Maung Shwe

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.

Effects of Chemotherapy and Psychosocial Distress on Perceived Cognitive Disturbances in Asian Breast Cancer Patients

Background: There is conflicting evidence on the effect of chemotherapy and psychosocial distress on perceived cognitive changes in cancer patients. Objective: To compare the severity of perceived cognitive disturbance in Asian breast cancer patients receiving chemotherapy and those not receiving chemotherapy, and identify clinical characteristics associated with perceived cognitive disturbances. Methods: A cross-sectional, observational study was conducted at the largest cancer center in Singapore. Breast cancer patients receiving chemotherapy and not receiving chemotherapy completed the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30), and Beck Anxiety Inventory to assess their perceived cognitive functioning, health-related quality of life, and anxiety, respectively. Multiple regression was conducted to delineate the factors associated with perceived cognitive disturbances. Results: A total of 85 breast cancer patients receiving chemotherapy and 81 not receiving chemotherapy were recruited. Chemotherapy patients experienced more fatigue (QLQ-C30 fatigue scores: 33.3 vs 22.2 points; p = 0.005) and moderate-to-severe anxiety (21.9% vs 8.6%; p = 0.002) compared to non-chemotherapy patients. Non-chemotherapy patients reported better perceived cognitive functioning than those who received chemotherapy (FACT-Cog scores: 124 vs 110 points, respectively; p < 0.001). Chemotherapy and endocrine therapy were strongly associated with perceived cognitive disturbances (p < 0.001 and 0.021, respectively). The interacting effect between anxiety and fatigue was moderately associated with perceived cognitive disturbances (β = -0.29; p = 0.037). Conclusions: Chemotherapy and endocrine treatment were associated with significant cognitive disturbances among Asian breast cancer patients. Psychosocial factors could be used to identify cancer patients who are more susceptible to cognitive disturbances in the clinical setting.

Psychometric Properties and Measurement Equivalence of the English and Chinese Versions of the Functional Assessment of Cancer Therapy-Cognitive in Asian Patients With Breast Cancer

OBJECTIVE This study was designed to examine the psychometric properties and measurement equivalence of the English and Chinese versions of the Functional Assessment of Cancer Therapy-Cognitive Function (Version 3) (FACT-Cog) in multiethnic Asian patients with breast cancer. METHODS This prospective study involved patients with breast cancer from the National Cancer Centre Singapore. The concurrent validity of the FACT-Cog was assessed according to its strength of correlation with the validated European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 cognitive functioning scale, and its association with fatigue, global health status, and anxiety. The known-group validity was assessed on the basis of receipt of chemotherapy. Factor analysis was conducted to ascertain the one-factor structure of each cognitive domain. The reliability was evaluated by using Cronbachs alpha and intraclass correlation coefficient within the cognitive domains. Multiple regression analyses were performed to compare the total scores between the two language versions, adjusting for covariates. RESULTS A total of 185 English-speaking and 143 Chinese-speaking patients were recruited. Both the English and Chinese FACT-Cog total scores correlated strongly with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 cognitive functioning scale scores (r = 0.725 and 0.646), whereas correlations with fatigue, anxiety, and global health status were weak to moderate (|r| = 0.376-0.589). Regarding the known-group validity, more severe perceived cognitive disturbance was observed among patients receiving chemotherapy than among those who were not for both versions (P = .010 and .008, respectively). Internal consistencies within the cognitive domains were high (Cronbachs α 0.707-0.929), and test-retest reliability was satisfactory for both versions (intraclass correlation coefficient 0.762 and 0.697). The measurement equivalence between the English and Chinese versions was established for all domains except the multitasking domain. CONCLUSION The English and Chinese versions of the FACT-Cog are valid, reliable, and equivalent for clinical and research use.

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.

Trajectory and risk factors for chemotherapy-induced nausea and vomiting in Asian patients with head and neck cancer.

The purpose of this study was to analyze the trajectory of and risk factors for chemotherapy‐induced nausea and vomiting in Asian patients with head and neck cancer.

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.

Distinct and heterogeneous trajectories of self-perceived cognitive impairment among Asian breast cancer survivors

Currently, there are no studies that have established the self‐perceived cognitive trajectories experienced by breast cancer patients (BCPs) post‐chemotherapy. Therefore, we characterized the long‐term trajectory of self‐perceived cognitive function among Asian early‐stage BCPs using the minimal clinically important difference of a subjective measure of cognitive function.

Psychometric properties and measurement equivalence of the Multidimensional Fatigue Syndrome Inventory- Short Form (MFSI-SF) amongst breast cancer and lymphoma patients in Singapore

BackgroundCurrently, several fatigue measurement instruments are available to evaluate and measure cancer-related fatigue. Amongst them, Multidimensional Fatigue Syndrome Inventory-Short Form (MFSI-SF) is a self-reported instrument and a multidimensional scale that aims to capture the global, somatic, affective, cognitive and behavioural symptoms of fatigue. This study examines the psychometric properties and measurement equivalence of the English and Chinese versions of MFSI-SF in breast cancer and lymphoma patients in Singapore.MethodsPatients were recruited from National Cancer Centre Singapore. Validity, reliability and responsiveness of MFSI-SF were evaluated in this study. Convergent validity was evaluated by correlating total and subscales of MFSI-SF to known related constructs in EORTC QLQ-C30. Known group validity was assessed based on patients’ cancer stage, pain, insomnia and depression symptoms. Reliability was evaluated by Cronbach’s α. Responsiveness analyses were performed with patients who have undergone at least one cycle of chemotherapy. Multiple regression was used to compare the total and subscale scores of MSFI-SF between the two language versions.ResultsData from 246 (160 English and 86 Chinese version) breast cancer and lymphoma patients were included in the study. Moderate to high correlations were observed between correlated MFSI-SF subscales and EORTC QLQ-C30 domains (|r| = 0.524 to 0.774) except for a poor correlation (r = 0.394) observed between MFSI-SF vigour subscale and EORTC QLQ-C30 role functioning subscale. Total MFSI-SF scores could differentiate between patients with higher depression, pain and insomnia status. Internal consistency of MFSI-SF was also high (α = 0.749 to 0.944). Moderate correlation was observed between change in total MFSI-SF score and change in fatigue symptom scale score and global QoL score on EORTC QLQ-C30 (|r| = 0.478 and 0.404 respectively). Poor correlations were observed between change in scores of hypothesised subscales (|r| = 0.202 to 0.361) except for a moderate correlation between change in MFSI-SF emotional fatigue score and change in EORTC QLQ-C30 emotional functioning domain score. Measurement equivalence was established for all subscales and total MFSI-SF score except for the emotional and vigour subscales.ConclusionsThis study supports the use of MFSI-SF as a reasonably valid scale with good internal consistency for measuring fatigue levels in the Singapore cancer population.

Impact of Adjuvant Anthracycline-Based and Taxane-Based Chemotherapy on Plasma VEGF Levels and Cognitive Function in Breast Cancer Patients: A Longitudinal Study

Background Vascular endothelial growth factor (VEGF) has been shown to induce neurogenesis in the brain and yield neuroprotective effects. It is hypothesized that chemotherapy reduces circulating VEGF levels and leads to cognitive decline among patients. This multicenter longitudinal study aimed to evaluate the impact of chemotherapy on VEGF levels and the association between VEGF levels and cognitive function. Patients and Methods A total of 145 early‐stage breast cancer patients were recruited and assessed before chemotherapy (T1), during chemotherapy (T2), and at the end of chemotherapy (T3). At each time point, plasma VEGF levels were assessed using a multiplex immunoassay. Cognitive function was assessed using both Functional Assessment of Cancer Therapy–Cognitive Function, Version 3 (FACT‐Cog), and Headminder (a computerized, web‐based neuropsychologic battery). Results Generally, we observed higher‐than‐baseline plasma VEGF levels after the start of chemotherapy (P < .001). Among patients receiving anthracycline‐based chemotherapy, the median plasma VEGF levels were significantly higher at T2 (T2: 37.3 pg/mL vs. T1: 21.3 pg/mL; P < .001) and T3 (T3: 35.5 pg/mL vs. T1: 21.3 pg/mL; P < .001) than at baseline. Plasma VEGF levels were not associated with chemotherapy‐associated cognitive impairment. Conclusion Breast cancer patients experience an increasing trend in plasma VEGF levels during chemotherapy, and the regimen types may have a differential effect on circulating VEGF levels. Furthermore, changes in plasma VEGF levels during chemotherapy were not associated with cognitive impairment. VEGF may play a minor role in mediating the occurrence of chemotherapy‐associated cognitive impairment. Micro‐Abstract Vascular endothelial growth factor (VEGF) levels increase after initiation of anthracycline therapy and decrease after initiation of taxane therapy in breast cancer patients. VEGF was not associated with cognitive changes in patients receiving chemotherapy.