Level of colorectal cancer awareness: a cross sectional exploratory study among multi-ethnic rural population in Malaysia

Assessing the Awareness on Symptoms and Risk Factors of Stroke amongst Rural Community in Central Region of Malaysia: A Cross-Sectional Survey

Background

As the third leading cause of mortality in Malaysia, stroke is recognised as a medical emergency which requires urgent medical attention within a limited timeframe to prevent exacerbation of the brain damage and death in patients. Recent report revealed a high prevalence of pre-hospital delay amongst the stroke patients due to the lack of awareness on symptoms and risk factors of stroke, as well as poor understanding on appropriate action towards stroke. A number of studies had assessed stroke awareness amongst urban population residing in central region of Malaysia but yet amongst rural population.

Methods

A cross-sectional survey was conducted amongst individuals residing in rural districts of Selangor by using a set of questionnaires assessing the sociodemographic characteristics, as well as the awareness and action towards stroke symptoms and risk factors.

Results

All 343 respondents were able to recognise at least one modifiable risk factor for stroke. Meanwhile, only 36.44% were able to identify all the stroke symptoms. Despite majority of them were familiar with the stroke term, less than half of the respondents were aware of calling the emergency medical service as the appropriate action towards stroke symptoms.

Conclusion

The present study indicated a poor level of awareness and action towards stroke symptoms and risk factors amongst rural population residing in Selangor.

Colorectal Cancer Awareness and Related Factors Among Adults Attending Primary Healthcare in North-Eastern of Iran: A Cross-sectional Study

BACKGROUND

Colorectal cancer (CRC) is the third most prevalent cancer in Iran. This study aimed to assess the level of awareness regarding CRC warning signs, risk factors, screening program, and related factors among adults in North-Eastern Iran. Study Design: A cross-sectional study.

METHODS

The multi-stage sampling method was used to survey 2614 participants attending primary healthcare centers in Mashhad, Iran. The data collection tools were the demographics section and Bowel/ CRC Awareness Measure (Bowel/Colorectal CAM). The data were analyzed by SPSS, version 25. The significance level of the data analysis was less than 0.05.

RESULTS

Mean awareness for CRC warning signs and CRC risk factors were 2.85±2.13 and 3.63±1.85, respectively. Most participants (97.2%) had no awareness of the CRC screening program. There was a significant association between marital status, education, job, income, and family history of CRC with awareness of warning signs (P<0.001); moreover, there was a significant association between age, education, job, income, and family history of CRC with awareness of risk factors (P<0.001). The results of logistic regression indicated that there was a significant association between age (P=0.022, OR=1.794, 95% confidence interval [CI]: 1.087, 2.962), gender (P=0.005, OR=0.488, 95% CI: 0.296, 0.803) and warning sign awareness (P<0.001, OR=1.278, 95% CI: 1.124, 1.454) with awareness of the CRC screening program.

CONCLUSION

In this study, most of the participants had low awareness of CRC. More aimed educational interventions are needed to promote Iranian adults' awareness of CRC.

Streptococcus gallolyticus infection: A neglected marker for colorectal cancer?

BACKGROUND AND STUDY AIMS

Colorectal cancer (CRC) is the second most common cancer in Malaysia and mostly detected at advanced stages due to lack of awareness of CRC symptoms and signs. CRC pathogenesis is multifactorial, and there is ambiguous evidence on association of Streptococcus gallolyticus infection with CRC that needs further attention. Thus, a case-control study was conducted to determine whether S. gallolyticus infection is a predictor for CRC occurrence among patients attending Sultan Ahmad Shah Medical Centre@IIUM (SASMEC@IIUM).

PATIENTS AND METHODS

A total of 33 stool samples from patients diagnosed with CRC and 80 from patients without CRC attending surgical clinic of SASMEC@IIUM were collected and analyzed with iFOBT test and PCR assay to detect S. gallolyticus.

RESULTS

In this study, the proportion of S. gallolyticus infection was higher among patients with CRC (48.5%) compared with the control group (20%). Univariate analysis shows that occult blood in stool, S. gallolyticus infection and family history were significantly associated with the development of CRC (P < 0.05). Using the multivariate logistic regression model, positive stool PCR for S. gallolyticus had the lowest relative standard error and almost five times the odds of developing CRC after adjusting other factors (adjusted odds ratio = 4.7, 95% confidence interval = 1.7-12.6, relative standard error = 59.6%).

CONCLUSION

This finding suggests that S. gallolyticus infection was the strongest predictor of CRC's development in our study and potentially serves as a predictive marker for early detection of disease progression.

Awareness of cervical cancer and its associated socio-demographic factors among Yemeni immigrant women in Malaysia

BACKGROUND

Studies have revealed that a higher proportion of women affected by cervical cancer are from some minority groups of immigrant women. Hence, this study was conducted to assess Yemeni immigrant women's awareness of cervical cancer and its associated socio-demographic factors.

METHODS

A cross-sectional study was conducted among 370 Yemeni women in Selangor and Kuala Lumpur, Malaysia. Data on the awareness of symptoms/signs, risk factors, and screening programme were collected using Cervical Cancer Awareness Measurement (Cervical CAM) questionnaire.

RESULTS

More than 74% of the study participants were unable to recall any warning symptoms/signs, and 73% were unable to recall any risk factors. The factors associated with the awareness of symptoms and risk factors were age (95% CI 4.22-5.22, p = 0.039), marital status (95% CI 4.05-7.87, p = 0.021), employment (95% CI 3.89-5.77, p = 0.046) and the number of children (95% CI 5.33-6.54, p = 0.041).

CONCLUSION

The findings underline the need for public awareness campaigns to improve public awareness of cancer symptoms and risk factors among underserved communities.

Cancer signs and risk factors awareness in Addis Ababa, Ethiopia: a population-based survey

BACKGROUND

There is a paucity of data on public awareness of cancer in Ethiopia. This study assessed cancer signs, symptoms, and risk factors awareness among individuals aged 18 and older in Addis Ababa, Ethiopia.

METHOD

A population-based face-to-face interview was conducted applying a validated cancer awareness measure (CAM) tool. A total of 600 adults (315 males and 285 females) were recruited using a multistage sampling technique. One open-ended and ten closed-ended questions were used to assess awareness of cancer signs and symptoms. To assess awareness of cancer risk factors, one open-ended and twelve closed-ended questions were used. Logistic regression analysis was used to test the association between sociodemographic status and awareness of cancer signs, symptoms, and risk factors.

RESULTS

Based on the responses for the open-ended questions, unexplained bleeding (23.16%) and smoking (24.17%) were the most frequently recalled cancer sign and risk factor, respectively. Based on the responses for the closed questions, the majority of respondents identified tiredness all the time (80.7%) as a cancer symptom and alcohol use (82.5%) as a cancer risk factor.  The odds of cancer signs and symptoms awareness was higher in those with primary (AOR = 4.50, 95% CI, 1.72-11.79, p = 0.02), secondary (AOR = 4.62; 95% CI 1.86-11.43; p = 0.001), and tertiary (AOR = 7.51; 95% CI 3.04-18.56; p < 0.001) education than those who were illiterate. The odds of awareness about cancer signs and risk factors was 0.28 (95% CI 0.12-0.65; p = 0.003) and 0.22 (95% CI 0.83-0.58; p = 0.002) times lower, respectively, among individuals aged 60 and older than those aged 18 to 29.

CONCLUSIONS

Young adults who attended formal education of primary or higher level may have a better cancer signs and symptoms awareness. Future education interventions to increase awareness of the society in Addis Ababa may target illiterate and the elderly.

Awareness of the Adult Population Toward Colorectal Cancer in Qassim Region, Saudi Arabia

Introduction Colon and rectal cancer are usually grouped together as they share similar features. They are the third most common cancer in the world and the second most common cancer in the Kingdom of Saudi Arabia (KSA). Awareness and preventive screening programs play a vital role in early diagnosis and improving the survival rate of such patients. This study aimed to assess the awareness and knowledge of colorectal cancer (CRC) among the adult population in the Qassim region of Saudi Arabia. Methods This is a cross-sectional study conducted among the adult population living in the Qassim region of Saudi Arabia. A self-administered questionnaire was disseminated among the adult population using WhatsApp and Twitter. The questionnaire contained demographic data and questions to assess the awareness, knowledge, and attitude regarding CRC risk factors and complications and the importance of screening. Results A total of 431 respondents were involved. The most common symptoms of colon cancer were abdominal pain and change in bowel habits. Risk factors associated with colon cancer were inflammatory bowel disease and fatty food. Colonoscopy was the most dominant choice for the detection of colon cancer. Conclusion The awareness of the adult population toward CRC was deficient. Better awareness can be predicted among individuals with better education. Addressing the gaps in awareness is vital to alleviate fears and misconceptions surrounding this disease.

Facilitators and barriers to colorectal cancer screening using the immunochemical faecal occult blood test among an average-risk population in semi-rural Malaysia: A qualitative study

BACKGROUND

Colorectal cancer (CRC) incidence in Malaysia is increasing, and most CRC patients are diagnosed at a late stage. This study investigated participant awareness of CRC and their perceptions and views about CRC screening, barriers, benefits, and facilitators towards CRC screening participation as well as health-seeking behaviour and the use of preventative health services.

METHOD

Eleven focus group discussions (FGDs) were conducted with a purposive sample of 89 participants aged > 50 from the major ethnic groups in the Segamat District, Johor State. FGDs were audiotaped, transcribed verbatim, and translated into English. Data were analysed using thematic analysis.

RESULTS

We identified trust in doctors as a key reason for whether or not to seek health care. Generally, the participants had low awareness of CRC sign/symptoms and screening. Emotional and logistic concerns about sending a stool sample to a clinic emerged as the main barriers to screening. Simplified illustrated instructions about stool collection in Malay, Chinese and Tamil, free screening at health clinics and reminders to complete the iFOBT test were perceived to facilitate engagement in screening, and posited as strategies that were likely to increase iFOBT uptake.

CONCLUSION

Primary care physicians play a crucial role in terms of reducing patient's misperceptions, recommending screening to patients, enhancing attendance, and improving uptake of CRC screening. There is a need for further research to investigate ways in which to reduce identified barriers and implement and test potential facilitative strategies as well as examine adherence by doctors to clinical guidelines about CRC screening.

Active Ageing Awareness and Quality of Life among Pre-Elder Malaysian Public Employees

Increasing life expectancy has led to a global rise in late-life diseases. Quality of Life (QOL) is important for healthy life expectancy. The active ageing framework serves as a guide for policymakers to design policies that enhance the QOL of older people. This study aims to determine the association between awareness of active ageing and QOL. The Malay version of the 26-item WHOQOL-BREF questionnaire was utilised along with the 14-item Active Ageing Awareness Questionnaire (AAAQ). A total of 532 participants had a mean (SD) age of 50.2 (5.9), were largely ethnic Malay (96.2%), female (52.8%), and comprised largely of low-income households (65.4%). The median (IQR) AAAQ score was 71.4 (19.1). The hierarchical multiple regression analysis revealed significant positive association between AAAQ and the QOL domains of physical (β = 0.154, p < 0.001), psychological (β = 0.196, p < 0.001), social relationship (β = 0.175, p < 0.001), and environment (β = 0.145, p < 0.001) after adjusting for all covariates. Awareness of active ageing was found to have a positive effect on all domains of QOL among pre-elder employees, and thus, we recommend that policies to improve active ageing awareness should be implemented for healthy life expectancy in ageing populations.

Public awareness of colorectal cancer in the Chinese population: An online cross-sectional survey study

OBJECTIVES

To investigate public awareness of colorectal cancer (three components: total knowledge, confidence and anticipated delay) in the Chinese population, to explore factors associated with total knowledge and to elucidate relationships among three components of public awareness of colorectal cancer.

METHODS

We recruited 562 adult Chinese participants with no history of colorectal cancer between March and May 2020 by convenience sampling method. Data were collected online using a self-designed demographic questionnaire and a simplified Chinese version of the Bowel Cancer Awareness Measure. Univariate analysis and multivariate linear regression were applied.

RESULTS

The mean score for total knowledge was 10.56 (SD: 5.89). Over half of the participants (58.2%) lacked confidence about detecting warning signs. For 42.7% of participants, the anticipated delay was not within the acceptable range (2 weeks). Totally eight demographic variables were identified as significant predictors of total knowledge, accounting for 36.2% of the variance. Total knowledge was positively correlated with confidence (r = 0.126, p < 0.01) and negatively associated with anticipated delay (F = 8.891, p < 0.01).

CONCLUSION

Public awareness of colorectal cancer was low in the Chinese population. Hence, educational interventions targeted for improving knowledge, enhancing individuals' confidence in detecting symptoms and reducing barriers to seeking medical help may be urgently required.

Colorectal cancer and potential predictors of never screened for faecal occult blood test: a narrative review

Colorectal cancer (CRC) is a major public health threat. Therefore, CRC screening uptake has been a focus with the established precancerous lesion and the strong association of early detection with staging and survival of the disease. However, CRC screening is relatively low in many countries. This article briefly discussed the current situation of CRC, recommendations, and current uptake of CRC screening in various countries. Besides that, this article also highlights the potential factors that help to predict the CRC screening uptake worldwide. Identification of those factors could guide policymakers to develop an effective strategy to improve the CRC screening uptake and ultimately improve the health outcome of the population.

Awareness of Colorectal Cancer and Associated Factors Among Adult Patients in Jimma, South-West Ethiopia: An Institution-Based Cross-Sectional Study

Background

Colorectal cancer (CRC) is the first commonest diagnosed cancer in men and the fourth commonest in women in Ethiopia. Awareness of CRC and associated factors is crucial in the prevention of CRC. However, there have not been studies about the awareness of CRC and associated factors among adult patients in Ethiopia. Therefore, the study aimed to assess the awareness of CRC and associated factors among adult patients in Jimma, South-West Ethiopia, 2020.

Methods

This institution-based cross-sectional study design was conducted among 422 adult patients. The study respondents were recruited by a systematic random sampling method. The Cancer Awareness Measure questions were used to measure awareness of CRC of adult patients. Descriptive and logistic regression analyses were conducted.

Results

More than half (57.6%) of respondents had low-level awareness of CRC. Respondents who were females (adjusted odds ratio [AOR] = 1.86; 95% CI: 1.26, 2.75), who are residing in urban areas (AOR = .45; 95% CI: .30, .67), who had a monthly income of 3000 Ethiopian Birr and above (AOR = 4.72; 95% CI: 3.11, 7.15), who heard about CRC (AOR = 4.48; 95% CI: 2.90, 6.93), who get information through social media about CRC (AOR = 2.51; 95% CI: 1.18, 5.37), and who had a family history of CRC (AOR = 3.27; 95% CI: 1.45, 7.36) had a high level of awareness of CRC, while those who cannot read and write (AOR = 2.83; 95% CI: 1.49, 5.37) and learn elementary school (AOR = 2.12; 95% CI: 1.15, 3.93) had a low level of awareness of CRC.

Conclusion

This study indicated that awareness of CRC of adult patients was inadequate. Adult patients’ gender, residency, level of education, monthly income, heard about CRC, sources of information about CRC, and a family history of CRC were found to be independent predictors of the awareness of CRC. Therefore, there is a need for health education and awareness campaigns for promoting awareness of CRC of adult patients, and the government should develop policy on CRC prevention and screening program.

Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study

OBJECTIVE

To assess the awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China.

DESIGN

A cross-sectional study was employed.

SETTING

This study was conducted in nine hospitals in Hunan province, China.

PARTICIPANTS

Individuals with a high-risk for colorectal cancer were interviewed using a pretested structured questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge, attitude towards colorectal cancer screening, sociodemographic factors associated with screening knowledge and behaviour and barriers of colorectal cancer screening.

RESULTS

This study included 684 participants. The mean knowledge score was 11.86/24 (SD 4.84). But over 70% of them held a positive attitude towards screening. Only 13.3% had undergone colorectal cancer screening. Independent factors related to knowledge were education level of college or above, working as a white collar, higher income, having health insurance, having seen a doctor in the past year and with a high perceived risk (p<0.05). Factors independently associated with screening behaviour included personal history of colorectal disease, having seen a doctor in the past year, previous discussion of colorectal cancer screening, high perceived risk and better knowledge (p<0.05). Main reasons for not undergoing screening were no symptoms or discomfort (71.1%), never having thought of the disease or screening (67.4%) and no doctor advised me (29.8%).

CONCLUSION

In China, the majority of high-risk people had deficient knowledge and had never undergone colorectal cancer screening. But most of them held a positive attitude towards the benefits of colorectal cancer screening. This has promising implications to design targeted educational campaigns and establish screening programmes to improve colorectal cancer awareness and screening participation. Healthcare professionals should advise high-risk individuals to participate in screening and inform them about cancer risk.

Factors Associated With Colorectal Cancer Screening Via Immunochemical Fecal Occult Blood Test in an Average-Risk Population From a Multiethnic, Middle-Income Setting

PURPOSE

The Malaysian Ministry of Health had launched free opportunistic screening for colorectal cancer using immunochemical fecal occult blood test (iFOBT) targeting the average-risk individuals since 2014. This study aims to determine factors associated with colorectal cancer screening using iFOBT among the average-risk Malaysian population.

METHODS

A cross-sectional study was conducted at five government-run health clinics in the state of Selangor. Adults with an average risk of colorectal cancer (age > 50 years, asymptomatic, and no family history of colorectal cancer) were recruited using systematic random sampling. An interviewer-administered questionnaire adapted from the Cancer Awareness Measure and Health Belief Model was used.

RESULTS

The median age of participants was 61 years (interquartile range, 56 to 66). Almost 60% of participants indicated their willingness to be screened. However, only 7.5% had undergone iFOBT. Good knowledge of risk factors of colorectal cancer, perceived susceptibility to the disease, and the doctor's recommendation were associated with increased willingness to be screened: adjusted odds ratio (aOR), 1.66 (95% CI, 1.12 to 2.46); aOR, 1.70 (95% CI, 1.08 to 2.70); and aOR, 5.76 (95% CI, 2.13 to 15.57), respectively. Nevertheless, being elderly (aOR, 0.67; 95% CI, 0.45 to 0.99) and high negative perception toward the testing method (iFOBT) (aOR, 0.12; 95% CI, 0.05 to 0.30) were independently associated with lower willingness to be screened. Multivariable analysis within the average-risk individuals who were willing to be screened for colorectal cancer showed that the doctor’s recommendations remained as an important cue for positive action, whereas negative perception toward the test was a significant barrier to the actual uptake of iFOBT.

CONCLUSION

The present findings must be factored in when tailoring colorectal cancer screening promotion activities in multiethnic, middle-income settings.

Anticipated delay in help-seeking for cancer symptoms: Findings from a nationwide study of Malaysian adults

BACKGROUND

To investigate the relationship between anticipated delay in help-seeking and cancer symptom recognition and the extent to which this relationship varied according to socio-demographic and health-related characteristics.

METHODS

A cross-sectional telephone survey was conducted of 1895 adults aged ≥40 years who were randomly selected across Malaysia and interviewed using the Awareness and Beliefs about Cancer questionnaire, which was previously validated and culturally adapted by the research team. Logistic regression analysis was used to test the associations between anticipated delay for help seeking >2 weeks and socio-demographic and health-related variables.

RESULTS

Anticipated delay in help-seeking was reported for persistent cough (19.3 %), rectal bleeding (6.1 %) and breast changes (2.5 %). Difficulty in accessing a doctor was associated with anticipated delayed help-seeking for breast changes and rectal bleeding (adjusted ORs 7.58; 95 % CI 1.98, 28.94 and 2.37; 95 % CI 1.21, 4.66, respectively); not recognising the symptom 'unexplained bleeding' as a colorectal cancer warning sign was associated with anticipated delayed help-seeking for rectal bleeding (adjusted OR 1.54; 95 % CI 1.03, 2.31); and ethnicity was associated with anticipated delay for rectal bleeding and persistent cough.

CONCLUSIONS

Generally, anticipated delay to help-seeking for cancer symptoms in Malaysia (a middle-income country) appeared to be a less significant problem compared to other countries including high-income countries. There appeared to be a significant association between social variation indicators in Malaysia and anticipated delay in help-seeking.

Factors of Never Screened with Faecal Occult Blood Test in Public Primary Care Facilities

BACKGROUND

Colorectal cancer (CRC) is still a major public health threat. In the effort to reduce CRC incidence and mortality, faecal occult blood test (FOBT) is currently the screening tools used for early detection of CRC. However, the uptake of FOBT screening is less than promising. This study aims to identify the prevalence and predictors of Never Screened with FOBT (NS-FOBT).

METHODS

A cross sectional study was conducted in five health clinics under Kota Kinabalu district, Sabah, Malaysia Borneo involving 162 attendees with age of 50 years old and above. A validated self-administered questionnaire was used to collect the data. Multiple logistic regression analysis was used to determine the predictors of NS-FOBT.

RESULTS

The prevalence of NS-FOBT was 85.8% (n=139). Important predictors of NS-FOBT were age (aOR: 0.922; 95% CI: 0.855, 0.995; p=0.035), Bumiputera ethnicity (vs Non Bumiputera; aOR: 4.285; 95% CI: 1.384, 13.263; p=0.012), knowledge score (aOR: 0.921; 95% CI: 0.856, 0.99; p=0.027), and attitude score (aOR: 0.801; 95% CI: 0.702, 0.913; p=0.001).

CONCLUSION

There is high prevalence of NS-FOBT. Age, ethnicity, knowledge, and attitude were important predictors of NS-FOBT. Strategies are needed to improve FOBT screening rate among the public. Socio-culturally tailored health promotion strategies as well as strengthening the communication, collaboration, and education to enhance the role of family physician is vital in improving the CRC prevention and care.

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site-specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems' capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.

Colorectal cancer awareness and its predictors among adults aged 50-74 years attending primary healthcare in the State of Qatar: a cross-sectional study

OBJECTIVE

The current study aimed to assess the awareness of colorectal cancer (CRC) symptoms and risk factors among the at-risk population visiting the primary healthcare (PHC) centres in Qatar. The secondary objective was to assess the differences in awareness among population subgroups.

DESIGN

A cross-sectional study design was employed.

SETTING

The study was conducted across six PHC centres in Qatar.

PARTICIPANTS

Patients, or their accompanying people, aged 50-74 years and Arabic or English speakers, were recruited from the main waiting areas of the selected PHC centres.

DATA COLLECTION AND ANALYSIS

Participants were interviewed using the validated Bowel/Colorectal Cancer Awareness Measure questionnaire. A non-probability convenient sampling technique was applied to recruit participants. Descriptive and analytic statistics were used when appropriate. A multivariate linear regression model was constructed to identify the independent predictors of CRC awareness.

RESULTS

The study includes 448 participants (response rate=87%). The mean age of the participants was 58.48 years (SD ±6.37). The mean awareness score among the participants was 3.63/9 (SD ±2.7) for CRC symptoms and 5.43/11 (SD ±3.3) for CRC risk factors. The overall mean awareness score was 9.03/20 (SD ±5.5). Multivariate linear regression identified the female gender (2.52 (95% CI 1.15 to 3.88)), non-Qatari Arab (2.91 (95% CI 1.64 to 4.18)) or non-Arab nationalities (1.76 (95% CI 0.28 to 3.24)), and tertiary education (4.10 (95% CI 2.55 to 5.66)) as independent predictors of higher CRC awareness.

CONCLUSION

In general, the awareness of CRC symptoms and risk factors was low among the at-risk population in Qatar. Specifically, the regression analysis showed men, Qataris, and those with no formal education had low awareness of CRC symptoms and risk factors. Such results emphasise the importance of tailoring future educational campaigns that are relevant, specific and appealing to such cohort.

Colorectal Cancer Knowledge and Awareness Among University Students in a Caribbean Territory: a Cross-sectional Study

INTRODUCTION

The burden of colorectal cancer (CRC) has been on the rise globally over the last decade. Several studies point to the fact that there is a lack of knowledge and awareness for CRC which may be attributed to the increase in the burden over time. Therefore, we aimed to assess the level and predictors for knowledge of CRC and its risk factors.

METHODS

This study was a cross-sectional study conducted on the student population of the University of the West Indies, St. Augustine Campus, Trinidad. We assessed CRC knowledge using scales examining their level of knowledge for CRC and its risk factors. Lifestyle behaviors (smoking, physical activity, dietary behaviors, and alcohol consumption) and perceived risk for developing CRC were also collected using a standard survey. Predictors for CRC knowledge were assessed using forward stepwise linear and logistic regression models.

RESULTS

The overall CRC knowledge was 54.740% ± 19.721%. Poor knowledge levels were seen among 36.23% while satisfactory/good knowledge was seen among 63.77%. Predictors of poor CRC knowledge were males (OR = 1.559; p = 0.003), frequent/excessive alcoholic drinkers (OR = 1.924; p = 0.029), and low physical activity (OR = 1.331; p = 0.042). Predictors of satisfactory/good CRC knowledge were those with higher scores for the prudent dietary pattern (OR = 0.893; p = 0.016), and compared with those who reported no risk, participants reporting low risk had an increased likelihood of obtaining good CRC knowledge scores (OR = 0.526; p = < 0.001) and high risk (0.310; p = < 0.001).

CONCLUSION

The level of awareness/knowledge on CRC and its risk factors is low. Improvement of CRC awareness and healthy lifestyle campaigns among young adults is needed for the Caribbean region.

Cancer symptom and risk factor awareness in Malaysia: findings from a nationwide cross-sectional study

BACKGROUND

Cancer incidence in Malaysia is expected to double by 2040. Understanding cancer awareness is important in order to tailor preventative efforts and reduce the cancer burden. The objective of this research was to assess nationwide awareness about the signs and symptoms as well as risk factors for various cancers in Malaysia and identify socio-demographic factors associated with awareness.

METHODS

This cross-sectional study was conducted from March-November 2014 in the form of a telephone survey. Participants aged 40 years and above were randomly selected across Malaysia and interviewed using the validated Awareness Beliefs about Cancer (ABC) measurement tool. Linear regression was conducted to test the association between symptom and risk factor recognition and socio-demographic variables.

RESULTS

A sample of 1895 participants completed the survey. On average, participants recognised 5.8 (SD 3.2) out of 11 symptoms and 7.5 (SD 2.7) out of 12 risk factors. The most commonly recognised symptom was 'lump or swelling' (74.5%) and the most commonly recognised risk factor was 'smoking' (88.7%). Factors associated with prompted awareness were age, ethnicity, education and smoking status.

CONCLUSION

Recognition of symptom and risk factors for most cancers was relatively low across Malaysia compared to previous studies in high-income countries and to studies conducted in Malaysia. There is a need to conduct regular public health campaigns and interventions designed to improve cancer awareness and knowledge as a first step towards increasing the early detection of cancer.

Clinical characteristics and predictors of 5-year survival among colorectal cancer patients in a tertiary hospital in Malaysia

Background

Colorectal cancer is the second most common cancer in Malaysia. Its disease burden is likely to increase over time owing to its current trends in this region. This study was undertaken to determine the 5-year survival rate and prognostic factors for survival in colorectal cancer patients treated in a tertiary hospital, in Malaysia.

Methods

We reviewed the records of colorectal cancer patients treated in Hospital Tuanku Ja'afar Seremban, Malaysia from 2008 to 2012. Survival analysis at five years was performed using the Kaplan-Meier method. Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival.

Results

Of the 275 patients, 43.3% were colon cancers, 51.8% were rectal cancers. Only 2.2% were diagnosed in Stage I. 28.7%, 33.1%, and 16.7% were in Stage II, III and IV respectively; 62/79 (78%) of Stage II patients were in Stage IIb; 15.7% of patients were below the age of 50 and fewer of them presented early (P=0.002). The overall 5-year survival was 46.5%. It was 67.9%, 50.5% and 12.8% for Stage I&II, III and IV patients respectively. Early stage of cancer (P<0.001) and age below the mean (P=0.01) were the most significant factor in predicting better survival. Gender and ethnic group were not associated with late presentation nor survival. Neither was there a difference between colon and rectum cancers nor patients who received elective surgical treatment compared to patients receiving other treatment first (P=0.085).

Conclusions

Late presentation is the most important predictor for poor outcome for colorectal cancer in Seremban. Patients under the age of 50 years present late more often, but do not have poorer survival.

Knowledge level of cancer symptoms and risk factors in the Gaza Strip: a cross-sectional study

BACKGROUND

In low-income settings, cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals. Therefore, this study examined public knowledge of cancer signs and symptoms as well as risk factors in Gaza.

METHODS

This was a cross-sectional study. Participants were recruited from adult visitors (≥18 years) to governmental hospitals covering all five governorates of Gaza, and adolescent students (15 to 17 years) from 10 high schools in corresponding locations. An Arabic version of the Cancer Awareness Measure (CAM) was completed in a face-to-face interview. It described demographic data and knowledge of: cancer prevalence, age-related risk, signs and symptoms as well as risk factors both in recall and recognition questions.

RESULTS

Of 3033 participants invited, 2886 completed the CAM (response rate = 95.2%). Adult mean age ± standard deviation was 33.7 ± 11.7 years and that of adolescents was 16.3 ± 0.8 years. Half of the participants (n = 1457, 50.5%) were adolescent (781 females; 53.6%) and 1429 (49.5%) were adult (702 females; 49.1%). About two thirds (n = 1885) thought about cancer as unrelated to age. Only 196 participants (6.8%) identified colorectal cancer as the most common cancer among men. Awareness of cancer signs/symptoms was poor to fair, where 'lump' was most commonly recognized (n = 2227, 77.2%) and 'change of bowel habit' the least (n = 670, 23.2%). Only 217 participants (7.5%) had a good level of recognizing risk factors with 'smoking' being the most identified and 'eating less than five portions of fruits and vegetables a day' the least. There was a higher likelihood for adults to identify most cancer signs/symptoms and risk factors than adolescents, except for recalling 'unexplained pain', 'persistent cough/hoarseness', 'non-healing ulcer', 'smoking', and 'eating less than five portions of fruits and vegetables a day'.

CONCLUSION

Public awareness of cancer signs/symptoms and risk factors needs to improve to facilitate early presentation and diagnosis in Gaza. Combining the delivery of public campaigns with tailored education to population groups, including the youth, may increase their knowledge and maintain its impact.

Change in public awareness of colorectal cancer symptoms following the Be Cancer Alert Campaign in the multi-ethnic population of Malaysia

Background

Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian countries. The Be Cancer Alert Campaign (BCAC) was a culturally adapted mass media campaign designed to improve CRC awareness and reduce late detection in Malaysia. The evaluation of the BCAC-CRC aimed to assess campaign reach, campaign impact and health service use.

Methods

Participants aged ≥40 years (n = 730) from randomly selected households in Selangor State Malaysia, completed interview-based assessments. Campaign reach was assessed in terms of responses to an adapted questionnaire that was used in evaluations in other countries. The impact of the campaign was assessed in terms of awareness, confidence to detect symptoms and self-efficacy to discuss symptoms with a doctor as captured by the Cancer Awareness Measure (CAM). CAM was administered before-and-after campaign implementation and responses by BCAC recognisers (i.e. participants who recognised one or more of the BCAC television, radio or print advertisements when prompted) and non-recognisers (i.e. participants who did not recognise any of the BCAC advertisements) were compared analytically. Logistic regression analysed comparative differences in cancer awareness by socio-demographic characteristics and recognition of the BCAC materials.

Results

Over 65% of participants (n = 484) recognised the BCAC-CRC. Campaign-recognisers were significantly more likely to be aware of each CRC symptom at follow-up and were more confident about noticing symptoms (46.9% vs 34.9%, p = 0.018) compared to non-recognisers. There was no difference between groups in terms of self-efficacy to see a doctor about symptoms. Improved symptoms awareness at follow-up was lower for Indians compared to Malays (adjusted odds ratio (OR) 0.53, 95% Confidence Interval (CI): 0.34, 0.83, p = 0.005). Health service use data did not indicate an increase in screening activity during or immediately after the campaign months.

Conclusion

Overall, the findings of the evaluation indicated that the culturally adapted, evidence-based mass media intervention improved CRC symptom awareness among the Malaysian population; and that impact is more likely when a campaign operates a differentiated approach that matches modes of communication to the ethnic and social diversity in a population.

Effectiveness of the ColorApp Mobile App for Health Education and Promotion for Colorectal Cancer: Quasi-Experimental Study

Background

Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer.

Objective

This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah.

Methods

A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA.

Results

There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F_1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F_1,95=0.36, P=.55).

Conclusions

The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer.

Seeking medical help for cancer among urban dwellers in Malaysia-Emotional barriers and awareness of cancer symptoms

OBJECTIVES

The main aims of the study were to identify barriers to seeking help for cancer, appraise demographic and socio-economic differences in relation to barriers and evaluate the association between barriers and cancer symptoms awareness and delayed help-seeking.

METHODS

A total of 2,360 adults (18 years and above) from randomly selected households in metropolitan Kuala Lumpur completed face-to-face interviews with trained research assistants that incorporated the validated Malay version of the Cancer Awareness Measure (CAM). Logistic regression was the main statistical technique that was used to investigate the study objectives and relationships (noted above).

RESULTS

The most commonly reported barriers to help-seeking were emotional barriers. The probability of delaying seeking help was 49% higher in participants who reported emotional barriers (OR = 1.49; CI: 1.32-1.68; p < .001); and each unit rise in the cancer symptom awareness score was associated with a reduced likelihood of 29% in help-seeking delay (OR = 0.71; 95% CI: 0.68-0.74; p < .001).

CONCLUSIONS

Our study presents clear evidence of the relationship between cancer awareness and help-seeking; and the need for, and potential positive impact of, providing cancer awareness-raising programmes. Cancer health education campaigns or programme should address emotional barriers and encourage early seeking help.

Awareness of Colorectal Cancer among the Urban Population in the Klang Valley

BACKGROUND

Colorectal cancer (CRC) is the second most common cancer in Malaysia. Awareness of risk factors, symptoms and warning signs of CRC will help in early detection. This paper presents the level of CRC awareness among the urban population in Malaysia.

METHOD

A cross-sectional study was conducted from November 2015 till December 2016 at three government clinics in the Klang Valley. The validated Bowel Cancer Awareness Measure questionnaire in both English and Malay was used. The mean knowledge scores for the warning signs and risk factors of CRC in different socio-demographic groups were compared using ANOVA in SPSS version 23. Statistical significance was set at p<0.05 and a 95% confidence level.

RESULTS

Of the 426 respondents, 29.1% were unable to recall the warning signs and symptoms of CRC. Average recall was less than two warning signs and symptoms (mean 1.62, SD 1.33). The mean total knowledge score for CRC was 9.91 (SD 4.78), with a mean knowledge scores for warning signs and risk factors at 5.27 (SD 2.74) and 4.64 (SD 2.78), respectively. Respondents with a higher level of education were found to have higher level of knowledge regarding the warning signs of CRC. There was a significant positive association between knowledge score for warning signs and level of confidence in detecting warning signs. Regarding the total knowledge score for CRC, 3.3% of respondents scored zero. For warning signs and risk factors, 8.2% and 8.5% of respondents had zero knowledge scores, respectively.

CONCLUSIONS

Generally, awareness of CRC is poor among the urban population of Klang Valley. Greater education and more confidence in detecting warning signs are significantly associated with better knowledge of warning signs. CRC awareness programs should be increased to improve awareness.

Assessing knowledge on preventive colorectal cancer screening in Saudi Arabia: A cross-sectional study

Context

According to the Saudi Cancer Registry's 2014 Cancer Incidence Report, colorectal cancer (CRC) is the leading form of malignant cancer among Saudi men and ranks third among women. Raising awareness about CRC risk factors could lead to a significant decline in incidence of disease.

Aims

To assess CRC awareness and evaluate the main barriers that might prevent individuals' participation in screening.

Settings and Design

A self-administered survey was conducted over two days as part of a CRC awareness campaign in Jeddah, Saudi Arabia in March, 2018.

Methods and Materials

The survey addressed issues regarding knowledge of CRC and available screening methods. The survey also examined barriers that might make one reluctant to undergo preventative screening. Stata/SE 15.0 was used for all statistical analyses.

Statistical Analyses

Continuous variables were described with frequencies and percentages. Stepwise linear regression models were constructed to predict CRC knowledge and barriers.

Results

Out of 422 participants, 50.2% were men. Most respondents were between 15-35 years old (65.8%). Multivariate analysis revealed that gender was a significant predictor of CRC knowledge. Furthermore, the variables of education and family history of CRC significantly predicted subjects' awareness of colonoscopic screenings. The most common barriers for seeking screening included fear of the procedure, absence of clinical symptoms, and fear of the results.

Conclusions

Our results highlight deficits in public CRC knowledge and their awareness of preventative measures. These shortcomings were found to be mainly related to education level. Specific barriers affecting screening decisions were also identified; intensive efforts on awareness to overcome these obstacles will be required.

Awareness of risk factors and warning symptoms and attitude towards gastric cancer screening among the general public in China: a cross-sectional study

OBJECTIVES

This study aimed to assess the knowledge of risk factors and warning symptoms and attitude towards gastric cancer screening among the general population in China.

SETTING

Hunan province, China PARTICIPANTS: Individuals aged older than 18 years were recruited using a cluster sampling method.

DESIGN

A cross-sectional study, and a pretested structured questionnaire was used to assess participants' awareness of gastric cancer.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge level of risk factors and warning symptoms of gastric cancer, gastric cancer screening attitude, sociodemographic factors associated with gastric cancer knowledge and screening behaviour.

RESULTS

This study comprised 1200 participants with a mean age of 40.31 (SD 16.73) years, of whom 622 (51.8%) were women. The mean score for gastric cancer knowledge was 8.85/22 (SD 6.48). There were 47.0% of the participants who had a low knowledge level about the risk factors and warning symptoms of gastric cancer. In total, 83.8% believed screening is helpful for early detection of gastric cancer, and 15.2% had undergone gastric cancer screening. The most common reason for not undergoing screening was having 'no symptoms' (63.0%), followed by 'fear of undergoing gastroscopy' (38.1%). Independent factors related to lower knowledge levels included male sex, living in rural areas, lower educational level, working as a farmer and without a family history of gastric cancer (p<0.05). Factors independently associated with screening behaviour included white-collar employment, higher income and having upper gastrointestinal tract diseases (p<0.05).

CONCLUSIONS

In China, people have poor knowledge about risk factors and warning symptoms of gastric cancer, but a majority have a positive attitude towards the benefits of gastric cancer screening. Being asymptomatic and having a fear of gastroscopy were the main self-reported reasons for not undergoing screening. These results highlight the urgent need for educational campaigns to improve gastric cancer awareness.

A Rural-Urban Comparison of Knowledge, Risk- Factors and Preventive Practices for Colorectal Cancer among Adults in Lagos State

Objective:

To assess and compare the knowledge, risk-factors and preventive practices for colorectal cancer among adults in Lagos State.

Material and methods:

This was a cross-sectional comparative study conducted among 607 respondents selected from one rural (Ikorodu) and one urban (Surulere) LGA using a multistage sampling technique. Data were collected using a pre-tested questionnaire administered by trained research assistants between April and September 2017.Data was analyzed using Epi-info statistical software version 3.5.1. Univariate and bivariate analysis was carried out and -p values of ≤0.05 were considered statistically significant.

Results:

Respondents’ knowledge of colorectal cancer was generally low, (rural-78.2%, urban- 62.2%, p<0.001). Urban respondents were significantly more knowledgeable than their rural counterparts (rural- 21.8%, urban- 37.8%, p<0.001). The presence of CRC risk-factors were higher among urban respondents (urban-49.3%, rural-42.6%, p= 0.09), however this difference was not statistically significant. Preventive practices were generally poor in both groups, although more (18.1%) urban respondents significantly took preventive actions against CRC compared with rural (6.9%) respondents, (p<0.001).Increasing levels of education were significantly associated with higher knowledge level in both groups (p≤0.05).

Conclusion:

The level of knowledge of colorectal cancer was generally poor in both groups but significantly poorer among rural respondents. The presence of known risk- factor was higher among urban respondents while preventive practices were poor in both groups.

Awareness of Cancer Signs and Barriers to Help Seeking: a National Survey

About 27% of cancer patients in Jordan are discovered in advanced stages; this resulted in poor prognosis and survival rates. One possible cause of late presentation is lack of awareness of warning signs and risk factors of cancer. The purpose of this study is to identify the level of awareness of cancer warning signs, risk factors, and barriers to seeking medical advice among the Jordanian public. A cross-sectional survey design was used. A convenience sample of 2292 participants from the Jordanian public was included in the study. The Cancer Awareness Measure (CAM) was used. Of the 2292 participants, 1206 were females with a mean age of 30.5 SD 11.3 years, ranging from 18 to 81 years. Recall (open question) was not good for all warning symptoms; the percentage of the participants who correctly recalled one of the nine symptoms ranged from 1.7 to 22.9%. However, the mean of the total number of recognized symptoms was also low 4.7 SD 2.4. The highest recognition percentages were as follows: lump/swelling (77.6%), weight loss (63%), and change in appearance of a mole (61.1%). In regard to recognizing risk factors, the most commonly known risk factor was being a smoker (81.4%), followed by drinking more than one unit of alcohol (74.8%). Overall, this study demonstrated that there is a low level of awareness on cancer symptoms and risk factors. This provided a room for improvement through public education which remains the mainstay for such improvement. Emotional barriers to seeking medical care should be addressed using behaviour-changing models.

The 'Be Cancer Alert Campaign': protocol to evaluate a mass media campaign to raise awareness about breast and colorectal cancer in Malaysia

Background

Breast and colorectal cancer are the two most common cancers in Malaysia. Low awareness coupled with stigma and erroneous beliefs delay help-seeking behaviours, lead to late presentation and contribute to poor detection rates. Promoting cancer awareness through mass media may be effective in improving cancer-related knowledge and uptake in screening tests. However, research is sparse regarding the cultural translation and implementation of mass media campaigns in Malaysia (and Asia) in terms of raising awareness about colorectal and breast cancer.

Methods

A collaborative partnership comprising researchers from Malaysia and the UK as well as policy makers, public health experts and non-government organisations from Malaysia was formed to design, deliver and evaluate the Be Cancer Alert Campaign. Each awareness-raising campaign will run for five weeks (Colorectal Cancer in April 2018, followed by Breast Cancer in October 2018). Evaluation of the campaigns will take place in Gombak district (Colorectal Cancer) and Petaling district (Breast Cancer) respectively, in the form of a pre-post randomly selected household survey and collection of service utilisation data. Occupants who are aged 40-years and above and are able to answer questions independently will be selected from each household. A sample of 730 with 80% power will detect a change of 6.09% in knowledge that unexplained lump or swelling is a symptom of breast cancer or changes in bowel habits is a symptom of colorectal cancer.

Discussion

Malaysia and most South-East Asian countries have a low middle-income economy, with limited resources for cancer control. Late-staged cancers impose a significant economic burden on patients, households, communities, employers, health systems and governments. Our proposed strategy for the implementation of the culturally sensitive mass media cancer awareness-raising campaign will serve as a blueprint for cancer prevention and control policy in South-East Asian countries where the burden of cancer is increasing and there are high cancer death rates.

Patterns and Determinants of Attitudes towards Genetic Risk of Cancer: Case Study in a Malaysian Public University

Genetic risk to cancer is a knowledge largely confined to experts and the more educated sectors of the developed western countries. The perception of genetic susceptibility to cancer among the masses is fragmented, particularly in developing countries. As cancer diseases affect developing countries as much as developed nations, it is imperative to study perception and reception of genetic risk to cancer in Southeast Asia. Here, we report on a novel case study to gauge the awareness and attitudes towards genetic determination of cancer among the undergraduates of a Malaysian public university. A total of 272 university undergraduate students completed an online questionnaire. On causes of cancer, the respondents believed that cancer is caused by lifestyle and environmental factors, but those with science background were more likely to associate it with genetic factors. The results on awareness of genetic profiling of cancer risk showed that there are significant differences between those with science and nonscience background but there are no significant differences for gender and socioeconomic background. As for attitudes towards cancer risk, female respondents, those from middle socioeconomic status and science background, are more likely to believe in genetic determinism of cancer. The findings have implications on target population segmentation in strategic health communication on cancer.

Knowledge and Awareness of Colorectal Cancer Early Warning Signs and Risk Factors among University Students in Jordan

In the present study, we aimed to assess the level of awareness regarding CRC warning signs and risk factors among undergraduate students. A cross-sectional survey using standardized questionnaire developed by the Cancer Research Center in the UK was carried out in three different public universities in Jordan including Jordan University of Science and Technology, Yarmouk University, and AL al-Bayt University over a 5-month period. Volunteers were asked about their knowledge regarding CRC symptoms, risk factors, and their behaviors regarding seeking medical advice. Findings revealed that response rate was 80.1%. Vast majority of responders were female (70.9%) and 18.2% of them were studying medical-related specialties. Regarding CRC symptoms, 14.3% of responders experienced poor knowledge, 52.9% have fair knowledge, and 32.8% have good knowledge. Abdominal pain was the most recognized warning signs where 70.8% of responders could recall it. In addition, risk factors awareness was lower than warning signs awareness. About 36.1% of responders have poor knowledge, 47.4% had fair knowledge, and 16.5% had good knowledge. Unhealthy diet was the most recognized risk factor where 32.3% of responders could recall it. Moreover, females were more aware regarding CRC symptoms. Similar findings were obtained for participants who were aged 20 years or more and for those who had previous experience of cancer. Students who were studying medical-related specialties were more aware of both CRC symptoms and risk factors than those who studying other specialties. Furthermore, regarding time to seek medical attention we found that 60.6% of volunteers would seek medical advice within 1 week of noticing CRC symptoms and 12% would seek it within 2 weeks. The mean duration for seeking medical advice was found to be 1.9 weeks. University students' awareness level of CRC is poor, and therefore, extended attention should be attempted to enhance the awareness of CRC via continuous education programs, lectures, or campaigns to encourage the early detection CRC.

Catastrophic Health Expenditure Among Colorectal Cancer Patients and Families: A Case of Malaysia

This study aimed to estimate the cost of colorectal cancer (CRC) management and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among CRC patients and their families arising from the costs of CRC management. Data were collected prospectively from 138 CRC patients. Patients were interviewed by using a structured questionnaire at the time of the diagnosis, then at 6 months and 12 months following diagnosis. Simple descriptive methods and multivariate binary logistic regression were used in the analysis. The mean cost of managing CRC was RM8306.9 (US$2595.9), and 47.8% of patients’ families experienced CHE. The main determinants of CHE were the economic status of the family and the likelihood of the patient undergoing surgery. The results of this study strongly suggest that stakeholders and policy makers should provide individuals with financial protection against the consequences of cancer, a costly illness that often requires prolonged treatment.

Predictors of Colorectal Cancer Knowledge among Adults in the United Arab Emirates

Objective:

To assess knowledge regarding colorectal cancer (CRC) and to identify its predictors in the UAE.

Materials and Methods:

A cross sectional study was conducted among subjects ≥ 50 years-old, using a validated self-administered questionnaire. Awareness of CRC risk factors, warning signs/symptoms (S/S), and screening methods was evaluated with a level of knowledge score for various areas. Low (poor) knowledge was defined as a score below the corresponding average value. The Chi-square test and logistic regression were used in the statistical analysis.

Results:

The percentage of respondents who had poor knowledge score concerning risk factors, warning S/S and screening were 81.7%, 84.7% and 94.1% respectively. Male and lower education level subjects had significantly higher probability of low knowledge related to risk factors and warning S/S. Also respondents without a family history of CRC or personal history of polyps had a significantly higher probability of low knowledge concerning warning S/S compared to those who had a positive history. Significantly higher probability of low knowledge concerning screening methods was noted among non-Arabs and subjects with a lower education level.

Conclusion:

Most of the respondents had poor knowledge. Gender, education level, family and personal history and ethnicity were found to be significant predictors of CRC knowledge.

Immediately modifiable risk factors attributable to colorectal cancer in Malaysia

Background

This study aimed to estimate potential reductions in case incidence of colorectal cancer attributable to the modifiable risk factors such as alcohol consumption, overweight and physical inactivity amongst the Malaysian population.

Methods

Gender specific population-attributable fractions (PAFs) for colorectal cancer in Malaysia were estimated for the three selected risk factors (physical inactivity, overweight, and alcohol consumptions). Exposure prevalence were sourced from a large-scale national representative survey. Risk estimates of the relationship between the exposure of interest and colorectal cancer were obtained from published meta-analyses. The overall PAF was then estimated, using the 2013 national cancer incidence data from the Malaysian Cancer Registry.

Results

Overall, the mean incidence rate for colorectal cancer in Malaysia from 2008 to 2013 was 21.3 per 100,000 population, with the mean age of 61.6 years (±12.7) and the majority were men (56.6%). Amongst 369 colorectal cancer cases in 2013, 40 cases (20 men, 20 women), 10 cases (9 men, 1 woman) or 20 cases (16 men,4 women) would be prevented, if they had done physical exercises, could reduce their body weight to normal level or avoided alcohol consumption, assuming that these factors are causally related to colorectal cancer. It was estimated that 66 (17.8%;66/369) colorectal cancer cases (42 men, 24 women) who had all these three risk factors for the last 10 years would have been prevented, if they could control these three risk factors through effective preventive measures.

Conclusions

Findings suggest that approximately 18% of colorectal cancer cases in Malaysia would be prevented through appropriate preventive measures such as doing regular physical exercises, reducing their body weight to normal level and avoiding alcohol consumption, if these factors are causally related to colorectal cancer. Scaling-up nationwide public health campaigns tailored to increase physical activity, controlling body weight within normal limits and avoid alcohol intake are recommended. Future studies with other site-specific cancers and additional risk factors are needed.

Survival rates and predictors of survival among colorectal cancer patients in a Malaysian tertiary hospital

Background

Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. It is the second most common cancer among both males and females in Malaysia. The economic burden of colorectal cancer is likely to increase over time owing to its current trend and aging population. Cancer survival analysis is an essential indicator for early detection and improvement in cancer treatment. However, there was a scarcity of studies concerning survival of colorectal cancer patients as well as its predictors. Therefore, we aimed to determine the 1-, 3- and 5-year survival rates, compare survival rates among ethnic groups and determine the predictors of survival among colorectal cancer patients.

Methods

This was an ambidirectional cohort study conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia. All Malaysian citizens or permanent residents with histologically confirmed diagnosis of colorectal cancer seen at UMMC from 1 January 2001 to 31 December 2010 were included in the study. Demographic and clinical characteristics were extracted from the medical records. Patients were followed-up until death or censored at the end of the study (31st December 2010). Censored patients’ vital status (whether alive or dead) were cross checked with the National Registration Department. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Log-rank test was used to compare the survival rates, while Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival.

Results

Among 1212 patients, the median survival for colorectal, colon and rectal cancers were 42.0, 42.0 and 41.0 months respectively; while the 1-, 3-, and 5-year relative survival rates ranged from 73.8 to 76.0%, 52.1 to 53.7% and 40.4 to 45.4% respectively. The Chinese patients had the lowest 5-year survival compared to Malay and Indian patients. Based on the 814 patients with data on their Duke’s staging, independent predictors of poor colorectal cancer (5-year) survival were male sex (Hazard Ratio [HR]: 1.41; 95% CI: 1.12, 1.76), Chinese ethnicity (HR: 1.41; 95% CI: 1.07,1.85), elevated (≥ 5.1 ng/ml) pre-operative carcino-embryonic antigen (CEA) level (HR: 2.13; 95% CI: 1.60, 2.83), Duke’s stage C (HR: 1.68; 95% CI: 1.28, 2.21), Duke’s stage D (HR: 4.61; 95% CI: 3.39, 6.28) and emergency surgery (HR: 1.52; 95% CI: 1.07, 2.15).

Conclusions

The survival rates of colorectal cancer among our patients were comparable with those of some Asian countries but lower than those found in more developed countries. Males and patients from the Chinese ethnic group had lower survival rates compared to their counterparts. More advanced staging and late presentation were important predictors of colorectal cancer survival. Health education programs targeting high risk groups and emphasizing the importance of screening and early diagnosis, as well as the recognition of symptoms and risk factors should be implemented. A nationwide colorectal cancer screening program should be designed and implemented to increase early detection and improve survival outcomes.

Delay in Presentation, Diagnosis and Treatment for Colorectal Cancer Patients in Jordan

PURPOSE

Colorectal cancer (CRC) ranked first among cancers reported in males and second among cancers reported in females in Jordan in 2010. There has been no specific CRC-control programme in Jordan. Additionally, there has been no published study from Jordan or its neighbours on patient delays in presentation, diagnosis or treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for CRC and to provide baseline data for future health promotion programmes for CRC in Jordan.

METHODS

This project was a cross-sectional study on CRC patients at Al Bashir Hospital, Ministry of Health, and at the Military Oncology Centre of the Jordanian Royal Medical Services.

RESULTS

The total number of participants was 189. The proportion of patients with presentation delay, diagnosis delay or treatment delay was 33.9, 68.1 and 32.6%, respectively. The main reasons reported for delay in presentation were lack of knowledge that symptoms were suggestive of cancer (58.5%), misdiagnosis by physicians or pharmacists (38.4%) or the patient did not want to visit a doctor (3.1%). Predictors of delay and mean time for presentation, diagnosis and treatment were identified.

CONCLUSIONS

Our results revealed that CRC patients in Jordan experience delays in presentation, Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnosis, and, to a lesser degree, in treatment. This could justify the advanced stages at diagnosis and poor outcomes for CRC patients. Our findings provide baseline information for future CRC-control programmes in Jordan. We recommend that CRC prevention programmes in Jordan focus on early detection of CRC and target both patients and physicians.

Colorectal Cancer Awareness and Screening Preference: A Survey during the Malaysian World Digestive Day Campaign

BACKGROUND

Although the incidence of colorectal cancer in Malaysia is increasing, awareness of this cancer, including its symptoms, risk factors and screening methods, remains low among Malaysian populations. This survey was conducted with the aim of (i) ascertaining the awareness level regarding colorectal cancer symptoms, risk factors and its screening among the general populations and (ii) assessing the public preference and willingness to pay for colorectal cancer screening.

MATERIALS AND METHODS

The questionnaire was distributed in eight major cities in West Malaysia during the World Health Digestive Day (WDHD) campaign. Two thousand four hundred and eight respondents participated in this survey.

RESULTS

Generally, awareness of colorectal cancer was found to be relatively good. Symptoms such as change in bowel habit, blood in the stool, weight loss and abdominal pain were well recognized by 86.6%, 86.9%, 83.4% and 85.6% of the respondents, respectively. However, common risk factors such as positive family history, obesity and old age were acknowledged only by less than 70% of the respondents. Almost 80% of the respondents are willing to take the screening test even without any apparent symptoms. Colonoscopy is the preferred screening method, but only 37.5% were willing to pay from their own pocket to get early colonoscopy.

CONCLUSIONS

Continous cancer education should be promoted with more involvement from healthcare providers in order to make future colorectal cancer screening programs successful.

Colorectal cancer in Malaysia: Its burden and implications for a multiethnic country

BACKGROUND

This study aims to provide an analytical overview of the changing burden of colorectal cancer and highlight the implementable control measures that can help reduce the future burden of colorectal cancer in Malaysia.

METHODS

We performed a MEDLINE search via OVID with the ​Medical Subject Headings (MeSH) terms "Colorectal Neoplasms"[Mesh] and "Malaysia"[Mesh], and PubMed with the key words "colorectal cancer" and "Malaysia" from 1990 to 2015 for studies reporting any clinical, societal, and economical findings associated with colorectal cancer in Malaysia. Incidence and mortality data were retrieved from population-based cancer registries/databases.

RESULTS

In Malaysia, colorectal cancer is the second most common cancer in males and the third most common cancer in females. The economic burden of colorectal cancer is substantial and is likely to increase over time in Malaysia owing to the current trend in colorectal cancer incidence. In Malaysia, most patients with colorectal cancer have been diagnosed at a late stage, with the 5-year relative survival by stage being lower than that in developed Asian countries. Public awareness of the rising incidence of colorectal cancer and the participation rates for colorectal cancer screening are low.

CONCLUSION

The efficiency of different screening approaches must be assessed, and an organized national screening program should be developed in a phased manner. It is essential to maintain a balanced investment in awareness programs targeting general population and primary care providers, focused on increasing the knowledge on symptoms and risk factors of colorectal cancer, awareness on benefits of screening, and promotion of healthy life styles to prevent this important disease.

Poor knowledge of colorectal cancer in Brunei Darussalam

BACKGROUND

Colorectal cancer (CRC) is the most common gastrointestinal cancer and the incidence is increasing in many developing countries. While it can be detected early and even prevented through screening and removal of premalignant lesions, there are barriers to screening which include low level of knowledge and awareness of CRC. This study assessed the level of knowledge of CRC in Brunei Darussalam.

MATERIALS AND METHODS

A total of 431 (262 male and 161 female) subjects participated in this questionnaire study. Subjects were scored on their knowledge of signs/symptoms (maximum 10 correct answers) and known risk factors for CRC (maximum 10 correct answers) and were categorised into poor (0-2), moderate (3-4) and satisfactory (5-10). Comparisons were made between the various patient factors.

RESULTS

Overall, 54.1% could not name any CRC signs/symptoms or associated risk factors. Most were not aware of any screening modalities. The overall scores for CRC signs/symptoms and risk factors were 1.3±1.39 (range 0-6) and 0.6±1.05 (range 0-5) respectively. Overall, the breakdown of scores was: poor (78.1%), moderate (20.3%) and satisfactory (6.2%) for signs/symptoms and poor (93.2%), moderate (6.2%) and satisfactory (0.7%) for risk factors. Higher level of education, female gender and non-Malay race were associated with higher scores for both signs/symptoms and knowledge of screening modality; however the overall scores were low.

CONCLUSIONS

Our study showed that the general knowledge of CRC in Brunei Darussalam is poor. Being female, with higher levels of education and non-Malay race were associated with higher scores, but they were still generally poor. More needs to be done to increase the public knowledge and awareness of CRC.

Knowledge about Colorectal Cancer in Northern Iran: a Population-Based Telephone Survey

BACKGROUND

Colorectal cancer (CRC) is one of the most common malignancies of the gastrointestinal tract. The aim of this study was to assess the general knowledge of CRC in individuals living in Rasht, Iran, using a population-based cross-sectional telephone survey.

MATERIALS AND METHODS

A total of 1557 participants between 18 and 80 years of age were interviewed using random sampling from the telephone directory. Knowledge of risk factors, symptoms, diagnosis, and prevention of CRC was assessed using a validated questionnaire.

RESULTS

The mean knowledge level of the 1,557 respondents (average age 46 y) was 13.5 ± 4.29 (maximum possible score = 26), and 46.4% (722/1,557) of the subjects achieved grades lower than the mean score. The mean scores for knowledge of symptoms and risk factors were 3.97 ± 1.83 (range: 0-7) and 5.17 ± 1.65 (range: 0-9), respectively. Older age, higher education, and employment were significantly associated with better scores for recognition of risk factors and warning symptoms. The majority of subjects correctly identified weight loss (70.2%; 1,093/1,557) and rectal bleeding (63.3%; 986/1,557) as symptoms of CRC, and that smoking (85.9%; 1,337/1,557) and a low- fiber diet (73.4%; 1,143/1,557) were risk factors. Approximately half of the subjects noted increasing age, genetic background and fried food as other risk factors. A considerable number (54.8%; 853/1,557) identified colonoscopy as a screening method for detecting CRC in asymptomatic patients. However, a third of the subjects in the target group for screening (≥ 50 y) were not interested in undergoing screening, primarily due to a lack of symptoms.

CONCLUSIONS

Our results suggest that the knowledge of CRC is poor among the public, and therefore greater attempts should be made to increase awareness. Public education emphasizing the risk factors and symptoms of CRC, as well as the importance of regular screening regardless of the presence of symptoms, may help to reduce CRC morbidity and mortality.

Chemopreventive effects of Strobilanthes crispus leaf extract on azoxymethane-induced aberrant crypt foci in rat colon

In this work, microscopic and histological studies suggest that Strobilanthes crispus ethanol extract reduce azoxymethane (AOM)-induced colonic aberrant crypt foci (ACF) in rats. S. crispus is considered a traditional medicine and used as an antioxidant. Its leaf contains a large amount of phenolic compounds to which its radical scavenging role is attributed and enhance its ability to eradicate oxidative stress reactions. The study was designed to determine the chemopreventive effect of S. crispus ethanol extract in vivo and in vitro by elucidating the effect of the extract on intermediate biomarkers which can be used as effective predictors of colon cancer. S. crispus was analyzed for DPPH free radical scavenging, nitric oxide (NO) and ferric acid reduction. The results indicated that S. crispus oral administration significantly inhibited colorectal carcinogenesis induced by AOM as revealed by the reduction in the number of ACF. S. crispus down-regulated the expression of PCNA, Bcl2 and β-catenin. Additionally, it exerted a pronounced inhibitory effect on MDA and NO levels and stimulatory effect on CAT and GPx activities. These results demonstrate that S. crispus is a chemopreventive agent for colorectal cancer through the suppression of early and intermediate carcinogenic phases that may be related to its flavonoid content.