Challenges in Obtaining and Seeking Information Among Breast Cancer Survivors in an Asian Country: a Qualitative Study.

Breast cancer survivors on adjuvant endocrine therapy (AET) have distinct information-seeking experience compared to those in the diagnosis and intensive treatment phase. This study aimed to understand the challenges in obtaining and seeking information among Malaysian breast cancer survivors. We conducted semi-structured, one-to-one interviews among patients using AET from two hospitals and a local cancer organization. Interviews were conducted until theme saturation was achieved (N = 25). Interviews were de-identified, transcribed verbatim, and analysed using thematic analysis. To ensure rigor, coding was conducted through regular discussions between two researchers and the findings were shared with several participants after analysis was completed. Three main themes were identified: limitations in the healthcare system, pitfalls of seeking information online, and limited information from local sources. The participants perceived that their information needs were not met by their healthcare providers and sought information on the Internet to complement their information needs. However, they were faced with risks of misinformation, information overload, and unethical promotion of health products. Those with limited English proficiency had difficulties in accessing quality information, and suggested that there should be more content created by local health advocates in local languages, with information that is tailored for local cultures. As the Internet has become an important medium of health education, healthcare providers and patients should be equipped with the skills to share and search for information online. Digital health literacy needs to be incorporated in patient education modules to create a more informed and empowered patient community.

Breast cancer prevention and treatment misinformation on Twitter: An analysis of two languages.

Objective: To determine the prevalence and types of misinformation on Twitter related to breast cancer prevention and treatment; and compare the differences between the misinformation in English and Malay tweets. Methods: A total of 6221 tweets related to breast cancer posted between 2018 and 2022 were collected. An oncologist and two pharmacists coded the tweets to differentiate between true information and misinformation, and to analyse the misinformation content. Binary logistic regression was conducted to identify determinants of misinformation. Results: There were 780 tweets related to breast cancer prevention and treatment, and 456 (58.5%) contain misinformation, with significantly more misinformation in Malay compared to English tweets (OR = 6.18, 95% CI: 3.45-11.07, p < 0.001). Other determinants of misinformation were tweets posted by product sellers and posted before the COVID-19 pandemic. Less misinformation was associated with tweets utilising official/peer-reviewed sources of information compared to tweets without external sources and those that utilised less reliable information sources. The top three most common content of misinformation were food and lifestyle, alternative medicine and supplements, comprising exaggerated claims of anti-cancer properties of traditional and natural-based products. Conclusion: Misinformation on breast cancer prevention and treatment is prevalent on social media, with significantly more misinformation in Malay compared to English tweets. Our results highlighted that patients need to be educated on digital health literacy, with emphasis on utilising reliable sources of information and being cautious of any promotional materials that may contain misleading information. More studies need to be conducted in other languages to address the disparity in misinformation.

Evaluation of pharmacy value-added services in public health facilities: Staff perception and cost analysis.

Background: Pharmacy Value Added Services (VAS) were introduced in Malaysian public health facilities to facilitate the process of medicine collection. Examples include Drive-through pharmacy, Medicine by Post, SMS Take&Go, Appointment Card and medicine locker, commonly referred to as Medibox. Objectives: To assess the perception of VAS among pharmacy staff, and to compare the time and cost needed to prepare medications for VAS and conventional counter service. Methods: A cross-sectional study was conducted in 17 public health facilities across Kuala Lumpur and Putrajaya from May until September 2020. There were two parts of this study: 1) a survey on the perception of VAS among pharmacy staff, which assessed respondents' experience of handling VAS and their perception towards the services; and 2) a cost analysis to compare the direct cost of preparing refill medications for VAS and conventional counter service, estimated from average salary and direct non-medical cost. Results: 290 respondents answered the survey. Most respondents had a positive opinion about VAS. Lack of storage and insufficient manpower were the top two barriers in VAS utilisation and implementation as perceived by pharmacy staff. The average time (in minutes) needed to prepare one prescription was highest for Medicine by Post service (10.31), followed by Medibox (10.25), Appointment Systems (6.24) and conventional counter service (3.99). Medibox had the highest average cost per prescription (RM5.49), followed by Medicine by Post (RM5.05), Appointment Systems (RM2.89) and conventional counter service (RM1.75). Conclusions: The majority of the respondents involved in this study acknowledged the benefits of VAS to patients, but there were aspects of the services that could be improved. Preparation of patient medication for VAS requires significantly more time and cost than conventional counter service, indicating the need to review and streamline implementation of the services.

Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review.

PURPOSE: This systematic review aimed to determine the rate and identify correlates of adherence and persistence over five years of treatment with adjuvant endocrine therapy in female breast cancer patients. METHODS: Relevant articles were identified from Medline, Embase, AMED, PsycINFO, International Pharmaceutical Abstracts, and APA PsycArticles. Studies that measured patient adherence in the implementation or persistence phase for a period of at least five years using objective or multiple measures of adherence and investigated correlates of adherence were included. The titles, abstracts and full articles were screened and reviewed by two authors and any discrepancies were discussed with a third author. RESULTS: Twenty-six studies were included. Mean rate of adherence at five-year for implementation phase was 66.2% (SD = 17.3%), and mean persistence was 66.8% (SD = 14.5%). On average, adherence decreased by 25.5% (SD = 9.3%) from the first to fifth year. Higher rate of adherence was observed through self-report in comparison to database or medical record. Older age, younger age, higher comorbidity index, depression and adverse effects were associated with lower adherence. Treatment with aromatase inhibitors, received chemotherapy, and prior medication use were associated with improved adherence. CONCLUSION: Adherence to adjuvant endocrine therapy decreased from the first to fifth year of treatment. On average, one-third of patients were not adherent to treatment by the fifth year. Nineteen recurring factors were found to be significantly associated with long-term adherence in multiple studies. Further research using objective or multiple measures of adherence are needed to improve validity of results.