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Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia

Su TT, Azzani M, Tan FL, Loh SY

Support Care Cancer, 2018 May;26(5):1617-1624.
PMID: 29209834 DOI: 10.1007/s00520-017-3987-y

PURPOSE: This study aimed, firstly, to assess the determinants of return to work (RTW), secondly, to explore the amount of annual wage loss, and finally, to discover the determinants of wage loss among breast cancer (BC) survivors.
METHODS: A cross-sectional study design was used in this research. The data was collected via interview using a validated questionnaire. Logistic regression models were developed to discover the significant determinants of RTW and of wage loss among BC survivors.
RESULTS: A total of 256 BC survivors were included in this study. The analysis showed that there was a 21% loss of or reduction in mean income within 1 year after diagnosis. The significant predictors of RTW are being a government employee, having reduced wages or wage loss, and if the case had been diagnosed 1 year or more ago. Being a private sector employee and having a late stage of cancer was a barrier to RTW. The main risk factors for reduced wages or wage loss were belonging to the age group of 40-59 years, being of Chinese or Indian ethnicity, having low educational status, and not returning to work. However, belonging to the higher monthly income group (earning > RM 2000) is a protective factor against the risk of reduced wages or wage loss.
CONCLUSIONS: Non-RTW and wage loss after diagnosis of BC may result in the survivors experiencing a significant financial burden. Assessment of these patients is becoming more crucial because more women participate in the workforce in Malaysia nowadays and because BC is managed using multiple treatment modalities with their consequences could lead to long absences from work.
Analysis of females with Chlamydia trachomatis infections attending a sexually transmissible infection clinic in Singapore in 2010

Low LC, Tan FL, Chan E, Chio M, Chan R, Sen P

Sex Health, 2013 Nov;10(5):470-1.
PMID: 24074902 DOI: 10.1071/SH13095

BACKGROUND: Chlamydia (Chlamydia trachomatis) is the most commonly diagnosed sexually transmissible infection (STI) in Singapore, with rising incidence.
METHOD: Random sampling was performed on all chlamydia-positive samples collected from female patients who attended a women's clinic from January 2010 to December 2010. Some 250 electronic medical records were analysed. Population demographics, sexual histories, symptoms, diagnostic methods and management were recorded.
RESULTS: One hundred and forty-two (56.8%) patients were under 25 years of age. The predominant race diagnosed with Chlamydia cervicitis were Chinese (116 cases, 46.4%) followed by 86 (34.4%) Malays and 20 (8%) Filipinos. Sixty-three (25.2%) were skilled workers and (47) 18.8% were students. Professionals and office workers together formed 68 (27.2%) of the patients. Some 248 (99.2%) patients were heterosexual and 2 (0.8%) patients were bisexual; 229 (91.6%) patients had regular partners, 18 (7.2%) had casual partners and 3 (1.2%) had both. Concurrency prevalence accounted for 49 cases (19.6%) and condom use was less common. Patients were generally asymptomatic, with 114 (45.5%) presenting with symptoms. One hundred and eight (43.2%) patients had 2-5 sexual partners in their lifetime. Patients with a termination made up 12% of our cohort. This episode of infection was the first diagnosis of an STI for 198 (79.2%) patients; 24 (9.6%) of patients had been previously diagnosed with chlamydia.
CONCLUSION: Chlamydia infection was most prevalent in skilled workers and their regular partners with heterosexual practices under 25 years old. Most patients had 2-5 sexual partners and did not use condoms consistently or at all.
Return to work in multi-ethnic breast cancer survivors--a qualitative inquiry

Tan FL, Loh SY, Su TT, Veloo VW, Ng LL

Asian Pac J Cancer Prev, 2012;13(11):5791-7.
PMID: 23317258

INTRODUCTION: Return-to-work (RTW) can be a problematic occupational issue with detrimental impact on the quality of life of previously-employed breast cancer survivors. This study explored barriers and facilitators encountered during the RTW process in the area of cancer survivorship.
MATERIALS AND METHODS: Six focus groups were conducted using a semi-structured interview guide on 40 informants (employed multiethnic survivors). Survivors were stratified into three groups for successfully RTW, and another three groups of survivors who were unable to return to work. Each of the three groups was ethnically homogeneous. Thematic analysis using a constant comparative approach was aided by in vivo software.
RESULTS: Participants shared numerous barriers and facilitators which directly or interactively affect RTW. Key barriers were physical-psychological after-effects of treatment, fear of potential environment hazards, high physical job demand, intrusive negative thoughts and overprotective family. Key facilitators were social support, employer support, and regard for financial independence. Across ethnic groups, the main facilitators were financial-independence (for Chinese), and socialisation opportunity (for Malay). A key barrier was after-effects of treatment, expressed across all ethnic groups.
CONCLUSIONS: Numerous barriers were identified in the non-RTW survivors. Health professionals and especially occupational therapists should be consulted to assist the increasing survivors by providing occupational rehabilitation to enhance RTW amongst employed survivors. Future research to identify prognostic factors can guide clinical efforts to restore cancer survivors to their desired level/type of occupational functioning for productivity and wellbeing.
Occupational rehabilitation in Singapore and Malaysia

Chan KF, Tan CW, Yeo DS, Tan HS, Tan FL, Tan EW, et al.

J Occup Rehabil, 2011 Mar;21 Suppl 1:S69-76.
PMID: 21328063 DOI: 10.1007/s10926-011-9289-1

INTRODUCTION: Asia is the new and favored magnet of economic attention and foreign investments after it made an almost uneventful rebound from the depths of financial crisis of 2008/2009. Not many Western observers fully understand the diversity that is Asia other than perhaps its 2 growing economic giants of China and India. Indeed many smaller countries like Singapore and Malaysia in South East Asia along with Australia and Hong Kong (a Special Administrative Region within China) look to symbiotic relationships with these two economic giants. The purpose of this discussion paper is to examine the current issues related to the development and provision of occupational rehabilitation services in Singapore and Malaysia with a forward-looking view of how Asia's different developing societies could potentially benefit from better alignment of occupational rehabilitation practices and sharing of expertise through international collaboration and dialogue platforms.
METHODS: Seven therapists and one physician who are frequently involved in occupational rehabilitation services in their home countries critically reviewed the current issues in Singapore and Malaysia which included analysis of the prevalence and cost of occupational injury; overview of workers' compensation system; current practices, obstacles, and challenges in providing occupational rehabilitation and return to work practices. They also offered opinions about how to improve the occupational rehabilitation programs of their two home countries.
CONCLUSION: Even though Malaysia and Singapore are two different countries, in many ways their current provision of occupational rehabilitation services and the problems they face with are very similar. There is a lot of room for systemic improvements that require government support and action. Most prominently, the training of more healthcare professionals in the assessment and rehabilitation of the injured worker should be encouraged. There could be better liaison between the many stakeholders and more funding made available to develop resources and to jump start strategic programs. As these two countries are witnessing rapid economic growth, more resources should be allocated to establish holistic care of the injured workers emphasizing early interventions and prevention of chronic disabilities.