Original Article Context: Spirituality is the essence of a human being. Patients who have good sp... more Original Article Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came from a different cultural background and was heavily based on Buddhism approach. Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background. Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In-depth interview with stratified purposive sampling method. The interviews took place in the oncology outpatient unit department and participants' home. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psychological disorder. Statistical Analysis Used: Descriptive statistic. Results: From October 2016 to February 2018, 16 women joined the study. Three themes emerged with five subthemes: (1) feeling life worthwhile, (2) sense of belonging in the community, and (3) feeling connected to the nature. Conclusions: For Thai women, who have breast cancer, their spirituality focuses on family, mainly their children. They also have better SWB if they have good family relationship, social support, or feeling connected with nature or higher being in a religious or nonreligious way. Future survey design needs to be broader in a secular view and on another perspective rather than the religious approach.
Background: To explore factors that influence quality of life (QOL) in patients receiving breast ... more Background: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. Results: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. Conclusions: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.
Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of li... more Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in post breast-conserving therapy (BCT) women. Materials and Methods: This cross-sectional study concerned one-year post-completed BCT Thai women. The data included subjective and objective CO with a questionnaire covering demographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG) performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B). Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breast cancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman's rank correlation Results: A total 127 participants volunteered for the study. The participant characteristics were age 52(±9), Buddhist 87%, married 65%, body mass index 25.0(±4.6), breast cup size A-C 91%, college educated 60%, employed 66%, ECOG 0-1 95%, tumor size less than or equal to 2 cm 55%, no lymph node metastasis 98%, and taking tamoxifen 57%. Two percent of the participants regretted their decision to undergo BCT. The SRCO was excellent in 2%, good in 68%, fair in 30%, and poor in 0%. For SRBS, rates were 17%, 58%, 24% and 1% for excellent, good, fair and poor cosmetic outcomes, respectively. The BCCT scores were excellent 24%, good 39%, fair 32%, and poor 6%. The median total QOL score of the participants was 130 (93-144). There was no significant correlation between CO and FACT-B scores. Conclusions: The significance of CO for FACT-B in Thai women with breast cancer could not be assessed in detail because of a very low level of correlation. The results may be due to the effects of cultural background.
Objective: To develop and validate the Thai version of the functional assessment of cancer therap... more Objective: To develop and validate the Thai version of the functional assessment of cancer therapy with nasopharyngeal cancer subscale (FACT-NP) with the abbreviated version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF). Material and Methods: A cross-sectional study was performed in the Radiology Department between January 2014 and October 2016. Inclusion criteria: nasopharyngeal carcinoma patients aged greater than 18 years. Exclusion criteria: no comprehension of the Thai language, had other cancers (except for skin cancer and diagnosed with impaired cognition and/or overt psychosis), major depression or delirium. After signing the consent form, participants were interviewed and self-completed FACT-NP and WHOQOL-BREF. The structure of the FACT-NP was determined with exploratory factors analysis. The internal reliability of identified domains was evaluated using Cronbach's alpha. The correlation between domains of the modified FACT-NP and the domains of WHOQOL-BREF were examined with Spearman's correlation. Known-group validity was determined by comparing patients with different sociodemographic and clinical characteristics using the T-test, Ranksum test and analysis of variance. A p-value of less than 0.05 was considered significant. Results: This study was terminated early due to a long accrual period. Of the 230 patients included in the study, only 220 completed both FACT-NP and WHOQOL-BREF. Exploratory factor analysis showed an accumulative variance
Objective: To understand the transition of changed body image after the diagnosis and surgery in ... more Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. Results: Participants' body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. Conclusion: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
Objective: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP... more Objective: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL. Methods: This study was based on secondary data from a cross-sectional study that aimed to develop the Thai version of functional assessment of cancer therapy with nasopharyngeal cancer subscale demographic data, clinical information of participants, and Functional Assessment of Cancer Therapy with Nasopharyngeal cancer subscale (FACT-NP) were utilized. Data were analyzed using Student's t-test, rank-sum test, variance analysis, and the Kruskal-Wallis test. Multiple linear regression with the stepwise model was used to determine multiple variable analysis. Statistical significance was defined at p-value < 0.05. Results: Two hundred and thirty NCP were included in the study with a mean age of 50.3±12.4 years. According to our findings, 68.3% were male, 81.7% were married or living with a partner, and 86.1% were Buddhism had the Eastern Cooperative Oncology Group (ECOG) performance status between 0-2 (95.2 %). The employment status, education level, economic status, ECOG, stage , and disease status significantly influenced patients' QoL. Patients who had active treatment and received prophylactic percutaneous gastrostomy were also impacted by the FACT-NP score. In the multivariate analysis, employment status, ECOG, and disease status were shown to be significant factors that were associated with their QOL in the final model. Conclusion: Employment status was a socioeconomic factor that led to positive QOL amongst NCP.
Background: This article demonstrates the innovative practice of using a card game to teach parti... more Background: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic.
Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying.
Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used.
Results Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.
Background Surgery has been the mainstay treatment for oral cancer. Those patients, who do not re... more Background Surgery has been the mainstay treatment for oral cancer. Those patients, who do not receive surgery are generally treated with concurrent chemoradiotherapy (CCRT). Many factors play a role in patients' survival; tumor volume might be one of those factors. This study aims to determine the effect of the pretreatment tumor volume on the survival of oral cancer. Methods Retrospective study of patients with histological confirmed squamous cell carcinoma, stage III-IV oral cancer, who received definitive CCRT. Tumor volume from pretreatment computed tomography (CT) scans were reviewed and analyzed. The optimal cut-off tumor volume was evaluated by receiver operating characteristic (ROC) curve analysis. Results From 67 patients, half of the primary tumor sites were oral tongue. The median total tumor volume (TTV) was 73.25 cm3, while the median survival was 12.5 months (95% CI 10.9-20.3). The optimal cut-off TTV =52.9 cm3 (P < 0.0001). The median survival of the patients,...
BACKGROUND To explore factors that influence quality of life (QOL) in patients receiving breast c... more BACKGROUND To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). MATERIALS AND METHODS In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. RESULTS Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) ...
Background: This article demonstrates the innovative practice of using a card game to teach parti... more Background: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic. Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying. Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used. Results Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown;...
14 Background: “The South Thailand Insurgency” is burning violence in the deep south of Thailand.... more 14 Background: “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The insurgency which has been ongoing since 2004 has played out in the three southernmost districts of the country Pattani, Yala and Narathiwat and some area of Songkhla, so-called the “Red Zone”. The chronic terrorism had major affected on cancer service. Many cancer patients gave up on their lives due to struggle with the disease itself, financial constraints due to longstanding economic downturn and security concerns during travelling led to high loss to follow-up rate and treatment delay. We, an oncology service team working at Songklanagarind hospital, the only one cancer center served this area together with primary doctors and nurses in the Red Zone created a network and utilized an oncology-specific electronic consultation and referral system to make more efficient care. We reported its performance in 3 years period. Methods: Electronic consultation system (E-consult) was a web-...
Background “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The... more Background “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The insurgency which has been ongoing since 2004 has played out in the three southern most districts of the country Pattani, Yala and Narathiwat and some area of Songkhla, so-called the “Red Zone”. Violence such as daily ambush, bombing on soldiers and civilians, caused people living in terror. This violence has affected cancer service. Many cancer patients gave up on their lives due to struggle with the disease itself, security concerns, traveling and caregiving burden led to a high loss to follow-up rate. We, an oncology service team working at Songklanagarind hospital, the only one radiation and oncology center located in this area, in cooperation with doctors and nurses working in the Red Zone created a network and utilized an electronic consultation and referral system to alleviate these suffering. We preliminarily reported its real-life performance in 3 years period. Methods Electroni...
Purpose: To evaluate the effects of regular bra-wearing during radiotherapy on acute skin toxicit... more Purpose: To evaluate the effects of regular bra-wearing during radiotherapy on acute skin toxicity (AST) and the Quality of Life (QOL) in women with breast conserving therapy (BCT). Methods: A prospective study of 99 patients with any stage of breast cancer who underwent BCT. Patients were instructed to wear an appropriate bra then they were classified by total hours of wearing bra during the radiotherapy treatment course into Non-Bra-Wearing (NBW) (0 hr.) and Bra-Wearing (BW) groups (>0 hr.). The AST was assessed weekly and one week after treatment end by CTCAE v 4.03. The QOL was assessed before and one week after treatment end by The Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) Thai version 4. Results: 66 patients were in the BW group and 33 patients were in the NBW group. The rate of ≥ G2 AST was lower in the BW group compared to the NBW group (16.7% vs. 54.5%, p<0.001, respectively). In the multivariate analysis, the statistically significant factor...
Objective: To develop and validate the Thai version of the functional assessment of cancer therap... more Objective: To develop and validate the Thai version of the functional assessment of cancer therapy with nasopharyngeal cancer subscale (FACT-NP) with the abbreviated version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF).Material and Methods: A cross-sectional study was performed in the Radiology Department between January 2014 and October 2016. Inclusion criteria: nasopharyngeal carcinoma patients aged greater than 18 years. Exclusion criteria: no comprehension of the Thai language, had other cancers (except for skin cancer and diagnosed with impaired cognition and/or overt psychosis), major depression or delirium. After signing the consent form, participants were interviewed and self-completed FACT-NP and WHOQOL-BREF. The structure of the FACT-NP was determined with exploratory factors analysis. The internal reliability of identified domains was evaluated using Cronbach’s alpha. The correlation between domains of the modified FACT-NP and the domains...
Objective: To understand the transition of changed body image after the diagnosis and surgery in ... more Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. Results: Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. Conclusion: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
Context: Spirituality is the essence of a human being. Patients who have good spiritual well-bein... more Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came from a different cultural background and was heavily based on Buddhism approach. Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background. Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In‑depth interview with stratifed purposive sampling method. The interviews took place in the oncology outpatient unit department and participants’ home. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psyc...
To determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissecti... more To determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissection (RHND) to adjuvant therapy on oncological outcomes in cervical cancer. The study included 110 stage IA2-IB1 cervical cancer patients who underwent RHND and adjuvant therapy. The patients were divided into 2 groups based on the cut-off points of TI of 4 and 6 weeks, respectively. The associations of TI and clinicopathologic factors with oncological outcomes were evaluated using Cox proportional-hazards regression. The median TI was 4.5 weeks. There were no statistical differences in 5-year recurrence-free survival (RFS) (89.2% vs. 81.0%, and 83.2% vs. 100.0%) or 5-year overall survival (OS) rates (90.9% vs. 97.2%, and 93.2% vs. 100.0%) between patients according to TI (≤4 vs. >4, and ≤6 vs. >6 weeks, respectively). Deep stromal invasion (p=0.037), and parametrial involvement (PI) (p=0.002) were identified as independent prognostic factors for RFS, together with the interaction be...
International Journal of Gynecological Cancer, 2017
ObjectiveThe aim of this study was to evaluate any association between metformin use and oncologi... more ObjectiveThe aim of this study was to evaluate any association between metformin use and oncological outcomes of cervical cancer in patients with type 2 diabetes mellitus (DM).MethodsWe retrospectively identified 248 patients with cervical cancer with type 2 DM who received primary treatment between 2004 and 2015. The clinicopathological characteristics and oncological outcomes were collected and analyzed. The patients were then separated into metformin use (n = 118) or non–metformin use (n = 130) groups.ResultsWith a median follow-up of 2.85 years, patients who were given metformin had lower recurrence rate than patients who did not receive metformin (P = 0.011). The 5-year disease-free survival (DFS) and overall survival (OS) were 81.55% and 93.27% in the metformin use group, and 65.06% and 86.82% for the non–metformin use group, respectively. In multivariate analysis, non–metformin use (hazard ratio [HR], 1.89; P = 0.037), baseline hypertension (HR, 2.52; P = 0.005), and stage (H...
Original Article Context: Spirituality is the essence of a human being. Patients who have good sp... more Original Article Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came from a different cultural background and was heavily based on Buddhism approach. Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background. Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In-depth interview with stratified purposive sampling method. The interviews took place in the oncology outpatient unit department and participants' home. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psychological disorder. Statistical Analysis Used: Descriptive statistic. Results: From October 2016 to February 2018, 16 women joined the study. Three themes emerged with five subthemes: (1) feeling life worthwhile, (2) sense of belonging in the community, and (3) feeling connected to the nature. Conclusions: For Thai women, who have breast cancer, their spirituality focuses on family, mainly their children. They also have better SWB if they have good family relationship, social support, or feeling connected with nature or higher being in a religious or nonreligious way. Future survey design needs to be broader in a secular view and on another perspective rather than the religious approach.
Background: To explore factors that influence quality of life (QOL) in patients receiving breast ... more Background: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. Results: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. Conclusions: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.
Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of li... more Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in post breast-conserving therapy (BCT) women. Materials and Methods: This cross-sectional study concerned one-year post-completed BCT Thai women. The data included subjective and objective CO with a questionnaire covering demographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG) performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B). Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breast cancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman's rank correlation Results: A total 127 participants volunteered for the study. The participant characteristics were age 52(±9), Buddhist 87%, married 65%, body mass index 25.0(±4.6), breast cup size A-C 91%, college educated 60%, employed 66%, ECOG 0-1 95%, tumor size less than or equal to 2 cm 55%, no lymph node metastasis 98%, and taking tamoxifen 57%. Two percent of the participants regretted their decision to undergo BCT. The SRCO was excellent in 2%, good in 68%, fair in 30%, and poor in 0%. For SRBS, rates were 17%, 58%, 24% and 1% for excellent, good, fair and poor cosmetic outcomes, respectively. The BCCT scores were excellent 24%, good 39%, fair 32%, and poor 6%. The median total QOL score of the participants was 130 (93-144). There was no significant correlation between CO and FACT-B scores. Conclusions: The significance of CO for FACT-B in Thai women with breast cancer could not be assessed in detail because of a very low level of correlation. The results may be due to the effects of cultural background.
Objective: To develop and validate the Thai version of the functional assessment of cancer therap... more Objective: To develop and validate the Thai version of the functional assessment of cancer therapy with nasopharyngeal cancer subscale (FACT-NP) with the abbreviated version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF). Material and Methods: A cross-sectional study was performed in the Radiology Department between January 2014 and October 2016. Inclusion criteria: nasopharyngeal carcinoma patients aged greater than 18 years. Exclusion criteria: no comprehension of the Thai language, had other cancers (except for skin cancer and diagnosed with impaired cognition and/or overt psychosis), major depression or delirium. After signing the consent form, participants were interviewed and self-completed FACT-NP and WHOQOL-BREF. The structure of the FACT-NP was determined with exploratory factors analysis. The internal reliability of identified domains was evaluated using Cronbach's alpha. The correlation between domains of the modified FACT-NP and the domains of WHOQOL-BREF were examined with Spearman's correlation. Known-group validity was determined by comparing patients with different sociodemographic and clinical characteristics using the T-test, Ranksum test and analysis of variance. A p-value of less than 0.05 was considered significant. Results: This study was terminated early due to a long accrual period. Of the 230 patients included in the study, only 220 completed both FACT-NP and WHOQOL-BREF. Exploratory factor analysis showed an accumulative variance
Objective: To understand the transition of changed body image after the diagnosis and surgery in ... more Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. Results: Participants' body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. Conclusion: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
Objective: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP... more Objective: To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL. Methods: This study was based on secondary data from a cross-sectional study that aimed to develop the Thai version of functional assessment of cancer therapy with nasopharyngeal cancer subscale demographic data, clinical information of participants, and Functional Assessment of Cancer Therapy with Nasopharyngeal cancer subscale (FACT-NP) were utilized. Data were analyzed using Student's t-test, rank-sum test, variance analysis, and the Kruskal-Wallis test. Multiple linear regression with the stepwise model was used to determine multiple variable analysis. Statistical significance was defined at p-value < 0.05. Results: Two hundred and thirty NCP were included in the study with a mean age of 50.3±12.4 years. According to our findings, 68.3% were male, 81.7% were married or living with a partner, and 86.1% were Buddhism had the Eastern Cooperative Oncology Group (ECOG) performance status between 0-2 (95.2 %). The employment status, education level, economic status, ECOG, stage , and disease status significantly influenced patients' QoL. Patients who had active treatment and received prophylactic percutaneous gastrostomy were also impacted by the FACT-NP score. In the multivariate analysis, employment status, ECOG, and disease status were shown to be significant factors that were associated with their QOL in the final model. Conclusion: Employment status was a socioeconomic factor that led to positive QOL amongst NCP.
Background: This article demonstrates the innovative practice of using a card game to teach parti... more Background: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic.
Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying.
Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used.
Results Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.
Background Surgery has been the mainstay treatment for oral cancer. Those patients, who do not re... more Background Surgery has been the mainstay treatment for oral cancer. Those patients, who do not receive surgery are generally treated with concurrent chemoradiotherapy (CCRT). Many factors play a role in patients' survival; tumor volume might be one of those factors. This study aims to determine the effect of the pretreatment tumor volume on the survival of oral cancer. Methods Retrospective study of patients with histological confirmed squamous cell carcinoma, stage III-IV oral cancer, who received definitive CCRT. Tumor volume from pretreatment computed tomography (CT) scans were reviewed and analyzed. The optimal cut-off tumor volume was evaluated by receiver operating characteristic (ROC) curve analysis. Results From 67 patients, half of the primary tumor sites were oral tongue. The median total tumor volume (TTV) was 73.25 cm3, while the median survival was 12.5 months (95% CI 10.9-20.3). The optimal cut-off TTV =52.9 cm3 (P < 0.0001). The median survival of the patients,...
BACKGROUND To explore factors that influence quality of life (QOL) in patients receiving breast c... more BACKGROUND To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). MATERIALS AND METHODS In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. RESULTS Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) ...
Background: This article demonstrates the innovative practice of using a card game to teach parti... more Background: This article demonstrates the innovative practice of using a card game to teach participants about Advance Care Planning (ACP) and palliative care in Thailand via Zoom during the COVID-19 pandemic. Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying. Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used. Results Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown;...
14 Background: “The South Thailand Insurgency” is burning violence in the deep south of Thailand.... more 14 Background: “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The insurgency which has been ongoing since 2004 has played out in the three southernmost districts of the country Pattani, Yala and Narathiwat and some area of Songkhla, so-called the “Red Zone”. The chronic terrorism had major affected on cancer service. Many cancer patients gave up on their lives due to struggle with the disease itself, financial constraints due to longstanding economic downturn and security concerns during travelling led to high loss to follow-up rate and treatment delay. We, an oncology service team working at Songklanagarind hospital, the only one cancer center served this area together with primary doctors and nurses in the Red Zone created a network and utilized an oncology-specific electronic consultation and referral system to make more efficient care. We reported its performance in 3 years period. Methods: Electronic consultation system (E-consult) was a web-...
Background “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The... more Background “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The insurgency which has been ongoing since 2004 has played out in the three southern most districts of the country Pattani, Yala and Narathiwat and some area of Songkhla, so-called the “Red Zone”. Violence such as daily ambush, bombing on soldiers and civilians, caused people living in terror. This violence has affected cancer service. Many cancer patients gave up on their lives due to struggle with the disease itself, security concerns, traveling and caregiving burden led to a high loss to follow-up rate. We, an oncology service team working at Songklanagarind hospital, the only one radiation and oncology center located in this area, in cooperation with doctors and nurses working in the Red Zone created a network and utilized an electronic consultation and referral system to alleviate these suffering. We preliminarily reported its real-life performance in 3 years period. Methods Electroni...
Purpose: To evaluate the effects of regular bra-wearing during radiotherapy on acute skin toxicit... more Purpose: To evaluate the effects of regular bra-wearing during radiotherapy on acute skin toxicity (AST) and the Quality of Life (QOL) in women with breast conserving therapy (BCT). Methods: A prospective study of 99 patients with any stage of breast cancer who underwent BCT. Patients were instructed to wear an appropriate bra then they were classified by total hours of wearing bra during the radiotherapy treatment course into Non-Bra-Wearing (NBW) (0 hr.) and Bra-Wearing (BW) groups (>0 hr.). The AST was assessed weekly and one week after treatment end by CTCAE v 4.03. The QOL was assessed before and one week after treatment end by The Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) Thai version 4. Results: 66 patients were in the BW group and 33 patients were in the NBW group. The rate of ≥ G2 AST was lower in the BW group compared to the NBW group (16.7% vs. 54.5%, p<0.001, respectively). In the multivariate analysis, the statistically significant factor...
Objective: To develop and validate the Thai version of the functional assessment of cancer therap... more Objective: To develop and validate the Thai version of the functional assessment of cancer therapy with nasopharyngeal cancer subscale (FACT-NP) with the abbreviated version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF).Material and Methods: A cross-sectional study was performed in the Radiology Department between January 2014 and October 2016. Inclusion criteria: nasopharyngeal carcinoma patients aged greater than 18 years. Exclusion criteria: no comprehension of the Thai language, had other cancers (except for skin cancer and diagnosed with impaired cognition and/or overt psychosis), major depression or delirium. After signing the consent form, participants were interviewed and self-completed FACT-NP and WHOQOL-BREF. The structure of the FACT-NP was determined with exploratory factors analysis. The internal reliability of identified domains was evaluated using Cronbach’s alpha. The correlation between domains of the modified FACT-NP and the domains...
Objective: To understand the transition of changed body image after the diagnosis and surgery in ... more Objective: To understand the transition of changed body image after the diagnosis and surgery in women with breast cancer. Methods: Semi-structured interview and focus group with narrative approach. Thematic analysis was performed using methodological and investigator triangulation methods. Results: Participants’ body image transformation was categorized into three phases: (1) the moment of diagnosis and changed self, (2) transition and recovery, and (3) normalization. Conclusion: The truth-telling process of breast cancer diagnosis and the freedom to choose their treatment options have a profound impact on body image transformation of women with breast cancer. Family support, social construction, and social support could help women with breast cancer pass through these transitional process faster, while inappropriate truth-telling by their surgeons and not having any choice in their treatment options will delay the transitional process.
Context: Spirituality is the essence of a human being. Patients who have good spiritual well-bein... more Context: Spirituality is the essence of a human being. Patients who have good spiritual well-being (SWB) will also have better quality of life. However, health-care providers usually under-assess this aspect due to lack of practical guideline. In Thailand, the validated survey came from a different cultural background and was heavily based on Buddhism approach. Aims: The aim of the study is to assess the meaning of spirituality and SWB in Thai breast cancer patients in Southern Thailand where people have more diverse cultural and religious background. Settings and Design: Descriptive qualitative phenomenology design. Subjects and Methods: In‑depth interview with stratifed purposive sampling method. The interviews took place in the oncology outpatient unit department and participants’ home. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, able to communicate in Thai, has a Palliative Performance Scale more than 50, and was not diagnosed with any psyc...
To determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissecti... more To determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissection (RHND) to adjuvant therapy on oncological outcomes in cervical cancer. The study included 110 stage IA2-IB1 cervical cancer patients who underwent RHND and adjuvant therapy. The patients were divided into 2 groups based on the cut-off points of TI of 4 and 6 weeks, respectively. The associations of TI and clinicopathologic factors with oncological outcomes were evaluated using Cox proportional-hazards regression. The median TI was 4.5 weeks. There were no statistical differences in 5-year recurrence-free survival (RFS) (89.2% vs. 81.0%, and 83.2% vs. 100.0%) or 5-year overall survival (OS) rates (90.9% vs. 97.2%, and 93.2% vs. 100.0%) between patients according to TI (≤4 vs. >4, and ≤6 vs. >6 weeks, respectively). Deep stromal invasion (p=0.037), and parametrial involvement (PI) (p=0.002) were identified as independent prognostic factors for RFS, together with the interaction be...
International Journal of Gynecological Cancer, 2017
ObjectiveThe aim of this study was to evaluate any association between metformin use and oncologi... more ObjectiveThe aim of this study was to evaluate any association between metformin use and oncological outcomes of cervical cancer in patients with type 2 diabetes mellitus (DM).MethodsWe retrospectively identified 248 patients with cervical cancer with type 2 DM who received primary treatment between 2004 and 2015. The clinicopathological characteristics and oncological outcomes were collected and analyzed. The patients were then separated into metformin use (n = 118) or non–metformin use (n = 130) groups.ResultsWith a median follow-up of 2.85 years, patients who were given metformin had lower recurrence rate than patients who did not receive metformin (P = 0.011). The 5-year disease-free survival (DFS) and overall survival (OS) were 81.55% and 93.27% in the metformin use group, and 65.06% and 86.82% for the non–metformin use group, respectively. In multivariate analysis, non–metformin use (hazard ratio [HR], 1.89; P = 0.037), baseline hypertension (HR, 2.52; P = 0.005), and stage (H...
Background: Radiotherapy in cholangiocrcinoma has to overcome organ tolerance of the upper abdome... more Background: Radiotherapy in cholangiocrcinoma has to overcome organ tolerance of the upper abdomen. Hi-technology radiotherapy may improve conformity and reduce dose to those organ. Objective: Quantitatively compare the dosimetry of conformal dynamic arc radiotherapy (CD-arcRT) and intensity modulated radiotherapy (IMRT) in unresectable cholangiocarcinoma. Material and methods: Eleven cases of unresectable cholangiocarcinoma were re-planned with IMRT and CD-arcRT at King Chulalongkhorn Memorial Hospital between 20 September 2004 and 31 December 2005. Both the planning techniques were evaluated using the dose volume histogram of the planning target volume and organ at risk. The conformation number and dose to critical normal structures were used to determine the techniques. Results: IMRT technique was significantly conformed to the planning target volume than CD-arcRT in term of conformation number. For critical structure, IMRT significantly reduced the radiation dose to liver in ter...
DESCRIPTION Death is a normal process of human life, but it may often be difficult for humans to ... more DESCRIPTION Death is a normal process of human life, but it may often be difficult for humans to accept. Death negotiation is the process of preparing oneself for the uncertainties of life. This paper reports death negotiation among women with breast cancer. Negotiated knowledge is adapted to the situation and context of the trepidation felt by women with breast cancer. These behaviors mostly result in acceptance and the ability to manage the inevitability of death. Acceptance of the truth strengthens the courage to persevere among women with breast cancer. (Thai Cancer J 2015;35:32-39) Keywords: breast cancer, negotiation, death
To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in pos... more To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in post breast-conserving therapy (BCT) women. This cross-sectional study concerned one-year post-completed BCT Thai women. The data included subjective and objective CO with a questionnaire covering demographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG) performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B). Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breast cancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman's rank correlation Results: A total 127 participants volunteered for the study. The participant characteristics were age 52(±9), Buddhist 87%, married 65%, body mass index 25.0(±4.6),...
Asian Pacific journal of cancer prevention : APJCP, 2012
The study aimed to compare treatment compliance and nutritional outcomes in nasopharyngeal carcin... more The study aimed to compare treatment compliance and nutritional outcomes in nasopharyngeal carcinoma (NPC) patients during chemoradiation. Clinical information of patients with NPC that underwent chemoradiation during 2004-2009 were retrieved from the hospital database and retrospectively reviewed. Patients were categorised into a prophylactic percutaneous endoscopic gastrostomy (PPEG) group and a non-PPEG group. Clinical information including treatment compliance, weight, haematological and renal toxicity was compared. A total of 219 patients were reviewed and categorised into PPEG (n=77) and non-PPEG (n=142). Significant differences in absolute percentage weight loss between groups were found from the 3rd cycle of chemotherapy. There were 24.2, 20.3 and 24.8% in the third, the fourth and the fifth cycles of chemotherapy, respectively. Migration of grade 2 to grade 3 weight loss was obviously seen in the 3rd cycle as well. A significant difference of grade 3 or more hypokalemia was...
Although radiotherapy usually implies a cancer diagnosis, no available study has been reported as... more Although radiotherapy usually implies a cancer diagnosis, no available study has been reported as to what proportion of Thai patients treated with radiotherapy know their diagnosis and how they want related information revealed. We questioned 106 patients in order to determine the proportion who knew their cancer diagnosis, and interviewed patients who knew the diagnosis and relatives of patients both who knew and did not know it with semi-structured questionnaires concerning how they wanted to be told. Sixty-seven patients (63.2%) knew their cancer diagnosis. Multivariate analysis showed that the patients with the following characteristics were inclined to know their diagnosis: younger than 70 years old, head and neck or gynecological cancer, no previous treatment before radiotherapy, no accompanying relatives during the treatment, and patients with relatives who wanted to disclose the information. 97.0% of patients who knew the diagnosis indicated that they had really wanted to kn...
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Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying.
Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used.
Results
Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.
Aims: To assess the feasibility of using online workshops to conduct sensitive topics of palliative care and death and dying.
Methods: The interactive online workshops were conducted after imposition of the COVID-19 restriction and national lockdown in Thailand between March and September 2020. The sessions were conducted via Zoom meetings and Facebook secret group. Trained facilitators plus one IT team member hosted each workshop. Participants were given an anonymous post-course evaluation with open-ended written feedback form. Content analysed was used.
Results
Eleven sessions were conducted. 103 participants joined the online classes. Participants gave an overwhelmingly positive of the workshops, emphasising on: (i) convenient; (ii) social connectedness during the lockdown; (iii) bichronous element of the activities.