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Fulltext Awareness and practice of breast self examination among Malaysian women with breast cancer

Loh SY, Chew SL

Asian Pac J Cancer Prev, 2011;12(1):199-202.
PMID: 21517257

Breast self-examination (BSE) is a self-generated, non-invasive and non-irradiative method of breast cancer detection. This paper documents Malaysian women's awareness and practice of regular BSE as a potent breast cancer detection tool. A pre-test post-test questionnaire survey on women diagnosed with breast cancer (n=66) was conducted. Descriptive statistics and Chi-square tests were performed to correlate demographic variables, knowledge and regular practice of BSE. Findings showed that 80% of the breast cancer survivors self-detected the breast lumps, despite a high 85% of these women reporting they were never taught about BSE. More than 70% of the women maintained that lack of knowledge/skill on the proper practice of BSE was the key barrier to a more regular BSE practice. After an educational intervention on BSE and breast awareness, we found an increase report from 17% (at pre-test) to 67% (at post-test) of self reported monthly BSE practices. Provision of self-management education incorporating BSE, a readily available cheap method, should be introduced at primary care and breast clinics. This strategy promotes women's self-efficacy which contributes towards cancer control agenda in less resource available countries around Asia Pacific. Longer follow up may be crucial to examine the adherence to positive BSE behaviour.
Fulltext Barriers to exercise: perspectives from multiethnic cancer survivors in Malaysia

Loh SY, Chew SL, Lee SY

Asian Pac J Cancer Prev, 2011;12(6):1483-8.
PMID: 22126486

BACKGROUND: Many cancer survivors are still not active enough to reap the benefits of physical activity. This study aimed to explore the correlation between perceived barriers and participation in exercise among multi- ethnic Malaysian women with breast cancer.

METHODS: A cross-sectional study using a pre-post questionnaire and a media-clip as a cancer control strategy was conducted on a random sample of women with breast cancer. The tools were structured questionnaires to collect socio-medical demographic and physical activity data (e.g. barriers, exercise self-efficacy).

RESULTS: A statistically significant relationship between level of physical activity before and after diagnosis of breast cancer (n=51, χ2=70.14, p<0.01) was found, whereby participants who rated more hours of physical activity before diagnosis were likely to persevere with exercise after diagnosis, r(49)=0.73, p<01. Some 76.5% of women engaged in low level activity and 23.5% of the participants engaged in moderate level of physical activity.

CONCLUSIONS: Despite the many benefits of physical activity, the majority of survivors in this study were not found to be physically active, and did not even consciously think of exercise participation. Lack of time is the main barrier amongst those survivors who are predominantly 40-50 year old housewives juggling with household chores, childcare and/or job commitments. Public health messages stressing that short bouts of exercise or some exercise are better than no exercise needs to be emphasised consistently.
Fulltext Physical activity and women with breast cancer: insights from expert patients

Loh SY, Chew SL, Lee SY

Asian Pac J Cancer Prev, 2011;12(1):87-94.
PMID: 21517237

INTRODUCTION: Physical activity participation amongst cancer survivors is low. This potent modifiable host factor has been disregarded in the cancer treatment plan for decades, despite its role in cancer control. The purpose of this study was to explore perception of physical activity among women with breast cancer.
METHODS: Focus group with purposive sampling methods were conducted on women at different cancer trajectory - ie. completed treatment (n = 6) and undergoing treatment (n = 8). The taped discussions were transcribed verbatim and analyzed using a grounded theory approach. Concepts were identified as unique or shared between the two groups, and ordered into subcategories.
RESULTS AND DISCUSSION: Three key categories on barriers to exercise; facilitator/motivator towards exercise; and myths around exercise were highlighted. There were more myths and reservations about physical activity in the UT (undergoing treatment) group, than in the CT (completed-treatment) group. Facilitators included positive experience from physical activity engagement, easy-access to facility, and good social support.
CONCLUSIONS: Although both groups expressed difficulties in engaging in physical activity, the newly diagnosed have more negative perception of physical activity engagement. Both groups did not note the significant role of physical activity and cancer prevention/ recurrence, which is a key strategy to promote the uptake of exercise and acceptance of active lifestyle for cancer survivors. Health care clinicians like occupational therapists need to play greater public health role in educating and counseling lifestyle redesign for survivors living with cancer.
Quality of life in breast cancer survivors: 2 years post self-management intervention

Loh SY, Chew SL, Lee SY, Quek KF

Asian Pac J Cancer Prev, 2011;12(6):1497-501.
PMID: 22126488

INTRODUCTION: Today, cancer survivors have an added new role to self manage living with the medical, emotional and role tasks that can affect their quality of life (QOL). The purpose of the study was to evaluate the QOL of women two years after participating in a self-management intervention program.
METHOD: The clinical trial was conducted at University Malaya Medical Centre between 2006 and 2008. The experimental group underwent a 4-week self management program, and the control group underwent usual care. Two years after the intervention, questionnaires were randomly posted out to the participants.
RESULTS: A total of 51 questionnaires returned. There were statistically differences between groups in psychological, self-care, mobility and participation aspects in PIPP (p<0.05). The experimental group reported having higher confidence to live with breast cancer compared to control group (p<0.05). There were significant between-group changes in anxiety scores at T2 (immediately after intervention) to T4 (two years later), and the differences in anxiety scores within groups between time point T2 and T4 were significantly different (p<0.05).
CONCLUSION: The SAMA program is potentially capable to serve as a model intervention for successful transition to survivorship following breast cancer treatment. The program needs to be further tested for efficacy in a larger trial involving more diverse populations of women completing breast cancer treatment.
Qualitative experiences of breast cancer survivors on a self-management intervention: 2-year post-intervention

Loh SY, Ong L, Ng LL, Chew SL, Lee SY, Boniface G

Asian Pac J Cancer Prev, 2011;12(6):1489-95.
PMID: 22126487

BACKGROUND: Increasing survivorship warrants evidence-based intervention to help women manage living effectively with breast cancer. Breast cancer survivors may have many medical and psychosocial issues in the post- treatment period. Qualitative research was carried out to assess survivors' overall experience and if intervention helps in survivorship care. This paper reports exploration of benefit-findings from participation in an earlier 4-week self management intervention.
METHODS: We used a grounded theory approach to analyze three focus groups conducted between May and August 2010 in Kuala Lumpur. We used random sampling to recruit the informants (n=21), all of whom had earlier participated in the 4 week self-management program held two years previously.
FINDINGS: The women reported positive experience and growth with the self management program. Self-efficacy appears as an important underlying theme for successful experiences. The lack of proactive plans to provide bereavement support to surviving women was a key negative experience.
CONCLUSION: The intervention successfully brought women together to work in close partnership with health professionals on ways to self manage the medical, emotional and role task as they live indefinitely with breast cancer, a new chronic illness. The beneficial effect from the 4 week intervention was expressed by women even at 2 years after the program. Having successfully developed a tightly knitted group, a major oversight was the lack of professional support on bereavement for grieving members when close friends passed away.
Pharmacokinetics of propofol infusion in Asian patients undergoing coronary artery bypass grafting

Lee HS, Khoo YM, Chua BC, Ng AS, Tan SS, Chew SL

Ther Drug Monit, 1995 Aug;17(4):336-41.
PMID: 7482686

The pharmacokinetics of propofol was studied in 11 Asian patients with fentanyl-isoflurane anaesthesia during cardiopulmonary bypass (CPB) and undergoing elective coronary artery bypass grafting (CABG). Instead of the usual increments of morphine and a benzodiazepine, propofol (4 mg/kg/h) was initiated at the start of CPB and ceased at CPB separation. Whole blood propofol concentrations were determined during and postinfusion using high-performance liquid chromatography with fluorescence detection. Data from four patients seemed to fit a two-compartment model, whereas those from seven patients were significantly (F test, p < 0.05) better fitted to a three-compartment model. The pharmacokinetic parameters were as follows: The mean (SD) of the initial distribution phase t1/2 pi, intermediate distribution phase t1/2 alpha, and elimination phase t1/2 beta were 2.22 (1.04) min, 42.9 (16.4) min, and 370 (138) min, respectively. The mean clearance of 1.31 (0.50) L/min was lower than those reported from other studies, whereas the mean blood concentration of 2.2 (1.0) mg/L at the 1-h infusion period was higher. The mean calculated apparent Css was 3.9 (1.5) mg/L. The low clearance is likely to be due to hemodynamic changes during CPB and CABG, thereby affecting drug distribution and blood flow to the liver.