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Animal salmonellosis in peninsular Malaysia. II. Annual and zoological distribution of Salmonella serotypes over the 10-year period 1966-1975

Joseph PG, Anwar M, Jegathesan M

Am J Trop Med Hyg, 1978 May;27(3):562-6.
PMID: 354419

A total of 860 Salmonella isolations were made in Peninsular Malaysia from 15 animal species (domestic and wild), eggs, molluscs, flies, and animal feed. The isolations were distributed among 31 serotypes in eight groups. The most common serotype isolated was Salmonella pullorum, followed by S. choleraesuis and S. infantis. S. typhimurium had the widest zoological distribution. The importance of controlling animal salmonellosis is emphasized.
Evaluation of the management of sexually transmitted infections by private practitioners in pulau pinang, malaysia

Anwar M, Sulaiman SA

Malays J Med Sci, 2008 Oct;15(4):41-7.
PMID: 22589637 MyJurnal

To determine the current practices of private practitioners for the management of STIs in Pulau Pinang, Malaysia, evaluation of pharmacotherapy for STIs in private clinics and to ascertain the management of STIs compared to standard guidelines.
METHODS: Data was collected by self-administered questionnaire for private practitioners, which gathered information on their socio-demographic as well as practice characteristics. Descriptive statistical analysis was performed by using SPSS for Windows version 13.0.
RESULTS: Data was collected from 78 practitioners. Most of the treatment choices mentioned for the treatment of gonorrhea were inconsistent with the guidelines. About 51.2% of practitioners did not screen their patients for HIV/AIDS. Majority of private practitioners counseled their patients about HIV/AIDS on an irregular basis. A high percentage of 59% did not inform health authorities about STI cases and 32.1% mentioned that they did not use any guidelines.
CONCLUSIONS: Management of STIs by private practitioners with respect to selection of antibiotics, patient counseling and case notification leaves a lot to be desired. Current management practices can adversely impact on HIV/AIDS transmission in the country. Interventions are needed to improve the management practices of private practitioners.
Knowledge towards breast cancer among Malaysian university students

Khan TM, Anwar M, Gillani W

Breast J, 2011 Sep-Oct;17(5):553-4.
PMID: 21827564 DOI: 10.1111/j.1524-4741.2011.01142.x
Fulltext A survey of knowledge of sexually transmitted infections among patients at a public hospital in Pulau Pinang, Malaysia

Anwar M, Sulaiman SA, Khan TM

Med Princ Pract, 2010;19(4):312-8.
PMID: 20516709 DOI: 10.1159/000312719

OBJECTIVE: The aim of this study was to assess the patients' knowledge and awareness of sexually transmitted infections (STIs).
SUBJECTS AND METHODS: A face-to-face interview was conducted among the patients visiting the Venereal Diseases Outpatient Department of the General Hospital of Pulau Pinang (Malaysia). A 19-item questionnaire was used. A total of 116 patients participated in the study and 107 patients had valid responses. The reliability and internal consistency of the questionnaire tool was estimated on the basis of Cronbach's alpha (= 0.81). The Statistical Package for Social Sciences (SPSS 13.0(R)) was used for data analysis. Student's t test and analysis of variance were used to analyse the knowledge differences among the groups.
RESULTS: Of the 107 patients, 82 (76.6%) were diagnosed with syphilis; AIDS was the most commonly known STI among the patients. Of the 107 patients, 35 were sexually active and of these 23 (65.7%) had more than 1 sexual partner. The most popular source of knowledge was newspapers (51 patients, 47.7%), with hospitals (3 patients, 2.8%) being the least popular one. Overall mean score on knowledge questions was 12.21 out of the maximum of 33 points. Knowledge about causative organisms, risk groups, transmission, symptoms, prevention and treatment of STIs was inadequate. The knowledge level was significantly related to gender (p = 0.03), religion (p = 0.005), educational level (p = 0.000), marital status (p = 0.000) and income level (p = 0.036).
CONCLUSION: This study demonstrated evidence of poor knowledge of STIs amongst the patients attending an STI service in the General Hospital of Pulau Pinang (Malaysia). Hence there is an immediate need for efforts towards improving patient knowledge of STIs.
Study site: Venereal Diseases Outpatient Department, General Hospital Pulau Pinang, Malaysia
Fulltext Malaysian pharmacy educators' view of the role of non-pharmacy trained educators in teaching pharmacy students

Ahmadi K, Anwar M, Hassali MA

Am J Pharm Educ, 2012 Sep 10;76(7):138.
PMID: 23049110 DOI: 10.5688/ajpe767138
Fulltext Spent mushroom waste as a media replacement for peat moss in Kai-Lan (Brassica oleracea var. Alboglabra) production

Sendi H, Mohamed MT, Anwar MP, Saud HM

ScientificWorldJournal, 2013;2013:258562.
PMID: 24106452 DOI: 10.1155/2013/258562

Peat moss (PM) is the most widely used growing substrate for the pot culture. Due to diminishing availability and increasing price of PM, researchers are looking for viable alternatives for peat as a growth media component for potted plants. A pot study was conducted with a view to investigate the possibility of using spent mushroom waste (SMW) for Kai-lan (Brassica oleracea var. Alboglabra) production replacing peat moss (PM) in growth media. The treatments evaluated were 100% PM (control), 100% SMW, and mixtures of SMW and PM in different ratios like 1 : 1, 1 : 2, and 2 : 1 (v/v) with/without NPK amendment. The experiment was arranged in a completely randomized design with five replications per treatment. Chemical properties like pH and salinity level (EC) of SMW were within the acceptable range of crop production but, nutrient content, especially nitrogen content was not enough to provide sufficient nutrition to plant for normal growth. Only PM (100%) and SMW and PM mixture in 1 : 1 ratio with NPK amendment performed equally in terms of Kai-lan growth. This study confirms the feasibility of replacing PM by SMW up to a maximum of 50% in the growth media and suggests that NPK supplementation from inorganic sources is to ensure a higher productivity of Kai-lan.
Fulltext Critical period of weed control in aerobic rice

Anwar MP, Juraimi AS, Samedani B, Puteh A, Man A

ScientificWorldJournal, 2012;2012:603043.
PMID: 22778701 DOI: 10.1100/2012/603043

Critical period of weed control is the foundation of integrated weed management and, hence, can be considered the first step to design weed control strategy. To determine critical period of weed control of aerobic rice, field trials were conducted during 2010/2011 at Universiti Putra Malaysia. A quantitative series of treatments comprising two components, (a) increasing duration of weed interference and (b) increasing length of weed-free period, were imposed. Critical period was determined through Logistic and Gompertz equations. Critical period varied between seasons; in main season, it started earlier and lasted longer, as compared to off-season. The onset of the critical period was found relatively stable between seasons, while the end was more variable. Critical period was determined as 7-49 days after seeding in off-season and 7-53 days in main season to achieve 95% of weed-free yield, and 23-40 days in off-season and 21-43 days in main season to achieve 90% of weed-free yield. Since 5% yield loss level is not practical from economic view point, a 10% yield loss may be considered excellent from economic view point. Therefore, aerobic rice should be kept weed-free during 21-43 days for better yield and higher economic return.
Fulltext Awareness of school students on sexually transmitted infections (STIs) and their sexual behavior: a cross-sectional study conducted in Pulau Pinang, Malaysia

Anwar M, Sulaiman SA, Ahmadi K, Khan TM

BMC Public Health, 2010;10:47.
PMID: 20113511 DOI: 10.1186/1471-2458-10-47

BACKGROUND: Sexually transmitted Infections (STIs) rank among the most important health issues for the people especially the young adults worldwide. Young people tend to engage in sexual activity at younger ages in the past decade than in the 1970s, and 1980s. Knowledge is an essential precursor of sexual risk reduction. A cross-sectional study was conducted in Pulau Pinang, Malaysia, to produce the baseline information about school students' awareness and perception about sexually transmitted Infections (STIs) and their sexual activity to help establish control and education programmes.
METHODS: Students from form 4 (aged between 15 to 16 years), form 5 (aged between 16 to 17 years) and form 6 (aged between 18 to 20 years) in their class rooms were approached and asked to complete self administered and anonymous pre-validated questionnaires. SPSS for windows version 13 was used to analyze the results statistically and results were presented in tabular form.
RESULTS: Data was collected from 1139 students aged between 15 to 20 years, 10.6% of which claimed that they never heard about STIs. Sexual experience related significantly with gender, race, and education level. Approximately 12.6% claimed to have sexual experience of which 75.7% had their sexual debut at 15-19 years and 38.2% were having more than 3 partners. Sexual experience was found to be significantly associated with gender (p = 0.003), ethnicity (p = 0.001) and education level (p = 0.030). However, multiple partner behaviour was significantly associated only with gender (p = 0.010). Mean knowledge score was 11.60 +/- 8.781 and knowledge level was significantly associated with religion (p = 0.005) education level (p = 0.000), course stream (p = 0.000), socioeconomic class (p = 0.000) and sexual experience (p = 0.022).
CONCLUSIONS: It was concluded that school students have moderate level of knowledge about STIs although they are sexually active. Interventions such as reinforcing the link between STIs and HIV/AIDS, assessing the current status of sexuality education in schools and arranging public talks and seminars focusing on STIs prevention education are needed to improve their awareness.
Fulltext Role of the husband's knowledge and behaviour in postnatal depression: a case study of an immigrant Pakistani woman

Khan TM, Arif NH, Tahir H, Anwar M

Ment Health Fam Med, 2009 Dec;6(4):195-201.
PMID: 22477910

Objective. This study aims to highlight the subjective experience of an immigrant Pakistani woman during postnatal depression (PND), with a special emphasis on the husband's knowledge and behaviour towards PND.
Methods. A face-to-face interview was conducted with a woman reporting symptoms of depression on the fourth day after delivery. She was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV)(1) and the Edinburgh Postnatal Depression Rating Scale (EPDRS).(2) The evaluations were completed by a qualified psychiatrist. The demographic information, personal and family medical history and attitude towards the child were the principal issues recorded. In addition, five items were used to evaluate the husband's knowledge about PND. The EPDRS differences before and after counselling were evaluated using a student t-test.
Results. The patient was 32 years old and this was her first experience of delivery by Caesarean section. The evaluation for depression confirmed the diagnosis of PND and she scored 16 on the EPDRS. The husband's knowledge of PND was poor.
Conclusion. This case study suggests that lack of social support and understanding appear to play a vital role in the persistence of symptoms of PND among new mothers. Therefore, counselling of couples may be an effective additional tool in treating PND.
Fulltext Allelopathic effects of litter Axonopus compressus against two weedy species and its persistence in soil

Samedani B, Juraimi AS, Rafii MY, Anuar AR, Sheikh Awadz SA, Anwar MP

ScientificWorldJournal, 2013;2013:695404.
PMID: 24260020 DOI: 10.1155/2013/695404

This study investigated the allelopathic effect of Axonopus compressus litter on Asystasia gangetica and Pennisetum polystachion. In experiment 1 the bioassays with 0, 10, 30, and 50 g L⁻¹ of aqueous A. compressus litter leachate were conducted. Experiment 2 was carried out by incorporating 0, 10, 20, 30, 40, and 50 g L⁻¹ of A. compressus litter leachate into soil. In experiment 3, the fate of A. compressus litter leachate phenolics in the soil was investigated. A. compressus leachates did not affect the germination percentage of A. gangetica and P. polystachion, but delayed germination of A. gangetica seeds and decreased seed germination time of P. polystachion. A. compressus litter leachates affected weeds hypocotyl length. Hypocotyl length reductions of 18 and 31% were observed at the highest concentration (50 g L⁻¹) compared to the control in A. gangetica and P. polystachion, respectively. When concentration of A. compressus litter leachate-amended soil increased A. gangetica and P. polystachion seedling shoot length, root length, seedling weight and chlorophyll concentration were not affected. The 5-week decomposition study of A. compressus showed that the phenolic compounds in A. compressus litter abruptly decreased about 52% after two weeks and remained steady until the end of the incubation.
Fulltext Competitive interaction of Axonopus compressus and Asystasia gangetica under contrasting sunlight intensity

Samedani B, Juraimi AS, Anwar MP, Rafii MY, Sheikh Awadz SH, Anuar AR

ScientificWorldJournal, 2013;2013:308646.
PMID: 24163618 DOI: 10.1155/2013/308646

Axonopus compressus is one of the native soft grass species in oil palm in Malaysia which can be used as a cover crop. The competitive ability of A. compressus to overcome A. gangetica was studied using multiple-density, multiple-proportion replacements series under a glasshouse and full sunlight conditions in a poly bag for 10 weeks. A. compressus produced more dry weight and leaf area when competing against A. gangetica than in monoculture at both densities in the full sunlight and at high density in the shade. Moreover, the relative yield and relative crowding coefficients also indicated A. compressus is a stronger competitor than A. gangetica at both densities in the full sunlight and high density in the shade. It seemed that A. gangetica plants in the shade did not compete with each other and were more competitive against A. compressus as could influence A. compressus height in the shade. It is concluded that although suppression of A. gangetica by A. compressus occurred under full sunlight, irrespective of plant density, this ability reduced under shade as A. compressus density decreased. The result suggests that A. compressus in high density could be considered as a candidate for cover crops under oil palm canopy.
Reasons, perceived efficacy, and factors associated with complementary and alternative medicine use among Malaysian patients with HIV/AIDS

Hasan SS, See CK, Choong CL, Ahmed SI, Ahmadi K, Anwar M

J Altern Complement Med, 2010 Nov;16(11):1171-6.
PMID: 20973734 DOI: 10.1089/acm.2009.0657

OBJECTIVES: The primary objective of this study was to evaluate the pattern of use, reasons for use, and perceived effect of complementary and alternative medicine (CAM), accompanied by identification and comparison of the factors that are potentially associated with CAM use.
DESIGN: This cross-sectional study was carried out in 325 randomly sampled patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), at HIV/AIDS referral clinics in the Hospital Sungai Buloh, Malaysia. Simple random sampling was used, where randomization was done using patients' medical record numbers.
SUBJECTS AND METHODS: Semistructured face-to-face interviews were conducted using 38 questions pertaining to type, pattern, perceived efficacy, adverse effects, and influential factors associated with CAM use. In addition, CD4 count and viral load readings were recorded.
RESULTS: Of 325 randomly sampled patients with HIV/AIDS, 254 of them were using some forms of CAM, resulting in a utilization rate of 78.2%. Vitamins and supplements (52.6%), herbal products (33.8%), and massage (16.6%) were the top three most frequently used CAM modalities. Sociodemographic factors including education level (p = 0.021, r(s) = 0.148), monthly income (p = 0.001, r(s) = 0.260), and family history of CAM use (p = 0.001, r(s) = 0.231) were significantly associated and positively correlated with CAM use. However, the majority of these patients (68%) did not disclose CAM use to health care professionals. About half of those who rated their health as good or very good perceived it as a result of CAM use.
CONCLUSIONS: This study confirmed the range of 30%-100% CAM use among individuals infected with HIV/AIDS. Although, on the one hand some types of CAM reduced viral load and enhanced the immune system, on the other hand some forms of CAM produced a detrimental effect on the virological suppression, opening this platform to more research and investigation in order to optimize the use of CAM among patients with HIV/AIDS.
Study site: HIV/AIDS clinic, Hospital Sungai Buloh, Selangor, Malaysia
Community knowledge, attitudes, and beliefs towards depression in the state of Penang, Malaysia

Khan TM, Sulaiman SA, Hassali MA, Anwar M, Wasif G, Khan AH

Community Ment Health J, 2010 Feb;46(1):87-92.
PMID: 20146000 DOI: 10.1007/s10597-009-9262-z

This study was intended to evaluate the mental health literacy vis-à-vis depression among inhabitants of Penang state in North Malaysia. Using a clustered random sampling method, 1,855 respondents were approached to participate in the survey. A total of 1,149 respondents actually participated, for a 61.9% response rate. Face to face interviews were then conducted using a pre-validated 21-item questionnaire. The mean age of the respondents was 30 years (SD +/-11.5). The majority (n = 884; 76.9%) could recognize three or more symptoms of depression. Chinese and/or female respondents performed the best in this domain. Respondents with a personal experience of depression displayed a significantly better knowledge of symptoms of and therapies for depression than those who did not (t = -35.745, P = <0.001). Overall, a moderate knowledge level of the symptoms of depression and a cursory knowledge towards therapy were observed among the general population in Penang. Notably, respondents were generally inclined towards the use of alternative medicine. The study suggests that strong beliefs in alternative and traditional medicines could undermine the respondents' willingness and ability to seek evidence-based mental health care.
Seroprevalence, associated risk factors and hematological impacts of toxoplasmosis in small ruminants of Multan, Punjab-Pakistan

Ullah MZ, Awais MM, Akhtar M, Anwar MI, Navid MT, Khan I, et al.

Trop Biomed, 2018 Dec 01;35(4):1028-1040.
PMID: 33601850

Toxoplasmosis is a protozoal infection of zoonotic potential with worldwide geographical distribution which affects nearly all warm-blooded animals including mammals and birds. Keeping in view, this study was conducted to determine the seroprevalence of toxoplasmosis along with associated risk factors and its haematological impacts in small ruminants of district Multan, Pakistan. In this study, a total of 250 sera samples collected from sheep (n=125) and goats (n=125) from three tehsils of Multan were examined using commercially available Latex agglutination test kit for the presence of anti-T. gondii antibodies. The haematological profiles of Toxoplasma seropositive and seronegative animals were determined by using automated haematology analyser. Overall seroprevalence of toxoplasmosis in small ruminants was 42.80% with a higher prevalence rate (44.80%) in sheep as compared to goats (40.80%). Sex, existence of co-morbid conditions, feeding pattern and presence of pet cats and dogs were identified as significant (P<0.05) risk factors associated with the presence of antibodies against toxoplasmosis. The breed was found to be a significant (P=0.026) risk factor for the seroprevalence of toxoplasmosis in goats but not in sheep. Haematological analysis revealed significantly altered leukocytic counts (P<0.05) in seropositive sheep and goats as compared to seronegative ones. Our findings showed that small ruminants of the Multan District in Pakistan are toxoplasma seropositive and may pose a serious threat of public health concern in the region.
Fulltext Responsible use of fixed-dose combination antibiotics in India

Shankar PR, Hassali MA, Shahwani NA, Iqbal Q, Anwar M, Saleem F

Lancet Glob Health, 2016 10;4(10):e689.
PMID: 27633429 DOI: 10.1016/S2214-109X(16)30214-5
Green Communication for Wireless Body Area Networks: Energy Aware Link Efficient Routing Approach

Anwar M, Abdullah AH, Altameem A, Qureshi KN, Masud F, Faheem M, et al.

Sensors (Basel), 2018 Sep 26;18(10).
PMID: 30261628 DOI: 10.3390/s18103237

Recent technological advancement in wireless communication has led to the invention of wireless body area networks (WBANs), a cutting-edge technology in healthcare applications. WBANs interconnect with intelligent and miniaturized biomedical sensor nodes placed on human body to an unattended monitoring of physiological parameters of the patient. These sensors are equipped with limited resources in terms of computation, storage, and battery power. The data communication in WBANs is a resource hungry process, especially in terms of energy. One of the most significant challenges in this network is to design energy efficient next-hop node selection framework. Therefore, this paper presents a green communication framework focusing on an energy aware link efficient routing approach for WBANs (ELR-W). Firstly, a link efficiency-oriented network model is presented considering beaconing information and network initialization process. Secondly, a path cost calculation model is derived focusing on energy aware link efficiency. A complete operational framework ELR-W is developed considering energy aware next-hop link selection by utilizing the network and path cost model. The comparative performance evaluation attests the energy-oriented benefit of the proposed framework as compared to the state-of-the-art techniques. It reveals a significant enhancement in body area networking in terms of various energy-oriented metrics under medical environments.
Fulltext Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Shakeel S, Nesar S, Rehman H, Jamil K, Mallick IA, Mustafa MS, et al.

Pharmacy (Basel), 2021 Dec 20;9(4).
PMID: 34941635 DOI: 10.3390/pharmacy9040203

Off-label drug prescribing (OLDP) must be based on strong scientific evidence to make sure that patients get the optimum therapeutic outcomes. Adherence to the prerequisites is determined by the physicians' attitude and knowledge. In this context, the present study was conducted with the goal of investigating psychiatrists' perceptions of the use of OLDP in their clinical practice. A total of 14 psychiatrists were interviewed using a semi-structured interview guide. Thematic content analysis was performed. Data saturation was achieved at the 12th interview. Six major themes and fifteen subthemes emerged from qualitative interviews. Among the major themes were knowledge and concepts about the off-label drugs, attitude and current practice of prescribing off-label drugs, and rationale of prescribing and suggestions for reducing the use of off-label drugs. Almost all of the respondents interviewed provided detailed comments concerning the OLDP concept, depicted an optimistic approach and deemed that OLDP is quite common in psychiatry. Off-label usage of benzodiazepines such as clonazepam, diazepam and lorazepam in mania, depression, and obsessive-compulsive disorder were commonly reported. It was observed that the majority of the respondents did not inform the patients before prescribing off-label drugs. The present findings revealed that respondents had awareness; however, they depicted diverse attitudes towards prescribing off-label drugs. Further education and sensitization in regions with impoverished knowledge would certainly assist in preventing the risks associated with the use of OLDP.
Fulltext Understanding of and attitudes toward epilepsy among the urban Chinese population in Malaysia

Hasan SS, Alen YK, Wayne WG, Ahmadi K, Anwar M, Goh GK

Singapore Med J, 2010 Apr;51(4):290-9.
PMID: 20505906

People with epilepsy are socially discriminated against on the grounds of widespread negative public attitudes, misunderstandings and defensive behaviour. The primary purpose of this study was to evaluate the public understanding of and attitudes toward epilepsy among the Chinese population in Malaysia.
Fulltext Integration of agronomic practices with herbicides for sustainable weed management in aerobic rice

Anwar MP, Juraimi AS, Mohamed MT, Uddin MK, Samedani B, Puteh A, et al.

ScientificWorldJournal, 2013;2013:916408.
PMID: 24223513 DOI: 10.1155/2013/916408

Till now, herbicide seems to be a cost effective tool from an agronomic view point to control weeds. But long term efficacy and sustainability issues are the driving forces behind the reconsideration of herbicide dependent weed management strategy in rice. This demands reappearance of physical and cultural management options combined with judicious herbicide application in a more comprehensive and integrated way. Keeping those in mind, some agronomic tools along with different manual weeding and herbicides combinations were evaluated for their weed control efficacy in rice under aerobic soil conditions. Combination of competitive variety, higher seeding rate, and seed priming resulted in more competitive cropping system in favor of rice, which was reflected in lower weed pressure, higher weed control efficiency, and better yield. Most of the herbicides exhibited excellent weed control efficiency. Treatments comprising only herbicides required less cost involvement but produced higher net benefit. On the contrary, treatments comprising both herbicide and manual weeding required high cost involvement and thus produced lower net benefit. Therefore, adoption of competitive rice variety, higher seed rate, and seed priming along with spraying different early-postemergence herbicides in rotation at 10 days after seeding (DAS) followed by a manual weeding at 30 DAS may be recommended from sustainability view point.
Fulltext Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review

Yeo HY, Liew AC, Chan SJ, Anwar M, Han CH, Marra CA

Patient Prefer Adherence, 2023;17:2679-2706.
PMID: 37927344 DOI: 10.2147/PPA.S432821

OBJECTIVE: Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients' treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options.
METHODS: We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings.
RESULTS: The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment.
CONCLUSION: The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient.

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