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Ng T, Teo SM, Yeo HL, Shwe M, Gan YX, Cheung YT, Foo KM, Cham MT, Lee JA, Tan YP, Fan G, Yong WS, Preetha M, Loh WJK, Koo SL, Jain A, Lee GE, Wong M, Dent R, Yap YS, Ng R, Khor CC, Ho HK, Chan A. Brain-derived neurotrophic factor genetic polymorphism (rs6265) is protective against chemotherapy-associated cognitive impairment in patients with early-stage breast cancer. Neuro Oncol 2015; 18:244-51. [PMID: 26289590 PMCID: PMC4724179 DOI: 10.1093/neuonc/nov162] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/17/2015] [Indexed: 12/31/2022] Open
Abstract
Background Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal function and development, is implicated in several neurodegenerative conditions. Preliminary data suggest that a reduction of BDNF concentrations may lead to postchemotherapy cognitive impairment. We hypothesized that a single nucleotide polymorphism (rs6265) of the BDNF gene may predispose patients to cognitive impairment. This study aimed to evaluate the effect of BDNF gene polymorphism on chemotherapy-associated cognitive impairment. Methods Overall, 145 patients receiving chemotherapy for early-stage breast cancer (mean age: 50.8 ± 8.8 y; 82.1% Chinese) were recruited. Patients' cognitive functions were assessed longitudinally using the validated Functional Assessment of Cancer Therapy–Cognitive Function (v.3) and an objective computerized tool, Headminder. Genotyping was performed using Sanger sequencing. Logistic regression was used to evaluate the association between BDNF Val66Met polymorphism and cognition after adjusting for ethnicity and clinically important covariates. Results Of the 145 patients, 54 (37%) reported cognitive impairment postchemotherapy. The Met/Met genotype was associated with statistically significant lower odds of developing cognitive impairment (odds ratio [OR] = 0.26; 95% CI: 0.08–0.92; P = .036). The Met carriers were less likely to experience impairment in the domains of verbal fluency (OR = 0.34; 95% CI: 0.12–0.90; P = .031) and multitasking ability (OR = 0.37; 95% CI: 0.15–0.91; P = .030) compared with the Val/Val homozygote. No associations were observed between Headminder and the BDNF Val66Met polymorphism. Conclusions This is the first study to provide evidence that carriers of the BDNF Met allele are protected against chemotherapy-associated cognitive impairment. Further studies are required to validate the findings.
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Affiliation(s)
- Terence Ng
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Shu Mei Teo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Hui Ling Yeo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yan Xiang Gan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yin Ting Cheung
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Koon Mian Foo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Mooi Tai Cham
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Jung Ah Lee
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yee Pin Tan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Gilbert Fan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Wei Sean Yong
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Madhukumar Preetha
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Wei-Jen Kiley Loh
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Si-Lin Koo
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Amit Jain
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Guek Eng Lee
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Mabel Wong
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Rebecca Dent
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Yoon Sim Yap
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Raymond Ng
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Chiea Chuen Khor
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore (T.N., S.M.T., H.L.Y., M.S., Y.T.C., H.K.H., A.C.); Department of Pharmacy, National Cancer Centre Singapore, Singapore (Y.X.G., A.C.); Department of Pharmacy, K.K. Women's and Children's Hospital, Singapore (K.M.F.); Breast Centre, K.K. Women's and Children's Hospital, Singapore (M.T.C., J.A.L.); Department of Psychosocial Oncology, National Cancer Centre Singapore, Singapore (Y.P.T., G.F.); Department of Surgical Oncology, National Cancer Centre Singapore, Singapore (W.S.Y., M.P.); Department of Medical Oncology, National Cancer Centre Singapore, Singapore (W.-J.K.L., S.-L.K., A.J., G.E.L., M.W., R.D., Y.S.Y., R.N.); Duke-N.U.S Graduate Medical School Singapore, Singapore (R.D., R.N.); Human Genetics, Genome Institute of Singapore, Singapore (C.C.K.); Singapore Eye Research Institute, Singapore (C.C.K.)
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