Gilbert Fan

Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study

This is one of the largest multicentered, cohort studies conducted to evaluate the proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. While elevated interleukin (IL)-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment.

Assessment of mental health literacy in patients with breast cancer

Introduction Psychosocial distress is often underdiagnosed and undertreated among breast cancer patients due to the poor recognition of the associated symptoms and inadequate knowledge of the treatments available. Objective To evaluate the mental health literacy of breast cancer patients by assessing (1) their ability to recognize the symptoms of anxiety, fatigue, depression, and cognitive disturbances, and (2) their knowledge of help-seeking options and professional treatments. Methods In this multi-center, cross-sectional study, early-stage breast cancer patients receiving chemotherapy underwent four assessments to measure their levels of anxiety, depression, fatigue, and cognitive disturbances. With the aid of cancer-specific vignettes, a questionnaire was administered to evaluate their mental health literacy. Results Fifty-four patients were recruited (77.7% Chinese, aged 52.7 ± 8.5 years). Clinically significant anxiety (15.1%), fatigue (27.8%), and cognitive disturbances (25.9%) were more prevalent than depression (5.6%). Although the majority of the patients could recognize the symptoms of fatigue accurately (75.9%), less than half could identify those of anxiety (35.2%), depression (48.1%), and cognitive disturbances (48.1%). Patients were more receptive to help from their family members (score: 3.39 out of 4.00) and oncologists (score: 3.13) than from other mental health specialists, such as psychiatrists (score: 2.26) and psychologists (score: 2.19) in the management of their psychosocial distress. Approximately half of the patients indicated that embarrassment and fear were their main barriers to seeking professional treatment (55.6%). Conclusions Our results suggest that the mental health literacy of breast cancer patients was inadequate. Intervention and management strategies could be implemented to teach these patients about evidence-based treatments and professional help that are specific to mental disorders.

Perceptions and Barriers of Survivorship Care in Asia: Perceptions From Asian Breast Cancer Survivors

Purpose With the long-term goal to optimize post-treatment cancer care in Asia, we conducted a qualitative study to gather in-depth descriptions from multiethnic Asian breast cancer survivors on their perceptions and experiences of cancer survivorship and their perceived barriers to post-treatment follow-up. Methods Twenty-four breast cancer survivors in Singapore participated in six structured focus group discussions. The focus group discussions were voice recorded, transcribed verbatim, and analyzed by thematic analysis. Results Breast cancer survivors were unfamiliar with and disliked the term “survivorship,” because it implies that survivors had undergone hardship during their treatment. Cognitive impairment and peripheral neuropathy were physical symptoms that bothered survivors the most, and many indicated that they experienced emotional distress during survivorship, for which they turned to religion and peers as coping strategies. Survivors indicated lack of consultation time and fear of unplanned hospitalization as main barriers to optimal survivorship care. Furthermore, survivors indicated that they preferred receipt of survivorship care at the specialty cancer center. Conclusion Budding survivorship programs in Asia must take survivor perspectives into consideration to ensure that survivorship care is fully optimized within the community.

Validation of Chinese and English versions of the Holistic Well-being Scale in patients with cancer

ObjectiveThe study aims to examine the psychometric properties of the Holistic Well-Being Scale (HWS), a new instrument developed on the Eastern concepts of affliction, and equanimity in a new sample involving patients with cancer.MethodsA cross-sectional survey was conducted with 300 patients with cancer in Singapore. The patients completed the HWS, WHO-5 Well-Being Index (WHO-5), and Hospital Anxiety and Depressions Scale (HADS). Thirty-two patients participated in the 2-week retest.ResultsMixed findings were obtained from the original seven-factor model in our sample: six factors had acceptable internal reliabilities (Cronbach’s α; range, 0.657–0.809), and construct validities were partially supported. Factor analysis suggested three factors: Blissful-self (α = 0.874), Disturbed-self (α = 0.885) and Embittered-others (α = 0.709). The novel factors demonstrated good test-retest reliability (ICC; range, 0.894–0.930) and construct validities, which were shown by significant correlations with HADS and WHO-5 in the predicted directions.ConclusionsThe present study is the first step taken to validate a scale that is essential in the development of culturally appropriate psychosocial interventions to support and promote personal well-being of cancer patients. The findings suggest that the three-factor model may be more applicable to the Singapore context, but it does not necessarily invalidate the original HWS. The results were discussed in terms of the meaning of the original HWS factors and cultural differences in coping behaviors between Singapore and Hong Kong, though both are Asian countries. The HWS could be further tested in other Asian populations as achieving holistic well-being is a common goal for patients in many cultures.

A culturally adapted survivorship programme for Asian early stage breast cancer patients in Singapore: A randomized, controlled trial.

As cancer mortality rates improve in Singapore, there is an increasing need to improve the transition to posttreatment survivorship care. This study aimed to evaluate the effectiveness of a psychoeducation group (PEG) intervention program compared with usual care to reduce distress for physical symptom and psychological aspects in Asian breast cancer survivors who have completed adjuvant chemotherapy.