Effectiveness of population-based colorectal cancer screening programme in down-staging.

BACKGROUND: This is the first evaluation study to assess the demographic characteristics of the colorectal cancer (CRC) cases detected in the prevalent round of the population-based Colorectal Cancer Screening Programme (CRCSP) in Hong Kong and to explore the effectiveness of the programme on the stage distribution of CRC. METHODS: This study covered the period between 28 September 2016 and 31 December 2018. Information on CRC diagnosis, age and stage at diagnosis were retrieved and reviewed by the Hong Kong Cancer Registry (HKCaR). The CRC detection rate among CRCSP-screened participants and incidence rate among the Hong Kong general population were calculated respectively. The odds ratio (OR) was calculated to measure the strength of association and quantify the effect of CRCSP on stage shift between CRCSP-detected CRC cases and an age-matched cohort of CRC cases diagnosed outside the programme. RESULTS: The CRC detection rate among participants of the CRCSP during the study period was 736.0/100,000, whereas the overall CRC incidence rate among general population of similar age groups was 393.7/100,000. For all ages and both sexes, the OR of stage I CRCSP-detected CRC compared to the CRC from the age-matched cohort was 3.91 (95%CI=3.41-4.48) and the OR dropped to 0.54 (95%CI=0.41-0.70) at stage IV. Meanwhile, the overall OR of CRCSP-detected CRC compared to CRC from the age-matched cohort dropped from 2.24 (95%CI=1.97-2.56) to 1.62 (95%CI=1.40-1.87) with increasing age. CONCLUSION: The present study has demonstrated the initial impact of the CRCSP on shifting the stage at diagnosis towards earlier stage. The benefit of stage-shift was similar for all ages from 60 to 77 in both sexes and seems to increase with younger age. Given the stage-dependent survival outcomes, this stage-shift could lead to a reduction in CRC-associated mortality in Hong Kong in future.

Resource loss, resource gain, and psychological resilience and dysfunction following cancer diagnosis: a growth mixture modeling approach.

OBJECTIVE: This study investigated trajectories of psychological distress and their relationships with change in psychosocial resources in the year following cancer diagnosis. DESIGN: Chinese colorectal cancer (CRC) patients (n = 234) were assessed within 12 weeks of diagnosis (T1) and again at 3-month (T2) and 12-month (T3) follow-ups. Growth mixture modeling was used to analyze the longitudinal data. MAIN OUTCOME MEASURES: Psychological distress was measured at the three time-points using Hospital Anxiety and Depression Scale (HADS). RESULTS: Growth mixture models identified four classes: chronic distress (7-9%), delayed distress (10-13%), recovery (13-16%), and resilient (65-67%). People in chronic distress were more likely to demonstrate loss in physical functioning and social relational quality than those in delayed distress, and loss in physical functioning, optimism, and hope than those in recovery, but more likely to demonstrate stability/gain in optimistic personalities than those in delayed distress and resilient. People in resilient were more likely to report stability/gain in optimistic personalities than those in delayed distress but not those in recovery. CONCLUSION: Understanding differential outcome trajectories and associated change in coping resources has implications for developing ongoing psychological services for cancer patients during the diagnosis and treatment process.

Does change in positive affect mediate and/or moderate the impact of symptom distress on psychological adjustment after cancer diagnosis? A prospective analysis.

Physical symptom distress is one of the commonest correlates of psychological adjustment in cancer patients. Positive affect (PA) can be a dynamic resource for patients to cope with the cancer-related physical demands. The present study examined whether differential patterns of change in PA were associated with anxiety and depressed mood, and whether PA modified the association between change in symptom distress and psychological distress in 215 Chinese people newly diagnosed with colorectal cancer (CRC). Participants completed measures of physical symptoms, PA, and anxiety and depression at diagnosis and again at 3-month follow-up. Multivariate analyses of covariance revealed that at follow-up, people reporting higher anxiety and depressed mood demonstrated loss in PA, whereas those reporting lower depressed mood demonstrated a gain in PA. Structural equation modelling revealed that change in PA significantly mediated and moderated the associations between increased symptom distress and anxiety and depressed mood. We conclude that in line with Hobfoll's conservation of resources theory, continuous physical symptom distress depletes PA of newly diagnosed cancer patients, resulting in higher levels of anxiety and depressed mood. Effectiveness of symptom management intervention could be enhanced by preserving or enhancing PA in patients.

Measuring social relational quality in colorectal cancer: the Social Relational Quality Scale (SRQS).

OBJECTIVES: Social relationships are central in Asian communities. Despite colorectal cancer (CRC) incidence increasing in Asian populations the roles of social activity in facilitating adjustment and optimizing coping resources in Asian peoples remains largely unknown. We derived and validated among Chinese CRC patients, an instrument assessing social relational quality to enable study of these social processes. METHODS: Qualitative interviews (n=16) generated 22-items subsequently administered to 166 Chinese CRC survivors. Principal components analyses identified underlying constructs. The draft instrument, plus measures of optimism, affect, physical symptoms, and perceived social support were administered to a second cohort of 234 newly diagnosed Chinese CRC patients. RESULTS: Three factors were extracted (54.44% of the total variance): Family Intimacy(7 items, 33.08%), Family Commitment (5 items, 14.17%), and Friendships (5 items, 7.19%). All subscales were internally consistent (alpha=0.75-0.82), exhibiting concurrent validity in negative correlations with anxiety and depression and positive correlations with physical and psychological well-being. Convergent validity was indicated by significant positive correlations with optimism, and divergent validity by insignificant inverse correlations with physical symptoms and moderate correlations with perceived social support. Hierarchical regressions revealed positive correlations of the three subscales with psychological well-being, controlling for perceived social support (beta=0.13-0.28). Good criterion validity was indicated. CONCLUSION: The Social Relational Quality Scale is a psychometrically sound self-report measure of social relational quality among Chinese CRC patients and needs further validation among other Asian groups.

New insights in symptom assessment: the Chinese Versions of the Memorial Symptom Assessment Scale Short Form (MSAS-SF) and the Condensed MSAS (CMSAS).

There are very few symptom assessment instruments in Chinese. We present the validity and reliability of the Memorial Symptom Assessment Scale Short Form (MSAS-SF) and the Condensed Form MSAS (CMSAS) in Chinese cancer patients. The Chinese version of the 32-item MSAS-SF, a self-report measure for assessing symptom distress and frequency in cancer patients, was administered to 256 Chinese patients with colorectal cancer at a clinical oncology outpatient unit. Highly prevalent symptoms included worrying (59%), dry mouth (54%), lack of energy (54%), feeling sad (48%), feeling irritable (48%), and pain (41%). Both the MSAS-SF and CMSAS demonstrated good validity and reliability. For the MSAS-SF subscales, Cronbach alphas ranged from 0.84 to 0.91, and for CMSAS subscales, from 0.79 to 0.87. Moderate-to-high correlations of MSAS-SF and CMSAS subscales with appropriate European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 subscales (0.42-0.71, Ps<0.001) indicated acceptable convergent validity. Low correlations with the Rosenberg Self-Esteem and Optimism Scale (0.22, P<0.001) indicated divergent validity. MSAS subscales varied as expected with other Chinese scales--the Chinese Health Questionnaire (CHQ) and the Life Orientation Scale. Construct validity of both MSAS versions was demonstrated by effective differentiation between clinically distinct patient groups (Karnofsky scores <80% vs. > or =80% [P<0.001]; no active treatment vs. active treatment [P<0.002-0.034]; CHQ-12 scores < or =4 vs. CHQ-12 scores >4 [P<0.001]). The Number of Symptoms subscale correlated appropriately with the EORTC QLQ-C30 function (-0.46 to -0.60, P<0.001) and symptom scales (0.31-0.64, P<0.001). The average time to complete the MSAS-SF was six minutes. The Chinese versions of the MSAS-SF and CMSAS are valid and practical measures. Further validation is needed for Chinese patients with other cancer types and with other symptom instruments.

Validation of the Chinese version of the EORTC colorectal cancer-specific quality-of-life questionnaire module (QLQ-CR38).

The European Organization for Research and Treatment of Cancer colorectal cancer (CRC)-specific quality-of-life questionnaire module (QLQ-CR38) assesses health-related quality of life in patients with CRC. We studied its psychometric properties and clinical validity in Hong Kong Chinese patients with CRC. The 38 items, forming functional and symptom scales, were administered to 256 Chinese patients diagnosed with CRC from a clinical oncology outpatient unit. Multitrait scaling analyses confirmed the hypothesized scale structure of the functional scales but not of the symptom scales, particularly those measuring chemotherapy side effects and gastrointestinal symptoms. The functional scales, but not the symptom scales, showed good internal consistency reliability. Convergent and divergent validity were satisfactory, as indicated by the correlations with other measures. The scales effectively differentiated between clinically distinct patient groups. As expected from a module designed to be used in conjunction with the core questionnaire, correlations between the QLQ-CR38 and the QLQ-30 are only weak to moderate. The functional scales of the Chinese version of the QLQ-CR38 show good psychometric performance and suitability for use with the QLQ-C30. Although, the results lend support to the clinical validity of the QLQ-C38, the symptom scales would benefit from further refinement to enhance their usefulness.

Toxicity profile and efficacy of oral capecitabine as adjuvant chemotherapy for Chinese patients with Stage III colon cancer.

PURPOSE: The Xeloda in Adjuvant Cancer Therapy trial, conducted in a white population of patients, established capecitabine (Xeloda) as adjuvant chemotherapy for Stage III colon cancer. Given the ethnical difference in toxicity of adjuvant chemotherapy in colon cancer, this study was designed to evaluate the safety and efficacy of adjuvant capecitabine in Chinese patients with colon cancer. METHODS: Chinese patients with curatively resected Stage III colon adenocarcinoma, who received adjuvant capecitabine, were entered into a prospective database. Oral capecitabine was given at 1,250 mg/m(2) twice daily, Days 1 to 14, every 21 days, for 8 cycles. Toxicities, laboratory abnormalities, and survival outcomes were evaluated. RESULTS: Fifty-eight patients were entered into the database between August 2004 and October 2005. The median age was 63.9 years with a male-to-female ratio of 1.15:1. With a median follow-up duration of 20.9 months, 14 patients relapsed and 3 patients died. Disease-free and overall survival at two years was 69 and 97 percent, respectively. Grade 3 toxicities occurred as follows: stomatitis (1.7 percent), diarrhea (0 percent), hand-foot syndrome (41.4 percent), leucopenia (1.7 percent), neutropenia (3.4 percent), and hyperbilirubinemia (1.7 percent). No Grade 4 or 5 toxicity was noted. Compared with the Xeloda in the Adjuvant Cancer Therapy trial, a much higher incidence of serious hand-foot syndrome and a lower rate of severe diarrhea were found in this study. CONCLUSIONS: A different toxicity profile of adjuvant capecitabine was noted in this study on Chinese patients with colon cancer compared with that reported in the Xeloda in Adjuvant Cancer Therapy trial, whereas the efficacy outcomes were comparable.

Follicular thyroid carcinoma: prognostic factors and the role of radioiodine.

BACKGROUND: The objective of this study was to investigate the patterns of recurrence, various prognostic factors, and the role of radioiodine in the treatment of patients with follicular thyroid carcinoma (FTC). METHODS: The clinical outcomes of 215 patients with FTC who were treated at a single institution were analyzed retrospectively. The mean follow-up was 10.8 years. RESULTS: The actuarial rates of cause specific survival (CSS), locoregional (LR) control, and freedom from distant metastasis (DM) at 10 years were 81%, 83%, and 72.3%, respectively. The independent prognostic factors for survival were metastasis at presentation (relative risk [RR], 47.7), radioiodine (RAI) treatment (RR, 0.25), extrathyroidal extension (RR, 3.8), and the postoperative absence of macroscopic disease in the neck region (RR, 0.06). In patients who were treated with RAI, both the LR failure rate (RR, 0.24) and the mortality rate (RR, 0.25) were reduced to about 25%. Subgroup analysis revealed that RAI improved the survival of patients with DM at presentation (RR, 0.17) and improved the LR control rate in patients who had no DM at presentation (RR, 0.13). For patients who underwent total thyroidectomy with negative resection margins, RAI significantly reduced the rate of LR recurrence (RR, 0.05). Patients with the minimally invasive type of FTC had a good prognosis. The 10-year rates for CSS, LR control, and freedom from DM were 97.6%, 100%, and 90.6%, respectively. The prognosis of patients with frankly invasive FTC was much poorer. The 10-year rates for CSS, LR control, and freedom from DM were 66.7%, 100%, and 45%, respectively. CONCLUSIONS: RAI is an effective treatment for patients with FTC. It was associated with improved survival rates and fewer recurrences.