and Questionnaires; Young Adult

The geriatric population in Malaysia is predicted to increase from 4% of the total population in 1998 to 9.8% by 2020, in parallel with developments in the socioeconomy. Cancer is expected to be a major medical issue among this population. However, the decision for treatment in Malaysia is always decided by the caregivers instead of the elderly patients themselves.. The aim of the study was to assess the willingness to accept chemotherapy among elderly Malaysians.. In this cross-sectional study, patients aged 60 and above from various clinics/wards were recruited. Those giving consent were interviewed using a questionnaire.. A total of 75 patients were recruited, 35 patients (47%) with a history of cancer. The median age was 73 years old. There were 29 Chinese (38.7%), 22 Indian (29.3%), 20 Malay (26.7%) and four other ethnicity patients. Some 83% and 73% of patients willing to accept strong and mild chemotherapy, respectively. Patients with cancer were more willing to accept strong and mild chemotherapy compared to the non-cancer group (88.6% vs 62.5%, P=0.005, 94% vs 80%, P=0.068). On sub-analysis, 71.4% and 42.9% of Chinese patients without a history of cancer were not willing to receive strong and mild chemotherapy, respectively.. The majority of elderly patients in UMMC were willing to receive chemotherapy if they had cancer. Experience with previous treatment had positive influence on the willingness to undergo chemotherapy.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Attitude to Health; Cross-Sectional Studies; Female; Follow-Up Studies; Health Surveys; Humans; Malaysia; Male; Middle Aged; Neoplasms; Patient Acceptance of Health Care; Prognosis; Surveys and Questionnaires

Health Related Quality of Life (HRQoL) is an important aspect in identifying cancer patients' perceptions of being diagnosed with cancer and the assessment of treatment outcomes. The present study aimedto assess the profile and predicators of HRQoL of Malaysian oncology patients.. A cross sectional study adopting the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was conducted. All cancer patients attending Penang General Hospital between August-November 2011 were approached. Descriptive statistics were used to assess demographic and disease related characteristics of the patients. All analyses were performed using SPSS v 16.0.. Three hundred and ninety three cancer patients met the inclusion criteria and were enrolled in the study. The mean age was 53.9 (SD±13) years. The cohort was dominated by females (n=260, 66.2%). Nearly half (n=190, 48.3%) of the participants were of Malay ethnicity, practicing Islam as their religion (n=194, 49.4%). Two hundred and ninety six (n=296, 75.3%) had beene diagnosed with cancer within six months to 3 years previously. The most common primary cancer site was breast (n=143, 36.4%). The mean Global Health Status (GHS) score was 60.7 (SD=21.3). Females (mean GHS score of 62.3, p=0.035) with Malay ethnicity (mean GHS score of 63.8, p=0.047), practicing Islam as their religion (mean GHS score of 63.0, p=0.011) had better GHS scores. Patients having medical insurance had good scores (mean 65.6, p=0.021). Marital status was significantly associated with GHS scores (p=0.022). Bone cancer patientshad the lowest mean GHS score of 49.2 (p=0.044). Patients at very advanced stages of cancer featured a low GHS mean score of 52.2 (p<0.001).. The present study identified many demographic and disease related factors which may contribute to the HRQoL of cancer patients, pointing to the necessity for improved management of disease symptoms and provision of psychological and financial support.

Topics: Adolescent; Adult; Aged; Cohort Studies; Cross-Sectional Studies; Female; Follow-Up Studies; Health Status; Humans; Malaysia; Male; Middle Aged; Neoplasms; Prognosis; Quality of Life; Surveys and Questionnaires; Young Adult

For a number of reasons from cultural compatibility, to accessibility, to cost, traditional healers are a major source of health care in developing countries. In Malaysia, 'en estimated that upwards of 80% of the population consult traditional healers even if simultaneously seeking treatment from the Western medical system. Partially as a result of the widespread practice of visiting traditional healers, cancer diagnosis and treatment in Malaysia is often delayed or interrupted resulting in late presentation, advanced stage diagnosis, and a higher mortality rate than in Western countries. However, there is very little research on the role of traditional healers in cancer treatment in Malaysia.. This qualitative study was designed to identify the roles traditional healers play in cancer diagnosis and treatment, with an eye to alleviating the cancer burden through educational responses with four publics in mind-policy makers, Western medical personnel, traditional healers, and the general public. In-depth interviews were conducted with 14 Malay traditional healers, 13 cancer survivors who had seen both traditional healers and Western doctors, and 12 cancer medical specialists.. Analysis of the data from these 39 participants revealed four roles traditional healers play in cancer treatment-medicinal healer, emotional comforter, spiritual guide, and palliative caregiver.. Three roles (emotional, spiritual, palliative) can be seen as complementary to the allopathic system. Emotional and spiritual roles may augment the effectiveness of biomedical treatment. Cancer awareness and education programs need to position traditional healers as complementary, rather than an alternative to Western medical treatment; Validating the roles Traditional Healers can play in cancer treatment in MY through health promotion and education will contribute to alleviating the nation's cancer burden.

Topics: Adult; Aged; Aged, 80 and over; Complementary Therapies; Female; Follow-Up Studies; Health Promotion; Humans; Malaysia; Male; Medicine, Traditional; Middle Aged; Neoplasms; Patient Acceptance of Health Care; Prognosis; Referral and Consultation

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

Topics: Adult; Aged; Delivery of Health Care; Female; Focus Groups; Humans; Malaysia; Male; Middle Aged; Neoplasms; Qualitative Research; Quality of Health Care; Volunteers

In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94 patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primary prophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysis of two antiemetic regimens from the payer perspective.. This cost evaluation refers to 2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drug acquisition, materials and time spent for clinical activities from prescribing to dispensing of home medications were 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 successfully treated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness.. Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimen than for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities were included, 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 was 7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-based regimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change of antiemetic effects of granisetron-based regimen.. While providing a better efficacy in acute emesis control, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis in LEC controversial.

Topics: Antiemetics; Antineoplastic Agents; Cost-Benefit Analysis; Dexamethasone; Drug Therapy, Combination; Follow-Up Studies; Granisetron; Humans; Malaysia; Metoclopramide; Nausea; Neoplasms; Prognosis; Retrospective Studies; Vomiting

Clinical trials on cancer subjects have one of the highest dropout rates. Barriers to recruitment range from patient-related, through institutional-related to staff-related factors. This paper highlights the low response rate and the recruitment barriers faced in our Qigong exercises trial.. The Qigong trial is a three-arm trial with a priori power size of 114 patients for 80% power. The University Malaya Medical Centre database showed a total of 1,933 patients from 2006-2010 and 751 patients met our inclusion criteria. These patients were approached via telephone interview. 131 out of 197 patients attended the trial and the final response rate was 48% (n=95/197).. Multiple barriers were identified, and were regrouped as patient- related, clinician-related and/or institutional related. A major consistent barrier was logistic difficulty related to transportation and car parking at the Medical Centre. conclusions: All clinical trials must pay considerable attention to the recruitment process and it should even be piloted to identify potential barriers and facilitators to reduce attrition rate in trials.

Topics: Exercise; Humans; Malaysia; Neoplasms; Patient Selection; Qigong; Randomized Controlled Trials as Topic; Survivors

Findings in the area of patient-physician relationship are riddled with inconsistencies. Although patient-centredness has been found to have special relevance in chronic illnesses, no study in the Southeast Asian region has so far examined role orientation and its implication for patient-centred outcomes in the cancer context. This study aimed to examine role orientation in cancer patients and their physicians, doctor-patient fit and how this congruence relates to patient satisfaction.. The participants were 80 cancer patients and 12 physicians from a single academic medical centre. All participants completed the Patient-Practitioner Orientation Scale, while only the patient participants completed the self-administered Patient Satisfaction Questionnaire.. The cancer patients and their oncologists were found to be patient-centred and thus showed a high doctor-patient fit. Our findings also support the hypothesis that patient-centredness (overall mean = 4.66 ± 0.585) and patient-physician congruence (overall mean = 4.95 ± 0.088) are significantly associated (t(90) = -1.75, p = 0.084) with patient satisfaction (r = 0.56, p < 0.01).. To our knowledge, this study is the first in the Southeast Asian context to examine congruence using role orientations of cancer patients and their oncologists as well as the resultant patient satisfaction in an actual clinical setting. The finding that strong doctor-patient fit is linked to higher patient satisfaction is unexpected and differs from the results of other studies from the USA. Further studies are required in order to examine how this may be influenced by differences in socio-cultural norms and expectations.

Topics: Academic Medical Centers; Adolescent; Adult; Aged; Attitude of Health Personnel; Attitude to Health; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Medical Oncology; Middle Aged; Neoplasms; Patient Satisfaction; Physician-Patient Relations; Surveys and Questionnaires; Workforce

Cancer patients more than often experience poor quality of life after diagnosis and treatment of cancer. As the disease progresses quality of life issues become important. This cross-sectional study assessed various features of quality of life among 61 (33 women and 28 men) patients with advanced cancer cared by selected hospices in Peninsular Malaysia. The Hospice Quality of Life Index was used to assess quality of life. The mean total Hospice Quality of Life Index score for all subjects was 189.9 ± 51.7. The possible scores range from 0 to 280. The most problem areas in these patients were in the domain of functional well-being, followed by psychophysiological and social/spiritual domain. Patients with advanced cancer have a diminished quality of life. These findings suggest that there is a need for improving quality of life in terminally ill cancer patients in hospice care.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Disability Evaluation; Female; Hospice Care; Humans; Malaysia; Male; Middle Aged; Neoplasms; Psychometrics; Quality of Life; Sickness Impact Profile; Spirituality; Terminally Ill; Young Adult

Endophytic fungi have been shown to be a promising source of biologically active natural products. In the present study, extracts of four endophytic fungi isolated from plants of the National Park, Pahang were evaluated for their cytotoxic activity and the nature of their active compounds determined. Those extracts exhibiting activity with IC(50) values less than 17 μg/ml against HCT116, MCF-7 and K562 cell lines were shown to induce apoptosis in these cell lines. Molecular analysis, based on sequences of the rDNA internal transcribed spacers ITS1 and ITS4, revealed all four endophytic fungi to be ascomycetes: three sordariomycetes and a dothideomycete. Six known compounds, cytochalasin J, dechlorogriseofulvin, demethylharzianic-acid, griseofulvin, harzianic acid and 2-hexylidene-3-methyl-succinic acid were identified from a rapid dereplication technique for fungal metabolites using an in-house UV library. The results from the present study suggest the potential of endophytic fungi as cytotoxic agents, and there is an indication that the isolates contain bioactive compounds that mainly kill cancer cells by apoptosis.

Topics: Antineoplastic Agents; Apoptosis; Ascomycota; Base Sequence; Biological Products; Cell Line, Tumor; DNA, Fungal; DNA, Ribosomal Spacer; Endophytes; Humans; Inhibitory Concentration 50; Malaysia; Neoplasms; Phytotherapy; Rain; Trees

The current study sought to evaluate Malaysian oncology patients' decision making about the use of Complementary and Alternative Medicine (CAM) for the management of their care. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified four central themes: Conceptualizing CAM, the decision making process; rationale given for selecting or rejecting CAM and barriers to CAM use. Participants generally used the term 'traditional medicine', referred to locally as 'ubat kampung', meaning medicine derived from 'local traditions'. Mixed reactions were shown concerning the effectiveness of CAM to cure cancer and the slow progression of CAM results and treatment costs were cited as major barriers to CAM use. Concerns regarding safety and efficacy of CAM in ameliorating cancer as well as potential interactions with conventional therapies highlighted the importance of patients' knowledge about cancer treatments.

Topics: Adult; Aged; Complementary Therapies; Decision Making; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Medicine, East Asian Traditional; Middle Aged; Neoplasms; Young Adult

There are an almost infinite number of states of health, all with differing qualities that can be affected by many factors. Each aspect of health has many components which contribute to multidimensionality. Cancer and its' related issues surrounding the treatment plan contribute to the variety of changes of quality of life of cancer patients throughout their life. The objective of this article was to provide an overview of some of the issues that can affect their quality of life and initiatives towards successful care in Malaysia by reviewing relevant reports and articles. The current strategies can be further strengthened by prevention of cancer while improving quality of service to cancer patients.

Topics: Government Programs; Humans; Malaysia; Neoplasms; Palliative Care; Quality Improvement; Quality of Life

Breaking bad news to cancer patients is a delicate and challenging task for most doctors. Better understanding of patients' preferences in breaking bad news can guide doctors in performing this task.. This study aimed to describe the preferences of Malaysian cancer patients regarding the communication of bad news.. This was a cross-sectional study conducted in the Oncology clinic of a tertiary teaching hospital. Two hundred adult cancer patients were recruited via purposive quota sampling. They were required to complete the Malay language version of the Measure of Patients' Preferences (MPP-BM) with minimal researcher assistance. Their responses were analysed using descriptive statistics. Association between demographic characteristics and domain scores were tested using non-parametric statistical tests.. Nine items were rated by the patients as essential: "Doctor is honest about the severity of my condition", "Doctor describing my treatment options in detail", "Doctor telling me best treatment options", Doctor letting me know all of the different treatment options", "Doctor being up to date on research on my type of cancer", "Doctor telling me news directly", "Being given detailed info about results of medical tests", "Being told in person", and "Having doctor offer hope about my condition". All these items had median scores of 5/5 (IQR:4-5). The median scores for the three domains were: "Content and Facilitation" 74/85, "Emotional Support" 23/30 and "Structural and Informational Support" 31/40. Ethnicity was found to be significantly associated with scores for "Content and Facilitation" and "Emotional Support". Educational status was significantly associated with scores for "Structural and Informational Support".. Malaysian cancer patients appreciate the ability of the doctor to provide adequate information using good communication skills during the process of breaking bad news. Provision of emotional support, structural support and informational support were also highly appreciated.

Topics: Cross-Sectional Studies; Female; Health Communication; Health Personnel; Humans; Malaysia; Male; Middle Aged; Neoplasms; Oncology Service, Hospital; Patient Preference; Patient Satisfaction; Physician-Patient Relations; Social Support; Surveys and Questionnaires; Truth Disclosure

This study aimed to compare the nutritional status of pediatric patients with hematological malignancies and solid tumors.. A total of 74 pediatric cancer patients were assessed for anthropometric status, biochemical profiles, and dietary intake.. The prevalence of undernutrition was higher among patients with solid tumors as reflected in their lower dietary intakes of energy and nutrients compared with patients with hematological malignancies.. Adequate dietary intake is important for pediatric cancer patients, but nurses need to pay more attention to the diets of patients with solid tumors as compared with those with hematological malignancies.

Topics: Adolescent; Anthropometry; Biomarkers, Tumor; Child; Child, Preschool; Cross-Sectional Studies; Diet; Female; Hematologic Neoplasms; Humans; Incidence; Malaysia; Male; Neoplasms; Nursing Assessment; Nutrition Disorders; Nutritional Status; Prevalence

This study sought to evaluate Malaysian oncology patients CAM disclosure to the health care providers. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified three themes: reasons of CAM disclosure, reasons of CAM non-disclosure and preference of CAM discussion to health care providers. Patients agreed that CAM disclosure is important to avoid any interaction with the conventional medicines. Perceived lack of physicians' knowledge & interest in CAM, fear of termination of therapy by the physicians upon CAM disclosure, and perceived simplicity of some of the CAM therapies were among the reasons of non-disclosure. Given the option of oncologists, pharmacists or nurses, patients described oncologists as the most suitable person to discuss or disclose CAM use due to confidence in their clinical skills. Understanding the underlying beliefs of patients' reluctance to disclose CAM to health care providers is important especially when they are on an ongoing treatment for cancer.

Topics: Adult; Aged; Complementary Therapies; Data Collection; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Patient Preference; Physician-Patient Relations; Truth Disclosure; Young Adult

The objective of this study was to explore the knowledge and perceptions of Malaysian tradition healers towards cancer and cancer prevention.. A total of 25 participants agreed to participate in this qualitative study during the period from 20th July 2011 until 24th of September 2011. The proposal of this study was approved by the Ethics Committee of Management and Science University (MSU). Once the participant agreed to be interviewed, date, time and place of the interviews were determined. Consent form was obtained from participants before the interview began. Participants were briefed about the study and its purpose, and after asking their permission, their replies were recorded. The data was organized into themes and analyzed manually.. Twenty-five Malaysian traditional healers participated in this qualitative study. The age of participants ranged between 26 to 78 years old. The majority were in the age group of 31-60 years old, male, Chinese, degree holders with a monthly income ranging from 1,000-5,000 Ringgit Malaysia (RM) and were married (56%, 80%, 48%, 52%, 68%, 84% respectively). The majority defined cancer as having high cholesterol or abscess accumulation. A few of them defined cancer as a type of cell growth. The majority mentioned that food and unhealthy lifestyles are the primary causes of cancer. Surprisingly some of them mentioned that cancer is caused by interference by ghosts. Regarding the diagnosis of cancer, the majority mentioned that they refer their patients to modern physicians' medical report when it comes to diagnosing or treating patients with cancer. The most common cancers that many patients came to seek treatment were breast cancers, followed by colon cancers, liver and lung cancers.. Despite good knowledge about the causes of cancer among traditional healers, misconceptions still exist. Insufficient knowledge about the definition of cancer was noted among the traditional healers. This urges immediate action by the Ministry of Health of Malaysia to set up a strict regulation and regular monitoring of the traditional healers nationally. Traditional and Complementary Medicine may be integrated into the healthcare system and need to have sustained cooperation for the benefit of patients since about 80% of patients use traditional medicines.

Topics: Adult; Complementary Therapies; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Medicine, Traditional; Middle Aged; Neoplasms; Perception; Prognosis; Qualitative Research; Surveys and Questionnaires

The objective of this study was to determine the knowledge, attitudes and practices of university students toward nutrition related to cancer prevention.. A total of 396 students from the Management and Science University (MSU) participated during the semester of March 2010. Stratified random sampling was used and consent was obtained before the questionnaire was distributed. ANOVA and the t-test were used for the univariate analysis and multiple linear regression was used for the multivariate analysis.. The participants ages ranged from 18 to 27 years (Mean ± SD = 23.3 ± 1.57), more than half being female (62.4%). The majority were 23 years old or younger, single, Malay and from non-Medical and Health Science faculties and with a family monthly income of less than 10,000 Ringgits Malaysia(79.5%; 99%, 65.9, 52.5%, 63.9%; respectively). Only 18.4% of participants reported a family history of cancer. About 32.1% had a medical check-up in the previous 12 months and 17.4% were smokers. Multivariate analysis showed the faculty type to be significantly associated with knowledge of cancer prevention (p = 0.04). Regular medical check-ups were associated with attitudes and practices of cancer prevention (p = 0.04, p=0.003 respectively), the latter being significantly influenced by sex, family history of cancer and smoking (p = 0.034, p=0.013, p=0.002; respectively).. The majority of participants had poor knowledge of nutrition as related to cancer prevention. Attention should be given to regular medical check-ups, awareness of family history and smoking influence.

Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Neoplasms; Nutrition Assessment; Nutritional Physiological Phenomena; Risk Factors; Smoking; Students; Surveys and Questionnaires; Universities; Young Adult

Cancer patients' knowledge about cancer and experiences with its treatment play an important role in long-term adherence in their disease management. This study aimed to explore cancer patients' knowledge about cancer, their perceptions of conventional therapies and the factors that contribute to medication adherence in the Malaysian population.. A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by cancer patients. Twenty patients were interviewed using a semi-structured interview guide. A saturation point was reached after the 18th interview, and no new information emerged with the subsequent 2 interviews. All interviews were transcribed verbatim and analysed by means of a standard content analysis framework.. The majority of patients related the cause of their cancer to be God's will. Participants perceived conventional therapies as effective due to their scientific methods of preparations. A fear of side effects was main reasons given for delay in seeking treatment; however, perceptions were reported to change after receiving treatment when effective management to reduce the risk of side effects had been experienced.. This study provides basic information about cancer patients' perceptions towards cancer and its treatment. These findings can help in the design of educational programs to enhance awareness and acceptances of cancer screening. Priorities for future research should focus on patients who refused the conventional therapies at any stage.

Topics: Adolescent; Adult; Aged; Female; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Malaysia; Male; Middle Aged; Neoplasms; Patients; Young Adult

Anemia is one of the most frequent hematological demonstration of malignant diseases, leading to impairment of function in all tissues and organs of cancer patients and associated with serious stress. This major problem may be exacerbated by radiotherapy or chemotherapy. It is characterized by lower hemoglobin (Hb) level or inadequate circulating red blood cells (RBCs). The present study evaluated the effectiveness of treatment guidelines for anemia among solid cancer patients in Penang hospital and to find associations between treatments and anemia onset and severity.. This is a retrospective observational study was conducted on 534 cancer patients with anemia who were admitted to a government hospital on Penang island i.e., Penang General Hospital in the period between 2003 to 2009.. Effectiveness of standard anemia treatment guidelines was not sufficient because correction of anemia was just temporary.. According to the results, erythropoietin must be used as a cornerstone even for patients who suffer from moderate anemia and blood transfusion should be used just for emergency cases when anemia leads to a critical situation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Antineoplastic Protocols; Disease Management; Erythropoietin; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Practice Guidelines as Topic; Retrospective Studies; Treatment Outcome; Young Adult

Thrombocytopenia denotes abnormal decreases in platelet numbers and is a major detrimental side effect of the chemotherapy or cancer disease itself which cal lead to hemorrhage from vital organ. This is particularly a problem for the brain specifically within solid cancer patients and has a great negative effect on cancer patients quality of life (QOL). It ranges from mild bleeding from small blood vessels to severe bleeding from large blood vessels. The present study was conducted to evaluate the effectiveness of treatment guidelines for thrombocytopenia among solid cancer patients in Penang hospital and to find associations between these treatments and thrombocytopenia onset and severity and to suggest changes in the guidelines.. This retrospective observational study, conducted in a government hospital on Penang island included 341 cancer patients with thrombocytopenia who were admitted in the period between 2003 to 2009. The main statistical tests used were Chi-square test and Logistic regression test. The level of significance was set at P < 0.05.. Of the total of 341, 21 (6.2%) showed thrombocytopenia before receiving chemotherapy and the remaining 320 (93.8%) after chemotherapy. The majority suffered from moderate thrombocytopenia (n=172; 53.8%), followed by mild a (n=97; 30.3%) and finally severe (n=51; 15.9%). For treatment, chemotherapy was delayed/ reduced (n=223; 65.4%) or platelets were transfused (n=51; 34.6%). However, thrombocytopenia problems were only temporarily solved.. Effectiveness of thrombocytopenia treatment guidelines was found to be insufficient. It is advisable that thrombopoietin be used as a cornerstone even for patients who suffer from moderate thrombocytopenia and platelets transfusion should be used just for emergency cases when thrombocytopenia leads to a critical situation.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Blood Platelets; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Platelet Transfusion; Retrospective Studies; Thrombocytopenia; Thrombopoietin; Treatment Outcome; Young Adult

Although the popularity of complementary indigenous Malay therapies (CIMT) in general healthcare is undeniable in the Malaysian context today, their usage within the palliative care scenarios remains unexplored. Our study was specifically embarked to determine CIMT’s usage pattern, reasons, attitudes, beliefs, perceptions and health-related quality of life (HRQoL) differences (users vs. non-users) in a sample of hospice-based palliative patients in Selangor, Malaysia. From the 39 consenting patients (mean age = 56 years; female = 56.4 percent; Malay = 53.8 percent), 38.5 percent were users of CIMT. Dried medicinal roots, herbs and sea cucumber products were the most preferred types of CIMT (53.3 percent). The most common reason cited for usage was because these were "easier and simpler to be administered" (46.7 percent). Although users' attitudes, beliefs and perceptions were more favourable than the non-users, between 30.0-73.3 percent of users remained unsure or had no knowledge regarding CIMT. They also exhibited significantly poorer Physical Symptoms than the non-users (p=0.006), a probable motive for seeking CIMT in the first place. Despite the small sample size, the findings provided some insight into the role of CIMT especially with regard to usage trends and overall well-being among the terminally-ill, of which healthcare professionals should constantly be vigilant of amidst their routine care responsibilities.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Hospices; Humans; Malaysia; Male; Medicine, East Asian Traditional; Middle Aged; Neoplasms; Palliative Care; Prospective Studies; Quality of Life; Socioeconomic Factors

To evaluate a psycho-educational program (PeP) for parents of children with cancer (PoCwC) in Malaysia.. Seventy-nine parents were invited to be either in an intervention (n=41) or a control group (n=38). Baseline assessment took place upon agreement of participation. Short-term effects were measured four weeks after the intervention. Control parents received standard care. Intervention parents received, in addition to standard care, 4 x 50 min sessions of information on childhood cancer and coping strategies.. Repeated measures of ANOVAs revealed increased knowledge about cancer (p=0.01) in the intervention parents compared with standard care. Intervention parents reported reduced anxiety and increased activities with children after the program; however, differences were not significant.. This PeP, the first of its kind in Malaysia, has significantly increased levels of knowledge among parents of seriously ill children which may point towards the potential for these services to increase coping in Malaysian PoCwC.

Topics: Anxiety; Child; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Neoplasms; Parent-Child Relations; Parents; Patient Education as Topic; Pilot Projects; Surveys and Questionnaires

Neonatal neoplasms are rare tumours notorious for their atypical presentation and unpredictable behaviour. Their optimal treatment remains uncertain, a dilemma compounded by the deleterious effects of adjuvant chemo- or radiotherapy during this vulnerable period of growth. This paper examined the relatively high incidence of these tumours and its impact on paediatric surgery in Malaysia.. Neonatal tumours treated at the Department of Paediatric Surgery, Kuala Lumpur Hospital over an 8-year period were retrospectively analysed. Besides data pertaining to patient demographics, distribution of tumour types and survival rates, morbidity from disease as well as treatment was emphasised in particular.. The 28 neonatal tumours, majority of which were sacrococcygeal teratoma, constituted 7% of all tumours treated by the unit. Surgical excision remained the mainstay of treatment. Mortality and morbidity from disease and treatment were not insignificant, at 7 and 29%, respectively.. The outcome of neonatal tumours treated in Malaysia appeared to be influenced by indigenous factors unique to the local healthcare setting. Several solutions were expounded, chief among these are strategies of improved and earlier detection, in addition to the centralisation of expertise for this group of tumours.

Topics: Diagnostic Imaging; Female; Follow-Up Studies; Humans; Infant, Newborn; Malaysia; Male; Morbidity; Neoplasms; Retrospective Studies; Surgical Procedures, Operative; Survival Rate

The purpose of the current study was to determine the prevalence of use of complementary and alternative medicine (CAM) by children with cancer and to compare the characteristics of CAM users and CAM nonusers.. A cross-sectional study was performed at a pediatric oncology center in Kuala Lumpur, Malaysia. The parents of 97 children with cancer were interviewed using a structured questionnaire.. Overall, 84.5% of the respondents had used CAM, and most of them believed that CAM provided a boost to the immune system, and used CAM with the intention to complement conventional treatment. The most frequently used CAM was water therapy (78%), followed by spirulina (33%), vitamin C (27%), multivitamin (23%), visit to traditional healers (22%), sea cucumber (Stichopus horrens) (15%), and Chinese traditional medicine (12%). The Malay (n = 67) were using more often (93%) CAM than non-Malay (n = 30, use 67%, P = 0.001).. CAM use is common among Malaysian children with cancer. Understanding the sociocultural dimension of patients' health beliefs is important to a successful treatment, and pediatric oncologists should ask for the use of CAM.

Topics: Adolescent; Child; Child, Preschool; Complementary Therapies; Cross-Sectional Studies; Ethnicity; Family Characteristics; Humans; Immune System; Infant; Infant, Newborn; Malaysia; Neoplasms; Parents; Surveys and Questionnaires

The aim of this paper was to determine the sociodemographic and cancer characteristics of patients with cancer at a tertiary care centre.. For the study, 80 newly-diagnosed cancer patients were selected and interviewed using structured questionnaires that included sociodemographic and cancer characteristic profiles. At the end of the study period of two years, the survivorship status of the patients was determined.. Gender, occupational status, type of cancer and stage of cancer were found to be significantly associated with the survival status among the study group of cancer patients. Results of logistic regression analysis showed that deceased patients were significantly more likely to be pensioners rather than employed, aged 60-69 years rather than 40-49 years, to have all other types of cancer rather than breast cancer, and to be in Stage 3 or 4 of the disease rather than in Stage 1 of the disease.. There is a greater necessity for psychosocial research in order to achieve optimal health for patients with cancer, and in turn, to improve the survival of cancer patients.

Topics: Adolescent; Adult; Aged; Child; Cost-Benefit Analysis; Female; Hospitals, Teaching; Humans; Malaysia; Male; Middle Aged; Neoplasms; Outcome Assessment, Health Care; Social Class; Treatment Outcome

Endophytes, microorganisms which reside in plant tissues, have potential in producing novel metabolites for exploitation in medicine. Cytotoxic and antibacterial activities of a total of 300 endophytic fungi were investigated.. Endophytic fungi were isolated from various parts of 43 plants from the National Park Pahang, Malaysia. Extracts from solid state culture were tested for cytotoxicity against a number of cancer cell lines using the MTT assay. Antibacterial activity was determined using the disc diffusion method.. A total of 300 endophytes were isolated from various parts of plants from the National Park, Pahang. 3.3% of extracts showed potent (IC50 < 0.01 microg/ml) cytotoxic activity against the murine leukemic P388 cell line and 1.7% against a human chronic myeloid leukemic cell line K562. Sporothrix sp. (KK29FL1) isolated from Costus speciosus showed strong cytotoxicity against colorectal carcinoma (HCT116) and human breast adenocarcinoma (MCF7) cell lines with IC50 values of 0.05 microg/ml and 0.02 microg/ml, respectively. Antibacterial activity was demonstrated for 8% of the extracts.. Results indicate the potential for production of bioactive agents from endophytes of the tropical rainforest flora.

Topics: Animals; Anti-Bacterial Agents; Antineoplastic Agents, Phytogenic; Cell Line, Tumor; Fungi; Humans; Malaysia; Mice; Neoplasms; Plants

Cancers and related treatments have devastating effects on psychosexual life of patients. This study helps us to understand the cultural perspectives of 50 Asian women diagnosed with cancer. Median age was 50+ years. Median duration of time from diagnosis to interview was 23 months. Thirty-eight per cent stopped sex before illness, 36% stopped sex completely whereas 18% stopped gradually after diagnosis; 8% continued to have sex till time of interview. Overall, 70% were living with spouse but not engaged in sexual intercourse; 31.4% slept in different room, 48.6% slept in the same room but without any form of sexual contact. Thirty-eight per cent believed sexual activity could cause cancer recurrence, and 30% believed cancer could be sexually transmitted. Eighty-two per cent reported acceptance of changes to physical appearance. Approximately 70-86% did not discuss sexuality with their doctor or spouse; 90% agreed doctors should ask about psychosexual issues on a routine basis. Approximately 74.4% reported good cooperation from spouse. Cultural beliefs of Asians pose as barriers to providing and receiving psychosexual affection between women diagnosed with cancer and their spouse. However, these beliefs also serve as protective factors in their mutual acceptance of change in psychosexual activities. Health-care professionals need to be sensitive to the vast cultural differences in psychosexual expressions and needs of women diagnosed with cancer.

Topics: Female; Humans; Malaysia; Menopause; Middle Aged; Neoplasms; Sexual Dysfunctions, Psychological; Surveys and Questionnaires; Women

Cancer patients frequently experience malnutrition and this is an important factor in impaired quality of life.. This cross-sectional study examined the association between global quality of life and its various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients cared for by selected hospices in peninsular Malaysia.. The Patient Generated-Subjective Global Assessment (PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality of life, respectively.. Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspected of being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score for these patients was 189.9-/+51.7, with possible scores ranging from 0 to 280. The most problem areas in these patients were in the domain of functional well-being and the least problems were found in the social/spiritual domain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, p<0.05), psychophysiological well-being (r2= 0.37, p<0.05), functional well-being (r2= 0.42, p<0.05) and social/ spiritual well-being (r2= 0.07, p<0.05). Thus, patients with a higher PG-SGA score or poorer nutritional status exhibited a lower quality of life.. Advanced cancer patients with poor nutritional status have a diminished quality of life. These findings suggest that there is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Hospice Care; Humans; Interviews as Topic; Linear Models; Malaysia; Male; Middle Aged; Neoplasms; Nutrition Disorders; Nutritional Status; Quality of Life; Terminally Ill

To determine the mortality rate and risk factors for death in a selected population in Songkhla province in southern Thailand.. The southern subjects were part of the Thai cohort which together with the cohort from China comprised the InterASIA survey which was conducted in the year 2000. Collected variables were the conventional ones and included the 2 ethnic groups which are specific for southern Thailand, i.e. Malay Muslims and Thai-Chinese Buddhists. Causes of death were determined by reviewing hospital records, verbal autopsies and a consensus by 2-3 physicians. Kaplan Meier's model was used to evaluate the independent factors related to death.. The follow-up was 5 years. Out of the original 1,006 subjects, the status could be examined in 86% and of these, 50 had died giving the Kaplan Meier 5-year survival rate of 94.3%. Sixteen died from cardiovascular diseases (CVD), 6 from strokes and 10 from coronary heart disease, and 15 died from cancer. Half of the deaths occurred in subjects older than 70 years. Independent risks for death were age, hypertension and diabetes mellitus. Risk for the major causes of death did not include ethnicity. Similar to the only existing prospective report of risk factors for death in Thailand (the Electricity Generating Authority of Thailand study), neither high total cholesterol, high triglyceride nor obesity were independent risks for death from CVD, but the present study differed in that the high density lipoprotein cholesterol was not found to be a protective factor for CVD death.. Risk factors for death in a five-year follow-up in Southern Thailand did not include lipids, ethnicity or urbanization but hypertension and diabetes mellitus did.

Topics: China; Coronary Artery Disease; Female; Health Surveys; Humans; Malaysia; Male; Middle Aged; Mortality; Neoplasms; Risk Factors; Stroke; Thailand; Time Factors

The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access.. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC.. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect.. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Delivery of Health Care; Female; Health Knowledge, Attitudes, Practice; Home Care Services; Humans; Malaysia; Male; Middle Aged; Morphine; Neoplasms; Pain; Palliative Care; Patient Acceptance of Health Care; Workforce

Within Malaysia's otherwise highly accessible public healthcare system, palliative medicine is still an underdeveloped discipline. Government surveys have shown that opioid consumption in Malaysia is dramatically lower than the global average, indicating a failure to meet the need for adequate pain control in terminally ill patients. Indeed, based on daily defined doses, only 24% of patients suffering from cancer pain receive regular opioid analgesia. The main barriers to effective pain control in Malaysia relate to physicians' and patients' attitudes towards the use of opioids. In one survey of physicians, 46% felt they lacked knowledge to manage patients with severe cancer pain, and 64% feared effects such as respiratory depression. Fear of addiction is common amongst patients, as is confusion regarding the legality of opioids. Additional barriers include the fact that no training in palliative care is given to medical students, and that smaller clinics often lack facilities to prepare and stock cheap oral morphine. A number of initiatives aim to improve the situation, including the establishment of palliative care departments in hospitals and implementation of post-graduate training programmes. Campaigns to raise public awareness are expected to increase patient demand for adequate cancer pain relief as part of good care.

Topics: Analgesics, Opioid; Developing Countries; Drug Utilization; Health Knowledge, Attitudes, Practice; Health Policy; Health Services Accessibility; Humans; Malaysia; Neoplasms; Pain; Palliative Care; Practice Patterns, Physicians'; Terminally Ill

The aims of this study were to determine the types of cancers and hematological disorders in patients attending a pediatric hematology-oncology clinic. This was a prospective study at the Pediatric Institute, General Hospital Kuala Lumpur, Malaysia from June 2005-November 2006. During the 18-month study, 803 patients attended the clinic, 730 had oncological problems and 73 had hematological problems. The age range was from 2 months to 28 years (median 6 years). The patients were Malay (66%), Chinese (23%), Indian (10%) and other races (1%). Of the oncological patients, 51% had either leukemia (n=293) or lymphoma (n=77). The other most common diagnoses were retinoblastoma, followed by Wilm's tumor and germ cell tumors. Six patients (0.8%) developed a second malignant neoplasm. Of the hematological patients, 60% had platelet disorders, most commonly chronic immune thrombocytopenic purpura. Twenty-four per cent had bone marrow failure and 16% had red cell disorders.

Topics: Adolescent; Adult; Cancer Care Facilities; Child; Child, Preschool; Female; Hematologic Neoplasms; Humans; Infant; Malaysia; Male; Neoplasms; Prospective Studies; Young Adult

Cancer burden in Malaysia is increasing. Although there have been improvements in cancer treatment, these new therapies may potentially cause an exponential increase in the cost of cancer treatment. Therefore, justification for the use of these treatments is mandated. Availability of local data will enable us to evaluate and compare the outcome of our patients. This will help to support our clinical decision making and local policy, improve access to treatment and improve the provision and delivery of oncology services in Malaysia. The National Cancer Patient Registry was proposed as a database for cancer patients who seek treatment in Malaysia. It will be a valuable tool to provide timely and robust data on the actual setting in oncology practice, safety and cost effectiveness of treatment and most importantly the outcome of these patients.

Topics: Databases, Factual; Health Policy; Humans; Malaysia; Neoplasms; Registries; Research Design; Treatment Outcome

We present the results and conclusions of an observational prospective cohort design study using self-administered questionnaires to determine correlation between psychosocial factors and cancer outcome among 80 consecutive newly diagnosed treatment naïve cancer subjects who were being referred to the Oncology Clinic, Hospital Universiti Kebangsaan Malaysia. Subjects were recruited over a period of 43 weeks from October 2000 till July 2001. Follow-up assessments were carried out at 6-months and 12 to 26 months later. The prediction of survival time was performed by the Cox Regression Analysis method with adjustments for biological and psychosocial risk factors. It was noted that depression (p = 0.001), stage 4 cancer disease (p = 0.016), neurological (p = 0.032), gastrointestinal tract (p = 0.04), head and neck (p = 0.011), gynaecological (p = 0.005) and bone and soft tissue (p = 0.030) malignancies were independent and statistically significant prognostic factor of survival during the study period. It was further shown than depressed patients were found to have almost four fold greater risk of dying than non-depressed patients and patients with stage 4 cancer illness have a five fold greater risk of dying than patients with stage 1 disease. Furthermore, based on tumour types subjects with neurological, gynaecological, head and neck, bone and soft tissue and gastro intestinal tract malignancies were found to have approximately thirty-six, twenty-five, twenty-two, sixteen and seven fold greater risk of dying respectively when compared to subjects with genitourinary cancers. This study further affirms the need for health care providers to be aware of the psychological aspects of the cancer patient and provide appropriate therapy so as to ensure that this group of individuals would have enhanced survival rates.

Topics: Adaptation, Psychological; Adolescent; Adult; Aged; Child; Comorbidity; Depression; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Neoplasms; Prognosis; Prospective Studies; Quality of Life; Risk Factors; Stress, Psychological; Surveys and Questionnaires; Young Adult

The challenge of a cancer diagnosis may eventually lead to the experience of positive psychological changes, also referred to as posttraumatic growth. As most research on posttraumatic growth in cancer patients has been conducted in Western countries, little is known about the experience of such positive psychological changes in non-Western countries. Therefore, the purpose of this cross-sectional study was to investigate the prevalence of posttraumatic growth in a Malaysian sample of cancer patients. Secondly, we examined the association of posttraumatic growth with patients' report of psychological distress and their use of coping strategies.. The study was conducted in 113 cancer patients. Posttraumatic growth was measured by the Posttraumatic Growth Inventory, coping strategies by the brief COPE, and psychological distress by the Symptom Check List (SCL-90-R).. Results showed that many patients reported posttraumatic growth, mostly in the domain of appreciation of life. As hypothesized, the experience of posttraumatic growth was not significantly related to the level of psychological distress. Findings indicated that greater use of the coping strategies instrumental support, positive reframing, and humor was associated with more posttraumatic growth.. Overall, this study suggests that posttraumatic growth is not only a Western phenomenon. Malaysian cancer patients show similar trends in the report of growth as well as in its correlates as their Western counterparts.

Topics: Adaptation, Psychological; Adolescent; Adult; Aged; Aged, 80 and over; Attitude to Health; Depressive Disorder; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Quality of Life; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Young Adult

Many conditions, including benign and malignant tumours, peripheral vascular diseases and open fracture grade 3C, have been successfully treated with limb sparing procedures. However, the same could not be said for treatment of limb infection, especially late stage diabetic foot complications.. This is a retrospective review of patients who underwent operations at our hospital from July 2003 to June 2005. All patients who underwent various types of limbs amputations were included. The cohort was divided according to the diagnosis leading to the amputation and the level of amputation. The number and levels of amputation were then compared with the various causes leading to the amputation.. There were 203 patients who underwent amputation during the period of study. 135 (66.5 percent) of the patients were diabetic and amputations performed were related to diabetic foot conditions. 68 (33.5 percent) patients were not known to have diabetes mellitus. Among nondiabetic patients, 54 (26.6 percent) amputations were due to trauma, 11 (5.4 percent) were related to musculoskeletal tumours and 3 (1.5 percent) were due to peripheral vascular disease. Among diabetic patients, 23 (17 percent) patients underwent above knee amputation, 44 (33 percent) patients underwent below knee amputation, and 68 (50 percent) patients underwent local foot amputation. 80 of 135 (59.3 percent) patients, who underwent amputation due to diabetic complications, were less than 60 years old.. Good diabetic control and detection of early diabetic foot complications will reduce the number of patients undergoing limb amputation as well as the number of amputees. Since the incidence of lower limb amputation is due mainly to poor diabetic control, it is important to protect this group of patients from a probable avoidable amputation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amputation, Surgical; Child; Child, Preschool; Diabetic Foot; Female; Humans; Leg; Leg Injuries; Malaysia; Male; Middle Aged; Neoplasms; Peripheral Vascular Diseases; Retrospective Studies

The diagnosis of prostatic carcinoma (Pca) on routine biopsies may be challenging, and to date the commonly used marker to distinguish prostate carcinoma from benign prostatic lesions has been High Molecular Weight-Cytokeratin (HMW-CK). However, the antigen of HMW-CK is susceptible to the effect of formalin fixation and causes frequent loss or patchy staining in the obviously benign glands. More recently, antibodies to p63 have been reported to be more sensitive than HMW-CK for the detection of prostatic basal cells. p63, a homologue of tumour suppressor gene p53, is essential for prostate development and is selectively expressed in the nuclei of basal cells of normal prostate glands. The objective of this study is to compare the sensitivity and specificity of HMW-CK and p63 in distinguishing prostatic carcinomas from benign prostatic lesions, as well as determining their positive predictive values. Seventy-two cases from HUKM (comprising 29 prostatic carcinomas and 43 benign prostatic hyperplasias) were stained for both HMW-CK and p63. The sensitivity of p63 and HMW-CK in identifying basal cells in benign glands was 88.37% and 90.70% respectively. The specificity of both reagents was 100%, and the positive predictive value for both reagents was also 100%. Thus, p63 is a useful complementary basal cell specific stain to HMW-CK, and would be very helpful to practicing pathologists in dealing with difficult cases.

Topics: Biomarkers; Diagnosis, Differential; Humans; Keratins; Malaysia; Male; Membrane Proteins; Molecular Weight; Neoplasms; Neoplasms, Basal Cell; Prostatic Neoplasms

In societies such as Australia with a strong multicultural makeup, culturally determined attitudes to genetics, testing, and counseling may be incompatible with current genetics service provision.. An ethnographic investigation using purposive sampling to increase subject diversity was used to explore the range of beliefs about kinship and inheritance using Chinese-Australians as a case. Participants comprised a sample of 15 Chinese-Australians who had been recruited through several community-based organizations.. The level of acculturation does not correlate with holding beliefs about inheritance, kinship, and causes of hereditary cancer that are based on "Western" biomedical or traditional concepts. Mismatch between beliefs may exist within families that can impact participation in cancer genetic testing. Family history taking that underpins the surveillance, management, and referral to genetic counseling where there is a strong family history of breast, ovarian, or colorectal cancer can also be impacted unless recognition is made of the patrilineal concept of kinship prevalent in this Chinese-Australian community.. This community-based study confirmed and validated views and beliefs on inheritance and kinship and inherited cancer attributed to senior family members by Chinese-Australians who attended cancer genetic counseling. Barriers to communication can occur where there may be incompatibility within the family between "Western" and traditional beliefs. The findings were used to develop strategies for culturally competent cancer genetic counseling with Australian-Chinese patients. These include nonjudgmental incorporation of their belief systems into the genetic counseling process and avoidance of stereotyping. They have also influenced the development of genetics education materials to optimize family history taking.

Topics: Adult; Aged; Asian People; Australia; China; Culture; Female; Genetic Counseling; Genetic Predisposition to Disease; Genetic Testing; Hong Kong; Humans; Malaysia; Male; Middle Aged; Neoplasms; Patient Acceptance of Health Care; Patient Education as Topic; Pedigree

The original version of the Brief Pain Inventory (BPI) was translated into a Malay version by the standard procedure and was then evaluated for its psychometric properties. Of 119 eligible patients, a total of 113 (95%) agreed to participate in this study. Ages ranged from 18 to 76 years and interviews were conducted between August, 2004 and November, 2004. The pain intensity items demonstrated high loading with one factor, whereas the pain interference items were loaded on another factor. Two factors explained 62% of the variance. Compared to the Karnofsky Performance Scale, the pain intensity scales had a moderate negative (Pearson's) correlation (-0.520, P < 0.001) and the pain interference scales had a high negative correlation (-0.732, P < 0.001), showing good concurrent validity. The coefficient alpha of both subscales demonstrated good internal consistency of the items. The intraclass correlation coefficient for the test-retest stability was 0.61 for the pain intensity scale and 0.88 for the pain interference scale. The Malay version of the BPI is a reliable and valid instrument for cancer pain assessment and is comparable with the original version of the BPI in terms of structure and psychometric properties.

Topics: Adult; Aged; Data Collection; Female; Humans; Language; Malaysia; Male; Middle Aged; Neoplasms; Pain Measurement; Pain, Intractable; Reproducibility of Results; Surveys and Questionnaires

To document the perception of terminally ill patients and their family members on the care provided to them, and to look at the components of holistic care that are viewed as inadequate.. Thirty cancer patients from a 10-bed palliative ward and their family members who were the chief carers were interviewed. They were asked to give their perceptions on four major areas of care: physical, social, psychological and spiritual. The participants were asked to report which area(s) of the service were inadequate.. Most patients and family members perceived that they received adequate physical care. However, the psychosocial and spiritual aspect of care were perceived as inadequate by the majority of patients and their families. None of the patients interviewed had ever been asked about spiritual distress.. The holistic model of care in caring for terminally ill patients is not practised fully. Further development in the psychosocial and spiritual aspects of care is necessary. There is a need to conduct further research to address these domains.

Topics: Aged; Anxiety; Attitude to Health; Cross-Sectional Studies; Depression; Family; Fear; Female; Grief; Health Services Needs and Demand; Holistic Health; Humans; Inpatients; Malaysia; Male; Middle Aged; Models, Nursing; Neoplasms; Nursing Methodology Research; Quality of Health Care; Social Support; Spirituality; Surveys and Questionnaires; Terminal Care; Total Quality Management

Effective cancer pain management is influenced by the attitudes and knowledge of treating physicians. A survey was conducted among the total population of government hospital doctors of Sarawak to study the barriers to cancer pain management. Two hundred and fifty-three respondents (83%) completed the survey. The study results highlight that knowledge about cancer pain management was low and barriers to morphine prescription were high. A majority of doctors were deterred from using morphine because of fear of addiction (36.5%) and respiratory depression (53.1%). Only 16.2% of the doctors chose the oral mode of administration to treat pain, furthermore 25% prescribed morphine on "PRN" basis. Doctors with undergraduate study in oncology consistently answered better suggesting that the situation can be improved by education. This study showed that barriers to morphine prescription and knowledge deficit amongst government doctors in Sarawak are strong but similar to those reported in western countries few years ago.

Topics: Adult; Analgesics, Opioid; Attitude of Health Personnel; Drug Administration Routes; Drug Utilization; Female; Humans; Malaysia; Male; Morphine; Neoplasms; Opioid-Related Disorders; Pain; Practice Patterns, Physicians'; Respiratory Insufficiency

This survey was intended to gauge the management of pain in palliative cancer patients by the doctors in Melaka Hospital. It also sought to identify possible barriers to adequate pain management among doctors and gauge their response to the adequacy of medical school teaching on cancer pain issues. A 39 item survey was used to cover the issues involved. Overall, the doctors displayed a lack of systematic approach to cancer pain management with inadequate knowledge of analgesia handling. Medical school exposure to cancer pain issues was lacking. Formulation of accepted clinical practice guidelines and new education strategies can improve cancer pain management.

Topics: Analgesics; Clinical Competence; Health Care Surveys; Humans; Malaysia; Medical Staff, Hospital; Neoplasms; Pain; Pain Measurement; Palliative Care; Patient Education as Topic; Practice Patterns, Physicians'

We studied the prevalence of raised serum CA125 in patients with pleural effusions and explored factors affecting its level. Sixty four patients with benign effusions and 36 patients with malignant effusions admitted to the University Malaya Medical Centre from May 2001 to January 2002 were included in the study. There were no significant differences in age, gender and ethnicity of the patients with benign and malignant effusions. There was also no difference in the frequency of the side of pleural effusion between the two groups but compared to benign effusions, a higher proportion of malignant effusions was moderate to large in size (66% versus 39%, p = 0.011). Serum CA125 levels were above 35U/dL in 83.3% and 78.1% of patients with malignant and benign effusions, respectively (p = 0.532). All patients with underlying malignancy and 95.3% of patients with benign effusions had pleural fluid CA125 levels above 35U/dL (p = 0.187). The median levels of CA125 were higher in the pleural fluid than in the serum in all aetiological groups. Higher serum CA125 levels were more likely to be found in patients with moderate to large effusions (p = 0.015), malignant effusions (p = 0.001) and in female patients (0.016). Serum CA125 level showed significant correlation with pleural fluid CA125 level (r = 0.532, p < 0.001) but not with pleural fluid total white blood cell count (r = -0.092, p = 0.362), red blood cell count (r = -0.082, p = 0.417) and lactate dehydrogenase level (r = 0.062, p = 0.541). We conclude that serum CA125 is commonly elevated in patients with benign and malignant pleural effusions.

Topics: Biomarkers; CA-125 Antigen; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Pleural Effusion; Prevalence; Prospective Studies; Risk Factors

The SRB cytotoxicity assay was used to screen extracts and isolated constituents of some traditional medicinal plants from Malaysia and Thailand against two human cancer cell lines, COR L23 lung cancer cell line and MCF7 breast cancer cell line and the non-cancer MCF5 cell line. Five out of the seven species tested, i.e. Thai Alpinia galanga, Alpinia officinarum, Cayratia japonica, Physalis minima, Tabernaemontana divaricata, exhibited interesting cytotoxicity activity and this is the first report of cytotoxicity from any Cayratia species. Following bioassay-guided fractionation, 1'-acetoxychavicol acetate (48h exposure against COR L23 cells, IC(50) 7.8 microM against MCF7 cells, IC(50) 23.9 microM) was isolated as the major cytotoxic component of the Alpinia species, physalin F as the major cytotoxic component of Physalis minima (48 h exposure against COR L23 cells IC(50) 0.4 microM against MCF7 cells, IC(50) 0.59 microM). The Malaysian Alpinia galanga showed weak activity compared with the Thai sample and this was shown to be due to the relatively high amounts of 1'-acetoxychavicol acetate present in the Thai sample.

Topics: Antineoplastic Agents, Phytogenic; Cell Line, Tumor; Cell Survival; Chromatography, Thin Layer; Drug Screening Assays, Antitumor; Humans; Magnetic Resonance Spectroscopy; Malaysia; Neoplasms; Phytotherapy; Plant Extracts; Plants, Medicinal; Rhodamines; Spectrometry, Mass, Electrospray Ionization; Spectrometry, Mass, Fast Atom Bombardment; Spectrophotometry, Infrared; Spectrophotometry, Ultraviolet; Thailand

Health-related quality of life (HRQoL) assessment is important in healthcare outcomes. This study aimed to determine the feasibility, reliability and validity of the Malay McGill Quality of Life Questionnaire--Cardiff Short Form (MMQOL-CSF) in advanced cancer population. Patients either completed the MMQOL-CSF alone or in addition to its long version. The study recruited 116 participants (average age = 44 years old). On average, MMQOL-CSF was completed in 5.4 minutes. Most domains showed evidence of reliability (Cronbach's alpha = 0.76-0.92). Correlation with its long version was moderate to strong (r(s) = 0.54-0.87). The MMQOL-CSF was a feasible, reliable and valid HRQoL instrument in this population.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Feasibility Studies; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Quality of Life; Reproducibility of Results; Surveys and Questionnaires

This was an international study of women's health issues, based on an Official Study Tour in Southeast Asia (the Philippines, Thailand, Malaysia, Hong Kong, and Singapore) and Canada. The objectives of the study were to identify and compare current gaps in surveillance, research, and programs and policies, and to predict trends of women's health issues in developing countries based on the experience of developed countries. Key informant interviews (senior government officials, university researchers, and local experts), self-administered questionnaires, courtesy calls, and literature searches were used to collect data. The participating countries identified women's health as an important issue, especially for reproductive health (developing countries) and senior's health (developed countries). Cancer, lack of physical activity, high blood pressure, diabetes, poverty, social support, caring role for family, and informing, educating, and empowering people about women's health issues were the main concerns. Based on this study, 17 recommendations were made on surveillance, research, and programs and policies. A number of forthcoming changes in women''s health patterns in developing countries were also predicted.

Topics: Acquired Immunodeficiency Syndrome; Canada; Developing Countries; Educational Status; Female; Hong Kong; Humans; International Cooperation; Malaysia; Male; Neoplasms; Philippines; Population Surveillance; Risk Factors; Singapore; Socioeconomic Factors; Surveys and Questionnaires; Thailand; Women's Health

Between July 1999 to November 2000, 115 patients undergoing radiotherapy were evaluated for the development of treatment-related fatigue, using a modified Piper's fatigue scale. The above scale determines 4 dimensions of fatigue ie behavioral severity (6 items), affective meaning (5 items), sensory (5 items), and cognitive mood (6 items). Radiotherapy was delivered to the head and neck, breast, pelvis, and miscellaneous sub-sites. The area of the radiation field ranged from 25 to 480 cm2 (median 156 cm2). Forty-three percent of patients experienced significant fatigue, which altered their work environment. The individual components of fatigue were behavioral severity 25%, affective meaning 21%, sensory 18%, and cognitive mood 16%. Significant radiotherapy-related fatigue was higher in patients treated with advanced-stage disease, large radiotherapy field area, and low pre-radiotherapy hemoglobin level.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Fatigue; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Prevalence; Radiotherapy; Sickness Impact Profile; Surveys and Questionnaires

Topics: Female; Humans; Malaysia; Male; Neoplasms

Topics: Body Mass Index; Cause of Death; China; Ethnicity; Female; Humans; Incidence; Malaysia; Male; Neoplasms; Obesity; Proportional Hazards Models; Prospective Studies; Risk Factors; Singapore

Topics: Biopsy, Needle; Cell Biology; Humans; Incidence; Malaysia; Mass Screening; Neoplasms; Quality Assurance, Health Care

The concept of Palliative Care is still quite new in Malaysia and there is a need to promote the awareness of its importance for patients with incurable and advanced illnesses, not only to the public but also to the nursing and medical professionals. These patients especially the poor ones very often have no one to turn to; they cannot afford to seek treatment from the private hospitals, they are turned away from acute General Hospitals and are told that there is nothing more to be done because their illnesses are no longer curable, they cannot pay for GPs to come to their homes, and there is difficulty in purchasing opiate drugs for pain relief. This is a retrospective observational study of the palliative care services we try to provide to those few patients referred to us. This study showed that out of the total of 156 patients, majority were Chinese, peak age between 50-59 years, referrals were mainly from the community and the Obstetrics + Gynaecology department, patients were referred rather late, 60% of patients died at home, most common malignancies being those of the breast, colorectal and cervix, common sites of metastases being the lungs, liver, bones, peritoneum and local infiltration, 87% of patients experienced pain, about 40% of patients were not fully aware of both diagnosis and prognosis, common drugs used being opiate analgesics followed by dexamethasone, H2 antagonist, antiemetics and NSAID.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Hospitals, General; Humans; Malaysia; Male; Middle Aged; Neoplasms; Palliative Care

Febrile neutropenia is a common and potentially fatal problem encountered in cancer patients undergoing chemotherapy. We carried out an observational study to evaluate the possible risk factors of developing fever amongst neutropenic children with an underlying malignancy. We also looked at the microbiological profile of causative pathogens in patients with febrile neutropenia. During a study period of 1 year, a total of 90 neutropenic episodes were recorded amongst 57 patients who were on treatment and follow-up during the study period. Multivariate analysis showed that factors such as chemotherapy status, underlying disease, existing central venous catheters, presenting white blood cell counts at chemotherapy, use of steroid therapy or hospitalisation at the onset of neutropenia, were not significant risk factors for developing fever during neutropenic episodes. Although the presence of a central venous catheter was associated with a higher risk of developing fever, it did not reach statistical significance (p=0.11). Of the 90 neutropenic episodes, 59 (65.6%) developed fever and 25 of these had positive blood cultures. The causative organisms include gram-negative bacteria (64%), gram positive bacteria (16%) and fungus (20%). Of the gram-negative organisms, Klebsiella spp. predominated (28%) with the extended spectrum beta-lactamase producing strain forming the majority (16%). Amongst those with fungaemia, Candida spp. and Candida tropicalis formed the majority (8% each) of the isolates.

Topics: Adolescent; Antineoplastic Agents; Child; Child, Preschool; Cross Infection; Female; Fever; Humans; Infant; Malaysia; Male; Neoplasms; Neutropenia; Risk Factors

In this prospective study, we examined stool specimens from children with cancer receiving chemotherapy who were admitted for fever to the Universiti Sains Malaysia Hospital in Kota Baru, Kelantan. Stool specimens were examined for ova and cysts of parasites. Over a period of 15 months, there were 129 febrile episodes in 50 children with cancer and, in all, 237 stool specimens were examined. Sixty-six per cent of febrile episodes were associated with neutropenia and 9 per cent were associated with diarrhoea. Stool parasites were found in 42 per cent of children. The most common were helminths, followed by protozoa. Trichuris trichiura was the most common parasite (24 per cent), followed by Ascaris lumbricoides (22 per cent). Hookworm was found in 2 per cent. Giardia lamblia was found in 6 per cent of children, Blastocystis hominis in 4 per cent, and Cryptosporidium parvum in 2 per cent.

Topics: Animals; Child; Child, Preschool; Cryptosporidiosis; Female; Humans; Infant; Intestinal Diseases, Parasitic; Malaysia; Male; Neoplasms; Prevalence; Prospective Studies

The National University of Singapore Heart Study measured cardiovascular risk factors, including selected plasma vitamins, on a random sample of the general population aged 30 to 69 years. Plasma vitamins A and E were normal and similar by ethnic group. Mean plasma vitamin A levels were: Chinese (males 0.68 and females 0.52 mg/L), Malays (males 0.67 and females 0.54 mg/L), and Indians (males 0.66 and females 0.51 mg/L). Mean plasma vitamin E levels were: Chinese (males 12.6 and females 12.6 mg/L), Malays (males 13.6 and females 13.3 mg/L), and Indians (males 12.9 and females 12.8 mg/L). No person had plasma vitamin A deficiency (< 0.01 mg/L) and only 0.1% had vitamin E deficiency (< 5.0 mg/L). In contrast, plasma vitamin C was on the low side and higher in Chinese than Malays and Indians. Mean plasma vitamin C levels were: Chinese (males 6.3 and females 8.4 mg/L), Malays (males 5.1 and females 6.4 mg/L), and Indians (males 5.7 and females 6.9 mg/L). Likewise, the proportions with plasma vitamin C deficiency (< 2.0 mg/L) were lower in Chinese (males 14.4 and females 0.7%), than Malays (males 19.7 and females 7.2%), and Indians (males 17.8 and females 11.0%). Relatively low levels of plasma vitamin C may contribute to the high rates of coronary heart disease and cancer in Singapore. In particular, lower plasma vitamin C in Malays and Indians than Chinese may contribute to their higher rates of coronary heart disease. However, plasma vitamin C does not seem to be involved in the higher rates of cancer in Chinese than Malays and Indians. The findings suggest a relatively low intake of fresh fruits and a higher intake is recommended. Also, food sources of vitamin C may be destroyed by the high cooking temperatures of local cuisines, especially the Malay and Indian ones.

Topics: Adult; Aged; Ascorbic Acid; Ascorbic Acid Deficiency; China; Cooking; Coronary Disease; Ethnicity; Feeding Behavior; Female; Fruit; Heart Diseases; Humans; India; Malaysia; Male; Middle Aged; Neoplasms; Risk Factors; Singapore; Smoking; Vitamin A; Vitamin E; Vitamin E Deficiency

A study was done on patients admitted to Penang Hospital with malignant disease in 1995. A total of 1333 patients (638 male, 695 female) with 1335 malignancies were studied. The majority (77.3%) were aged 41-80 years. The commonest cancers in males were cancers of lung, nasopharynx, colon and rectum, leukemia and larynx whereas the commonest malignancies in females were of the breast, cervix, colon and rectum, leukemia and ovarian/lung carcinoma. The average number of admissions was 2.2 and the average length of stay was 12.7 days. Cancer admissions account for a significant proportion of the inpatient workload of Penang Hospital.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Patient Admission

Despite the fact that Malaysia has good treatment centers for reproductive cancer, mortality rates from breast and cervical cancer are high because of a lack of early detection. Breast cancer mortality rates have risen since 1985, while cervical cancer mortality rates declined from 1985 to 1993 and then increased in 1997. There is no standardized cancer registry, so incidence and mortality rates are likely to be higher than reported. In 1995, the government launched its first nationwide cancer prevention campaign and stressed breast self-examination and yearly examination by a medical professional for woman aged 20 years and above. The same year, eligibility for pap smears was extended to all women who have been or are sexually active and are aged 20-65 years. Between 1993 and 1996, 35% of the breast cancer cases presented at stage 3 or 4, and 93% of these women had a lump of a mean size of 5.3 cm. Cultural taboos prevent women from examining their own bodies, and women fear their husbands will leave them if they have a mastectomy. Malay women also deny themselves preventive care, and sometimes physicians and nurses deny Pap smears to unmarried women. Women are not empowered with the knowledge they need to seek preventive screenings, and older women are difficult to reach with information because they are unlikely to visit maternal-child health or family planning clinics. Malaysia needs to institute a standardized cancer registry and to conduct research that will address the barriers faced by women.

Topics: Asia; Asia, Southeastern; Breast Neoplasms; Delivery of Health Care; Developing Countries; Diagnosis; Disease; Evaluation Studies as Topic; Health; Health Services; Health Services Accessibility; Malaysia; Mass Screening; Neoplasms; Organization and Administration; Program Evaluation; Uterine Cervical Neoplasms

Infectious complications are the major cause of morbidity and mortality in children with malignancy. Empirical antimicrobial therapy in the management of fever of unknown origin should be tailored to local bacteriological data and antibiotic sensitivity patterns. Five-hundred-and-fifty-nine cases of culture-proven septicaemia occurring in pediatric cancer patients between 1990 and 1994 were retrospectively analysed and compared with a similar study done in our centre between 1976 and 1979. A wide spectrum of organisms was isolated. Staphylococcus epidermidis, Staphylococcus aureus, and Klebsiella pneumoniae were the most common and consistent bacteria isolated during the 5 year period. More than 70 per cent of the staphylococci were sensitive to methicillin and universally sensitive to vancomycin. However, a worrying trend of ceftazidime-resistance amongst gram-negative organisms was found. In these situations, the use of imipenem is recommended as resistance to this antimicrobial agent was exceedingly rare.

Topics: Bacteria; Bacterial Infections; Chi-Square Distribution; Child; Child, Preschool; Female; Fever; Humans; Immunocompromised Host; Infant; Malaysia; Male; Neoplasms; Retrospective Studies; Sepsis

Topics: Adult; Child; Child, Preschool; Cultural Diversity; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Malaysia; Male; Medicine, Traditional; Neoplasms; Parents

The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.

Topics: Adult; Aged; Coronary Disease; Female; Humans; Malaysia; Male; Mammography; Middle Aged; Neoplasms; Papanicolaou Test; Primary Health Care; Retrospective Studies; Vaginal Smears

Topics: Congresses as Topic; Humans; India; Malaysia; Neoplasms

Quality-of-life assessment has become an accepted method of evaluation in clinical medicine. The technique is based on a patient's self-assessment of physical, psychological, and social function, as well as the effects of distressing physical symptoms. The most important aspect of quality-of-life assessment is that it brings into focus a patient-centred view of health outcome, which is broader than the physiologic measures which predominate in Western medicine. Strategies for the development and use of assessment questionnaires have evolved over the past 15 years, and numerous questionnaires have been created. Most originate in Western societies, with English as the most common language of development. Adapting such questionnaires for use in other language and cultural settings is an imprecise practice. Language translation and equivalent cultural meaning must both be addressed. This paper reports on the language translation process and results for the Functional Living Index for Cancer (FLIC) as translated into Chinese and Malay in Singapore. We employed a step-wise process beginning with translation/back translation, followed by structured pilot field trials and population sampling. Taped versions of the questionnaire were devised to meet illiteracy problems in the sample population. Paired comparisons of the Chinese and Malay versions of individual questions with their English counterparts show good correlations and similar means most of the time. Factor analysis on a population sample of 246 (112 Chinese, 35 Malay and 98 English speaking) with cancers of minimal, extensive or palliative extent is convergent with that obtained on a North American population. However, a separate analysis of the Chinese questionnaires showed some differences in factor pattern. Specific language and cultural translation difficulties are discussed. Of note is the predicted significant decrease in total FLIC scores with extent of disease within each of the language preference populations, which provides some evidence for the validity for each language version in the Singapore culture(s). Thus, the FLIC translations into Malay and Chinese in Singapore can be considered for use in local trials, subject to ongoing evaluation.

Topics: Activities of Daily Living; Attitude to Health; China; Culture; Educational Status; Ethnicity; Factor Analysis, Statistical; Female; Forecasting; Humans; Language; Malaysia; Male; Middle Aged; Neoplasm Staging; Neoplasms; Outcome Assessment, Health Care; Palliative Care; Pilot Projects; Quality of Life; Reproducibility of Results; Sampling Studies; Self-Assessment; Singapore; Social Adjustment; Surveys and Questionnaires

Eight cases of dermatomyositis were seen in the Skin Department, Hospital Besar Kuala Lumpur between 1989 and 1993. There was one case of juvenile dermatomyositis. There was a majority of Chinese patients (87.5%). There were three patients (37.5%) with underlying malignancies, two of which (66.7%) were nasopharyngeal carcinomas; all were under the age of fifty years. It is important to screen all adult patients for underlying malignancies, even those in the younger age group.

Topics: Adult; China; Dermatomyositis; Female; Hospitals; Humans; Incidence; Malaysia; Male; Middle Aged; Neoplasms

Topics: Adaptation, Psychological; Attitude of Health Personnel; Humans; Malaysia; Neoplasms; Physician-Patient Relations; Truth Disclosure

2,124 cases of cancer diagnosed and/or treated in Penang between 1987-1990 were reported to the National Cancer Registry of Malaysia by hospitals in Penang. 1,762 met the criteria for Penang incident cases first diagnosed between 1987-1990, and were the subjects on which all subsequent analyses were based. 85 per cent of case notifications were from Mount Miriam Hospital. Among males, all-site cancer incidence rates (age-standardised) were highest among Chinese, and lowest among Malays. Among females, the Indian female incidence rate was highest, higher than that of any other ethnic-gender sub-group. Site-specific cancer rates varied according to ethnicity and gender, but overall the four most frequent cancers reported from Penang were breast, lung, cervix and nasopharynx cancers. It needs to be emphasised that all these results are highly tentative since they are based on notified cancer occurrences and hence are very uncertain proxies for true cancer incidence. Based on incidence rates from the Singapore Cancer Registry (1978-1982), the expected number of incident cases in 1989 for Penang (Malays, Chinese and Indians combined) was 1,561. The number notified to the National Cancer Registry was 496. This underlines the tentative nature of this analysis of the returns for 1987-1990 from Penang.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Incidence; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Neoplasms; Registries; Sex Factors; Time Factors

The Medical Department of Sabah, in collaboration with various governmental and non-governmental agencies and 'Surgeons International' conducted a state-wide campaign for the 'Early Detection of Cancer' over a period of 3 months from July 1992. The purpose of the campaign was to educate the population about the early signs and symptoms of common cancers, to remove the myth that cancer was incurable and to impress on the public the need to detect cancer early for a possible cure and a better prognosis.

Topics: Australia; Developing Countries; Humans; International Cooperation; Malaysia; Mass Screening; Neoplasms; Social Responsibility; Time Factors

Topics: Humans; Malaysia; Muscular Diseases; Neoplasms; Sarcocystosis; Urban Health

Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Cisplatin; Cyclophosphamide; Drug Administration Schedule; Epirubicin; Fluorouracil; Gastrointestinal Neoplasms; Head and Neck Neoplasms; Humans; Malaysia; Methotrexate; Mitomycin; Nasopharyngeal Neoplasms; Neoplasms; Private Practice

Topics: Humans; Malaysia; Neoplasms; Public Health

Malignant neoplasms diagnosed histologically in the state of Sabah during the period November 1983 to October 1988 were analysed to determine the distribution of malignant neoplasms according to site, age, sex and major ethnic groups. The five commonest malignant neoplasms in males were carcinomas of the nasopharynx, stomach, skin, lung and liver. In females the five commonest malignant neoplasms were carcinomas of the cervix uteri, breast, ovary, thyroid and skin. There was variation in these frequencies among the major ethnic groups. The most striking of these was the high frequency of nasopharyngeal carcinoma among Kadazan and Chinese males but not in males of the other indigenous groups. A significant number of patients with nasopharyngeal carcinoma was found in the younger age groups and most of the patients in the younger age groups were Kadazans. A relatively high frequency of carcinoma of the stomach, skin and liver was seen among Kadazans and other indigenous groups while carcinoma of the lung was seen relatively frequently among Chinese males. Among females carcinomas of the breast and cervix uteri were the most frequent malignant neoplasms in all the main ethnic groups. Possible reasons for these findings are discussed.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Ethnicity; Female; Humans; Infant; Malaysia; Male; Middle Aged; Neoplasms

Congo red screening of 27,052 routine biopsy specimens from 22,827 patients over a 5 1/2-year period in the Department of Pathology, University of Malaya detected 186 cases of amyloidosis. The categories of amyloidosis encountered and their prevalences in relation to each other were: systemic AL (5.9%); systemic AA (3.2%); isolated atrial (14%); primary localized cutaneous (7.5%); other primary localized deposits (3.2%); localized intratumour (58%); and dystrophic (8.6%). A third of patients with systemic AL amyloidosis had coexistent immunocyte abnormality. The commonest underlying pathology for systemic AA amyloidosis was leprosy. Notable among the types of localized amyloidosis revealed by this study were isolated atrial amyloidosis, which appeared to complicate chronic rheumatic heart disease, and intratumour amyloidosis complicating nasopharyngeal carcinoma. Other tumours in which amyloid deposits were observed included basal cell carcinoma, islet cell tumour and medullary carcinoma of the thyroid. Dystrophic amyloidosis was observed in fibrotic tissues, such as damaged cardiac valves and osteoarthritic joints. Heredofamilial amyloidosis, senile systemic amyloidosis and degenerative cerebral amyloidosis were notably absent from this study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amyloid; Amyloidosis; Cardiomyopathies; Child; Humans; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Immunohistochemistry; Malaysia; Microscopy, Electron; Middle Aged; Neoplasms; Potassium Permanganate; Prevalence; Skin Diseases

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Female; Hospital Departments; Hospitals, General; Humans; Malaysia; Male; Middle Aged; Neoplasms; Pathology Department, Hospital; Sex Factors

The findings of autopsies performed on 35 leprosy subjects in the University Hospital, Kuala Lumpur, between January 1981 and December 1985 are presented. This is the first report based on autopsy findings from Malaysia. The patients were elderly subjects with a mean age of 74 years. Sixty-six percent had lepromatous leprosy. None had active skin lesions. The most common cause of death was pyogenic infection, particularly bronchopneumonia. Tuberculosis was noted in 25% of the cases. The other important causes of death included cardiac and renal failure. Renal lesions were evident in 71% of the cases, and the most common pathology was interstitial nephritis. Generalized amyloidosis complicated six (17%) patients.

Topics: Aged; Aged, 80 and over; Amyloid; Amyloidosis; Bronchopneumonia; Female; Heart Diseases; Humans; Kidney; Leprosy; Malaysia; Male; Middle Aged; Myocardium; Neoplasms; Peripheral Nerves; Skin; Tuberculosis, Pulmonary

Congo red screening of tumour material examined at the Department of Pathology, University of Malaya revealed intratumour deposits of amyloid in 12% of nasopharyngeal carcinomas, 66% of basal cell carcinomas, 100% of medullary carcinomas of the thyroid, 56% of islet cell tumours of the pancreas, 1 out of 16 carcinoids and 1 out of 100 thyroid adenomas. All the deposits were permanganate resistant and did not contain AA protein, indicating that what was encountered was not secondary amyloid. The deposits showed variable staining for immunoglobulin light chains and amyloid P component with a standard peroxidase antiperoxidase method. The possibility that intratumour amyloid has a neoplastic origin is discussed.

Topics: Adenoma, Islet Cell; Amyloid; Amyloidosis; Carcinoid Tumor; Carcinoma, Basal Cell; Histocytochemistry; Humans; Immunochemistry; Malaysia; Nasopharyngeal Neoplasms; Neoplasms; Pancreatic Neoplasms; Thyroid Neoplasms

Topics: China; Female; Humans; India; Malaysia; Male; Neoplasms

Topics: Age Factors; Ethnicity; Female; Hospitals, University; Humans; Malaysia; Male; Neoplasms; Retrospective Studies; Sex Factors

A descriptive epidemiology of cancer in Sarawak, based on histopathology records in the Central Medical Laboratory, Kuching, Sarawsk, in 1981 and 1982 was presented. There were 8,219 patients from whom biopsies were taken and 485 from whom marrow biopsies were taken. Out of these, 1,326 were reported malignant. Most of the cases were from Kuching. There were slightly more males than females. The Chinese formed the majority of cases followed by the Sea Dayaks and Malays. The most common cancer sites among males were lymph nodes, nasopharynx, skin and stomach, while in the females the most common sites were the breast, cervix and lymph nodes. Among the Chinese the most common cancers were those of the nasopharynx in males, and breast in females. Among the Sea Dayaks, the most common cancers were those of the lymph nodes in males and cervix in females. Among the Malays, skin cancers were relatively common, and among the Land Dayaks nasopharyngeal cancers were common. Most of the patients were in the older age groups. The pattern of cancers has not changed much since 1966 and the findings of the present study are very similar to the series from the Institute of Medical Research, Kuala Lumpur, in 1969 to 1971.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; China; Female; Humans; Infant; Malaysia; Male; Middle Aged; Neoplasms; Sex Factors

Some information on cancer in Malaysia are available, and its epidemiology is described. There is a need for systematic and coordinated collection of cancer statistics which are essential to patient management, cancer control programme formulation, implementation and evaluation. The decision of the Ministry of Health to introduce National Cancer Registry and to encourage epidemiological studies, which will ultimately lead to the utilization of data and introduction of control and preventive activities for cancers are positive steps in the right direction. Meanwhile, curative and palliative treatment is available from the existing hospital facilities, and preventive activities such as actions on smoking and health will be continued until such time when a comprehensive prevention and control programme for cancers in the country is evolved.

Topics: Adult; Age Factors; Aged; China; Female; Humans; Malaysia; Male; Middle Aged; Neoplasms; Sex Factors

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Ethnicity; Female; Hospitals, University; Humans; Infant; Malaysia; Male; Middle Aged; Neoplasms

The history of efforts to establish a cancer registry in Malaysia since 1961 is reviewed. In 1980, the staff of the Institute for Medical Research in Kuala Lumpur was authorized to develop an official registry that would combine the resources of the various university faculties, the hospitals, research institutes, and the Cancer Society. Special registries operate for oral precancerous conditions and for nasopharyngeal carcinoma (NPC). The topics of recent epidemiological studies include: a review of all cancers diagnosed at the University Hospital during 1972-74, the association of Epstein-Barr virus and NPC, social and environmental factors associated with NPC, oral cancers, and childhood cancers.

Topics: Child; China; Female; Humans; India; Malaysia; Male; Neoplasms; Registries; Socioeconomic Factors

The Singapore Cancer Registry started operations on January 1, 1968. It is a population-based registry that seeks to obtain basic epidemiological and clinical data on all cases of cancer diagnosed in Singapore. The results presented pertain only to Singapore citizens and permanent residents and cover the period from 1973 to 1977. Of special interest are the cancer patterns of the main ethnic groups in Singapore. Generally, the Chinese (76% of total population) have significantly higher risks for cancer; the most prevalent sites are the nasopharynx, esophagus, stomach, liver, and lung. Within the Chinese group are also dialect group differences. The Malays (15% of population) have the lowest rates for most sites, whereas among the Indians (7% of population), mouth cancer is an important site for both sexes. All these variations provide useful clues in the search for etiological factors.

Topics: China; Ethnicity; Female; Humans; India; Malaysia; Male; Neoplasms; Singapore

An abnormal, fast-moving 5'-nucleotide phosphodiesterase isozyme was found in 90.0% of 20 Malaysian patients with primary hepatoma and in 23.5% of 391 Malaysian patients with various malignant diseases; it was also discovered in 42.9% of 14 Malaysian and American patients with clinically active hepatitis B infection; in 16.7% of 18 healthy American blood bank donors who were positive for hepatitis B surface antigen (HBsAg); in 13.9% of 287 healthy Malaysian blood bank donors, some positive for HBsAg; and in none of 160 healthy American donors who were negative for HBsAg. A correlation of this abnormal isozyme with hepatoma and with infectious hepatitis B is clearly evident.

Topics: Adult; Carcinoma, Hepatocellular; Female; Hepatitis B; Humans; Isoenzymes; Liver Neoplasms; Malaysia; Male; Neoplasms; Nucleotides; Phosphodiesterase I; Phosphoric Diester Hydrolases; United States

No population-based cancer registry exists in Malaysia; thus our main sources of incidence data were biopsy series. We determined the frequency of cancers by body site, sex, and ethnic group from biopsy records of the Division of Pathology of the Institute for Medical Research in Kuala Lumpur for the years 1969-71. We then made comparisons of leading sites with data from the Singapore Cancer Registry. Relative risk values for 21 sites indicated significant differences among ethnic groups for cancers of the nasopharynx, larynx, lung, bone, skin, cervix, ovary, prostate, and penis and for lymphomas.

Topics: Epidemiologic Methods; Ethnicity; Female; Humans; Malaysia; Male; Neoplasms; Risk

Topics: Adolescent; Adult; Aged; Breast Neoplasms; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Leukemia; Liver Neoplasms; Lung Neoplasms; Malaysia; Male; Middle Aged; Neoplasms; Stomach Neoplasms; Uterine Cervical Neoplasms

Topics: Adult; Aged; Asian People; Female; Humans; Leukemia; Malaysia; Male; Middle Aged; Neoplasms; Skin Neoplasms; Time Factors; Uterine Cervical Neoplasms

The level of serum alpha-fetoprotein (AFP) was estimated by radioimmunoassay in 153 normal healthy Malysians of different ethnic groups. The mean level was 7.5 In1/ml (SD 2.28InU/ml). Among 330 patients with malignant tumors, 11 had increased levels of AFP. The only patient who had hepatoma had a very high level of serum AFP. High levels were also found in three of four patients with dysgerminoma of the ovary, in the only two patients with carcinoma of the testis, and in one patient with secondary carcinoma of the humerus of unknown origin. Lower, but significantly increased levels were observed in one patient (of 48) with breast carcinoma, one patient (of 8) with basal cell carcinoma of the nose, one patient (0f 27) with carcinoma of the lung, and one patient (of 59) with nasopharynegeal carcinoma.

Topics: Adult; alpha-Fetoproteins; Breast Neoplasms; Carcinoma, Hepatocellular; Female; Fetal Proteins; Humans; Liver Diseases; Liver Neoplasms; Malaysia; Male; Neoplasms; Nose Neoplasms; Ovarian Neoplasms; Pregnancy; Racial Groups; Testicular Neoplasms

The organisation of the radiological services in Malaysia is described and those diseases in which radiology plays an important part in diagnosis are discussed. As radiology embraces all specialities a pattern of diseases emerges which is different from that seen in the West. The control of infectious diseases, the general improvement in health care and the more sophisticated radiological investigations now available mean that in future radiology will play a much more important part in diagnosis and management of patients.

Topics: Biliary Tract Diseases; Bone Diseases; Cardiovascular Diseases; Communicable Diseases; Community Health Services; Diagnostic Services; Gastrointestinal Diseases; Humans; Joint Diseases; Lung Diseases; Malaysia; Neoplasms; Radiography; Radiology; Urinary Tract Infections

Topics: Birth Rate; Cardiovascular Diseases; Female; Fertility; Health; Health Expenditures; Humans; Infant Mortality; Infant, Newborn; Life Expectancy; Malaria; Malaysia; Male; Maternal Mortality; Mortality; Neoplasms; Parasitic Diseases; Poliomyelitis; Population Growth; Pregnancy; Singapore; Smallpox; Sri Lanka

Topics: Burkitt Lymphoma; Female; Humans; Liver Neoplasms; Lung Neoplasms; Malaysia; Male; Neoplasms; Racial Groups; Sex Factors

Topics: Asian People; Cheek; Choriocarcinoma; Female; Humans; Malaysia; Male; Mouth Neoplasms; Nasopharyngeal Neoplasms; Neoplasms; Pregnancy

Topics: Abortion, Habitual; Adolescent; Asthma; Dysmenorrhea; Family Practice; Female; Gastroenterology; General Practice; Geriatrics; Humans; Hypertension; Hypnosis; Labor, Obstetric; Malaysia; Neoplasms; Pregnancy; Rhinitis, Allergic, Seasonal; Singapore

Topics: Diagnosis; Humans; Malaysia; Neoplasms; Pathology; Sarcoidosis

Topics: Animals; Culicidae; Geography; Humans; Malaysia; Neoplasms

Topics: Areca; Humans; Malaysia; Mouth Neoplasms; Neoplasms

Topics: Child; Humans; Infant; Malaysia; Neoplasms

Topics: Geography; Humans; Malaysia; Neoplasms

Topics: Adenoma, Pleomorphic; Humans; Malaysia; Neoplasms; Salivary Gland Neoplasms; Salivary Glands

Topics: Ameloblastoma; Cysts; Humans; Jaw; Malaysia; Neoplasms; Osteomyelitis