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Gimm G, Yoon JY, Ahn E, Oh S, Jo CH. Clinical Implication of Glenohumeral and Subacromial Synovitis in Rotator Cuff Tears. Orthop J Sports Med 2023; 11:23259671231207818. [PMID: 38035213 PMCID: PMC10687959 DOI: 10.1177/23259671231207818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 12/02/2023] Open
Abstract
Background Synovitis of the glenohumeral (GH) joint and the subacromial (SA) space is commonly observed during arthroscopic rotator cuff surgery. Purpose To investigate the distribution, severity, and clinical implications of synovitis in the GH joint and SA space in patients with a full-thickness rotator cuff tear (RCT). Study Design Case series; Level of evidence, 4. Methods Data were retrospectively collected from 207 patients with a full-thickness RCT who underwent arthroscopic repair. Preoperative parameters used in the clinical assessment included pain, range of motion (ROM), muscle strength, and functional scores. Macroscopic assessment of synovitis was performed intraoperatively in the 3 regions of interest (ROIs) of the GH joint and 4 ROIS of the SA space using an evaluation system. The distribution and severity of synovitis and the association between synovitis and clinical assessment were evaluated. Results Synovitis was more severe in the GH joint than in the SA space (P < .001). Synovitis in the posterior GH joint and the lateral SA space, where most of the rotator cuff was located, was the most severe area among the ROIs of the GH joint and the SA space, respectively (P < .05). All types of pain, except for pain at rest, were associated with synovitis in the posterior GH joint (P < .05). All ROM measures were associated with synovitis in the posterior and inferior GH joint (|r| > 0.20; P < .05 for both). The strength of the supraspinatus and the infraspinatus was associated with synovitis in the posterior GH joint (P < .05). Shoulder function was associated with synovitis in the posterior and inferior GH joint and more in the posterior GH joint (P < .05 for both). Synovitis in the SA space was not associated with any of the clinical parameters. Conclusion Synovitis in the posterior GH joint was the most severe form of synovitis in the GH joint in patients with a full-thickness RCT. Synovitis in the posterior GH joint was closely associated with increased pain and decreased ROM, muscle strength, and functional score. Synovitis in the SA space was milder and not associated with any clinical parameters.
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Affiliation(s)
- Geunwu Gimm
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Yong Yoon
- Department of Orthopedic Surgery, 88 Hospital, Seoul, Republic of Korea
| | - Eunmi Ahn
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Jiang C, Yuan Y, Gu B, Ahn E, Kim J, Feng D, Huang Q, Song S. Preoperative prediction of microvascular invasion and perineural invasion in pancreatic ductal adenocarcinoma with 18F-FDG PET/CT radiomics analysis. Clin Radiol 2023:S0009-9260(23)00219-2. [PMID: 37365115 DOI: 10.1016/j.crad.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 06/28/2023]
Abstract
AIM To develop and validate a predictive model based on 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG) positron-emission tomography (PET)/computed tomography (CT) radiomics features and clinicopathological parameters to preoperatively identify microvascular invasion (MVI) and perineural invasion (PNI), which are important predictors of poor prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Preoperative 18F-FDG PET/CT images and clinicopathological parameters of 170 patients in PDAC were collected retrospectively. The whole tumour and its peritumoural variants (tumour dilated with 3, 5, and 10 mm pixels) were applied to add tumour periphery information. A feature-selection algorithm was employed to mine mono-modality and fused feature subsets, then conducted binary classification using gradient boosted decision trees. RESULTS For MVI prediction, the model performed best on a fused subset of 18F-FDG PET/CT radiomics features and two clinicopathological parameters, with an area under the receiver operating characteristic curve (AUC) of 83.08%, accuracy of 78.82%, recall of 75.08%, precision of 75.5%, and F1-score of 74.59%. For PNI prediction, the model achieved best prediction results only on the subset of PET/CT radiomics features, with AUC of 94%, accuracy of 89.33%, recall of 90%, precision of 87.81%, and F1 score of 88.35%. In both models, 3 mm dilation on the tumour volume produced the best results. CONCLUSIONS The radiomics predictors from preoperative 18F-FDG PET/CT imaging exhibited instructive predictive efficacy in the identification of MVI and PNI status preoperatively in PDAC. Peritumoural information was shown to assist in MVI and PNI predictions.
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Affiliation(s)
- C Jiang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Nuclear Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Y Yuan
- Biomedical and Multimedia Information Technology Research Group, School of Computer Science, University of Sydney, Sydney, Australia
| | - B Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - E Ahn
- Discipline of Information Technology, College of Science & Engineering, James Cook University, Australia
| | - J Kim
- Biomedical and Multimedia Information Technology Research Group, School of Computer Science, University of Sydney, Sydney, Australia
| | - D Feng
- Biomedical and Multimedia Information Technology Research Group, School of Computer Science, University of Sydney, Sydney, Australia
| | - Q Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - S Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
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Kim TJ, Oh HK, Lee HS, Kim SE, Park J, Kim JY, Lee J, Song J, Hong JH, Seo SY, Ahn E, Lee SK, Lee J, Chung JW, Kim HC, Shin DH, Lee HY, Kim BJ, Seo WK, Park JM, Lee SJJ, Jung KH, Kwon SU, Hong YC, Kim HS, Kang HJ, LEE JUNEYOUNG, BAE HJ. Abstract WP40: Development Of The System For National Statistics Of Stroke And Acute Myocardial Infarction Using Claims-based Algorithms In Korea. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
The epidemiology of stroke and acute myocardial infarction (AMI) in Korea is limited by inaccurate methods for estimating incidence. Therefore, this study aimed to build the system for national statistics of stroke and AMI in Korea using claims-based identification algorithms.
Methods:
We identified stroke and AMI using the claims-based algorithms based on the 2018 National Health Insurance Service (NHIS) data. The identification algorithms were validated using investigation of medical records of the sampled cases including the patient groups and the control groups based on a 2-stage stratified sampling method. The sampled cases were divided into 6 strata according to regions (capital and non-capital) and types of centers (tertiary hospitals, general hospitals, and hospitals). Based on the medical records results, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and weighted PPV and weighted NPV were calculated by applying strata-specific sampling rates. The incidence rate of stroke and AMI is the number of new cases of stroke and AMI, including recurrent events, which was calculated by applying the algorithms using weighted PPV and NPV to the claims data.
Results:
In total, 2,200 cases (1,086 cases in stroke [578 patients and 508 controls] and 1,114 cases in AMI [520 patients and 594 controls]) were sampled after applying algorithms for review of hospital records. In hospital record reviews, the stroke algorithm had 95.2% sensitivity, 99.6% specificity, 89.3% PPV, and 99.8% NPV, and AMI algorithms showed 97.7% sensitivity, 99.9% specificity, 90.0% PPV, and 99.9% NPV. We identified 94,994 stroke and 33,834 AMI cases including recurrent events using validated identification algorithms in 2018. The age- and sex-standardized incidence rate of stroke was 175.7 cases per 100,000 person-years and the incidence rate of AMI was 49.3 cases per 100,000 person-years in 2018.
Conclusion:
We developed the national statistical system to estimate the incidence of stroke and AMI using validated claims-based algorithms in Korea. By using this system, we expect that it will be possible to conduct nationwide epidemiological research and improve acute cardiovascular care in Korea.
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Affiliation(s)
- Tae Jung Kim
- Neurology, Seoul National Univ Hosp, Seoul, Korea, Republic of
| | - Hyun-kyung Oh
- Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | | | | | - Jinju Park
- NeurologyCentral Div of Cardio-cerebrovascular Disease Management, Seoul National Univ Hosp, Seoul, Korea, Republic of
| | - Jun Y Kim
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si
| | - Jiyoon Lee
- Biostatistics, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Jieun Song
- Biostatistics, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Jin-Hyuk Hong
- Central Div of Cardio-cerebrovascular Disease Management, Seoul National Univ Hosp, Seoul, Korea, Republic of
| | - Soon-young Seo
- NeurologyChronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | - Eunmi Ahn
- NeurologyChronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | - Seon Kui Lee
- Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, Korea, Republic of
| | - Joongyub Lee
- NeurologyPreventive Medicine, Seoul National Univ College of Medicine, Seoul, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Sun U Kwon
- Neurology, Asan Med Cntr, Seoul, Korea, Republic of
| | - Yun-Chul Hong
- Preventive Medicine, Seoul National Univ College of Medicine, Seoul, Korea, Republic of
| | - Hyo S Kim
- SEOUL NATIONAL UNIVERSITY HOSPITAL, Seoul
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Coleman M, Andorsky DJ, Yacoub A, Melear JM, Fanning SR, Kolibaba KS, Lansigan F, Reynolds C, Nowakowski G, Gharibo M, Ahn E, Li J, Rummel MJ, Sharman JP. PATIENTS WITH RELAPSED/REFRACTORY MARGINAL ZONE LYMPHOMA IN THE MAGNIFY PHASE 3B INTERIM ANALYSIS OF INDUCTION R2 FOLLOWED BY MAINTENANCE. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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5
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Kim HB, Kim A, Kim Y, Kim GT, Ahn E, So MW, Sohn DH, Lee SG. Associations of serum monocyte-to-high-density lipoprotein cholesterol ratio with digital ulcers and skin fibrosis in patients with systemic sclerosis. Scand J Rheumatol 2020; 50:231-238. [PMID: 33243053 DOI: 10.1080/03009742.2020.1837237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To investigate the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and clinical manifestations in patients with systemic sclerosis (SSc).Method: This was a cross-sectional analysis of a cohort study comprising 111 female SSc patients recruited from a tertiary care rheumatology centre. We also assessed 222 age-matched female healthy controls. Serum MHR was measured in all study participants. Digital ulcer (DU) was defined as an active or healed ulceration, and the magnitude of skin fibrosis was determined according to the modified Rodnan skin score (mRSS).Results: The mean age and median disease duration in patients with SSc were 56.3 years and 98 months, respectively. The MHR in SSc patients was significantly higher than that in controls. DU was found in 35 patients (31.5%) with SSc (active in 12 and healed in 23), and the median mRSS was 8. SSc patients with DU had a significantly higher median MHR than those without (11.43 vs 7.62, p < 0.001), and MHR significantly positively correlated with mRSS (ρ = 0.289, p = 0.002). Multivariable logistic regression revealed that an elevated MHR was independently associated with increased risk of DU (odds ratio = 1.21; 95% confidence interval = 1.07-1.35; p = 0.002). In the multivariable linear regression analysis, higher MHR showed a significant association with increased log-transformed mRSS (unstandardized β = 0.052, p = 0.003).Conclusion: Our findings suggest that the MHR could be serve as a potential biomarker of the risk of DU and advanced skin fibrosis in patients with SSc.
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Affiliation(s)
- H-B Kim
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - A Kim
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Y Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea
| | - G-T Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea
| | - E Ahn
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - M W So
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - D H Sohn
- Department of Microbiology and Immunology, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - S-G Lee
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Furuse J, Goyal L, Meric-Bernstam F, Hollebecque A, Valle J, Morizane C, Karasic T, Abrams T, Kelley R, Cassier P, Klumpen HJ, Uboha N, Mahipal A, Mitchell E, Ahn E, Chang HM, Masuda K, He Y, Benhadji K, Bridgewater J. 116MO Efficacy, safety, and quality of life (QoL) with futibatinib in patients (pts) with intrahepatic cholangiocarcinoma (iCCA) harboring FGFR2 fusions/rearrangements: FOENIX-CCA2. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ahn E, Song IG, Choi JY, Jho HJ, Park I, Sung S, Shin S, Park SJ, Nam EJ, Jeong SH, Chang YJ. Effectiveness of home hospice care: a nationwide prospective observational study. Support Care Cancer 2019; 28:2713-2719. [PMID: 31691034 DOI: 10.1007/s00520-019-05091-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Many assert the need for home hospice care. However, limited research has shown its effectiveness. The authors of this study thus evaluated the effectiveness of a home hospice care pilot project regarding (1) early enrollment in hospice care, (2) efficient use of inpatient hospice resources, and (3) enabling terminally ill patients to stay at their preferred place of care. METHODS The authors conducted a nationwide prospective observational study. Patients were divided into home hospice care users (ever-users, n = 902) and inpatient-only hospice care users (never-users, n = 8210). Information about hospice service utilization was collected from a web-based registry system. Patients were registered if they started to receive the hospice service after providing written informed consent during the pilot project from March 2016-July 2017. RESULTS Most ever-users preferred to stay at home (84.0%), while never-users preferred hospital admission (66.9%). Most ever-users were enrolled in hospice by home care (78.9%) and used both home and inpatient care (72.4%). The overall duration of hospice care was significantly longer among ever-users than never-users (median 39 vs. 15 days, respectively; mean ± SD 59.6 ± 62.8 vs. 24.8 ± 32.1, respectively; p < .001). Participation in the pilot program improved bed utilization (p = .025) and turnover rate (p < .001) of inpatient hospice service. CONCLUSIONS Home hospice care enabled early enrollment in hospice services and provided a valid option to patients who wished to stay at home. Policy efforts to facilitate home hospice care are needed.
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Affiliation(s)
- Eunmi Ahn
- Division of Health Services Development for Persons with Disabilities, Ministry of Health and Welfare National Rehabilitation Center, 58 Samgaksan-ro, GangBuk-gu, Seoul, 01022, South Korea
| | - In Gyu Song
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Young Choi
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Hyun Jung Jho
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Ilyeon Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Suah Sung
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Seohyun Shin
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - So Jung Park
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Eun Jung Nam
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Sung Hoon Jeong
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Yoon Jung Chang
- National Hospice Center, National Cancer Center, 323 Ilsan-ro, Ilsnadong-gu, Goyang-si, Gyeonggi-do, South Korea.
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Kim MS, Choi DH, Kwon H, Ahn E, Cho HY, Baek MJ, Shin JE, Moon MJ. Procedural and obstetric outcomes after embryo reduction vs fetal reduction in multifetal pregnancy. Ultrasound Obstet Gynecol 2019; 53:214-218. [PMID: 29418029 DOI: 10.1002/uog.19024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the obstetric outcome and incidence of procedure-related adverse events after embryo reduction (ER) vs fetal reduction (FR), in multifetal pregnancies undergoing reduction to twins or singletons. METHODS We analyzed retrospectively data from multifetal pregnancies that underwent transvaginal ER (n = 181) at a mean gestational age of 7.6 weeks or transabdominal FR (n = 115) at a mean gestational age of 12.9 weeks between December 2006 and January 2017. FR was performed after a detailed fetal anomaly scan. The two groups were compared with respect to obstetric outcomes, such as incidence of miscarriage, early or late preterm delivery, maternal complications and fetal loss, and procedure-related adverse events, including incidence of subchorionic hematoma and procedure-related fetal loss. RESULTS Compared with pregnancies that underwent ER, the incidence of procedure-related fetal loss was lower in the FR group (7.2% vs 0.9%; P = 0.039; odds ratio (OR), 0.12; 95% CI, 0.02-0.89). Mean gestational age at delivery for twins was 34.2 weeks in the ER group and 35.7 weeks in the FR group (P = 0.014). Compared with the ER group, the FR group had lower miscarriage (8.8% vs 2.6%; P = 0.045; OR, 0.28; 95% CI, 0.08-0.97) and overall fetal loss (13.3% vs 5.2%; P = 0.031; OR, 0.36; 95% CI, 0.14-0.91) rates. CONCLUSIONS The FR procedure is, overall, a better and safer approach to reducing morbidity and mortality in multifetal pregnancies. Spontaneous demise of one fetus may occur after ER, and FR has the advantage that chorionic villus sampling and ultrasound screening for increased nuchal translucency and anatomical defects can be conducted before the procedure. The ER approach is still reasonable when a patient's religious or other ethical concerns are of primary importance. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M S Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - D H Choi
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - H Kwon
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - E Ahn
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - H Y Cho
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - M J Baek
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - J E Shin
- Fertility Center of CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - M J Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Republic of Korea
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Hansra DM, McIntyre K, Ramdial J, Sacks S, Patrick CS, Cutler J, McIntyre B, Feister K, Miller M, Taylor AK, Farooq F, de Mayolo JA, Ahn E. Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center. Evid Based Complement Alternat Med 2018; 2018:8081018. [PMID: 29849727 PMCID: PMC5925032 DOI: 10.1155/2018/8081018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 11/20/2022]
Abstract
Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P ≤ 0.05). Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.
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Affiliation(s)
- D. M. Hansra
- Cancer Treatment Centers of America, Atlanta, GA, USA
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - K. McIntyre
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J. Ramdial
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - S. Sacks
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C. S. Patrick
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J. Cutler
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - B. McIntyre
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - K. Feister
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - M. Miller
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - A. K. Taylor
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - F. Farooq
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - E. Ahn
- Cancer Treatment Centers of America, Atlanta, GA, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Miller School of Medicine, University of Miami, Miami, FL, USA
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Raymond VM, Diaz J, Banks KC, Ahn E, Brufsky A, Ellis M, Lippman M, Lee C, Pluard T, Schreeder M, Schwab R, Lanman RB. Abstract P2-02-12: Cell free DNA analysis identifies actionable ERBB2 amplifications in patients with HER2 negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Identification of ERBB2 (HER2) overexpression in metastatic breast cancer informs utilization of HER2 targeted therapy. The NCCN recommends HER2 expression re-evaluation at the first disease recurrence in patients with negative or equivocal tissue status given results discrepancies due to inadequate tissue biopsy, tumoral heterogeneity, biopsy technique or fixation as well as discordance in ERBB2 (HER2) expression between primary and metastatic lesions. We examined the incidence of ERBB2 (HER2) negative to positive “flips” (e.g. to ERBB2-amplified in plasma) in a cohort of patients who underwent a blood-based cell-free DNA (cfDNA) assay at a CLIA-certified/CAP-accredited/NYSDOH-approved molecular diagnostic laboratory.
Laboratory database was queried for samples from patients with a breast cancer diagnosis. The query was filtered to ensure patients with multiple cfDNA timepoints were counted only once. Patients without a pathology report submitted at any cfDNA collection timepoint or the pathology report did not include ERBB2 (HER2) status, results were inconclusive or quantity not sufficient were excluded. Between March 2014 and April 2017, 1,853 unique patients were identified with reported ERBB2 (HER2) status. For patients with more than one cfDNA timepoint collected (N=349; 18.8%), the earliest pathology report was referenced. 1,386 patient tumor samples were negative for HER2 overexpression (74.8%), 325 (17.5%) were positive, and 142 (7.7%) were equivocal. Twenty-nine of the 1,386 patients with reported tumor negative HER2 status had amplification on subsequent cfDNA analysis (2.1%).
All 29 patients were female. Most patients (N=21) had a single cfDNA timepoint collected. Median age at cfDNA blood draw was 58 years (range 28–68). Median length of time between reported tissue negative status and cfDNA blood draw was 405 days (range 21–4,060). Median plasma ERBB2 copy number was 2.44 (greater than 50th-centile per laboratory data) (range 2.15–16.5).
Clinical follow-up was obtained for 19 patients (65%). Nine patients were lost to follow-up or succumbed to disease prior to initiation of a new therapeutic regimen. One patient was known HER2 positive prior to receipt of the cfDNA results. In the remaining nine patients, six initiated targeted HER2 therapy following receipt of the cfDNA results, with five of six (83%) demonstrating a clinical response. In one patient with known ER/PR positive, HER2 negative disease, progressing through multiple lines of therapy, addition of trastuzumab and pertuzumab to her paclitaxel regimen following identification of the cfDNA ERBB2 amplification resulted in a significant reduction in CEA levels (238 to 37.9 ng/mL) by week five. In a second patient, following identification of the cfDNA ERBB2 amplification, she was treated with trastuzumab and pertuzumab along with docetaxel and had a dramatic response. She continues on trastuzumab and pertuzumab alone.
Although a modest sample size, this is the second cfDNA series demonstrating that ERBB2 (HER2) status may flip from negative to positive upon recurrence or metastasis, and that targeting plasma-detected ERBB2 amplification with anti-HER2 has clinical benefit. cfDNA is a viable alternative to tissue rebiopsy in this patient population.
Citation Format: Raymond VM, Diaz J, Banks KC, Ahn E, Brufsky A, Ellis M, Lippman M, Lee C, Pluard T, Schreeder M, Schwab R, Lanman RB. Cell free DNA analysis identifies actionable ERBB2 amplifications in patients with HER2 negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-02-12.
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Affiliation(s)
- VM Raymond
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - J Diaz
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - KC Banks
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - E Ahn
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - A Brufsky
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - M Ellis
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - M Lippman
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - C Lee
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - T Pluard
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - M Schreeder
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - R Schwab
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - RB Lanman
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
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11
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Kim MA, Park JH, Park HJ, Yi J, Ahn E, Kim SY, Shin DW, Park M, Lim YJ, Park ES, Park KD, Hong JS. Experiences of peer exclusion and victimization, cognitive functioning, and depression among adolescent cancer survivors in South Korea. Am J Orthopsychiatry 2018; 88:441-449. [PMID: 29369652 DOI: 10.1037/ort0000292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Adolescents who reenter school after treatment for cancer may face certain challenges, such as social exclusion by their peers and difficulties in cognitive functioning, due to the cancer treatment and its psychosocial sequelae. Such challenges may have an impact on their mental health. This cross-sectional study examined the impact of peer exclusion-victimization and cognitive functioning on depression among adolescent survivors of childhood cancer. A total of 175 adolescent survivors of childhood cancer between the ages of 13 and 19 years completed a self-reported questionnaire. Their mean age was 15.33 years (SD = 1.65), the mean time since diagnosis was 7.97 years (SD = 3.91), and 49.7% experienced at least 1 kind of peer exclusion in school. Multiple regression analysis was conducted to examine the effects of survivors' experiences related to peer exclusion-victimization and cognitive functioning on depression, controlling for demographic (age and gender) and cancer-related (cancer type, time since diagnosis, recurrence) characteristics. The model with peer exclusion-victimization and cognitive functioning as predictors accounted for 27.9% of the variance in depression. More experiences in peer exclusion-victimization (β = .200, p = .024) and lower cognitive functioning (β = -.465, p < .001) were associated with greater levels of depression. Understanding the impact of survivors' experiences of peer exclusion-victimization and cognitive functioning on their mental health will help professionals to provide appropriate counseling services to moderate peer exclusion-victimization as well as resources for academic performance for those cancer survivors at risk for depression. (PsycINFO Database Record
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Affiliation(s)
- Min Ah Kim
- Department of Social Welfare, Myongji University
| | | | | | - Jaehee Yi
- College of Social Work, University of Utah
| | - Eunmi Ahn
- Hospice and Palliative Care Branch, Division of Cancer Management Policy, National Cancer Center
| | - So Young Kim
- Department of Public Health and Preventive Medicine, Chungbuk National University Hospital
| | - Dong Wook Shin
- Cancer Survivorship Clinic, Seoul National University Cancer Hospital
| | - Meerim Park
- Department of Pediatrics, College of Medicine, Chungbuk National University
| | - Yeon-Jung Lim
- Department of Pediatrics, College of Medicine, Chungnam National University
| | - Eun Sil Park
- Department of Pediatrics, Health Science Institute, School of Medicine, Gyeongsang National University
| | - Kyung Duk Park
- Department of Pediatrics, Cancer Research Institute, College of Medicine, Seoul National University
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12
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Ahn E, Park HJ, Baek HJ, Hwang PH, Lee YH, Park BK, Kim YS, Shim HY, Shin D, Yang HK, Park JH, Park KD. Awareness about past diagnosis and treatment history: nationwide survey of childhood cancer survivors and their parents. Jpn J Clin Oncol 2017; 47:962-968. [PMID: 28981736 DOI: 10.1093/jjco/hyx102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/28/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To assess the awareness of past medical history and long-term care issues of childhood cancer survivors (CCS) in Korea. Methods A nationwide survey was conducted on CCS and their parents in 10 regional cancer centers in Korea. Answers regarding cancer diagnosis and treatment history were compared with the treatment summary and categorized into three ('specific,' 'general,' and 'no') or two ('yes' and 'no') groups. Results Out of 343 contacts, 293 dyads completed the survey, and 281 dyads were analyzed. Awareness of cancer diagnosis was mostly specific for parents (76.5%) and CCS (35.2%). Awareness of anti-cancer treatment exposure was mostly general (84.6% for surgery, 67.9% for chemotherapy, and 53.9% for hematopoietic stem cell transplantation) rather than specific. In particular, more than half of the parents were not aware of the exposure to cardiotoxic agents (72.9%) or radiation therapy (56.3%). Providing information about long-term side effects and prevention of secondary cancer was significantly correlated only with more concern and more follow-up visits (P ≤ 0.001, respectively), without correlation with more specific awareness of exposure to cardiotoxic agents or radiation. Conclusion(s) Most of the parents of CCS were not aware of treatment-related risk factors necessary for long-term care. Providing information was significantly correlated with more concern and more follow-up visits, without improving corresponding knowledge about their past medical history. Effort aimed towards improving awareness about risk factors, the manner of providing information, and the patient referral system within which we use this information is warranted.
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Affiliation(s)
- Eunmi Ahn
- Hospice and Palliative Care Branch, Division of Cancer Management Policy, National Cancer Center
| | - Hyeon Jin Park
- Center for Pediatric Cancer, National Cancer Center, Gyeonggi-do
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam
| | - Pyoung Han Hwang
- Department of Pediatrics, Chonbuk National University Medical School, Jeollabuk-do
| | - Young Ho Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul
| | - Byung-Kiu Park
- Center for Pediatric Cancer, National Cancer Center, Gyeonggi-do
| | - Young So Kim
- Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do.,College of Medicine, Chungbuk National University.,Graduate School of Health Science Business Convergence, Chungbuk National University, Chungbuk
| | - Hye-Young Shim
- Department of Preventive Medicine, School of Medicine, Eulji University,Daejeon
| | - Dongwook Shin
- Cancer Survivorship Clinic, Seoul National University Cancer Hospital
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do
| | - Jong Hyock Park
- Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do.,College of Medicine, Chungbuk National University.,Graduate School of Health Science Business Convergence, Chungbuk National University, Chungbuk
| | - Kyung Duk Park
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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13
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Chun SH, Cho B, Yang HK, Ahn E, Han MK, Oh B, Shin DW, Son KY. Performance on physical function tests and the risk of fractures and admissions: Findings from a national health screening of 557,648 community-dwelling older adults. Arch Gerontol Geriatr 2017; 68:174-180. [DOI: 10.1016/j.archger.2016.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/21/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
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14
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Lee K, Oh S, Ahn E, Lee J, Jung S, Moon K. P08.55 Lichen secondary metabolite, usnic acid, inhibit glioblastoma progression through the reduction of epithelial-mesenchymal transition and glioma stemness factors. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Lee H, Shin DW, Lee TH, Yang HK, Ahn E, Yoon JM, Lee HK, Suh B, Son KY, Kim JS, Cho B. Association Between Change in Serum Aminotransferase and Mortality: A Nationwide Cohort Study in Korea. Medicine (Baltimore) 2016; 95:e3158. [PMID: 27015199 PMCID: PMC4998394 DOI: 10.1097/md.0000000000003158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is little information on how the change in serum aminotransferase affects mortality. We investigated the association between changes in serum aminotransferase levels and mortality from all causes, cardiovascular disease (CVD), and liver disease.Three percent of men from the Korean National Health Insurance database were sampled randomly at the end of 2002. After excluding patients with cancer, CVD, CVD risk factors, or liver disease, those who participated in 2 consecutive rounds of the national health screening examination were included (n = 68,431). The primary outcome was CVD mortality. Secondary outcomes were liver disease mortality and all-cause mortality. Change in metabolic profiles was analyzed based on changes in liver enzyme levels. Elevated levels of serum aminotransferase were associated with CVD, liver disease, and all-cause mortality. Men who had sustained elevation of serum aminotransferase during 2 subsequent liver enzyme tests showed a significantly higher risk of CVD mortality (adjusted hazard ratio [aHR] 1.95; 95% confidence interval [CI] 1.07-3.56, 2.29; 1.27-4.12) than the sustained normal group. In contrast, the normalization group (aHR 1.52, 95% CI 0.82-2.81 for aspartate aminotransferase [AST]; aHR 1.35, 95% CI 0.70-2.61 for alanine aminotransferase [ALT]) and the new elevation group (aHR 1.27, 0.66-2.44 for AST; aHR 0.99, 95% CI 0.49-2.20 for ALT) were not different from the sustained normal group in CVD mortality.Individuals with serum aminotransferase elevation, particularly when sustained, are at higher risk of mortality, and should receive appropriate medical attention.
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Affiliation(s)
- Hyejin Lee
- From the Department of Family Medicine and Health Promotion Center (HL, DWS, EA, J-MY, H-KL, BS, KYS, JSK, BC), Seoul National University Hospital; Department of Family Medicine (DWS, BC), College of Medicine, Seoul National University, Seoul, Korea; Division of Gastroenterology and Hepatology (THL), Metro Health Medical Center, Case Western Reserve University, Cleveland, OH; and Cancer Policy Branch (H-KY), National Cancer Control Institute, National Cancer Center, Goyang, Korea
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16
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Nguyen Q, Ahn E, Tsai L. From vision to reality: a guide to the biomedical design and development process for interventional radiologists. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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17
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Alvarez RH, Hartman S, Bosch B, Kendrick D, Cohen L, Fridman J, Ottersen D, Walcott K, Ware S, Castro I, Thomas J, Niu J, Ahn E, Denny D, Markman M. Abstract P1-10-27: Self-reported symptoms and interference issues in breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer and its treatments produce multiple symptoms that significantly impact patient quality of life (QOL). Distress and impaired function are the most commonly referred symptoms [Cleeland CS, 2007]. Routine cancer care assessment of patient-reported outcomes (PROs), including symptoms, function, and QOL, has been shown to improve symptom management, identification of psychosocial problems, and patient-provider communication. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients' perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) [Cleeland CS, Cancer 2013], and validated assessment instrument with 8 questions added and a free text box by Cancer Treatment Centers of America (CTCA). CTCA is a national network of five hospitals that specialize in cancer treatment and integrative oncology.
PATIENTS & METHODS: Patients reported symptoms intensity using 19-item MD Anderson Symptom Inventory (MDASI) and 8 additional questions created by CTCA (constipation, swelling, mouth soreness, bleeding, sexual interest, family, hope & QOL). Symptoms were rated "at the worst" on an 11-point numeric scale ranging from 0 ('no present") to 10 ("as bad as you can imagine") in the previous 24 hours. SIT became an integral part of patient care at CTCA beginning in 2012.
RESULTS: From July 2012 to February 2015, a total of 3,740 outpatients with breast cancer were evaluated at CTCA.
A total of 13,852 assessments were analyzed. The assessments consisted of 3,513 completed at baseline, 2,237 completed at the 2nd follow up (FU), and 8,014 completed at 3rd FU or greater. Median age was 50 (range, 17-88), 60% of patients were ER+. Race: White (68%), Black (29%), and other (3%). Disease extension: locoregional (86%) and metastatic (13.6%). The average time since cancer was diagnosed were 35 months, and 50.7% of the patients received prior systemic therapy: chemotherapy (55%), hormone-therapy (41%), and immunotherapy (4%). Mean, standard deviation and inter quartile ranges at baseline assessment are depicted in.
Table 1.Patient Reported SymptomBaseline assessment statisticsPercentage of patients with severe symptoms at baseline and reporting a clinically significant change (2 points) at 2nd SIT assessment Mean +/- STDInterquartile range (IQR)Significant decreaseNo changeDistress3.0 +/- 3.0[0.5]695 (31.3%)594 (26.8%)414 (18.7%)Sadness2.5 +/- 2.9[0.4]622 (28%)718 (32.3%)358 (16.1%)Disturbed Sleep3.3 +/- 3.2[0.6]550 (24.8%)517 (23.3%)642 (28.9%)Mood2.6 +/- 2.7[0.4]549 (24.7%)678 (30.5%)447 (20.1%)Pain2.7 +/- 3.0[0.5]523 (23.9%)675 (30.8%)519 (23.7%)*IQR is a measure of variability, based on dividing a data set into quartiles. Quartiles divide a rank-ordered data set into four equal parts
CONCLUSIONS: The SIT was successful in identifying symptoms burden and interference with life issues in breast cancer patients. Distress, sadness, disturbed sleep, mood and pain were the most common reported symptoms. Early identification of patient burden symptoms allowed immediate intervention and improvement in approximately a quarter of patients.
Citation Format: Alvarez RH, Hartman S, Bosch B, Kendrick D, Cohen L, Fridman J, Ottersen D, Walcott K, Ware S, Castro I, Thomas J, Niu J, Ahn E, Denny D, Markman M. Self-reported symptoms and interference issues in breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-27.
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Affiliation(s)
- RH Alvarez
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - S Hartman
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - B Bosch
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - D Kendrick
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - L Cohen
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - J Fridman
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - D Ottersen
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - K Walcott
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - S Ware
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - I Castro
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - J Thomas
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - J Niu
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - E Ahn
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - D Denny
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
| | - M Markman
- Cancer Treatment Centers of America, Newnan, GA; GRU-UGA Medical Partnership, Athens, GA
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18
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Alvarez RH, Thomas JW, Kramer K, Niu J, Ahn E, McKnight JE, Dhillon N, Pabbathi H, Johnson AT, Wang K, Ross JS, Miller VA, Stephens PJ, Daneker GW, Ali S, Markman M. Abstract P6-07-06: Clinicopathologic characterization and comprehensive genomic profiling (CGP) of advanced breast cancer patients with fibroblast growth factor receptor (FGFR) alterations. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-07-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: FGFR family members are infrequently mutated but are frequently overexpressed in breast cancer and often accompanied by increased, or altered, expression of FGF ligands. In this retrospective study, we reviewed a large series of FGFR altered breast cancer cases that received comprehensive genomic profiling (CGP) in the course of clinical care.
MATERIAL AND METHODS: CGP was performed on hybridization-captures, adaptor ligation-based libraries using DNA extracted from 40 μm formalin-fixed paraffin-embedded (FFPE) section cut at 10 μm performed in a CLIA-certified lab (Foundation Medicine, Inc.). The pathologic diagnosis of each case was confirmed on routine hematoxylin and eosin-stained slides, and all samples forwarded for DNA extraction contained a minimum of 20% of DNA derived from tumor cells. The FoundationOne test sequences the full coding regions of up to 315 cancer-related genes, and up to 28 genes that are frequently altered in cancer to detect all classes of genomic alterations including base substitutions, indels, copy-number alterations (CNA), and fusions/rearrangements. The average depth of coverage is greater than 600X. The genomic profiles of 2,617 patients with diverse advanced malignancies who were evaluated at Cancer Treatment Centers of America between 12/24/12 and 03/11/15 were reviewed. 176 FGFR alterations (7.8%) were detected, of which 76 (43.5%) were found in breast cancer cases out of 434 (16.5%). The study was carried out in accordance with WIRB Institutional Review Board.
RESULTS: A total of 76 female breast cancer patients, having a median age 50 (range, 28-69), with FGFR alterations were reviewed. All patients had metastatic/relapsed advanced breast cancer. 54 patients were Estrogen Receptor-positive (70%), and 15 were HER2+ (20%). 6 patients had gBRCA deleterious mutations. 84% of the samples (n=67) tissue block were analyzed, and the anatomic sites represented by the samples were 24 breast primary tumor (31%), 15 liver (19%), 10 lymph nodes (13%), and other sites (37%). The median number of chemotherapies cycles was 4 (range, 1-12), and the median time to metastasis was 31 months (range, 0-175). At the time of this report, 31 patients (40%) were deceased. 79 FGFR gene alterations were identified in 76 patients, including FGFR1 (65), FGFR2 (6), FGFR3 (2), and FGFR4 (4), with all but 7 of these being amplifications. The most co-existent altered gene was TP53 (66%), and other altered genes included PIK3CA (37%), MYC (28%), FGF3/4/19 (17%), CCND1 (17%), and CCNE1 (16%). The subset of co-amplified FGF3/4/19 and FGFR amplified patients were all (7) ER+ except for 1 patient.
CONCLUSIONS: FGFR genomic alterations in breast cancer patients are predominantly amplifications and are most commonly observed in ER+ patients. Further review of treatment history will be performed to evaluate the hypothesis that alterations of FGFR is a modifier of response to endocrine therapy, and co-amplified FGF3/4/19 and FGFR breast cancer cases may be a distinct clinic-pathologic entity. Any patients in this series initiated on anti-FGFR targeted therapy will also be reported.
Citation Format: Alvarez RH, Thomas JW, Kramer K, Niu J, Ahn E, McKnight JE, Dhillon N, Pabbathi H, Johnson AT, Wang K, Ross JS, Miller VA, Stephens PJ, Daneker GW, Ali S, Markman M. Clinicopathologic characterization and comprehensive genomic profiling (CGP) of advanced breast cancer patients with fibroblast growth factor receptor (FGFR) alterations. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-07-06.
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Affiliation(s)
- RH Alvarez
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - JW Thomas
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - K Kramer
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - J Niu
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - E Ahn
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - JE McKnight
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - N Dhillon
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - H Pabbathi
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - AT Johnson
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - K Wang
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - JS Ross
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - VA Miller
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - PJ Stephens
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - GW Daneker
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - S Ali
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
| | - M Markman
- Cancer Treatment Centers of America, Newnan, GA; Foundation Medicine Inc, Cambridge, MA
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Dixon J, Ahn E, Zhou L, Lim R, Simpson D, Merriman EG. Venous thromboembolism rates in patients undergoing major hip and knee joint surgery at Waitemata District Health Board: a retrospective audit. Intern Med J 2016; 45:416-22. [PMID: 25644232 DOI: 10.1111/imj.12702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Symptomatic venous thromboembolism (VTE) complicates approximately 4% of major orthopaedic surgical procedures performed without thromboprophylaxis. Randomised clinical trials demonstrate primary thromboprophylaxis reduces VTE rates to <1%, with low rates of clinically important bleeding, using low molecular weight heparin (LMWH), oral FXa inhibitors or thrombin inhibitors. We reviewed the rates of VTE in patients undergoing major hip/knee joint surgery at Waitemata District Health Board (WDHB). METHODS Cases of VTE within 90 days of orthopaedic surgery were identified by retrospective audit of data from the haematology VTE database. The number of major hip/knee joint surgeries at WDHB from January 2006 to December 2010 was obtained from clinical coding data. RESULTS The cumulative incidence of VTE within 90 days of surgery was 3.29%. The median time from surgery to diagnosis was 7 days. Deep vein thrombosis comprised 75% of cases, 77.6% distal and 23.2% proximal. Pulmonary embolism comprised 26.5% of VTE; 47.7% had right heart strain on computed tomography/echocardiography. Hip fracture surgery comprised one-third of patients. Of patients developing VTE, 85.5% had chemical thromboprophylaxis - aspirin 73%, LMWH 20 mg 16%, LMWH 40 mg 16%, therapeutic LMWH 3%, unfractionated heparin twice daily 1%, and warfarin 4%; 75.6% received mechanical prophylaxis, while 4% of patients received no prophylaxis. CONCLUSION VTE incidence after major hip/knee joint surgery at WDHB is high, with pulmonary embolism comprising almost one-third of all VTE in this study, indicating the prophylaxis given is suboptimal. Implementation of appropriate, extended duration prophylaxis as per evidence-based guidelines is required to reduce these rates.
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Affiliation(s)
- J Dixon
- Haematology Department, Waitemata District Health Board, Auckland, New Zealand
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20
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Ahn E, Shin DW, Yang HK, Yun JM, Chun SH, Suh B, Lee H, Son KY, Cho B. Treatment Gap in the National Health-screening Program in Korea: Claim-based Follow-up of Statin Use for Sustained Hypercholesterolemia. J Korean Med Sci 2015; 30:1266-72. [PMID: 26339166 PMCID: PMC4553673 DOI: 10.3346/jkms.2015.30.9.1266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/07/2015] [Indexed: 11/24/2022] Open
Abstract
Participation in a screening program by itself may not improve clinical outcomes. Treatment gaps in the program may limit its full benefit. We evaluated statin prescription rates for subjects with sustained hypercholesterolemia to assess the treatment gaps in the National Health Screening Program (NHSP) in Korea. A retrospective, random cohort was established among National Health Insurance Corporation (NHIC) members. Finally, we examined 465,499 individuals who attended the NHSP from 2003 to 2010 without any history of dyslipidemia, statin prescription, or hospitalization for cardiovascular events until the end of 2002. The subsequent statin prescription rates were identified from the NHIC medical service claim database from 2003 to 2011. Descriptive data and odds ratio from multivariate logistic analyses on statin prescription rates and the corresponding correlations were evaluated. The NHSP detected 114,085 (24.5%) cases of newly diagnosed hypercholesterolemia. However, only 8.6% of these received statin prescription within 6 months of diagnosis. For cases of sustained hypercholesterolemia determined in the next screening visit by the NHSP, the statin prescription rate increased, but only to 12.2%. Statin prescriptions were more common among females, older individuals, and hypertension or diabetes patients. Furthermore, the statin prescription rates had increased over the study period. The NHSP exhibited low statin prescription rate which has been improving. For the NHSP to be effective, it would be worthwhile to decrease the gap between the diagnosis of hypercholesterolemia and the following treatment.
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Affiliation(s)
- Eunmi Ahn
- Cancer Policy Branch, National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Korea
- JW Lee Center for Global Medicine, and College of Medicine, Seoul National University, Seoul, Korea
| | - Hyung-kook Yang
- Cancer Policy Branch, National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - So Hyun Chun
- Department of Family Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Beomseok Suh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Ki Young Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Korea
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21
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Kim SH, Shin DW, Kim SY, Yang HK, Nam E, Jho HJ, Ahn E, Cho BL, Park K, Park JH. Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language? Cancer Res Treat 2015; 48:759-67. [PMID: 26323640 PMCID: PMC4843735 DOI: 10.4143/crt.2015.124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients’ cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. Materials and Methods A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don’t know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. Results Only 411 respondents (20.6%) chose “advanced,” while most respondents (74.5%) chose “terminal stage” as the stage of the hypothetical patient, and a small proportion of respondents chose “early stage” (0.7%) or “don’t know” (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. Conclusion A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.
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Affiliation(s)
- Sang Hyuck Kim
- Department of Family Medicine and Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine and Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - So Young Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyung Kook Yang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunjoo Nam
- Cancer Policy Branch, National Cancer Center, Goyang, Korea
| | - Hyun Jung Jho
- Hospice and Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunmi Ahn
- Hospice and Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Be Long Cho
- Department of Family Medicine and Cancer Survivorship Clinic, Seoul National University Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Institute on Aging, Seoul National University College of Medicine, Seoul, Korea ; Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Korea
| | - Keeho Park
- Cancer Policy Branch, National Cancer Center, Goyang, Korea
| | - Jong-Hyock Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, Korea.,Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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22
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Suh B, Yun JM, Park S, Shin DW, Lee TH, Yang HK, Ahn E, Lee H, Park JH, Cho B. Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB-4 liver fibrosis index. Cancer 2015; 121:3818-25. [PMID: 26178294 DOI: 10.1002/cncr.29577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/15/2015] [Accepted: 06/22/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although heavy alcoholics are at heightened risk for hepatocellular carcinoma (HCC), there are no guidelines that recommend HCC screening for heavy alcoholics. This study investigated FIB-4, a noninvasive and easily applicable liver fibrosis index, as a risk factor for HCC incidence among alcohol drinkers without viral hepatitis. METHODS This retrospective cohort study included 6661 generally healthy adults who were 30 years old or older, did not have chronic viral hepatitis, and visited Seoul National University Hospital for a general, routine health evaluation. The future HCC incidence was determined from National Health Insurance medical service claims data (median follow-up, 6.2 years). RESULTS With adjustments for age, sex, body mass index, smoking, and alcohol, compared with subjects with FIB-4 values less 1.00, subjects with FIB-4 values greater than or equal to 1.75 and less than 2.10 and subjects with FIB-4 values greater than or equal to 2.10 had adjusted hazard ratios (aHRs) of 5.18 (95% confidence interval [CI], 1.12-24.00) and 13.63 (95% CI, 3.77-49.33), respectively, for HCC incidence. This was heightened in subjects who drank more 30 g of alcohol per day: the aHRs were 8.39 (95% CI, 1.28-54.87) and 16.58 (95% CI, 3.87-71.04), respectively. FIB-4 was shown to have a higher predictive value for HCC incidence than ultrasonographically detected liver cirrhosis (C-index, 0.665 vs 0.527; P = .044). CONCLUSIONS High FIB-4 is a risk factor with a high predictive value for HCC incidence, especially among moderate to heavy alcoholics (>30 g/d). FIB-4 is a readily available and probably cost-effective clinical tool with potential value for identifying subpopulations of alcoholics at particularly high risk who would benefit from regular HCC screening. Further investigations are warranted to validate our results; nonetheless, our study suggests that FIB-4 may be useful in HCC screening among alcoholics.
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Affiliation(s)
- Beomseok Suh
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Moon Yun
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sehhoon Park
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
| | - Tae Hoon Lee
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Hyung-Kook Yang
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Eunmi Ahn
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
| | - Jin Ho Park
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - BeLong Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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23
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Suh B, Park S, Shin DW, Yun JM, Yang HK, Yu SJ, Shin CI, Kim JS, Ahn E, Lee H, Park JH, Cho B. High liver fibrosis index FIB-4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers. Hepatology 2015; 61:1261-8. [PMID: 25502481 DOI: 10.1002/hep.27654] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/06/2014] [Indexed: 12/11/2022]
Abstract
UNLABELLED Screening for hepatocellular carcinoma (HCC) is clinically important given that its early detection has remarkable survival benefits. We investigated the possible role of FIB-4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers 40 years of age or older who visited Seoul National University Hospital for a health checkup. National medical service claims data were used to determine HCC incidence. Median follow-up time was 5.4 years (interquartile range: 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and antiviral medication for hepatitis B, compared to subjects with FIB-4 <1.25, subjects with 1.7≤ FIB-4 <2.4 showed an adjusted hazard ratio (aHR) of 4.57 (95% confidence interval [CI]: 1.50-13.92) and subjects with FIB-4 ≥2.4 showed an aHR of 21.34 (95% CI: 7.73-58.92) for HCC incidence. FIB-4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C-index: 0.701 vs. 0.831; P = 0.001). FIB-4 was also better predictive of HCC incidence, compared to that of ultrasonographic liver cirrhosis (C-index: 0.775 vs. 0.701; P = 0.040). CONCLUSION High FIB-4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB-4 is a promising, easily applicable, and cost-effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests that FIB-4 may play a valuable role in HCC screening among HBsAg carriers.
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Affiliation(s)
- Beomseok Suh
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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24
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Ahn E, Son KY, Shin DW, Han MK, Lee H, An AR, Kim EH, Cho B. Perceived risk as a barrier to appropriate diagnosis of irritable bowel syndrome. World J Gastroenterol 2014; 20:18360-18366. [PMID: 25561803 PMCID: PMC4277973 DOI: 10.3748/wjg.v20.i48.18360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/16/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate perceived risk, diagnostic testing, and acceptance of a diagnosis of irritable bowel syndrome (IBS) among the Korean laypersons.
METHODS: We designed a conceptual framework to evaluate the health-seeking behavior of subjects based on a knowledge, attitude, and practice model. We developed a vignette-based questionnaire about IBS based on a literature review and focused group interviews. The vignette described a 40-year-old woman who meets the Rome III criteria for IBS without red-flag signs. It was followed by questions about demographic characteristics, health behaviors, IBS symptoms, risk perception, perceived need for diagnostic tests, and acceptance of a positive diagnosis of IBS. We planned a nationwide survey targeting laypersons without IBS and between the ages of 20 and 69 years. Survey participants were selected by quota sampling stratified by gender, age, and nationwide location. A multivariate logistic model was constructed based on literature reviews, univariate analysis, and a stepwise selection method to investigate correlations between the perceived risk, need for diagnostic tests, and acceptance of a positive diagnosis.
RESULTS: Of 2354 eligible households, 1000 subjects completed the survey and 983 subjects were analyzed, excluding those who met symptom criteria for IBS. After reading the IBS vignette, the majority of subjects (86.8%) responded that the patient was at increased risk of severe disease. The most frequent concern was colon cancer (59.8%), followed by surgical condition (51.5%). Most subjects responded the patient needs diagnostic tests (97.2%). Colonoscopy was the most commonly required test (79.5%). Less than half of the respondents requested a stool examination (45.0%), blood test (40.7%), abdominal ultrasound (36.0%), or computed tomography (20.2%). The subjects who felt increased risk were more likely to see a need for colonoscopy [adjusted odds ratio (aOR) = 2.10, 95%CI: 1.38-3.18]. When asked about the positive diagnosis, the most frequent response was that “the patient would not be reassured” (65.7%). The increased risk perception group was less likely to be reassured by a positive diagnosis of IBS, compared to the other respondents (aOR = 0.52, 95%CI: 0.34-0.78).
CONCLUSION: For IBS diagnosis, increased risk perception is a possible barrier to the appropriate use of diagnostic tests and to the patient’s acceptance of a positive diagnosis.
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Shin DW, Cho J, Kim SY, Chung IJ, Kim SS, Yang HK, Ahn E, Park BR, Seo H, Park JH. Discordance among patient preferences, caregiver preferences, and caregiver predictions of patient preferences regarding disclosure of terminal status and end-of-life choices. Psychooncology 2014; 24:212-9. [PMID: 25099223 DOI: 10.1002/pon.3631] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 05/31/2014] [Accepted: 07/04/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The complexity of end-of-life (EOL) communication in cancer care is often increased by family caregivers, who frequently affect the information and decision-making process. We assessed cancer patient preferences (PP), family caregiver preferences (FCP), and family caregiver predictions of patient preferences (FCPPP) regarding the disclosure of terminal status, family involvement in the disclosure process, and EOL choices, and we evaluated the concordances among them. METHODS A national, multicenter, cross-sectional survey of 990 patient-caregiver dyads (participation rate = 76.2%) was performed. A set of paired questionnaires was independently administered to patients and their caregivers. RESULTS While patients and family caregivers had wide spectra of preferences, patients significantly preferred disclosure, direct disclosure by a physician, and palliative care options (all P < 0.001). Family caregiver predictions were similar to PP with regard to terminal disclosure (P = 0.35) but significantly different with regard to family involvement in the disclosure process and EOL choices (P < 0.001). The concordances of PP and FCP (κ = 0.08-0.13), and those of PP and FCPPP (κ = 0.09-0.17), were poor. The concordances of FCP and FCPPP were fair to moderate (κ = 0.35-0.67). Discrepancies between PP and FCP and between PP and FCPPP were associated with dysfunctional family communication. CONCLUSIONS Family caregivers do not generally concur with patients in their preferences, nor do they reliably predict PP. Open dialogue between patient and family caregivers would reduce the discrepancy. More emphasis on incorporating family caregivers in EOL communication is needed from clinical, research, and training perspectives.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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26
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Suh B, Park S, Shin DW, Yun JM, Keam B, Yang HK, Ahn E, Lee H, Park JH, Cho B. Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults. Ann Oncol 2014; 25:2260-2266. [PMID: 25057172 DOI: 10.1093/annonc/mdu274] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chronic inflammation is known to be one of the main steps in carcinogenesis. Identification of those with chronic inflammation may help identify subjects at risk of cancer. Previous studies have reported low albumin-to-globulin ratio (AGR) to be associated with increased cancer mortality in cancer patients, but there has been no study based on healthy populations. PATIENTS AND METHODS Our retrospective cohort study involved 26 974 generally healthy adults aged 30 or older who visited Seoul National University Hospital Health Promotion Center for self-referred health checkup. National medical service claims data were used to determine cancer incidence, and Korean death registry data was used to determine mortality. Median follow-up time for survival was 5.9 years (interquartile range 4.1 years). RESULTS Compared with subjects with AGR ≥ 1.5, subjects with 1.1 > AGR ≥ 1.0 and 1.0 > AGR showed adjusted hazard ratio (aHR) 2.69 (95% confidence interval, CI, 1.54-4.72) and aHR 6.71 (95% CI 3.56-12.66) for all-cause mortality, aHR 2.95 (95% CI 1.42-6.11) and aHR 4.38 (95% CI 1.57-12.25) for cancer mortality, and aHR 2.07 (95% CI 1.28-3.36) and aHR 3.99 (95% CI 2.10-7.58) for cancer incidence, respectively. When cancer incidence events after 2 years from baseline were separately analyzed, subjects with 1.1 > AGR ≥ 1.0 and 1.0 > AGR were associated with aHR 1.88 (95% CI 1.01-3.48) and aHR 2.55 (95% CI 1.03-7.11) for cancer incidence, respectively. Cancer events were increased in all types of cancer, but especially in liver and hematologic malignancies. CONCLUSIONS Low AGR is a risk factor for cancer incidence and mortality, both short- and long terms, in a generally healthy screened population. The results of this study need to be replicated in larger studies, along with the determination of the sensitivity and other diagnostic values of low AGR.
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Affiliation(s)
- B Suh
- 3rd Air Defense Missile Brigade, Republic of Korea Air Force, Seoul; Departments of Family Medicine and Health Promotion Center
| | - S Park
- Internal Medicine, Division of Hematology and Medical Oncology, Seoul National University Hospital, Seoul
| | - D W Shin
- Departments of Family Medicine and Health Promotion Center; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul.
| | - J M Yun
- Departments of Family Medicine and Health Promotion Center
| | - B Keam
- Internal Medicine, Division of Hematology and Medical Oncology, Seoul National University Hospital, Seoul
| | - H-K Yang
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - E Ahn
- Departments of Family Medicine and Health Promotion Center
| | - H Lee
- Departments of Family Medicine and Health Promotion Center; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul
| | - J H Park
- Departments of Family Medicine and Health Promotion Center
| | - B Cho
- Departments of Family Medicine and Health Promotion Center; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul
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An AR, Shin DW, Lee SM, Cho J, Ahn E, Lee H, Son KY, Choi HC, Park JH, Cho B. Sexual problems of female cancer survivors compared to women without cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ah Reum An
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - Seung Mi Lee
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Juhee Cho
- Cancer Education Center, Samsung Medical Center, Seoul, South Korea
| | - Eunmi Ahn
- Seoul National University Hospital, Seoul, South Korea
| | - Hyejin Lee
- Seoul National University Hospital, Seoul, South Korea
| | - Ki Young Son
- Seoul National University Hospital, Seoul, South Korea
| | - Ho-Chun Choi
- Seoul National University Hospital, Seoul, South Korea
| | - Jin Ho Park
- Seoul National University Hospital, Seoul, South Korea
| | - Belong Cho
- Seoul National University Hospital, Seoul, South Korea
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Shin DW, Park JH, Kim SY, Park EW, Yang HK, Ahn E, Park SM, Lee YJ, Lim MC, Seo HG. Guilt, censure, and concealment of active smoking status among cancer patients and family members after diagnosis: a nationwide study. Psychooncology 2013; 23:585-91. [PMID: 24352765 DOI: 10.1002/pon.3460] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to identify the prevalence of feelings of guilt, censure, and concealment of smoking status among cancer patients and their family members who continued to smoke after the patient's diagnosis. METHODS Among 990 patient-family member dyads, 45 patients and 173 family members who continued to smoke for at least 1 month after the patients' diagnoses were administered questions examining feelings of guilt, censure, and smoking concealment. RESULTS Most patients who continued to smoke reported experiencing feelings of guilt toward their families (75.6%) and censure from their family members (77.8%), and many concealed their smoking from their family members (44.4%) or healthcare professionals (46.7%). Family members who continued to smoke also reported feelings of guilt with respect to the patient (63.6%) and that the patient was critical of them (68.9%), and many concealed their smoking from the patient (28.5%) or healthcare professionals (9.3%). Patients' feeling of guilt was associated with concealment of smoking from family members (55.9% vs. 10.0%) or health care professionals (55.9% vs. 20.0%). Family members who reported feeling guilty (36.5% vs. 16.3%) or censured (34.5% vs. 16.7%) were more likely to conceal smoking from patients. CONCLUSION Many patients and family members continue to smoke following cancer diagnosis, and the majority of them experience feelings of guilt and censure, which can lead to the concealment of smoking status from families or health care professionals. Feelings of guilt, censure, and concealment of smoking should be considered in the development and implementation of smoking cessation programs for cancer patients and family members.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
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29
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Ahn E, Shin DW, Choi JY, Kang J, Kim DK, Kim H, Lee E, Hwang KO, Oh B, Cho B. The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients. Psychooncology 2013; 22:2771-8. [PMID: 23839783 DOI: 10.1002/pon.3346] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/05/2013] [Accepted: 06/10/2013] [Indexed: 11/07/2022]
Abstract
OBJECTS We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. METHODS Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. RESULTS Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p < 0.001), 'maintaining hope and pleasure' (4.55 vs. 3.92; p = 0.002), and 'unawareness of death' (4.41 vs. 4.26; p = 0.024). CONCLUSION Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged.
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Affiliation(s)
- Eunmi Ahn
- Department of Family Medicine, Family Medicine, Seoul National University Hospital, Seoul, Korea
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Ambros T, Zeichner SB, Zaravinos J, Montero AJ, Ahn E, Mani A, Kronish L, Mahtani RL, Vogel CL. Abstract P1-12-03: Low-dose capecitabine monotherapy in HER-2 negative metastatic breast cancer: a retrospective study. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Capecitabine (CAPE) has clinical activity in metastatic breast cancer (MBC) at an FDA approved dose of 1,250mg/m2 twice daily for 14 days every 21 days (BID Q14). This schedule has been adopted by many United States oncologists, although the starting dose is often reduced. To determine if lower doses of CAPE have comparable clinical activity as the FDA approved dose, we performed a retrospective analysis.
Methods: A retrospective review of records from a large breast cancer oncology practice and from Sylvester Cancer Center Deerfield Beach from 2000–2008 was performed after approval of the University of Miami IRB. Standard practice was CAPE low dose (CAPE-L) 1,000mg BID Q14. Primary outcome was clinical benefit rate (CBR) defined as complete response (CR), partial response (PR) or stable disease (SD) lasting for ≥ 6 months. Response rates (RR) in patients with measurable disease, progression free survival (PFS), overall survival (OS) defined as time period between beginning of CAPE and death, and adverse events (AE) defined according to the NCI CTCAE version 3.0 were secondary endpoints. A literature review was performed for comparison.
Results: Data from 296 patients (pts) with HER-2 negative MBC were reviewed. Of those, 73 received CAPE-L at a starting dose between 303 mg/m2 and 965 mg/m2 (median 614 mg/m2) BID Q14. Median number of prior lines of therapy was 1 (range 0–10); 34/73 (46.6%) of pts received CAPE-L as first line therapy. 23.3% of pts required dose reductions because of palmar-plantar erythrodysesthesia (PPE) (44%), diarrhea (17%), mucositis (11%) or other (28%). RR in 61 patients with measurable disease was 25%. PR occurred in 16/73 (22%), CR (0%), SD ≥ 6 months 21/73 (29%), and PD 31/73 (43%), with a CBR of 37/73 (51%). Median PFS and OS were 6.2 months (95% CI, 4.4 to 8) and 21.4 months (95% CI, 14.4 to 28.6), respectively. AEs are reported in table 2. We recognized 12 trials that used the FDA approved dose in 1,949 patients. Bidimensionally measurable disease was present in 1,630 patients. CBR was reported as 62% in 1,006 patients and RR as 24% in 398. Weighted averages of median PFS and OS were 5.1 months (95% CI, 4.5 to 5.7) and 12 months (95% CI, 9.6 to 14.4), respectively. Detailed toxicity data were available in 11 trials with 1,883 patients. A comparison of current series with literature review at standard dose follows (table 1).
Conclusion: Compared with previously published data, CAPE-L appeared more tolerable with comparable clinical efficacy as package insert doses.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-12-03.
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Affiliation(s)
- T Ambros
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - SB Zeichner
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - J Zaravinos
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - AJ Montero
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - E Ahn
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - A Mani
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - L Kronish
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - RL Mahtani
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
| | - CL Vogel
- University of Miami, FL; Mount Sinai Medical Center, Miami Beach, FL; Memorial Hospital West, Pembroke Pines, FL; SUNY Downstate, Brooklyn, NY
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Schwaiger N, Witek V, Feiner R, Pucher H, Zahel K, Pieber A, Pucher P, Ahn E, Chernev B, Schroettner H, Wilhelm P, Siebenhofer M. Formation of liquid and solid products from liquid phase pyrolysis. Bioresour Technol 2012; 124:90-4. [PMID: 22989638 DOI: 10.1016/j.biortech.2012.07.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 05/03/2023]
Abstract
The aim of the present work was to improve the C:O ratio in biomass by preserving the lignin macrostructure of lignocellulosic feed. The intention of liquid phase pyrolysis is to liquefy biomass and prepare biomass for further upgrading steps like hydrogenation and deoxygenation. Pyrolysis was carried out in a non-aqueous liquid phase heat carrier. The process was carried out in a semi-batch reaction vessel under isothermal conditions at T=350°C, supported by a quench to stop reactions instantaneously in order to observe formation of solid intermediates. This pyrolysis system enables the observation of liquid and solid product formation. Transformation of biomass into biochar was analyzed by infrared spectroscopy and elemental analysis. Stable lignin structure throughout the whole transformation was confirmed. It was shown that the lignin frame in wood remains without substantial loss, while the major amount of carbohydrates is pyrolyzed during liquid phase pyrolysis at T=350°C.
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Affiliation(s)
- N Schwaiger
- Institute of Chemical Engineering, Graz University of Technology, Graz, Austria.
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Yun YH, Kim SH, Yang AJ, Ahn E, Kim SH, Shin DO, Sun JS, Kim SO, Lee KM, Lee KS, Baik SH, Kim SK, Seo HS. Validation of the Energy Conservation Strategies Inventory (ECSI). J Pain Symptom Manage 2012; 43:606-13. [PMID: 22337351 DOI: 10.1016/j.jpainsymman.2011.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 04/08/2011] [Accepted: 04/12/2011] [Indexed: 11/19/2022]
Abstract
CONTEXT In applying good energy conservation strategies to relieve cancer-related fatigue, it is critical to first identify cancer patients who are at a high risk for poor energy conservation. However, instruments have not been developed to evaluate energy conservation strategies in an oncology setting. OBJECTIVES The aim of this study was to validate an instrument that cancer patients may use to evaluate energy conservation strategies to overcome cancer-related fatigue. METHODS The questionnaire development followed a four-phase process: 1) item generation and reduction, 2) construction, 3) pilot testing, and 4) field testing. Using relevant and priority criteria, as well as pilot testing, we developed a 25-item questionnaire. After field testing, five items were discarded. Finally, 20 items were included in the Energy Conservation Strategies Inventory (ECSI). Factor analysis, multitrait scaling analysis, and Cronbach's α were used to determine the construct validity and reliability. RESULTS Factor analyses of data from 140 cancer patients resulted in the ECSI, which covers activities related to planning, overcoming distractions, labor saving, burden reducing, and comfort. All subscales (Cronbach's α range, 0.69-0.78) and total scores (Cronbach's α=0.87) were found to possess acceptable internal consistency. CONCLUSIONS The good psychometric properties of the ECSI instrument show that it may be useful for measuring the frequency of energy conservation strategies used by cancer patients.
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Affiliation(s)
- Young Ho Yun
- Cancer Management Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
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Weizman AV, Ahn E, Thanabalan R, Leung W, Croitoru K, Silverberg MS, Steinhart AH, Nguyen GC. Characterisation of complementary and alternative medicine use and its impact on medication adherence in inflammatory bowel disease. Aliment Pharmacol Ther 2012; 35:342-9. [PMID: 22176478 DOI: 10.1111/j.1365-2036.2011.04956.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients is common. We characterised CAM utilisation and assessed its impact on medical adherence in the IBD population. AIM To characterise CAM utilisation and assess its impact on medical adherence in the IBD population. METHODS Inflammatory bowel disease patients recruited from an out-patient clinic at a tertiary centre were asked to complete a questionnaire on CAM utilisation, conventional IBD therapy, demographics and communication with their gastroenterologist. Adherence was measured using the self-reported Morisky scale. Demographics, clinical characteristics and self-reported adherence among CAM and non-CAM users were compared. RESULTS We recruited prospectively 380 IBD subjects (57% Crohn's disease; 35% ulcerative colitis, and 8% indeterminate colitis). The prevalence of CAM use was 56% and did not significantly vary by type of IBD. The most common reason cited for using CAM was ineffectiveness of conventional IBD therapy (40%). The most popular form of CAM was probiotics (53%). CAM users were younger than non-CAM users at diagnosis (21.2 vs. 26.2, P < 0.0001) and more likely than non-CAM users to have a University-level education or higher (75% vs. 62% P = 0.006). There was no overall difference in adherence between CAM and non-CAM users (Morisky score: 1.0 vs. 0.9, P = 0.26). CONCLUSIONS The use of complementary and alternative medicine is widely prevalent among IBD patients, and is more frequent among those with experience of adverse effects of conventional medications. From this cross-sectional analysis, complementary and alternative medicine use does not appear to be associated with reduced overall adherence to medical therapy.
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Affiliation(s)
- A V Weizman
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada
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Matsuo K, Prather C, Ahn E, Eno M, Im D, Rosenshein N, Yessaian A, Lin Y. Significance of perioperative infectious disease in patients with ovarian cancer. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ahn E, Shin DW, Cho SI, Park S, Won YJ, Yun YH. Suicide rates and risk factors among Korean cancer patients, 1993-2005. Cancer Epidemiol Biomarkers Prev 2010; 19:2097-105. [PMID: 20696665 DOI: 10.1158/1055-9965.epi-10-0261] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As the number of cancer survivors increases, suicide risk approaches that of the general population. We therefore investigated suicide rates and risk factors among Korean cancer patients. METHODS We observed 816,295 cancer patients for 3,007,294 person-years from 1993 to 2005 through a nationwide cancer registry. We calculated their sex- and age-standardized mortality ratios (SMR) and studied suicide risk factors using rate ratios (RR) based on a log-linear Poisson regression model. RESULTS Compared with the Korean general population, the suicide rate among cancer patients was high [SMR, 2.00; 95% confidence interval (95% CI), 1.91-2.08]. The rates were highest in the year following the cancer diagnosis (SMR, 3.45; 95% CI, 3.19-3.73) and were still elevated 5 years later (SMR, 1.23; 95% CI, 1.12-1.36). The clinical groups at highest risk were male pancreas cancer patients (SMR, 6.01; 95% CI, 4.33-8.33) and female lung cancer patients (SMR, 3.55; 95% CI, 2.55-4.94). The sociodemographic groups at highest risk were those who had no spouse versus those who were married (RR, 1.50; 95% CI, 1.35-1.68), those who were not employed versus those who were (RR, 1.39; 95% CI, 1.26-1.54), and those who did not have high school education versus those who had (RR, 1.52; 95% CI, 1.30-1.79). CONCLUSIONS Korean cancer patients are at increased risk of suicide. Both clinical and sociodemographic factors play a role. IMPACT There is a need for social support and suicide prevention strategies for cancer survivors in Korea.
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Affiliation(s)
- Eunmi Ahn
- Research Institute and Hospital, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
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Lucas MR, Armstrong TS, Acquaye A, Balachandran D, Mahajan A, Kang DH, Vera-Bolanos E, Gilbert MR, Lovely MP, Page M, Mogensen K, Arzbaecher J, Amidei C, Lupica K, Maher ME, Sherwood P, Kagan S, Sizoo EM, Pasman HRW, Reijneveld JC, Heimans JJ, Deliens L, Taphoorn MJ, Sheth R, Bagan BT, Baig MN, Karas C, Jacobs DI, Grimm SA, Rademaker A, Rice L, Chandler JP, Muro K, Marymount M, Helenowski IB, Wagner LI, Bennett CL, Raizer JJ, Evans A, Dhall G, Finlay J, Wong K, McComb G, Soffietti R, Mueller RP, Abacioglu U, Villa S, Fauchon F, Baumert B, Fariselli L, Tridello G, Kocher M, Bottomley A, Pendleton C, Adams H, Jallo GI, Carson BS, Ahn E, Quinones-Hinojosa A, Acquaye AA, Vera-Bolanos E, Armstrong TS, Bekele BN, Gilbert MR, Jacobs DI, Grimm SA, Rademaker A, Rice L, Chandler J, Muro K, Marymount M, Helenowski IB, Wagner LI, Raizer JJ, Nestor V, Fink K, Nashed M, Linskey M, Bota DA, Hoeben W, Hilverda K, Heimans JJ, Taphoorn MJ, Postma TJ, Buter J, Lenting J, Collette EH, Reijneveld JC, Klein M, van Nieuwenhuizen D, Bosscher L, Szymanska E, Heimans JJ, Peerdeman SM, Klein M, Reijneveld JC, van Nieuwenhuizen D, Erdmann T, Heimans JJ, Reijneveld JC, Peerdeman SM, Klein M, Lawrence Recht SN, Armstrong T, Vera-Bolanos E, Gning I, Acquaye A, Gilbert MR, Cleeland C, Mendoza TR, Jouniaux-Delbez N, Delattre JY, du Montcel ST, Butowski N, Parvataneni R, Nicole A, Lamborn K, Polley M, Clarke J, Chang S, Page M, Prados M, Liepa A, Shi P, Thornton D, Kahlenberg CA, Fadul CE, Scott R, Roberts DW, Thadani V, Bujarski K, Lallana EC, Jobst BC, Walker JG, Schultz D, Grisdale K, Groves MD, Peters KB, Reardon DA, Vredenburgh JJ, Desjardins A, Friedman HS, Allen DH, Carlson B, Neelon V, Giovanello K, Carlson J, Raynor R, Desjardins A, Rice L, Lall R, Ha S, Marymont M, Grimm S, Raizer J, Chandler J, Muro K, Keir ST. Quality of Life. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schwaiger N, Mertlitz V, Pucher P, Ahn E, Siebenhofer M. Feste und flüssige Produkte der Flüssigphasen-Pyrolyse. CHEM-ING-TECH 2010. [DOI: 10.1002/cite.201050207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shin DW, Ahn E, Kim H, Park S, Kim YA, Yun YH. Non-cancer mortality among long-term survivors of adult cancer in Korea: national cancer registry study. Cancer Causes Control 2010; 21:919-29. [PMID: 20169405 DOI: 10.1007/s10552-010-9521-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 02/04/2010] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the pattern of non-cancer deaths and to determine whether there is excess mortality from non-cancer causes among Korean long-term survivors of adult cancer. METHODS We merged national cancer registry data and national death registration data to determine non-cancer death patterns of 243,713 people who were diagnosed with cancer from 1993 to 2000 and who survived > or =5 years. We calculated standardized mortality ratios (SMRs) by an indirect standardization method. RESULTS Of the patient population, 26,498 (10.9%) had died as of December 2005; the cause of death for 6,364 (24.0%) of those was not cancer. The proportion of non-cancer mortality increased with age at diagnosis and correlated with the 5-year survival rate (r = 0.336 for women, 0.571 for men). Although the risk for non-cancer death was lower among long-term survivors in general (SMR, 0.78; 95% CI, 0.76-0.80), it was higher among younger survivors (SMR, 1.23-2.50, for those who died before 50) than the general population. Survivors had an elevated suicide rate (SMR, 1.28; 95% CI, 1.15-1.42), especially male (SMR, 1.35; 95% CI, 1.19-1.53) and stomach cancer survivors (SMR, 1.38; 95% CI, 1.14-1.66). CONCLUSIONS Appropriate medical attention for long-term adult cancer survivors, especially younger survivors, is warranted to prevent premature deaths from non-cancer causes.
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Affiliation(s)
- Dong Wook Shin
- National Cancer Control Institute (NCCI) and Hospital, National Cancer Center, 323 Ilsanro, Ilsan dong-gu, Goyang-si, Gyeonggi-do, 411-769, Korea
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Frühwirth H, Borkenstein C, Knoblechner I, Ahn E, Schagerl M, Siebenhofer M. Energetische Nutzung von Algenbiomasse. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mertlitz V, Schwaiger N, Ahn E, Siebenhofer M. Flüssigphasen-Pyrolyse biogener Edukte. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Dilated cardiomyopathy (DCM) is a common cardiac diagnosis that may result as a consequence of a variety of pathologies. The differential diagnosis remains quite broad since many pathologies can present as DCM, and as a result the approach to diagnosis may, at times, be quite difficult. This review article discusses genetic and acquired causes of DCM, pathophysiology of myocardial damage, pathology, and diagnostic criteria. An approach to management is also included, in the hope of informing physicians of a clinical entity that afflicts a substantial number of people worldwide.
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Affiliation(s)
- A Luk
- Department of Medicine, Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
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Soor GS, Luk A, Ahn E, Abraham JR, Woo A, Ralph-Edwards A, Butany J. Hypertrophic cardiomyopathy: current understanding and treatment objectives. Clin Mol Pathol 2009; 62:226-35. [DOI: 10.1136/jcp.2008.061655] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shin DW, Ahn E, Kim YM, Kang S, Kim BG, Seong SJ, Cha SD, Park CY, Yun YH. Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer quality of life questionnaire cervical cancer module. Oncology 2009; 76:190-8. [PMID: 19209009 DOI: 10.1159/000201571] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 09/10/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the psychometric properties of the Korean version of the Quality of Life questionnaire cervical cancer module (QLQ-CX24), developed by the European Organization for Research and Treatment of Cancer (EORTC). METHODS The EORTC QLQ-CX24 and the core questionnaire (the EORTC QLQ-C30) were administered to 860 Korean disease-free survivors of cervical cancer and 494 female control subjects from the general Korean population. The construct reliability and validity of the EORTC QLQ-CX24 questionnaire were assessed via factor analysis, multitrait scaling analyses and known group comparisons. RESULTS Factor structure of the Korean version of the EORTC QLQ-CX24 questionnaire agreed with the originally hypothesized scale structure. Scale reliability was confirmed by Cronbach's alpha coefficients for internal consistency, which ranged from 0.78 to 0.87. Convergent and discriminant validity was confirmed by multitrait scaling analysis, which revealed scaling errors of 0.9. The clinical validity of the Korean version of the EORTC QLQ-CX24 was demonstrated by the ability to discriminate among controls and patient subgroups of different stages, treatments and overall health status. CONCLUSIONS The Korean version of the EORTC QLQ-CX24 was found to be a reliable and a valid measure of quality of life among survivors of cervical cancer when administered in a large survey setting.
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Affiliation(s)
- Dong Wook Shin
- National Cancer Control Research Institute and Hospital, National Cancer Center, Ilsan-Gu, Goyang, Korea
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Ahn E, Cho J, Shin DW, Park BW, Ahn SH, Noh DY, Nam SJ, Lee ES, Yun YH. Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them. Breast Cancer Res Treat 2008; 116:609-16. [PMID: 18855135 DOI: 10.1007/s10549-008-0209-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
Abstract
We investigated the impacts of breast cancer diagnosis and treatment on employment status and the ability to perform occupational and housekeeping tasks. We performed a cross-sectional study to compare Korean breast cancer survivors (n = 1,594) who had been working before cancer diagnosis with a group of 20 to 60-year-old women from the general Korean population (n = 415). Employment decreased from 47.6% to 33.2% after cancer treatment. It was significantly smaller relative to the general population (52.1%) [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI): 1.35-2.11). There was an inverse association between employment and low levels of education, low household income, multiple comorbidities, disease stage, and mastectomy. In addition, women who lived with a spouse were more likely to quit working after treatment compared to women who had no spouse. Fatigue and exhaustion were the most frequent difficulties encountered during occupational work (by 46.8% of cancer survivors) and housework (64.6%). Our findings suggest that breast cancer has a greater impact on employment among Korean women than among women in previously studied Western populations. Our data suggest that socio-cultural factors, as well as certain clinical characteristics, influence the decisions of Korean women to return or to not return to work after surviving breast cancer.
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Affiliation(s)
- Eunmi Ahn
- National Cancer Control Research Institute & Hospital, National Cancer Center, Ilsandong-gu, Goyang-si, 410-769 Gyeonggi-do, South Korea
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Blaya M, Lopes GL, Roman E, Ahn E, Macintyre J, Quesada J, Levi J, Walker G, Green M, Rocha Lima CM. Phase II trial of capecitabine and docetaxel as second line therapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15029 Background: Docetaxel and Capecitabine in combination are synergistic in preclinical models. The role of second line chemotherapy in pancreatic cancer is palliative and the role under investigation. Methods: Capecitabine 800 mg/m2 PO bid on days 1–14 in combination with docetaxel 30 mg/m2 IV on days 1 and 8 of each 21-day cycle were given to patients with advanced and metastatic pancreatic cancer previously treated with Gemcitabine. A 3-stage sequential design phase II trial was used with early stopping rules for efficacy at 13 and 26 enrolled patients Results: Twenty-four patients are evaluable for toxicity and evaluable for response. Thirteen are females and 11 male patients. Median age was 65 years. ECOG PS was as follows: PS 0: 2 patients; PS 1: 15 patients; PS 2: 5 patients. Three patients achieved a PR, with a RR of 12.5%. Stable disease for 2 or more cycles was observed in 70.8% of patients (n=17). 45 % (n=11) of patients had a 50% or more decrease in CA 19–9 levels. Treatment was well tolerated with no toxic deaths. Grade III and IV toxicities consisted of fatigue in 4 pts (17%); hand-foot syndrome in 4 patients (17%); diarrhea, anemia and mucositis in 2 patients (9%) and peripheral neuropathy in one patient (4%) Conclusions: The combination of capecitabine and docetaxel is active and well tolerated in pancreatic cancer previously treated with gemcitabine based-therapy. Enrollment continues. [Table: see text]
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Affiliation(s)
- M. Blaya
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - G. L. Lopes
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - E. Roman
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - E. Ahn
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - J. Macintyre
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - J. Quesada
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - J. Levi
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - G. Walker
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - M. Green
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
| | - C. M. Rocha Lima
- University of Miami Jackson Memorial Hospital, Miami, FL; NOCR, Atlanta, GA
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Ernst M, Gangl W, Ahn E, Hilber T, Siebenhofer M, Marr R. Elektrochemische Oxidation und Mineralisierung von Aldehyden. CHEM-ING-TECH 2006. [DOI: 10.1002/cite.200650079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lopes G, Bastos B, Ahn E, Quesada JA, Allison M, Flores A, Ribeiro A, Levi J, Macintyre J, Rocha-Lima CM. A phase II trial of capecitabine and docetaxel in patients with previously treated pancreatic cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14111 Background: There is no accepted standard treatment for patients with advanced pancreatic cancer who progress after gemcitabine-based therapy. Capecitabine and docetaxel have single-agent activity in pancreatic cancer and have documented synergy in both pre-clinical models and in the treatment of other solid tumors. Methods: A phase II trial with a 3-stage sequential design was planned to assess the efficacy (primary end-point: response rate) and toxicity of capecitabine 800 mg/m2 PO bid on days 1–14 in combination with docetaxel 30 mg/m2 IV on days 1 and 8 of each 21-day cycle in patients with advanced pancreatic cancer who failed first-line gemcitabine-based chemotherapy. If no responses are observed after 13 patients or less than 3 responses are seen after 26 patients, accrual will stop and the combination deemed ineffective. Results: Eight patients have been enrolled (5 women, 3 men). Median age was 67 years. ECOG PS was as follows: PS 1, three patients; PS 2, five patients. All patients had adequate organ function. A total of 26 cycles have been administered (median: 2 cycles, range 1 to 8). Four patients had stable disease (median duration 9 weeks, range 6 to 24), and 3 had progressed at the time of first evaluation (2 cycles). One patient has not yet completed 2 cycles and is therefore not assessable for radiologic response. Out of 7 patients with an elevated CA 19–9, four had a decrease of 50% or greater while on chemotherapy. Grade 1 or 2 toxicity was seen in 3 patients (diarrhea, 1 patient; fatigue, 2 patients). Grade 3 or 4 toxicity was as follows: fatigue, 2 patients; dehydration, 1 patient; neuropathy, 1 patient. There were no treatment related deaths. Enrollment continues. Efficacy data fulfilling the first stage sequential design should be available at the time of the meeting. Median survival for all patients is currently 13 weeks (range 7–23 weeks) Conclusions: Capecitabine in combination with docetaxel is a well-tolerated regimen in the treatment of patients with pancreatic cancer who have failed prior gemcitabine-based therapy. Four out of 8 patients have had stable disease. Four of 7 patients have had a decrease of 50% or greater in CA 19.9 levels. Enrollment continues. Median survival of 13 weeks underscores the poor prognosis of this patient population. [Table: see text]
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Affiliation(s)
- G. Lopes
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - B. Bastos
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - E. Ahn
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - J. A. Quesada
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - M. Allison
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - A. Flores
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - A. Ribeiro
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - J. Levi
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - J. Macintyre
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
| | - C. M. Rocha-Lima
- Sylvester Comprehensive Cancer Center/University of Miami, Miami, FL
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Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, Navioz Y, Ungar WJ. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J OBSTET GYNAECOL 2005; 25:241-4. [PMID: 16147725 DOI: 10.1080/01443610500060651] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Pregnancy-Unique Quantification of Emesis (PUQE) is a scoring system to quantify the severity of nausea and vomiting of pregnancy (NVP). Based on quantification of the 3 physical symptoms of NVP (nausea, vomiting and retching), PUQE closely correlates with the validated but much more complex Rhodes' score. We examined the ability of PUQE to predict four independent aspects of NVP: (a) pregnant women's ability to take multivitamins. (b) rates of emergency room visits and hospitalisation for NVP. (c) health cost of NVP. (d) women's self scores of well-being in NVP. Using large prospective cohorts of women for each end point, severity of NVP measured by PUQE had significant predictive value for all 4 aspects sought. PUQE has been validated through 4 independent clinical outcomes of direct importance and relevance for NVP. The simplicity of PUQE and the ease of its execution make it a practical tool for both clinical follow-up and research.
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Affiliation(s)
- G Koren
- The Motherisk Program, Division of Clinical Pharmacology/Toxicology, The Hospital for Sick Children, University of Toronto, Canada.
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Ernst M, Marr R, Ahn E, Hilber T, Siebenhofer M. Untersuchungen zur elektrochemischen Oxidation von Polyolen. CHEM-ING-TECH 2005. [DOI: 10.1002/cite.200590378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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