Assessment of fatigue in cancer patients and community dwellers: validation study of the Filipino version of the brief fatigue inventory.

OBJECTIVE: Clinical trials that might identify effective therapies for cancer-related fatigue, one of the most distressing symptoms experienced by patients, require a validated fatigue assessment tool. We developed and validated a Filipino language version of the Brief Fatigue Inventory (BFI-F) for describing the prevalence and severity of fatigue among Filipino patients with cancer. METHODS: We conducted a cross-sectional study in Manila, Philippines, in 206 patients with cancer and 170 age-matched community-dwelling adults who had never had a diagnosis of cancer. Validity and reliability were evaluated by principal factor analysis and Cronbach's α coefficients. RESULTS: Factor analysis extracted 1 factor, i.e. fatigue severity, with a Cronbach's α of 0.95; this is consistent with the original BFI English version validation study. Approximately 49% of the patients with cancer had mild fatigue, 34% had moderate fatigue, and 17% had severe fatigue. Patients with a poorer performance status had significantly worse fatigue than patients with a better performance status (5.0 ± 2.8 vs. 3.8 ± 2.2; p < 0.05). Compared with community adults, the patients with cancer reported significantly higher levels of fatigue. CONCLUSIONS: The BFI-F had satisfactory internal consistency and validity, and it was able to measure the severity of fatigue and its influence on Filipino cancer patients.

Frequency of the CHEK2 1100delC mutation among women with breast cancer: an international study.

A founder allele in the CHEK2 gene (1100delC) has been associated with an elevated risk of breast cancer. This allele is responsible for the majority of CHEK2-associated breast cancers in women from northern European countries; however, within Europe, it seems to be rare in countries that are close to the Mediterranean. The frequency of the 1100delC allele has not been measured in non-White populations. We measured the frequency of the CHEK2 founder allele in 3,882 breast cancer patients and 8,609 controls from various countries. The allele was not seen among Asian patients (from Pakistan or the Philippines) and was present in 1 of 155 cases from Brazil. Among White women, the allele was present in 1.5% of 825 familial cases of breast cancer and in 0.7% of 1,106 patients with nonfamilial breast cancer. The allele was equally frequent in Jewish and non-Jewish patients. We estimate that the CHEK2 1100delC allele is associated with an odds ratio of 2.6 for breast cancer, which corresponds to a lifetime risk of approximately 24% in Ontario.

Filipino version of the M. D. Anderson Symptom Inventory: validation and multisymptom measurement in cancer patients.

Assessing cancer-related symptoms requires a brief, reliable, valid, and culturally adapted symptom screening tool. In the Philippines, cancer patients (n=206) and community-dwelling adults (n=170) participated in a cross-sectional validation study of the Filipino version of the M. D. Anderson Symptom Inventory (MDASI-F). Both exploratory factor analysis and hierarchical cluster analysis revealed two underlying symptom severity constructs--general and gastrointestinal symptoms--consistent with the English, Japanese, and Chinese versions of the MDASI. Cronbach alpha coefficients of 0.79 and 0.77, respectively, demonstrated acceptable internal consistency for the two factors. Known-group validity was confirmed by significant differences on MDASI-F items by performance status (P<0.01 or P<0.001). Fatigue, sadness, distress, and pain were significant predictors of symptom interference. Cancer patients reported significantly greater symptom severity on multiple items than did the community sample. The MDASI-F is reliable and valid for evaluating cancer-related symptoms and their impact on Filipino cancer patients.

Method of cooking and risk of breast cancer in the Philippines.

OBJECTIVE: Among Asian countries, the highest age-standardized rates of breast cancer have been reported for the Philippines. The influence of diet and lifestyle factors as possible contributors to these high rates has not been well-studied. We conducted a case-control study in Manila to examine the association between methods of cooking and the risk of breast cancer. METHODS: Eligible subjects were women undergoing evaluation at the Philippine General Hospital (PGH), Manila for a breast problem. All of the women completed a risk factor questionnaire prior to the determination of their case (n = 240) or control (n = 240) status. Information regarding current, as well as usual method of cooking in the household at 12 years of age was obtained. RESULTS: Boiling food in coconut milk was associated with a significantly increased risk of breast cancer (odds ratio (OR) = 2.2; 95% confidence interval (CI) 1.3-3.8). There were positive associations between boiling food in coconut milk and the risk of breast cancer currently (OR = 1.9; 95% CI 1.0-3.3), and at 12 years of age (OR = 2.9; 95% CI 1.6-5.5). A positive association between frying food and breast cancer risk was restricted to women whose household fried food at 12 years of age (OR = 1.89; 95% CI 1.1-3.4). CONCLUSIONS: The results of this study suggest that various cooking methods during adolescence and possibly in adulthood may be associated with an increased risk of breast cancer. These findings require confirmation.

Androgen receptor gene polymorphism and breast cancer susceptibility in The Philippines.

Up to one-third of women with breast cancer have a family history of breast cancer, and approximately 5% of cases are attributed to mutations in high-risk breast cancer susceptibility genes, such as BRCA1 and BRCA2. It is believed that genes of lower penetrance, but of greater prevalence, may also modulate a woman's risk of breast cancer. We studied the association of breast cancer and the trinucleotide repeat polymorphism (CAGn) in exon 1 of the androgen receptor gene (AR) in 299 cases of breast cancer and in 229 hospital-based controls from The Philippines. Women for whom the mean length of the CAG repeat allele was < or = 25 units had approximately one-half of the risk of breast cancer compared with women with a mean repeat length of > or = 26 [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.28-0.8). The association with breast cancer risk was particularly strong among older women (> or = 50 years; OR, 0.2; 95% CI, 0.04-0.94). The association was also observed for the longer of the two AR alleles; there was a 5% increase in breast cancer risk for each unit increase in CAG repeat number. These findings support the theory that short trinucleotide repeat genotypes of the AR gene protect against breast cancer.

BRCA1 and BRCA2 mutations among breast cancer patients from the Philippines.

Age-adjusted incidence rates of breast cancer vary more than 10-fold worldwide, with the highest rates reported in North America and Europe. The highest breast cancer incidence rates in Southeast Asia have been reported for the Manila Cancer Registry in the Philippines, with an age-standardized rate of 47.7 per 100,000 per year. The possible contribution of hereditary factors to these elevated rates has not been investigated. We conducted a case-control study of 294 unselected incident breast cancer cases and 346 female controls from Manila, Philippines. Cases and controls were selected from women below the age of 65 undergoing evaluation at the PGH in Manila because of a suspicious breast mass. Molecular analysis identified 12 BRCA2 mutations and 3 BRCA1 mutations. We estimate the prevalence of BRCA mutations among unselected breast cancer cases in the Philippines to be 5.1% (95% CI: 2.6-7.6%), with a prevalence of 4.1% (95% CI: 1.8-6.4%) for BRCA2 mutations alone. The BRCA2 4265delCT and 4859delA mutations were found in 2 and 4 unrelated cases, respectively; haplotype analysis confirmed that these, and the BRCA1 5454delC mutation, are founder mutations. BRCA2 mutations were also found in 2 of 346 controls (0.6%; 95% CI: 0.2-1.4%). Compared with non-carrier cases, the cumulative risk of breast cancer for first-degree relatives of mutation carriers was 24.3% to age 50, compared with <4% for first-degree relatives of non-carrier cases (RR = 6.6; 95% CI: 2.6-17.2; p= 7.5 x 10(-6)). Our data suggest that penetrance of BRCA mutations is not reduced in the Philippines. Germline mutations in the BRCA2 gene contribute more than mutations BRCA1 to breast cancer in the Philippines, due in large part to the presence of 2 common founder mutations.

Evidence-based clinical practice guidelines on the diagnosis and management of breast cancer part I. Early breast cancer

The clinical area identified by the Philippine College of Surgeons (PCS) for the third evidence-based clinical practice guidelines (EBCPGs) was on the management of breast cancer. Funding for the research project was provided by the Philippine Council for Health Research and Development (PCHRD), and a Technical Working Group (TWG) was formed, composed of 5 general surgeons and 1 medical oncologist. The TWG was tasked to identify the clinical questions and to adhere to the PCS approved method of developing EBCPGs. The TWG decided to divide the report into two parts: Early Breast Cancer, and Locally Advanced and Metastatic Breast Cancer. This first report will focus on Early Breast Cancer The definition of early breast cancer is that used by the Early Breast Cancer Trialists Collaborative Group (EBCTG), since the regular systemic reviews (meta-analysis) of the group on the primary and adjuvant therapies of early breast cancer currently comprise the strongest evidence. "In women with "early breast cancer", all detectable cancer is, by definition, restricted to the breast and, in the case of node positive patients, the local lymph nodes can be removed surgically." The TWG began work on July 1, 2000. The literature search, limited to English publications, used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane library, Issue 2, 2000; 2) National Library of Medicine-Medline (PubMed, no time limit); and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD Titles of all articles were printed and at least 2 members of the TWG went over the list and checked the titles of articles whose abstract they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members of the TWG, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. The TWG then compiled, summarized and classified the evidence according to 3 levels and proposed a first draft to recommendations according to 3 categories.(Author)