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Othman MF, Zakaria AD, Yahya MM, Md Hashim MN, Wan Mokhter WM, Wan Zain WZ, Mohamad IS, Mohd Shah MS, Syed Abd Aziz SH, Nik Ab Kadir MN, Zakaria Z, Wong MPK. Comparing Low Volume Versus Conventional Volume of Polyethylene Glycol for Bowel Preparation during Colonoscopy: A Randomised Controlled Trial. Malays J Med Sci 2023; 30:106-115. [PMID: 37928791 PMCID: PMC10624433 DOI: 10.21315/mjms2023.30.5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Polyethylene glycol (PEG) solution is widely used as a colonoscopic bowel cleaning agent, although some patients are intolerant due to the need for ingesting large solution volumes and unpleasant taste. A low-volume solution may enhance patient tolerability and compliance in bowel preparation. Accordingly, this study compared the effectiveness of two difference PEG volumes for bowel preparation before colonoscopy in terms of bowel cleanliness, completeness of colonoscopy, patient tolerability and colonoscopy duration. Methods Using a prospective randomised controlled single-blinded study design, 164 patients scheduled for colonoscopy were allocated to two groups (n = 82 patients in each) to receive either the conventional PEG volume (3 L, control group) or the low volume (2 L, intervention group). The Boston Bowel Preparation Scale (BBPS), a validated scale for assessing bowel cleanliness during colonoscopy, was used to score bowel cleanliness in three colon segments. Secondarily, colonoscopy completeness, tolerability to drinking PEG and the duration of colonoscopy were compared between the groups. Results There were no statistically significant differences between the two intervention groups in terms of bowel cleanliness (P = 0.119), colonoscopy completion (P = 0.535), tolerability (P = 0.190) or the amount of sedation/analgesia required (midazolam, P = 0.162; pethidine, P = 0.708). Only the duration of colonoscopy differed between the two groups (longer duration in the control group, P = 0.039). Conclusion Low-volume (2 L) PEG is as effective as the standard 3 L solution in bowel cleaning before colonoscopy; however, the superiority of either solution could not be established.
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Affiliation(s)
- Muhammad Faeid Othman
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Maya Mazuwin Yahya
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Nizam Md Hashim
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mokhzani Wan Mokhter
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Zainira Wan Zain
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ikhwan Sani Mohamad
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Shahrulsalam Mohd Shah
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Syed Hassan Syed Abd Aziz
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Zaidi Zakaria
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
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Nik Ab Kadir MN, Mohd Hairon S, Ab Hadi IS, Yusof SN, Muhamat SM, Yaacob NM. A Comparison between the Online Prognostic Tool PREDICT and myBeST for Women with Breast Cancer in Malaysia. Cancers (Basel) 2023; 15:cancers15072064. [PMID: 37046725 PMCID: PMC10093426 DOI: 10.3390/cancers15072064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The PREDICT breast cancer is a well-known online calculator to estimate survival probability. We developed a new prognostic model, myBeST, due to the PREDICT tool’s limitations when applied to our patients. This study aims to compare the performance of the two models for women with breast cancer in Malaysia. A total of 532 stage I to III patient records who underwent surgical treatment were analysed. They were diagnosed between 2012 and 2016 in seven centres. We obtained baseline predictors and survival outcomes by reviewing patients’ medical records. We compare PREDICT and myBeST tools’ discriminant performance using receiver-operating characteristic (ROC) analysis. The five-year observed survival was 80.3% (95% CI: 77.0, 83.7). For this cohort, the median five-year survival probabilities estimated by PREDICT and myBeST were 85.8% and 82.6%, respectively. The area under the ROC curve for five-year survival by myBeST was 0.78 (95% CI: 0.73, 0.82) and for PREDICT was 0.75 (95% CI: 0.70, 0.80). Both tools show good performance, with myBeST marginally outperforms PREDICT discriminant performance. Thus, the new prognostic model is perhaps more suitable for women with breast cancer in Malaysia.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Imi Sairi Ab Hadi
- Breast and Endocrine Surgery Unit, Department of Surgery, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bharu 15586, Kelantan, Malaysia
| | - Siti Norbayah Yusof
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Federal Territory of Putrajaya, Malaysia
| | - Siti Maryam Muhamat
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Federal Territory of Putrajaya, Malaysia
| | - Najib Majdi Yaacob
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Nik Ab Kadir MN, Mohd Hairon S, Yaacob NM, Yusof SN, Musa KI, Yahya MM, Mohd Isa SA, Mamat Azlan MH, Ab Hadi IS. myBeST-A Web-Based Survival Prognostic Tool for Women with Breast Cancer in Malaysia: Development Process and Preliminary Validation Study. Int J Environ Res Public Health 2023; 20:2985. [PMID: 36833678 PMCID: PMC9966929 DOI: 10.3390/ijerph20042985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Women with breast cancer are keen to know their predicted survival. We developed a new prognostic model for women with breast cancer in Malaysia. Using the model, this study aimed to design the user interface and develop the contents of a web-based prognostic tool for the care provider to convey survival estimates. We employed an iterative website development process which includes: (1) an initial development stage informed by reviewing existing tools and deliberation among breast surgeons and epidemiologists, (2) content validation and feedback by medical specialists, and (3) face validation and end-user feedback among medical officers. Several iterative prototypes were produced and improved based on the feedback. The experts (n = 8) highly agreed on the website content and predictors for survival with content validity indices ≥ 0.88. Users (n = 20) scored face validity indices of more than 0.90. They expressed favourable responses. The tool, named Malaysian Breast cancer Survival prognostic Tool (myBeST), is accessible online. The tool estimates an individualised five-year survival prediction probability. Accompanying contents were included to explain the tool's aim, target user, and development process. The tool could act as an additional tool to provide evidence-based and personalised breast cancer outcomes.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Najib Majdi Yaacob
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Siti Norbayah Yusof
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Federal Territory of Putrajaya, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Maya Mazuwin Yahya
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Seoparjoo Azmel Mohd Isa
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | | | - Imi Sairi Ab Hadi
- Breast and Endocrine Surgery Unit, Department of Surgery, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bharu 15586, Kelantan, Malaysia
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Nik Ab Kadir MN, Yaacob NM, Yusof SN, Ab Hadi IS, Musa KI, Mohd Isa SA, Bahtiar B, Adam F, Yahya MM, Hairon SM. Development of Predictive Models for Survival among Women with Breast Cancer in Malaysia. Int J Environ Res Public Health 2022; 19:15335. [PMID: 36430052 PMCID: PMC9690612 DOI: 10.3390/ijerph192215335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Prediction of survival probabilities based on models developed by other countries has shown inconsistent findings among Malaysian patients. This study aimed to develop predictive models for survival among women with breast cancer in Malaysia. A retrospective cohort study was conducted involving patients who were diagnosed between 2012 and 2016 in seven breast cancer centres, where their survival status was followed until 31 December 2021. A total of 13 predictors were selected to model five-year survival probabilities by applying Cox proportional hazards (PH), artificial neural networks (ANN), and decision tree (DT) classification analysis. The random-split dataset strategy was used to develop and measure the models' performance. Among 1006 patients, the majority were Malay, with ductal carcinoma, hormone-sensitive, HER2-negative, at T2-, N1-stage, without metastasis, received surgery and chemotherapy. The estimated five-year survival rate was 60.5% (95% CI: 57.6, 63.6). For Cox PH, the c-index was 0.82 for model derivation and 0.81 for validation. The model was well-calibrated. The Cox PH model outperformed the DT and ANN models in most performance indices, with the Cox PH model having the highest accuracy of 0.841. The accuracies of the DT and ANN models were 0.811 and 0.821, respectively. The Cox PH model is more useful for survival prediction in this study's setting.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Najib Majdi Yaacob
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Siti Norbayah Yusof
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Federal Territory of Putrajaya, Malaysia
| | - Imi Sairi Ab Hadi
- Breast and Endocrine Surgery Unit, Department of Surgery, Hospital Raja Perempuan Zainab II, Ministry of Health Malaysia, Kota Bharu 15586, Kelantan, Malaysia
| | - Kamarul Imran Musa
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Seoparjoo Azmel Mohd Isa
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Balqis Bahtiar
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Federal Territory of Putrajaya, Malaysia
| | - Farzaana Adam
- Public Health Division, Penang State Health Department, Ministry of Health Malaysia, Georgetown 10590, Penang, Malaysia
| | - Maya Mazuwin Yahya
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Nik Ab Kadir MN, Hairon SM, Yaacob NM, Ab Manan A, Ali N. Prognostic Factors for Bladder Cancer Patients in Malaysia: A Population-Based Study. Int J Environ Res Public Health 2022; 19:ijerph19053029. [PMID: 35270721 PMCID: PMC8910605 DOI: 10.3390/ijerph19053029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/24/2022]
Abstract
Background: Malaysia has the third highest crude mortality rates of bladder cancer within Southeast Asia. We aimed to identify the prognostic factors for bladder cancer patients in Malaysia. Methods: A retrospective population-based study was conducted among patients diagnosed between 2007 and 2011. Death date until 31 December 2016 was updated. Cox proportional hazard regression analysis was performed to examine clinical variables as prognostic factors of death. Results: Identified prognostic factors of 1828 analyzed patients were age groups, ethnicity, morphology, stage, and surgery. As compared to patients aged 15–44, the adjusted Hazard Ratio for those aged 45–54, 55–64, 65–74, and ≥75 were 1.59, 1.87, 2.46, and 3.47, respectively. Malay and other ethnic groups had 1.22- and 1.40-times the risk of death compared to Chinese. Patients with squamous cell carcinoma were at 1.47-times the hazard of death compared to urothelial carcinoma patients. Stages II, III and IV patients had 2.20-, 2.98-, and 4.12-times the risk of death as compared to stage I. Patients who did not receive surgery were at 50% increased hazard of death. Conclusion: Early detection and/or surgery, especially for those more than 75 years old, Malay, and squamous cell carcinoma could potentially improve survival. The findings could inform national cancer control programs.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Correspondence:
| | - Najib Majdi Yaacob
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Azizah Ab Manan
- Timur Laut District Health Office, Penang State Health Department, Ministry of Health Malaysia, Georgetown 11600, Penang, Malaysia;
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Selangor, Malaysia;
| | - Nabihah Ali
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Selangor, Malaysia;
- Public Health Medicine Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
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Nik Ab Kadir MN, Mohd Hairon S, Yaacob NM, Ab Manan A, Ali N. Survival and Characteristics of Bladder Cancer: Analysis of the Malaysian National Cancer Registry. Int J Environ Res Public Health 2021; 18:ijerph18105237. [PMID: 34069096 PMCID: PMC8156894 DOI: 10.3390/ijerph18105237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
Background: Bladder cancer ranked ninth of principal male cancer in Malaysia. This study aimed to evaluate the clinical characteristics and survival of bladder cancer patients in Malaysia. Methods: A retrospective cohort study was conducted by obtaining records in the Malaysian National Cancer Registry. Patients aged 15 years old and above with diagnosis date between 2007 and 2011 were included. Death was updated until 31 December 2016. Five-year observed survival and median survival time were determined by the life table method and Kaplan–Meier estimate method. Results: Among 1828 cases, the mean (SD) age of diagnosis was 64.9 (12.5) years. The patients were predominantly men (78.7%), Malay ethnicity (49.4%) and transitional cell carcinoma (78.2%). Only 14.8% of patients were at stage I. The overall five-year observed survival and median survival time was 36.9% (95% CI: 34.6, 39.1) and 27.3 months (95% CI: 23.6, 31.0). The highest five-year observed survival recorded at stage I (67.6%, 95% CI: 62.0, 73.3) and markedly worsen at stage II (34.3%, 95% CI: 27.9, 40.8), III (25.7%, 95% CI: 18.7, 32.6) and IV (12.2%, 95% CI: 8.1, 16.3). Conclusions: Survival of bladder cancer patients in Malaysia was lower with advancing stage. The cancer control programme should be enhanced to improve survival.
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Affiliation(s)
- Mohd Nasrullah Nik Ab Kadir
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
- Correspondence:
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Azizah Ab Manan
- Timur Laut District Health Office, Penang State Health Department, Ministry of Health Malaysia, Georgetown 11600, Malaysia;
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Malaysia;
| | - Nabihah Ali
- Malaysian National Cancer Registry Department, National Cancer Institute, Ministry of Health Malaysia, Putrajaya 62250, Malaysia;
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