Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings.

Purpose: This study aimed to compare health behaviors between the childhood cancer survivors (CCS) and their sibling controls and to examine the pattern of health behaviors of the Hong Kong Chinese CCS and its associations with their health-related quality of life and psychological distress. Methods: A cross-sectional telephone survey was conducted. A total of 614 CCS and 208 sibling controls participated in this study. Patterns of health behaviors including lifestyle behaviors, cancer screening practices, and insurance coverage were compared. Multivariate regression analyses were performed for examining factors associated with health behaviors in CCS. Results: CCS had less alcohol consumption when compared with their sibling controls (adjusted odds ratio (AOR) = 0.65, p = 0.035). The sibling controls were more likely to have cancer screening practices (AOR = 0.38, p = 0.005) and health (AOR = 0.27, p < 0.001) and life insurance coverage (AOR = 0.38, p < 0.001). Among the CCS, those who were male, having a job or higher education, shorter time since diagnosis, and type of cancer suffered were significantly associated with alcohol consumption. Those CCS who were drinkers indicated poorer mental health (p = 0.004) and more psychological distress. Female CCS undertaking cancer screening were more likely to be employed, married/cohabiting, and have received intensive cancer treatment. Conclusion: This study reveals that Chinese childhood cancer survivors are less likely to engage in unhealthy lifestyle behaviors, insurance coverage and cancer screening, when compared with their siblings. Implications for Cancer Survivors: It is crucial for healthcare professionals to identify strategies or target interventions for raising CCS's awareness of their cancer risks and healthy lifestyle throughout their life.

Prevention of gastrointestinal side-effects in paediatric oncology: what are the guidelines?

PURPOSE OF REVIEW: Gastrointestinal side-effects, particularly with regard to alimentary tract mucositis and chemotherapy-induced nausea and vomiting (CINV), continue to be frequent and debilitating symptomatic conditions among children and adolescents receiving cytotoxic cancer therapy. Further avenues of progress for mucositis and CINV prevention in paediatric oncology setting are warranted. RECENT FINDINGS: The current article reviews the major guidelines and literature published in 2016 pertaining to the prevention of mucositis and CINV. Considerable professional organizational efforts have been made to develop consensus-based or evidence-based guidelines that periodically update to define basic standards of mucositis and CINV prevention. There are a few published works in 2016 that may contribute to the emerging evidence on prevention of mucositis and CINV in the paediatric setting for future guideline updates. SUMMARY: The concomitant use of 5-HT3 receptor antagonist and dexamethasone are effective to prevent acute and delayed CINV in children who are to receive highly or moderately emetogenic chemotherapy. Optimal control of acute and delayed CINV can prevent anticipatory CINV. Oral care protocols would be beneficial to prevent mucositis in children across all cancer treatment modalities. Cryotherapy or low-level light therapy may be applied to cooperative children undergoing chemotherapy or haematological stem cell transplant conditioning regimens with a high rate of mucositis.

A qualitative insight into self-management experience among Chinese breast cancer survivors.

BACKGROUND: With increasing awareness in the chronic nature of cancer, promoting the engagement of breast cancer survivors in self-management has become a priority of cancer care reform initiatives. This study aimed to reveal Chinese breast cancer survivors' views and experiences of self-management in extended survivorship. METHODS: Archived interview transcripts from 19 breast cancer survivors (<5 years since diagnosis) were subjected to a secondary analysis. Each transcript was re-examined through qualitative content analysis. RESULTS: Three categories were established to represent the perceptions of the participants on their self-management tasks related to health and well-being, emotions, and roles and relationships. Managing health and well-being covers modifying lifestyle, taking traditional Chinese medicine, attending regular follow-ups, managing symptoms, and adhering to hormonal therapy. Managing emotions involves maintaining a positive attitude and utilizing supportive resources. Managing roles and relationships comprises adjusting to life as cancer survivors, maintaining marital relationships, and performing familial and other social roles. CONCLUSIONS: Most participants actively participated in various self-management tasks and behaviors that can help improve their health and prevent cancer recurrence. They may exhibit optimal self-management in their emotions and most health aspects but may exert limited efforts in managing their different roles during survivorship.

A mixed-methods exploration of the quality of life of Chinese breast cancer survivors.

Quality of life (QOL) in cancer survivorship is a multidimensional and subjective concept, which represents the personal sense of the physical, psychological, social, and spiritual consequences of cancer diagnosis and its treatment. This mixed method study aimed to explore the QOL of Chinese breast cancer survivors. Participants were recruited from a cancer self-help organization in the central area of China. QOL was assessed using the QOL-Cancer Survivor Scale and subsequently elicited by in-depth interviews. Results showed that participants had good overall QOL but with unfavorable aspects in psychological and social well-being. Interview data revealed that participants seldom attended spiritual activities. Instead, they actively reconnected with their "self" to create a positive meaning from their cancer experience. Understanding how Chinese breast cancer survivors perceive QOL is important for health professionals to address survivorship in this population.

Negative and positive life changes following treatment completion: Chinese breast cancer survivors' perspectives.

PURPOSE: Although we acknowledge the negative and positive aspects of the cancer survivorship experience, we have little information on this issue from the perspective of Chinese breast cancer survivors. This study aimed to explore the perceptions of negative and positive life changes following treatment completion among this population. METHODS: Using purposive sampling, 29 breast cancer survivors were selected from the attendees of a local cancer self-help organization in middle China and proceeded with semi-structured in-depth interviews. Each interview was transcribed verbatim and analyzed using directed content analysis. RESULTS: Two predetermined categories were identified to represent participant perception of the breast cancer survivorship experience, namely, negative life changes and positive life changes. The first category included fear of recurrence, symptom experience, poor body image, altered sexuality and intimacy, and financial burden. The second category consisted of new life perspective, personal growth, and enhanced relationships with family. CONCLUSIONS: Our findings contribute to the emerging evidence on the duality of breast cancer survivorship. This enhanced understanding of the specific negative and positive changes experienced by Chinese breast cancer survivors can assist health professionals in addressing survivorship issues by designing appropriate interventions to minimize negative consequences and enhance positive growth.

Feasibility of psychoeducational interventions in managing chemotherapy-associated nausea and vomiting (CANV) in pediatric oncology patients.

PURPOSE: Childhood cancer patients often suffer from Chemotheraphy-Associated Nausea and Vomiting (CANV). To alleviate CANV, relaxation techniques and patient education were combined to develop a multidimensional psychoeducational intervention package. The aim of this pilot study was to assess the feasibility of the two major components, namely, (1) relaxation, and (2) patient education, of a psychoeducational intervention, prior to the commencement of the main study. METHODS: A pre-test-post-test control group design was adopted. Twenty patients were allocated equally to the relaxation group (10 participants) and to the educational group (10 participants). Twenty historical matched control cases were identified to form the control groups. Besides, a process evaluation was adopted to assess the feasibility of the study. RESULTS: In relation to episodes of vomiting on day 3, a significant difference was detected from the results (X(2) = 8.54, p = 0.036), in that fewer patients in the relaxation group experienced vomiting. A significant difference was not found in both the use of antiemetics and body weight between the groups. All subjects in the intervention groups adhered to the intervention and completed the questionnaire without difficulty. Patients and parents perceived the intervention as being moderately useful. CONCLUSIONS: Although the beneficial effect of relaxation and education in alleviating CANV was not well-supported statistically, the findings from descriptive data suggest that these interventions promoted the intake of antiemetics as a preventive method. Both interventions and instruments were well-received by the patients and also by their parents.

Exploring the influence of Traditional Chinese Medicine on self-care among Chinese cancer patients.

PURPOSE: The aim of this study was to explore the influence of traditional Chinese medicine (TCM) on self-care among Chinese cancer patients. METHODS: This was an exploratory qualitative study. A purposive sample of thirty cancer patients who were currently undergoing either chemotherapy or radiotherapy was interviewed. Qualitative content analysis was conducted for data analysis. RESULTS: Two core categories were emerged from their accounts of experiences with practising TCM-supported self-care activities: perceived beneficial effects and concerns about undesirable effects. The perceived beneficial effects of these self-care activities were mainly stemmed from the traditional beliefs in TCM, which included: strengthening the "origin", removing toxins, and mind-soothing. Concerns about undesirable effects of these self-care activities were raised due to lack of knowledge and unpleasant experience with these self-care activities. CONCLUSION: The findings revealed that the philosophy of TCM had been deeply integrated by Chinese cancer patients into their self-care. While Western medicine is the mainstream cancer treatment, Chinese cancer patients also practised various TCM-supported self-care activities. However, they were perplexed about the effects of these self-care activities. They could not ascertain whether the perceived benefits were just due to their own belief in the TCM philosophy, and their lack of knowledge in this aspect and unpleasant experience further confused them. Nurses have to be proactive in identifying the unique health-deviation self-care requisites of their clients in a culturally sensitive manner, explore how their self-care experience affects their wellbeing and treatment compliance, and be prepared to clarify misconceptions about their conditions and progress.

Health-related quality-of-life and psychological distress of young adult survivors of childhood cancer in Hong Kong.

BACKGROUND AND PURPOSE: Previous literatures on young adult survivors of childhood cancer show inconsistent findings with regards to their psychological distress and health-related quality of life (HRQOL). Much of the available data focus on negative patient outcomes following cancer treatments prescribed from 1970 to 1990. In the present study, HRQOL and psychological distress of young adult survivors in Hong Kong was examined. It focused on subjects who had received cancer treatments prescribed in the last two decades. METHODS: A structured telephone survey was conducted with 614 eligible survivors and 208 sibling controls in Hong Kong. RESULTS: The survivors reported significantly lower mean scores in physical role and functioning, whereas their mental, social, and psychological well-being was similar to that of their sibling controls. Being female, older age, longer survival time, and specific cancer diagnoses were the factors associated with poorer physical and mental adaptation. HRQOL was negatively correlated with psychological distress. CONCLUSIONS: Findings of the study suggest that most survivors adjusted fairly well in mental, psychological, and social aspects. Survivors with a higher risk of poor HRQOL could benefit from appropriate screening and counseling at an early stage to mitigate their survivorship difficulties. Prospective follow-up studies on childhood cancer survivors are recommended to detect changes over longer survival periods.

Symptom distress in older adults during cancer therapy: impact on performance status and quality of life.

BACKGROUND: This study aims to identify a sub-group of older patients who experience a higher level of symptoms of distress during cancer therapy. The symptoms that had the greatest impact on the patients' performance status and quality of life (QoL) are also identified. METHODS: This cross-sectional study used secondary data from a convenience sample of 120 patients, 65years of age and older, receiving cancer therapy. The measuring instruments used included the Symptom Distress Scale, the Karnofsky Performance Scale (KPS) and the Functional Assessment of Cancer Therapy-General (FACT-G). Hierarchical cluster analysis was used to categorize the patients into groups. RESULTS: The patients had multiple symptoms, with a mean number of 5±3 symptoms per patient. Mood disturbance was the most prevalent (87%), while nausea (28%) was the least prevalent. Approximately 28% and 72% of the patients fell into the high-symptom and low-symptom groups, respectively. The high-symptom group reported significantly lower mean KPS scores, and FACT-G sub-scale and total scores (p<0.01). Impaired mobility had the strongest standardized coefficients in the KPS (-0.63; p<0.01), the FACT-G functional (-0.49; p<0.05) and the physical (-0.45; p<0.05) sub-scales. Concentration difficulties had the strongest standardized coefficients (-0.47; p<0.01) in the FACT-G total. CONCLUSION: Most of the older patients in this study reported suffering from a multitude of symptoms, with mood disturbance being the most prevalent. The older patients in the high-symptom group had a significantly lower performance status and QoL compared to the patients in the low-symptom group.

Social support and quality of life among Chinese breast cancer survivors: findings from a mixed methods study.

BACKGROUND: Social support has been identified as a significant factor positively influencing quality of life (QOL) in breast cancer survivors. However, less is known about whether and how social support remains important among cancer survivors over the course of the survivorship trajectory. AIM: To explore social support and its relationship with QOL in breast cancer survivors in China. METHODS: This was a sequential mixed methods study. In Phase I, 100 breast cancer survivors were surveyed using standardized questionnaires. A multivariate regression analysis was performed to examine the relationship between social support and QOL after controlling for annual household income and length of survivorship. In Phase II, individual in-depth interviews were conducted to understand social support experience from 29 survivors selected from Phase I. Interview data were transcribed and analyzed using qualitative content analysis. RESULTS: Survivors reported a median support network size of 2.2 persons (interquartile range = 1.2-3.8) and a median support satisfaction score of 5.5 (interquartile range = 5-6). While support satisfaction was found to be associated with QOL, no association was found between support network size and QOL. Interview findings revealed that close family members and peer survivors constituted the major source of breast cancer survivors' support, especially in emotional and informational support aspects. Cultural factors played a role in the perception and utilization of support of the breast cancer survivors. CONCLUSIONS: This study has indicated that support satisfaction is more critical than support network size in influencing various aspects of survivors' QOL through the underlying different types of situation-specific support.

Gender differences in the use of colorectal cancer tests among older Chinese adults.

PURPOSE: The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS: A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS: The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS: The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.

Coping with breast cancer survivorship in Chinese women: the role of fatalism or fatalistic voluntarism.

BACKGROUND: The existing knowledge on fatalism in the field of cancer has arisen largely from the cancer prevention and screening literature. Little is known about the role of fatalism in cancer survivorship, particularly within Chinese population. OBJECTIVE: This study aimed to explore the role of fatalism in coping with breast cancer survivorship in Chinese women. METHODS: In-depth interviews were conducted on 29 participants selected from those who attended a local cancer self-help organization in China. Interview transcripts were transcribed and analyzed using qualitative content analysis. RESULTS: Although they actively engaged in emotional regulation and self-care management to cope with survivorship, participants believed in fatalism and accepted their inability to change the final outcome of cancer. Such contradictory behavioral and cognitive aspects of coping reported by participants highlighted the role of a complex belief system involving Ming in positively influencing the interpretation of fatalism and the actual coping efforts taken. CONCLUSIONS: Findings suggest that fatalism related to coping in the Chinese context combined 2 elements: fatalistic belief in and acceptance of the way things are as well as the exertion of personal efforts over the situation. As such, it seems more effectively depicted in terms of the emerging concept "fatalistic voluntarism." IMPLICATIONS FOR PRACTICE: When planning intervention for Chinese population, incorporating fatalistic voluntarism as a cognitive belief system in the process of adaptation to survivorship may be more culturally relevant for facilitating their coping behaviors.

Use of Rasch analysis in the evaluation of the Oropharyngeal Mucositis Quality Of Life Scale.

BACKGROUND: Oropharyngeal mucositis (OM) is a significant clinical problem causing profound impairment of health-related quality of life (HQoL) for patients undergoing cancer therapy. The Oropharyngeal Mucositis-Specific Health-Related Quality of Life Measure (OMQoL) was developed using classical test theory to measure the self-perceived HQoL of patients with mucositis. OBJECTIVES: The aim of this study was to analyze the OMQoL according to the Rasch model and, on the basis of results, determine whether improvements could be made. METHOD: A multicenter approach was used, and 210 patients treated with stomatotoxic chemotherapy (36%), high-dose myeloablative chemotherapy ± total body irradiation (10%), or head and neck irradiation ± chemotherapy (54%) completed the OMQoL. The Partial Credit Model of Rasch analysis was applied to evaluate the 31-item OMQoL using WINSTEPS and R software. Unidimensionality (measurement of a single construct), item fit, response category performance, person separation reliability, targeting of item difficulty to person ability, and differential item functioning (DIF) were examined. RESULTS: Of 31 items, 5 were removed due to misfit; the OMQoL was reduced to 26 items with acceptable information weighted fit/outlier-sensitive fit indices (within 0.7-1.3) and eigenvalue units (≤2.0), confirming the unidimensionality of the reduced OMQoL. The OMQoL and its four subscales showed ordered category thresholds, and the person separation reliability was high (person separation index >0.2 with reliability >.8). Nevertheless, some of the items in the OMQoL might not be targeted effectively to patients with low levels of OM. Significant uniform and nonuniform DIFs were not found for gender (uniform DIF, p = .26; nonuniform DIF, p= .24) and age (uniform DIF, p = .95; nonuniform DIF, p = .65). DISCUSSION: Rasch analysis reveals that the reduced 26-item OMQoL is unidimensional and is adequate to measure HQoL for patients with OM regardless of gender and age group. This improved version can provide a common platform for nurses to use in their assessment, caring, and treatment of patients with OM.

Piloting electronic self report symptom assessment - Cancer (ESRA-C) in Hong Kong: a mixed method approach.

PURPOSE: The benefits of utilizing computerized assessment in clinical settings have been reported in studies over the last three decades and more recently in the oncology settings. This study aimed to assess the feasibility and acceptability of using an electronic self report symptom assessment tool among Chinese oncology patients. METHODS AND SAMPLE: The tool, developed by The University of Washington, Distributed Health Assessment and Intervention Research (DHAIR) group was translated into Chinese. The adapted web-based survey platform, the Electronic Self Report Assessment - Cancer (ESRA-C), was tested in a local cancer resource center in Hong Kong. Participants' perceptions of the acceptability and feasibility of the symptom assessment process were assessed using the Acceptability E-scale as well as observation and qualitative interview data. Demographic data were also collected through the touch screen computer system. A convenience sample of 30 (11 male and 19 female) oncology patients was recruited to use the touch-screen computer to assess participants' symptoms using ESRA-C. RESULTS: The acceptability scale indicated moderately high acceptability in each subscale (mean score of 3.32-4.71). On average, participants took 17.5 min (SD: 8.9) to complete the ESRA-C. The qualitative interview data revealed that the majority (25 participants) asserted that the ESRA-C was useful and effective in reporting personal health conditions. CONCLUSIONS: The study suggested that electronic assessment can offer a feasible, attractive, and viable means of implementing regular and comprehensive symptom assessment, which can lead to better symptom management in cancer patients.

Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer.

BACKGROUND: Most elderly patients with cancer suffer from a multitude of intense physical and psychological symptoms regardless of the stage of disease. The current paper describes the prevalence of pain, fatigue, insomnia, and mood disturbance, alone and in combination in elderly cancer patients, as well as the inter-correlations among these four symptoms, and the relationship of the symptom cluster to functional status and quality of life (QoL) during cancer therapy. PATIENTS AND METHODS: This cross-sectional study used secondary data from a convenience sample of 120 patients, 65 years of age and older, with colorectal, lung, head/neck, breast, gynecological, prostate or esophageal cancer receiving chemotherapy or radiotherapy. Measuring instruments included the Karnofsky Performance Scale (KPS), the respective items from the Chinese version of the Symptom Distress Scale (SDS-C), and the Functional Assessment of Cancer Therapy-General (FACT-G [C]). The influence of the symptom cluster on patients' functional status and QoL was determined by hierarchical multiple regression. RESULTS: Twenty percent and 29.2% of patients reported co-occurrence of any two and any three symptoms of pain, fatigue, insomnia, and mood disturbance, respectively. About one-third of patients (31.2%) reported co-occurrence of all of the four symptoms. The inter-correlations among pain, fatigue, insomnia, and mood disturbance were mild to moderate (r=0.29-0.43, p<0.01). In terms of functional status, the KPS showed a moderate negative correlation with the four symptoms (r=-0.29 to -0.55, p<0.01). Correlations between the FACT-G (C) subscale/total scores and symptom cluster showed moderate negative correlations (r=-0.23 to -0.55, p<0.01). About 8.7-52.9% of variance in functional status and QoL is explained by the symptom cluster of pain, fatigue, insomnia, and mood disturbance in elderly cancer patients receiving cancer therapy after adjustment for gender, age, co-morbidity, stage of disease, and treatment modality. CONCLUSIONS: Our results suggest that pain, fatigue, insomnia, and mood disturbance are highly prevalent in elderly patients who undergone cancer therapy. These four symptoms may occur in a cluster and may negatively influence elderly patients' functional status and QoL during cancer therapy.

Quality of life constructs of Chinese people living with HIV/AIDS.

A range of quality of life (QOL) measurements specific for people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) are available. They were, however, developed before or at about the time of introducing highly active antiretroviral therapy (HAART) and there has been very little measurement developed from a Chinese perspective. A study was therefore undertaken and we report our findings of the first phase, in which Chinese people living with HIV/AIDS in Hong Kong were asked to explain their perceptions of QOL so as to identify their construct of QOL using a qualitative approach. Thirty-six participants, thirty males and six females, of mixed demographic and disease-related characteristics were recruited through purposive sampling. Following thematic analysis, nine QOL constructs emerged which included perceptions of adaptation and coping, physical health, stigmatization and discrimination, HIV care services, antiretroviral therapy, sexual relationships, relationships with family and friends, work and money, and pleasure and contentment. When comparing these constructs with those of Western populations, they contain more components on focusing psychosocial and spiritual aspects but less on functional status and HIV-related symptoms. The differences may not be attributed by cultural variations alone but also by the dynamic nature of QOL. Since there has been a rapid evolution of HIV medicine, instrument developers may need to regularly review and update measures of QOL. The subjective perceptions and experiences of targeted population should be addressed. Our findings also suggest the need of maintaining tailor-made psychosocial support services for HIV-infected people despite general reduction of morbidity and mortality from HAART.

A patient-reported outcome instrument to assess the impact of oropharyngeal mucositis on health-related quality of life: a longitudinal psychometric evaluation.

GOALS OF WORK: An oropharyngeal mucositis (OM)-specific health-related quality of life measure (OMQoL) has been developed to assess the impact of OM from the perspective of patients. The current paper describes the convergent, concurrent, and known-group validities and responsiveness in relation to clinical and health outcomes. MATERIALS AND METHODS: A multicenter approach was used, and 137 patients treated with different cancer therapies completed the OMQoL and the European Organization for Research and Treatment of Cancer Quality of Life questionnaire [EORTC QLQ-C30 (Ch)] twice over a 4-week period or weekly over a 7-week period, along with concurrent measures of OM and its related symptoms. MAIN RESULTS: The OM-related symptom scores correlated highly with the OMQoL, confirming its convergent validity (r = -0.724--0.971, p < 0.01). Moderate correlations between the subscales of the OMQoL and EORTC QLQ-C30 (Ch) were indicative of good concurrent validity (r = 0.450-0.724, p < 0.01). The OMQoL was able to distinguish between patients with different severities of OM (p < 0.01) and types of cancer therapy (p < 0.01), providing evidence of good known-group validity. The changes in effects sizes corresponding to changes in OM curves indicate that the OMQoL is responsive to changes in OM status. CONCLUSIONS: These findings suggest that the OMQoL has very good psychometric properties and can be used as a health-related quality of life assessment for cancer patients with OM. Much work is still needed in strengthening the psychometric qualities and interpretability of the OMQoL by demonstrating its ability to detect outcome changes over time.

Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale.

The purpose of this study was to translate the Memorial Symptom Assessment Scale (MSAS) into Chinese and evaluate the psychometric properties of this version. The original MSAS is a 32-item, patient-rated measure that was developed to assess common cancer-related physical and psychological symptoms with respect to frequency, intensity, and distress. In this study, a two-phase design was used. Phase I involved iterative forward-backward translation, testing of content validity (CVI) and a pretest. Phase II established the psychometric properties of the Chinese version MSAS (MSAS-Ch). Results showed that the MSAS-Ch achieved content relevancy CVI of 0.94 and semantic equivalence CVI of 0.94. Pretesting was performed in 10 cancer patients, and the results revealed adequate content coverage and comprehensibility of the MSAS-Ch. A convenience sample of 370 patients undergoing cancer therapy or at the early post-treatment stage was recruited for psychometric evaluation. Confirmatory factor analysis confirmed the construct validity of the MSAS-Ch, with a good fit between the factor structure of the original version and our present sample data (goodness-of-fit indices all above 0.95). The internal consistency reliability of subscales and total MSAS-Ch was moderately high, with Cronbach alpha coefficients ranging from 0.79 to 0.87. The test-retest intraclass correlation results for the subscale and total MSAS-Ch ranged from 0.68 to 0.79. The subscale scores of MSAS-Ch were moderately correlated with the scores on various validation measurements that assessed psychological distress, pain, and health-related quality of life (r = 0.46-0.65, P < 0.01), confirming that they were measurements of similar constructs. The validity of the construct validity was also supported by comparing the MSAS-Ch scores for subpopulations that varied clinically. Inpatients and patients with poorer performance status scored higher on the MSAS-Ch subscale and total scores than outpatients and patients with higher performance status (P < 0.05). Our study shows that the MSAS-Ch has adequate psychometric properties of validity and reliability, and can be used to assess symptoms during cancer therapy and at the early post-treatment stage in Chinese-speaking patients.

Risk factors for oral mucositis in children undergoing chemotherapy: a matched case-control study.

Oral mucositis (OM) is the most frequent and severe complication of chemotherapy for children with cancer, yet little is known about its risk factors. The aim of this study was to determine the risk factors associated with chemotherapy-induced OM in children. A matched case-control design was used. The matching criteria were age, type of cancer and chemotherapy regimen. Patient-and treatment-related data were collected via chart review. Conditional logistic regression analyses were performed to estimate odds ratios (OR) and adjusted odds ratios (AOR) for the development of OM. Fifty-one cases and 51 controls were identified. The mean+/-SD age of the children was 7.6+/-5.2 years, with 65 (63.73%) boys. Eighty-two percent of the children had been diagnosed with haematological malignancies (n=84). The most common chemotherapy regimen was a combination of plant alkaloids and antitumor antibiotics (n=42, 41.18%). In the multivariable model, lower body weight (AOR=0.91; 95% CI=0.84-0.98; p=0.013), lower value of log nadir neutrophil count (AOR=0.33; 95% CI=0.16-0.68; p=0.0025), and higher value of peak creatinine (AOR=1.06; 95% CI=1.01-1.12; p=0.025) were significantly associated with a greater risk of OM. Our findings suggest that children who are neutropenic, those with serum creatinine elevation, and those with a low body weight prior to chemotherapy are at greater risk of developing OM.