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Financial burden of colorectal cancer treatment among patients and their families in a middle-income country

Azzani M, Roslani AC, Su TT

Support Care Cancer, 2016 10;24(10):4423-32.
PMID: 27225528 DOI: 10.1007/s00520-016-3283-2

BACKGROUND: In Malaysia, the healthcare system consists of a government-run universal healthcare system and a co-existing private healthcare system. However, with high and ever rising healthcare spending on cancer management, cancer patients and their families are likely to become vulnerable to a healthcare-related financial burden. Moreover, they may have to reduce their working hours and lose income. To better understand this issue, this study aims to assess the financial burden of colorectal cancer patients and their families in the first year following diagnosis.
METHODS: Data on patient costs were collected prospectively in the first year following diagnosis by using a self-administered questionnaire and telephone interviews at three time points for all four stages of colorectal cancer. The patient cost data consisted of direct out-of-pocket payments for medical-related expenses such as hospital stays, tests and treatment and for non-medical items such as travel and food associated with hospital visits. In addition, indirect cost data related to the loss of productivity of the patient and caregiver(s) was assessed. The patient's perceived level of financial difficulty and types of coping strategy were also explored.
RESULT: The total 1-year patient cost (both direct and indirect) increased with the stage of colorectal cancer: RM 6544.5 (USD 2045.1) for stage I, RM 7790.1 (USD 2434.4) for stage II, RM 8799.1 (USD 2749.7) for stage III and RM 8638.2 (USD 2699.4) for stage IV. The majority of patients perceived paying for their healthcare as somewhat difficult. The most frequently used financial coping strategy was a combination of current income and savings.
CONCLUSION: Despite the high subsidisation in public hospitals, the management of colorectal cancer imposes a substantial financial burden on patients and their families. Moreover, the majority of patients and their families perceive healthcare payments as difficult. Therefore, it is recommended that policy- and decision-makers should further consider some financial protection strategies and support for cancer treatment because cancer is a very costly and chronic disease.

Matched MeSH terms: Colorectal Neoplasms/therapy
Association of Knowledge and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment of Breast Cancer: a Systematic Review

Khan TM, Leong JP, Ming LC, Khan AH

Asian Pac J Cancer Prev, 2015;16(13):5349-57.
PMID: 26225677

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer mortality among women of all ethnic and age groups in Malaysia. Delay in seeking help for breast cancer symptoms is preventable and by identifying possible factors for delayed diagnosis, patient prognosis and survival rates could be improved.
OBJECTIVES: This narrative review aimed to understand and evaluate the level of in-depth breast cancer knowledge in terms of clinical breast examination and breast self-examination, and other important aspects such as side-effects and risk factors in Malaysian females. Since Malaysia is multicultural, this review assessed social perceptions, cultural beliefs and help-seeking behaviour in respect to breast cancer among different ethnic groups, since these may impinge on efforts to 'avoid' the disease.
MATERIALS AND METHODS: A comprehensive literature search of seven databases was performed from December 2015 to January 2015. Screening of relevant published journals was also undertaken to identify available information related to the knowledge, perception and help-seeking behaviour of Malaysian women in relation to breast cancer.
RESULTS: A total of 42 articles were appraised and included in this review. Generally, women in Malaysia had good awareness of breast cancer and its screening tools, particularly breast self-examination, but only superficial in-depth knowledge about the disease. Women in rural areas had lower levels of knowledge than those in urban areas. It was also shown that books, magazines, brochures and television were among the most common sources of breast cancer information. Delay in presentation was attributed mainly to a negative social perception of the disease, poverty, cultural and religion practices, and a strong influence of complementary and alternative medicine, rather than a lack of knowledge.
CONCLUSIONS: This review highlighted the need for an intensive and in-depth breast cancer education campaigns using media and community health programmes, even with the existing good awareness of breast cancer. This is essential in order to avoid misconceptions and to frame the correct mind-set about breast cancer among women in Malaysia. Socio-cultural differences and religious practices should be taken into account by health care professionals when advising on breast cancer. Women need to be aware of the risk factors and symptoms of breast cancer so that early diagnosis can take place and the chances of survival improved.

Matched MeSH terms: Breast Neoplasms/therapy*
MicroRNA-based therapy and breast cancer: A comprehensive review of novel therapeutic strategies from diagnosis to treatment

Kaboli PJ, Rahmat A, Ismail P, Ling KH

Pharmacol Res, 2015 Jul;97:104-21.
PMID: 25958353 DOI: 10.1016/j.phrs.2015.04.015

MicroRNAs (miRNA) are 21-23 nucleotide molecules not translated into proteins that bind and target the 3' untranslated regions of mRNA. These characteristics make them a possible tool for inhibiting protein translation. Different cellular pathways involved in cancer development, such as cellular proliferation, apoptosis, and migration, are regulated by miRNAs. The objective of this review is to discuss various miRNAs involved in breast cancer in detail as well as different therapeutic strategies from the clinic to industry. A comprehensive discussion is provided on various miRNAs involved in breast cancer development, progression, and metastasis as well as the roles, targets, and related therapeutic strategies of different miRNAs associated with breast cancer. miRNAs known to be clinically useful for the diagnosis and prognosis of breast cancer are also discussed. Different strategies and challenges, including nucleic acid-based (miRNA mimics, antagomiRs, and miRNA sponges) and drug-based (drug resistance, drugs/miRNA interaction, nanodelivery, and sensing systems) approaches to suppress specific oncogenes and/or activate target tumor suppressors are discussed. In contrast to other articles written on the same topic, this review focuses on the therapeutic and clinical value of miRNAs as well as their corresponding targets in order to explore how these strategies can overcome breast cancer, which is the second most frequent type of cancer worldwide. This review focuses on promising and validated miRNAs involved in breast cancer. In particular, two miRNAs, miR-21 and miR-34, are discussed as the most promising targets for RNA-based therapy in non-invasive and invasive breast cancer, respectively. Finally, relevant and commercialized therapeutic strategies are highlighted.

Matched MeSH terms: Breast Neoplasms/therapy*
Primary malignant melanoma of the oesophagus

Gul YA, Prasannan S, Hairuszah I

Acta Chir. Belg., 2003 Aug;103(4):420-2.
PMID: 14524166

Primary malignant melanoma arising in the oesophagus is a rare condition with a dismal prognosis. The diagnosis is often made following surgical resection even though the endoscopic features may be pathognomonic. The classical treatment is oesophagectomy even though the advanced disease stage at the time of presentation and aggressive biological behaviour of the tumour usually results in a fatal outcome. We report the case of a male patient initially diagnosed with squamous oesophageal carcinoma and treated with conventional neo-adjuvant chemo-radiotherapy. Poor clinical and radiological response resulted in a review of the original histology confirming a diagnosis of primary malignant melanoma of the oesophagus. The subsequent alteration in management conferred the patient an improved quality of life. A short review of the literature on primary malignant melanoma of the oesophagus supplements this case report.

Matched MeSH terms: Esophageal Neoplasms/therapy
Fulltext Breast Surgery International--breast cancer in developing countries

Sandelin K, Apffelstaedt JP, Abdullah H, Murray EM, Ajuluchuku EU

Scand J Surg, 2002;91(3):222-6.
PMID: 12449462

Breast Surgery International (BSI) was formed in 1999 as an integrated society within the International Surgical Society ISS/SIC. One goal is to promote breast surgery world wide and focus on the situation in the developing countries. An edited summary of a symposium on locally advanced breast cancer (LABC) and the current situation in two African countries and in Malaysia is reported. Diagnosis, management and treatment options differ from recommendations that prevail due to lack of resources, lack of access to facilities and cultural and socioeconomic barriers. Younger age at onset, more men are affected and locally advanced breast cancer dominates the clinical panorama. A rational treatment plan for LABC should have chemotherapy, surgery, radiotherapy and hormonal therapy as armaments. A unique opportunity exists for international interchange within a professional organization such as BSI, for providing training opportunities, for clinical and experimental studies of the world' s most common female malignancy.

Matched MeSH terms: Breast Neoplasms/therapy
Fulltext Chronic pain management--upper visceral malignancies coeliac plexus block with CT scanning--a case report

Choy YC, Puvenesvari S, Samad S

Med J Malaysia, 1998 Sep;53(3):277-9.
PMID: 10968166

Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.

Matched MeSH terms: Pancreatic Neoplasms/therapy*
Fulltext Overview of cancer in Malaysia

Lim GC

Jpn J Clin Oncol, 2002 Mar;32 Suppl:S37-42.
PMID: 11959876 DOI: 10.1093/jjco/hye132

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.

Matched MeSH terms: Neoplasms/therapy
Quality of life in breast cancer patients: validation of a FACT-B Malayalam version

Pandey M, Thomas BC, Ramdas K, Eremenco S, Nair MK

Qual Life Res, 2002 Mar;11(2):87-90.
PMID: 12018741

BACKGROUND: Recent advances in diagnosis and treatment of cancer have led to an increase in cancer survival, and hence, there is a greater emphasis on quality beside quantity of survival. Developing countries too have begun to recognize the need for monitoring quality of life (QOL). However, in most of the developing countries, a validated and reliable tool for the purpose is yet to be realized.
MATERIAL AND METHOD: The functional assessment of chronic illness therapy (FACIT) system is a collection of QOL questionnaires targeted to measure QOL in chronic illness. The functional assessment of cancer therapy for breast cancer (FACT-B) was translated into the local language (Malayalam) and tested for validity and reliability.
RESULTS: The tool thus developed showed substantial sensitivity, as does the source tool. The Cronbach's alpha for the total FACT-B was 0.87, which is similar to the alpha of 0.9 observed in the FACT-B English version. The mean FACT-B score was 94.3 compared to 112.8 for the source tool.
CONCLUSION: The Malayalam translation of the FACT-B questionnaire was developed, tested and validated, and was found satisfactory in comparison to the source tool.

Matched MeSH terms: Breast Neoplasms/therapy
Fulltext Meningioma--the Sarawak General Hospital experience

Wong SH, Chan SH

Med J Malaysia, 2002 Dec;57(4):467-73.
PMID: 12733172

The aim of this study was to determine the factors for the large size of intracranial meningiomas at the time of presentation to the Sarawak General Hospital. The data was collected prospectively from 1/3/2000 to 28/2/2001. During this period a total of 57 cases of intracranial tumours were operated upon. Twenty of these cases (35%) were meningioma, making meningioma the most common intracranial tumour operated in the Neurosurgery service here with one to two cases operated per month. Headache was the most common symptom. The average duration of symptoms before the diagnosis was made was twenty-five months, the longest being fifteen years. The patients needed an average of seven visits prior to the diagnosis.

Matched MeSH terms: Brain Neoplasms/therapy
Fulltext Palliative care: experience with 156 cases in a general hospital

Khoo SB

Med J Malaysia, 2002 Dec;57(4):408-17.
PMID: 12733165

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.

Matched MeSH terms: Neoplasms/therapy*
Thyroid cancer: The Kuala Lumpur experience

Abdullah M

ANZ J Surg, 2002 Sep;72(9):660-4.
PMID: 12269919

There have been few detailed studies on thyroid cancer (TC) in Malaysia, a multiethnic country with three major races - Malays, Chinese and Indians.

Matched MeSH terms: Thyroid Neoplasms/therapy
Clear cell sarcoma of kidney: a clinicopathological study of eight cases from Malaysia

Cheah PL, Looi LM, Lin HP

Histopathology, 1992 Oct;21(4):365-9.
PMID: 1328018

Eight cases of clear cell sarcoma of kidney were seen in the Department of Pathology, University Hospital, Kuala Lumpur, Malaysia over the 16-year period from 1973 to 1989. Five of the patients were males. Six patients were Malay, one Chinese and one Indian. The patients' ages ranged from 8 months to 3 years. Clear cell sarcoma was the original diagnosis in two patients while six were diagnosed as blastemal-predominant Wilms' tumours at presentation. Metastases developed in five patients. Metastatic sites included the thoracic vertebra, skull, orbit, humerus, radius, ulna, shoulder, lung and liver. The prolonged survival, of 9 years and 9 months, seen in one patient despite omission of Adriamycin (doxorubicin) from the chemotherapeutic protocol is highlighted. We also emphasise the histological factors which are of help in differentiating clear cell sarcoma from Wilms' tumour.

Matched MeSH terms: Kidney Neoplasms/therapy
Activities of gamma-glutamyl transpeptidase and erythrocyte glutathione dependent enzymes in nasopharyngeal carcinoma patients and normal controls

Ngah WZ, Shamaan NA, Said MH, Azhar MT

Eur Arch Otorhinolaryngol, 1993;250(5):304-7.
PMID: 8105826

Plasma gamma-glutamyltranspeptidase (gamma-GT), glutathione peroxidase (GPx) and glutathione reductase (GR) activities were determined in normal and nasopharyngeal carcinoma (NPC) patients. No difference in enzyme activities was observed in the three major races of the Malaysian population, i.e. Malay, Chinese and Indian patients. However, plasma gamma-GT, erythrocyte glutathione S-transferase (GST) and GPx activities were significantly increased in all NPC patients, while GR activity remained unchanged. Patients with elevated plasma gamma-GT activities also had increased GST and GPx activities. Plasma gamma-GT and GPx activities were then found to be affected by treatment. Patients with plasma gamma-GT activity greater than 70 IU/l had very poor prognoses but patients with decreased gamma-GT activities were found to be in remission.

Matched MeSH terms: Nasopharyngeal Neoplasms/therapy
Fulltext Primary non-Hodgkin's lymphoma of the pelvic bone in a child

Hoe TS, Sivanantham M, Phang KS, Yogeswary S, Foo LS

Med J Malaysia, 1994 Sep;49(3):289-91.
PMID: 7845282
Matched MeSH terms: Bone Neoplasms/therapy
Belief in traditional healers amongst Malaysian parents of children with cancer

Ariffin H, Abdullah WA, de Bruyne J, Lee CL, Peng LH

J Trop Pediatr, 1997 12;43(6):375-6.
PMID: 9476465 DOI: 10.1093/tropej/43.6.375
Matched MeSH terms: Neoplasms/therapy*
Fulltext Perforating invasive mole masquerading as an ovarian tumour--case report

Chandran R, Tham KY, Rose I

Med J Malaysia, 1991 Sep;46(3):255-8.
PMID: 1839922

An invasive mole causing uterine perforation is a rare occurrence. We describe below a case with an unusual presentation which was mistaken for an ovarian tumour. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.

Matched MeSH terms: Ovarian Neoplasms/therapy
Nasopharyngeal carcinoma in Malaysians under the age of 20 years

Yadav M, Tan MK, Singh P, Dharmalingam SK

Clin Oncol, 1984 Dec;10(4):353-61.
PMID: 6509817

A total of 52 cases of NPC were found in a five-year survey from 1978 to 1982 in Malaysia. The annual rate of occurrence was 3.4, 3.0, 2.4 and 1.8 for Chinese, Malays, Kadazans and Sarawakians, respectively. The age-specific incidence rates per 100 000 were highest for Kadazans (2.34 to 7.59) in comparison to the other races (0.11 to 1.24). The proportion of NPC in young Malaysians formed 1.2% in Chinese, 7.2% in Malays and 6.9% for others. A sexual bias was present in Chinese (male:female = 2.2) and Sarawakians (1.7) but not in Kadazans and Malays (0.9). In most Chinese, the primary tumour histologically is of the poorly differentiated characteristic and this type is the predominant tumour in the country. The Kadazans presented with well differentiated primary tumour and the Malays with all three histological types i.e. well-, poorly- and undifferentiated. At first examination enlarged lymph nodes were found in 95.7% of the patients and 65.2% had epistaxis and growth in the postnasal space. Antibodies to IgA anti-VCA were present in half of the 6 patients serologically studied.

Matched MeSH terms: Nasopharyngeal Neoplasms/therapy
Fulltext Bladder tumours - a review of 150 patients treated at the Institute of Urology and Nephrology General Hospital Kuala Lumpur

Mahamooth Z, Awang H

Med J Malaysia, 1983 Mar;38(1):4-8.
PMID: 6633334

One hundred and fifty patients with urothelial tumours were reviewed. They form the majority of patients with bladder cancer referred to the Institute of Urology over the past three years. From the study it becomes very apparent that the majority of patients are seen late in the course of their disease. The results of treatment of patients with early lesions have been satisfactory but the patients with late invasive lesions have very poor prognosis. A plea is made that one be more aware of this condition and that symptoms of haematuria and urinary tract infections should have a full urological assessment early.

Matched MeSH terms: Urinary Bladder Neoplasms/therapy
Fulltext Anaplastic squamous cell carcinoma of the mouth - a report on 100 consecutive cases

Ramanathan K, Ng KH, Ramanathan J, Chelvanayagam PI

Med J Malaysia, 1981 Sep;36(3):174-6.
PMID: 7329375

Squamous cell carcinoma is the commonest malignant tumour of the mouth (91 percent) in people living in Peninsular Malaysia. Since the histological grading of oral carcinoma ·is one of the several important factors to be considered in the long term survival of patients a more detailed study of anaplastic carcinoma of the mouth in 100 patients is made in this study. As reported in an earlier study the Chinese seem to be more prone to develop anaplastic carcinoma of the mouth. In contrast although oral carcinoma occurs most commonly in the Indians, the development of anaplastic carcinoma seems to be the least in them. The Indians seem to have a better host immune response to oral carcinoma than the Chinese and the Malays occupy an intermediary position. The peak age incidence was between 51-70 years (50 percent). In descending order of frequency anaplastic carcinoma involved the gingiva (29 percent), buccal mucosa (22 percent), palate (20 percent), and tongue (16 percent). Further studies may help to formulate a more effective tailor-made regime of treatment for each individual oral carcinoma patient.

Matched MeSH terms: Mouth Neoplasms/therapy
Advanced retinoblastoma in Malaysian children

Sinniah D, Narasimha G, Prathap K

Acta Ophthalmol, 1980 Oct;58(5):819-24.
PMID: 7211270

Twenty children with retinoblastoma are reviewed who were treated at the University Hospital, Kuala Lumpur over a 10-year-period. They constitute 6.6% of childhood malignancies and without exception all presented with advanced disease. Hereditary cases were notably absent in the the series probably because past cases have almost invariably succumbed without an opportunity to transmit the gene. With enucleation and radiotherapy six of the patients have survived from 2 to 12 years. The addition of vincristine and cyclophosphamide has not been associated with improved survival.

Matched MeSH terms: Eye Neoplasms/therapy

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