Publications (5)16.49 Total impact
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Article: Racial differences in acute toxicities of neoadjuvant or adjuvant chemotherapy in patients with early-stage breast cancer.
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ABSTRACT: Racial disparities in breast cancer outcomes are attributed to differences in baseline tumour characteristics and biology, stage, age, ethnic background and socioeconomic factors. However, little is known about racial differences in treatment-related toxicities. We hypothesised that racial/ethnic differences result in differential tolerance to chemotherapy potentially, leading to compromised dose intensity/density of chemotherapy in patients with early-stage breast cancer. Data were collected from patients treated at five international centers for early breast cancer with the same adjuvant/neoadjuvant chemotherapy (FEC 100: fluorouracil 500mg/m(2), epirubicin 100mg/m(2), and cyclophosphamide 500mg/m(2),every 21d for 3-6 cycles). Toxicities were assessed by first episode of ⩾grade 2 toxicity. Toxicities were compared according to four race/ethnicity groups (103 Caucasian, 30 African American, 164 Asian, and 34 Hispanic patients). Tumour characteristics across four race/ethnicity groups were similar. Asians had a significantly higher rate of grade 3 haematologic toxicity than Caucasians, African Americans or Hispanic women (32%, 16%, 10%, and 15%, respectively; p<0.05). In multivariate analysis, only lower BMI was associated with a higher incidence of ⩾grade 3 toxicities. However, no significant differences in chemotherapy dose intensity/density were shown across the four race/ethnicity groups. Racial differences in acute toxicity were noted in women with breast cancer who were treated with FEC 100 chemotherapy, suggesting that extrapolating toxicities from chemotherapy across ethnicities is not possible and emphasising the need to validate safety of chemotherapeutic regimens in patients of different ethnicities by enhancing the participation of minorities in clinical trials.European journal of cancer (Oxford, England: 1990) 07/2011; 47(17):2537-45. · 4.12 Impact Factor -
Article: The Chinese Medical Interview Satisfaction Scale-revised (C-MISS-R): development and validation.
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ABSTRACT: The Medical Interview Satisfaction Scale (MISS) measures patient consultation satisfaction. We validated a translated short-form of the original MISS on Hong Kong Chinese women with breast cancer. The four highest scoring MISS Cognitive and Affective sub-scales items were administered in Chinese (C-MISS) to 224 female out patients. Phrasing revisions (C-MISS-R) were tested on 82 women. Random split tested factor structure stability. Convergent, divergent and criterion validation against other instruments was performed on 405 women. Two-factors accounted for 61.7% of variance but factor loadings differed from the original. Phrasing revision increased Affective sub-scale item-item correlations exceeding 0.3-64%. Two factors matching those of the original MISS, accounting for 65.2% of variance, explained 36.6% (Cognitive) and 28.8% (Affective) of variance, respectively. Alpha was 0.84,0.74 and 0.83 for the Cognitive and Affective sub-scales and total respectively. Correlations of difficulties with treatment decision making (r = -0.298), Self-efficacy (r = 0.194), optimism (r = 0.33), psychological morbidity (r = -209), marital status, education and age indicated acceptable validity. Test-retest reliability was 0.410. The Chinese MISS-Revised (C-MISS-R) has suitable factor structure and psychometric properties for use in consultation studies among Chinese female populations. Further validation is needed for males.Quality of Life Research 06/2005; 14(4):1187-92. · 2.30 Impact Factor -
Article: Brief communication: The Chinese medical interview satisfaction scale-revised (C-MISS-R): Development and validation
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ABSTRACT: Background: The Medical Interview Satisfaction Scale (MISS) measures patient consultation satisfaction. We validated a translated short-form of the original MISS on Hong Kong Chinese women with breast cancer. Methods: The four highest scoring MISS Cognitive and Affective sub-scales items were administered in Chinese (C-MISS) to 224 female out patients. Phrasing revisions (C-MISS-R) were tested on 82 women. Random split tested factor structure stability. Convergent, divergent and criterion validation against other instruments was performed on 405 women. Results: Two-factors accounted for 61.7% of variance but factor loadings differed from the original. Phrasing revision increased Affective sub-scale item–item correlations exceeding 0.3–64%. Two factors matching those of the original MISS, accounting for 65.2% of variance, explained 36.6 (Cognitive) and 28.8% (Affective) of variance, respectively. Alpha was 0.84, 0.74 and 0.83 for the Cognitive and Affective sub-scales and total respectively. Correlations of difficulties with treatment decision making (r = –0.298), Self-efficacy (r = 0.194), optimism (r = 0.33), psychological morbidity (r=–209), marital status, education and age indicated acceptable validity. Test–retest reliability was 0.410. Discussion: The Chinese MISS-Revised (C-MISS-R) has suitable factor structure and psychometric properties for use in consultation studies among Chinese female populations. Further validation is needed for males.Quality of Life Research 04/2005; 14(4):1187-1192. · 2.30 Impact Factor -
Article: Gambling with your life: the process of breast cancer treatment decision making in Chinese women.
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ABSTRACT: Treatment decision making (TDM) studies have primarily focused on assessing TDM quality and predominantly presume rational analytic processes as the gold standard. In a grounded theory study of 22 Hong Kong Chinese women following breast surgery who completed an in-depth interview exploring the process of TDM in breast cancer (BC), narrative data showed that discovery of a breast abnormality and emotional responses to BC diagnosis influence the TDM process. Lack of guidance from surgeons impaired TDM. Decisions were, for the most part, made using intuitive, pragmatic and emotionally driven criteria in the absence of complete information. The experience of TDM, which was likened to gambling, did not end once the decision was made but unfolded while waiting for surgery and the post-operative report. In this waiting period, women were emotionally overwhelmed by fear of death and the uncertainty of the surgical outcome, and equivocated over whether they had made the 'right' choice. This suggests that Chinese women feel they are gambling with their lives during TDM. These women are particularly emotionally vulnerable whilst waiting for their surgery and the post-surgical clinical pathology results. Providing emotional support is particularly important at this time when these women are overwhelmed by uncertainty.Psycho-Oncology 02/2005; 14(1):1-15. · 3.34 Impact Factor -
Article: Participation and satisfaction with surgical treatment decision-making in breast cancer among Chinese women.
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ABSTRACT: To report Chinese women's preferred and perceived participation in breast cancer treatment decision making (TDM), describe influences on women's participation preference and participation congruence (PC) (correspondence between preferred and actual amount of participation in TDM), and explore subsequent satisfaction with TDM. Of 172/211 eligible and available Chinese women recently undergoing breast cancer surgery at one of six Hong Kong government hospitals 154 (89.5%) were recruited. Within 12 days after surgery, women provided interview information on preferred and perceived TDM participation, satisfaction with TDM consultation, difficulties in TDM, and medical and demographic information. Half (55%) reported a treatment choice: 33% wanted the choice to be their own, 59% wanted to share and 8% wanted to delegate the decision. Only age predicted participation preference with older women preferring a more passive role. Eighty percent of women participated as much as, 13% more than and 6% less than desired. Adjusted for age, women reporting PC had fewer difficulties in TDM (beta = 0.21, p = 0.009) than women not reporting PC, while over-involved women had more doubts about their choice (beta = -0.23, p = 0.005). PC was associated with being offered a treatment option (chi2 = 15.59, p < 0.001) and surgeons expressing a surgical preference (chi2 = 6.63, p = 0.036). Satisfaction was unrelated to PC. Most Chinese women want shared TDM and to know their surgeon's treatment preference. Over-involved women are at greater risk of difficulties and doubts in TDM and under-involved women perceive a lack of time and information to make their decision.Breast Cancer Research and Treatment 07/2003; 80(2):171-80. · 4.43 Impact Factor
