Screening for Frailty Using the FRAIL Scale in Older Cancer Survivors: A Cross-sectional Comparison With the Fried Phenotype.

OBJECTIVES: To examine the diagnostic performance of the FRAIL Scale for frailty screening with reference to the Fried phenotype and investigate its association with health outcomes in older cancer survivors. DATA SOURCE: In this cross-sectional quantitative study, participants were post-treatment cancer survivors aged 65 or above. Measurements included the FRAIL Scale, Fried phenotype, Geriatric Depression Scale-15 item, Modified Barthel Inventory, and EORTC Core Quality of Life Questionnaire. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the FRAIL Scale with reference to the Fried phenotype. Health outcomes associated with being frail as estimated by the FRAIL Scale and Fried phenotype were also examined using regressions. RESULTS: Based on 293 older cancer survivors, the area under curve (AUC) of the FRAIL Scale was 0.79, and the optimal cut-off of 1 yielded a sensitivity of 92% and specificity of 41%. According to regression results, the FRAIL Scale was modified by adding an item on time since cancer treatment completion (AUC = 0.81), and using a cut-off of 2 for older cancer survivors, which yielded a sensitivity of 74% and specificity of 67%. The modified FRAIL Scale was associated with depressive symptoms, functional independence, fatigue, dyspnea, physical functioning, and role functioning. CONCLUSIONS: The modified FRAIL Scale is proposed for use in older cancer survivors, and a cut-off of 2 should be used. IMPLICATIONS FOR NURSING PRACTICE: The modified FRAIL Scale can serve as a brief screening tool for identifying frailty among older cancer survivors in practice.

First Case Report of Maternal Mosaic Tetrasomy 9p Incidentally Detected on Non-Invasive Prenatal Testing.

Tetrasomy 9p (ORPHA:3390) is a rare syndrome, hallmarked by growth retardation; psychomotor delay; mild to moderate intellectual disability; and a spectrum of skeletal, cardiac, renal and urogenital defects. Here we present a Chinese female with good past health who conceived her pregnancy naturally. Non-invasive prenatal testing (NIPT) showed multiple chromosomal aberrations were consistently detected in two sampling times, which included elevation in DNA from chromosome 9p. Amniocentesis was performed and sent for chromosomal microarray, which was normal. Maternal karyotype revealed that mos 47,XX,+dic(9;9)(q21.1;q21.1)(24)/46,XX(9) presents mosaic tetrasomy for the short arm of chromosome 9p and is related to the NIPT results showing elevation in DNA from chromosome 9p. The pregnancy was uneventful, and the patient was delivered at term. Maternal samples were obtained at two different time points after delivery showed the same multiple chromosomal aberrations detected during pregnancy. This is a first report on an unusual case of mosaic isodicentric tetrasomy 9p in a healthy adult with normal intellect. With widespread adoption of NIPT for screening fetal aneuploidy and genome-wide copy number changes, a rise in incidental detection of maternal rare genetic syndrome will bring challenges in our current approach to genetic counselling and prenatal diagnosis.

BRCA mutation testing for ovarian cancer in the context of available targeted therapy: Survey and consensus of Hong Kong specialists.

AIMS: BRCA mutation (BRCAmut) testing is an important tool for the risk assessment, prevention and early diagnosis of breast cancer (BC) and ovarian cancer (OC), and more recently, for determining patient susceptibility to targeted therapy. This study assessed the current BRCAmut testing patterns and explored physicians' perspectives on the utilities and optimal sequencing of the testing, in order to facilitate and standardize testing practices. METHODS: Medical specialists in BC and OC in Hong Kong were invited to complete a questionnaire on BRCAmut testing practices. A panel of specialists with extensive BRCAmut testing experience was also convened to develop consensus statements on testing, using the Delphi method and an anonymous electronic voting system. RESULTS: The survey respondents (n = 71) recognized family history (FH) of BC and/or OC and an early age of onset as key factors for referring BRCAmut testing. The proportion of respondents who would test all OCs regardless of FH or age, as per the recent international guideline, was low (28.2%). The largest hurdles to testing were the cost, as well as the availability of next-generation sequencing-accredited testing and genetic counseling facilities. The panelists suggested that the sequence of somatic testing followed by germline testing may help address both the imminent need of treatment planning and longer term hereditary implications. The potential emotional and financial burdens of BRCAmut testing should be weighed against the potential therapeutic benefits, and the type and timing of testing personalized. CONCLUSIONS: Accessibility of BRCAmut testing to all at-risk individuals will be achievable through improvements in testing affordability, as well as widened availability of accredited testing and genetic counseling facilities.

MRI-guided adaptive brachytherapy for locally advanced cervix cancer: Treatment outcomes from a single institution in Hong Kong.

BACKGROUND: Paradigm has shifted from 2D to image-guided adaptive brachytherapy (IGABT) for locally advanced cervix cancer (LACC). Increasing reports from pioneering institutions and large retrospective multicenter series have demonstrated improvements in outcome and reduction in toxicity with IGABT. However, there is scarcity of data on magnetic resonance (MR)-IGABT in Chinese patients. PURPOSE: To evaluate the clinical outcome of MR-IGABT for LACC in a single institution in Hong Kong. MATERIAL AND METHODS: Patients with FIGO stage IB-IVA LACC treated with definitive external beam radiotherapy +/- concurrent cisplatin followed by MR-IGABT from January 2015 to January 2018 were included. Brachytherapy planning and dose reporting followed the GEC-ESTRO recommendations. Dosimetric and clinical outcomes including local control (LC), pelvic control (PC), cancer-specific survival, overall survival (OS), and toxicity were analyzed. RESULTS: Forty-two consecutive patients were included. 71% were FIGO stage IIB or above; 52% had pelvic node involvement. Median high-risk clinical target volume (HRCTV) was 34.7 cm3 (12.3-155.1 cm3). Median dose to HRCTV D90 was 88.5 Gy (63.4-113.4 Gy) (EQD210). Median doses to the D2cc of bladder, rectum, sigmoid, and small bowel were 83.1 Gy, 67.5 Gy, 69.0 Gy, and 68.9 Gy (EQD23), respectively. Median followup was 20.3 months (4.0-35.1 months). 24-month actuarial LC, PC, cancer-specific survival, and OS were 90%, 84%, 90%, and 90%, respectively. Stratification by clinical variables showed that FIGO stage had significant impact on LC and dose to HRCTV on both LC and PC. Treatment was well tolerated without any severe late toxicity. CONCLUSIONS: Intermediate-term results from systematic MR-IGABT for LACC demonstrate very promising outcomes with minimal toxicity. This fills the gap in evidence for MR-IGABT in Chinese patients.

Profile of mood states and quality of life of Chinese postmastectomy women in Hong Kong: Integrating variable- and person-centered approaches.

Understanding the mood state and its relationship with quality of life (QOL) of mastectomy recipients can serve as baseline within which a sound rehabilitation program can be developed. This study therefore was conducted to facilitate a better understanding of participants' postmastectomy mood states, identify their potential predictors, identify clusters of mood profiles, and clarify between-cluster differences in terms of QOL. Hong Kong mastectomy patients completed the Profile of Mood States and Ferrans and Powers Quality of Life Index. We extended the complementary strengths of the application of both variable- and person-centered approaches to clarify relationships and to identify profiles of mood states in relation to QOL in a sample of 200 women who had undergone a mastectomy in Hong Kong. Simultaneous regression identified age and educational attainment as predictors of mood states, and cluster analysis identified three distinct mood profiles that are able to explain differences in various measures of QOL after mastectomy. Implications for future research and practice are discussed.