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Kim Y, Keam B, Kang EJ, Kim JS, Kim HR, Lee KW, Kwon JH, Lee KE, Yang Y, Choi YH, Kim MK, Ji JH, Yun T, Choi MY, Lee KH, Kim SB, Ahn MJ. Analysis of Response and Progression Patterns of Tyrosine Kinase Inhibitors in Recurrent or Metastatic Adenoid Cystic Carcinoma: A Post Hoc Analysis of Two KCSG Phase II Trials. Cancer Res Treat 2024:crt.2024.008. [PMID: 38637966 DOI: 10.4143/crt.2024.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024] Open
Abstract
Purpose In this study, we evaluated 66 patients diagnosed with adenoid cystic carcinoma (ACC) enrolled in two Korean Cancer Study Group trials to investigate the response and progression patterns in recurrent and/or metastatic ACC treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs). Materials and Methods We evaluated 66 patients diagnosed with ACC who were enrolled in the Korean Cancer Study Group trials. The tumor measurements, clinical data, treatment outcomes, and progression patterns of therapy were analyzed. Results In the 66 patients (53 receiving axitinib and 13 receiving nintedanib), the disease control rate was 61%, and 3 patients achieved partial response. The median follow-up, median progression-free survival (PFS), overall survival, and 6-month PFS rate were 27.6, 12.4, and 18.1 months and 62.1%, respectively. Among 42 patients who experienced progression, 27 (64.3%) showed target lesion progression. Bone metastasis was an independent poor prognostic factor. Conclusion Overall, most patients demonstrated stable disease with prolonged PFS; however, prominent target lesion progression occurred in some patients. Thus, PFS may capture VEGFR-TKI efficacy better than the objective response rate.
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Affiliation(s)
- Youjin Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Joo Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hye Ryun Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Hye Kwon
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyoung Eun Lee
- Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk University Hospital, Chungbuk University College of Medicine, Cheongju, Korea
| | - Yoon Hee Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Min Kyoung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Ho Ji
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tak Yun
- Rare Cancers Clinic, Center for Specific Organs Cancer, National Cancer Center, Goyang, Korea
| | - Moon Young Choi
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk University Hospital, Chungbuk University College of Medicine, Cheongju, Korea
| | - Sung-Bae Kim
- Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim DH, Lim ST, Kim HR, Kang EJ, Ahn HK, Lee YG, Sun DS, Kwon JH, Lee SC, Lee HW, Kim MK, Keam B, Park KU, Shin SH, Yun HJ. Impact of PIK3CA and cell cycle pathway genetic alterations on durvalumab efficacy in patients with head and neck squamous cell carcinoma: Post hoc analysis of TRIUMPH study. Oral Oncol 2024; 151:106739. [PMID: 38458039 DOI: 10.1016/j.oraloncology.2024.106739] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES This study aimed to investigate whether genetic alterations in PI3KCA and the cell cycle pathways influence the efficacy of durvalumab, an immune checkpoint inhibitor, in patients with head and neck squamous cell carcinoma (HNSCC) who had previously failed platinum-based treatment. MATERIALS AND METHODS We obtained data from a phase II umbrella trial of patients with HNSCC who failed platinum-based treatment (TRIUMPH, NCT03292250). Patients receiving durvalumab treatment comprised those with PIK3CA alterations (Group A), those with cell cycle pathway alterations such as CDKN2A (Group B), and those with no druggable genetic alterations (Group C). We analyzed the overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) in each group and evaluated the potential predictive factors for durvalumab. RESULTS We analyzed the data of 87 patients: 18, 12, and 57 in groups A, B, and C, respectively. The ORRs were 27.8 %, 8.3 %, and 15.8 % in Groups A, B, and C, respectively (P = 0.329), and the median PFS for each group was 2.3, 1.6, and 1.7 months, respectively, with no significant differences between the groups (P = 0.24). Notably, patients with lower neutrophil-lymphocyte ratio (NLR) (≤5.8) had longer PFS (median, 2.8 vs 1.6 months, P < 0.001), while those with lower platelet-lymphocyte ratio (PLR) (≤491.2) exhibited longer PFS (median, 1.8 vs 1.2 months, P < 0.001). CONCLUSION Durvalumab's efficacy was similar, irrespective of the presence of PIK3CA or cell cycle pathway genetic alterations in patients with platinum-resistant HNSCC. The NLR and PLR may be promising predictive biomarkers.
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Affiliation(s)
- Dong Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Taek Lim
- Hematology and Medical Oncology, Wonju Severance Christianity Hospital, Wonju, Republic of Korea
| | - Hye Ryun Kim
- Divison of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Seoul, Republic of Korea
| | - Eun Joo Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Ahn
- Department of Medical Oncology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Der Sheng Sun
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min Kyoung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Keon-Uk Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Seong-Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea.
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Choi HW, Jung Y, Kim UJ, Lee SC, Kwon JH, Kim H, Kim S, Lee Y, Shim HJ, Cho SH, Chung IJ, Hwang EC, Kang SJ, Bae WK, Kee SJ. Comparative Study on the Immunogenicity of COVID-19 mRNA Vaccines in Patients Receiving Adjuvant and Palliative Chemotherapy. Chonnam Med J 2024; 60:69-77. [PMID: 38304127 PMCID: PMC10828089 DOI: 10.4068/cmj.2024.60.1.69] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 02/03/2024] Open
Abstract
This study was conducted to investigate potential differences in vaccine efficacy between patients undergoing palliative chemotherapy and receiving adjuvant chemotherapy. Additionally, the study proved the influence of vaccination timing on vaccine efficacy during active chemotherapy. Anti-receptor-binding domain (RBD) IgG binding antibody assays and surrogate neutralizing antibody assays were performed after BNT162b2 or mRNA-1273 vaccination in 45 solid cancer patients (23 adjuvant and 22 palliative chemotherapy) and in 24 healthy controls before vaccination (baseline), at every two to four weeks after the first (post-dose 1) and the second vaccination (post-dose 2). The levels of anti-RBD IgG and neutralizing antibodies increased significantly from baseline through post-dose 1 to post-dose 2 in all three groups. At the post-dose 1, the anti-RBD IgG and neutralizing antibody levels were significantly lower in cancer patients than in healthy controls. However, by post-dose 2, the seropositivity of anti-RBD IgG and neutralizing antibodies uniformly reached 100% across all groups, with no significant disparity in antibody levels among the three groups. Moreover, the antibody titers were not significantly different between patients with a vaccine and chemotherapy interval of more than 14 days or those with less than 14 days. This study demonstrated that after second doses of mRNA COVID-19 vaccines, humoral immune responses in patients receiving chemotherapy were comparable to those of healthy controls, regardless of whether the purpose of the anti-cancer treatment was palliative or adjuvant. Furthermore, the timing of vaccination did not affect the level of humoral immunity after the second vaccination.
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Affiliation(s)
- Hyun-Woo Choi
- Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Younggon Jung
- Division of Infectious Disease, Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sang-Cheol Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Jung Hye Kwon
- Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyeonjong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sarah Kim
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Yoonjung Lee
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Hyun-Jung Shim
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sang-Hee Cho
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Ik-Joo Chung
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Seung Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Seung-Jung Kee
- Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Kim DH, Lim Y, Ock CY, Park G, Park S, Song H, Ma M, Mostafavi M, Kang EJ, Ahn MJ, Lee KW, Kwon JH, Yang Y, Choi YH, Kim MK, Ji JH, Yun T, Kim SB, Keam B. Artificial intelligence-powered spatial analysis of tumor-infiltrating lymphocytes as a predictive biomarker for axitinib in adenoid cystic carcinoma. Head Neck 2023; 45:3086-3095. [PMID: 37828867 DOI: 10.1002/hed.27537] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND This study analyzed the predictive value of artificial intelligence (AI)-powered tumor-infiltrating lymphocyte (TIL) analysis in recurrent or metastatic (R/M) adenoid cystic carcinoma (ACC) treated with axitinib. METHODS Patients from a multicenter, prospective phase II trial evaluating axitinib efficacy in R/M ACC were included in this study. H&E whole-side images of archival tumor tissues were analyzed by Lunit SCOPE IO, an AI-powered spatial TIL analyzer. RESULTS Twenty-seven patients were included in the analysis. The best response was stable disease, and the median progression-free survival (PFS) was 11.1 months (95% CI, 9.2-13.7 months). Median TIL densities in the cancer and surrounding stroma were 25.8/mm2 (IQR, 8.3-73.0) and 180.4/mm2 (IQR, 69.6-342.8), respectively. Patients with stromal TIL density >342.5/mm2 exhibited longer PFS (p = 0.012). CONCLUSIONS Cancer and stromal area TIL infiltration were generally low in R/M ACC. Higher stromal TIL infiltration was associated with a longer PFS with axitinib treatment.
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Affiliation(s)
- Dong Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | | | | | | | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yoon Hee Choi
- Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, South Korea
| | - Min Kyoung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jun Ho Ji
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Tak Yun
- Rare Cancers Clinic, Center for Specific Organs Cancer, National Cancer Center, Goyang, South Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Cho MS, Lee SK, Kwon JH, Nam SW. Hepatobiliary and Pancreatic: Challenges in the diagnosis of hepatic nodules in patients with alcoholic liver cirrhosis. J Gastroenterol Hepatol 2023; 38:1867. [PMID: 37427538 DOI: 10.1111/jgh.16277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- M S Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S K Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J H Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S W Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Won YW, Kang JH, Kwon JH, Koo DH, Kang JH, Maeng CH, Ahn HK, Oh SY, Lee DW, Sohn J, Oh SY, Lee KH, Koh SJ, Lee KS, Kim CK, Kim JY, Ji JH, Kim SB, Ha JY, Kim HY. A Multicenter, Prospective, Observational Study to Evaluate Ethanol-Induced Symptoms in Patients Receiving Docetaxel Chemotherapy. Cancer Res Treat 2023; 55:1096-1103. [PMID: 37054719 PMCID: PMC10582550 DOI: 10.4143/crt.2022.1565] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms. MATERIALS AND METHODS This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day. RESULTS Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms. CONCLUSION The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.
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Affiliation(s)
- Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Jin-Hyoung Kang
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong,
Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jung Hun Kang
- Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju,
Korea
| | - Chi Hoon Maeng
- Division of Oncology and Hematology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Hee Kyung Ahn
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Sung Yong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan,
Korea
| | - Dae-Won Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Joohyuk Sohn
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - So Yeon Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan University College of Medicine, Yangsan,
Korea
| | - Kyung Hee Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu,
Korea
| | - Su-Jin Koh
- Division of Hematology and Oncology, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan,
Korea
| | - Keun Seok Lee
- Center for Breast Cancer, Research Institute, National Cancer Center, Goyang,
Korea
| | - Chan-Kyu Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Ji-Yeon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jun Ho Ji
- Division of Hematology and Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon,
Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Joo Young Ha
- Division of Hematology and Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Ho Young Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
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Yoon SJ, Suh SY, Hiratsuka Y, Choi SE, Kim SH, Koh SJ, Park SA, Seo JY, Kwon JH, Park J, Park Y, Hwang SW, Lee ES, Ahn HY, Cheng SY, Chen PJ, Yamaguchi T, Tsuneto S, Mori M, Morita T. Validation of Modified Models of Objective Prognostic Score in Patients With Advanced Cancer. J Palliat Med 2023; 26:1064-1073. [PMID: 37200448 DOI: 10.1089/jpm.2022.0509] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Background: The objective prognostic score (OPS) needs to be modified to reflect practical palliative care circumstances. Objectives: We aimed to validate modified models of OPS with few or no laboratory tests for patients with advanced cancer. Design: An observational study was performed. Setting/Subjects: A secondary analysis of an international, multicenter cohort study of patients in East Asia was performed. The subjects were inpatients with advanced cancer in the palliative care unit. Measurements: We developed two modified OPS (mOPS) models to predict two-week survival: mOPS-A consisted of two symptoms, two objective signs, and three laboratory results, while mOPS-B consisted of three symptoms, two signs, and no laboratory data. We compared the accuracy of the prognostic models using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Calibration plots for two-week survival and net reclassification indices (NRIs) were compared for the two models. Survival differences between higher and lower score groups of each model were identified by the log-rank test. Results: We included a total of 1796 subjects having median survival of 19.0 days. We found that mOPS-A had higher specificity (0.805-0.836) and higher AUROCs (0.791-0.797). In contrast, mOPS-B showed higher sensitivity (0.721-0.725) and acceptable AUROCs (0.740-0.751) for prediction of two-week survival. Two mOPSs showed good concordance in calibration plots. Considering NRIs, replacing the original OPS with mOPSs improved overall reclassification (absolute NRI: 0.47-4.15%). Higher score groups of mOPS-A and mOPS-B showed poorer survival than those of lower score groups (p < 0.001). Conclusions: mOPSs used reduced laboratory data and had relatively good accuracy for predicting survival in advanced cancer patients receiving palliative care.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Shin Ae Park
- Hospice and Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Ji-Yeon Seo
- Hospice and Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
| | - Youngmin Park
- Department of Family Medicine, Hospice and Palliative Care Center, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang-si, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Kang S, Lee MW, Song IC, Lee HJ, Yun HJ, Jo DY, Kim JS, Kwon JH, Kim JY, Lee KH, Ryu H. Maintenance therapy with Fluoropyrimidine and cetuximab or bevacizumab after first line FOLFOX-chemotherapy in metastatic colorectal cancer according to RAS or BRAF V600E mutation status. J Cancer Res Clin Oncol 2023; 149:7819-7829. [PMID: 37031435 DOI: 10.1007/s00432-023-04720-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/21/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Fluoropyrimidine (FP) with oxaliplatin-based chemotherapy is the standard first-line treatment for metastatic colorectal cancer (mCRC); however, oxaliplatin-induced neuropathy critically affects the quality of life of patients. Maintenance strategies with FP plus bevacizumab have been well-established; nonetheless, the real-world outcomes of maintenance therapy with FP and cetuximab are unclear. We investigated the clinical outcomes of patients who underwent maintenance therapy with cetuximab. METHODS We retrospectively identified and analyzed patients with mCRC who were treated between 2012 and 2021 with first-line oxaliplatin-based induction chemotherapy (IC) plus biologic agents (either cetuximab or bevacizumab), and underwent maintenance therapy (IC regimen without oxaliplatin) after IC. RESULTS In total, 19 patients who were treated with mFOLFOX6 (FP/leucovorin/oxaliplatin) with cetuximab, and 26 patients who were treated with mFOLFOX6 with bevacizumab were included. In the cetuximab group, all patients were KRAS-, NRAS-, and BRAF-wild type, whereas most patients in the bevacizumab group harbored KRAS or BRAFV600E or NRAS mutants. During the maintenance treatment, seven patients (four [21%] in the cetuximab group and three [11%] in the bevacizumab group) achieved partial response after achieving nadir during induction chemotherapy. The disease control rates of maintenance therapy were 79% and 74% in the cetuximab and bevacizumab groups, respectively. The median progression-free survival of maintenance therapy and overall survival was 5.98 months and 32.4 months in the cetuximab group, and 4.83 months and 25.6 months in the bevacizumab group, respectively. CONCLUSIONS Maintenance therapy with FP plus biologic agents (either bevacizumab or cetuximab) is a feasible strategy for appropriate mCRC patients according to their RAS/BRAF status. Further large-scale randomized studies are needed to validate the efficacy of anti-epidermal growth factor receptor-based maintenance therapy.
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Affiliation(s)
- Sora Kang
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Myung-Won Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ik-Chan Song
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyo-Jin Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hwan-Jung Yun
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Deog-Yeon Jo
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung Sun Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Ji-Yeon Kim
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Kyung-Ha Lee
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyewon Ryu
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
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9
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Kwon JH, Nickel KB, Reske KA, Stwalley D, Dubberke ER, Lyons PG, Michelson A, McMullen K, Sahrmann JM, Gandra S, Olsen MA, Burnham JP. Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic. J Hosp Infect 2023; 133:8-14. [PMID: 36493966 PMCID: PMC9724556 DOI: 10.1016/j.jhin.2022.11.020] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate risk factors for hospital-acquired infection (HAI) in patients during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, including historical and concurrent cohorts. DESIGN Retrospective cohort. SETTING Three Missouri hospitals, data from 1st January 2017 to 30th September 2020. PARTICIPANTS Patients aged ≥18 years and admitted for ≥48 h. METHODS Univariate and multi-variate Cox proportional hazards models incorporating the competing risk of death were used to determine risk factors for HAI. A-priori sensitivity analyses were performed to assess the robustness of the urine-, blood- and respiratory-culture-based HAI definition. RESULTS The cohort included 254,792 admissions, with 7147 (2.8%) HAIs (1661 blood, 3407 urine, 2626 respiratory). Patients with SARS-CoV-2 had increased risk of HAI (adjusted hazards ratio 1.65, 95% confidence interval 1.38-1.96), and SARS-CoV-2 infection was one of the strongest risk factors for development of HAI. Other risk factors for HAI included certain admitting services, chronic comorbidities, intensive care unit stay during index admission, extremes of body mass index, hospital, and selected medications. Factors associated with lower risk of HAI included year of admission (declined over the course of the study), admitting service and medications. Risk factors for HAI were similar in sensitivity analyses restricted to patients with diagnostic codes for pneumonia/upper respiratory infection and urinary tract infection. CONCLUSIONS SARS-CoV-2 was associated with significantly increased risk of HAI.
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Affiliation(s)
- J H Kwon
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - K B Nickel
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - K A Reske
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - D Stwalley
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - E R Dubberke
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - P G Lyons
- Division of Pulmonary and Critical Care Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - A Michelson
- Division of Pulmonary and Critical Care Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - K McMullen
- Mercy, Infection Prevention, St Louis, MO, USA
| | - J M Sahrmann
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - S Gandra
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - M A Olsen
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - J P Burnham
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, MO, USA.
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10
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Lee SW, Kwon JH, Beom SH, Shin SJ, Kim HS, Rha SY, Jung M, Sohn JH, Ahn JB, Chung HC, Kim GM, Kim HR, Kang B, Hu YJ, Choi HJ. Outcomes of an Acute Palliative Care Unit at a Comprehensive Cancer Center in Korea. Palliat Med Rep 2023; 4:9-16. [PMID: 36743339 PMCID: PMC9892919 DOI: 10.1089/pmr.2022.0033] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/19/2023] Open
Abstract
Background The acute palliative care unit (APCU) bridges between active cancer treatment and hospice care. However, no study has proven the efficacy of APCU in Korea. Objective To evaluate the first-year outcomes of the patients admitted to an APCU at a tertiary hospital in Korea. Design The APCU admitted 205 patients between April 14, 2014, and April 30, 2015. Of these patients, 57 were evaluable for baseline and one-week follow-up Edmonton Symptom Assessment System (ESAS). Results Of the 57 participants, 56.1% were male, with a median age of 60 years (range, 52.8-69.5 years). All patients had advanced cancer, and 42 out of 57 had terminal illnesses. The median APCU stay was 14 days (range, 10-17 days). The 42 (73.7%) patients were referred to the APCU after anticancer treatment was completed. Ten (17.5%) patients died during their stay, and 20 (35.1%) were discharged home. Among those who completed the ESAS, there were significant improvements in scores in the following symptoms: fatigue, depression, loss of appetite, and shortness of breath. Physical symptoms (pain, fatigue, nausea, drowsiness, appetite, and shortness of breath) and the total ESAS scores were significantly improved (p = 0.002 and p = 0.005, respectively). Each non-medical palliative care program, such as art and music therapy, yoga, foot massage, haircut, and body care, showed no significant differences between the group who received them and those who did not. Conclusion During the APCU stay, the overall symptoms of inpatients were reduced. A comprehensive and multidisciplinary team approach is essential for patients who need palliative care.
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Affiliation(s)
- Si Won Lee
- Palliative Care Center, Yonsei Cancer Center, Seoul, Republic of Korea.,Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Sejong Chungnam National University Hospital, Sejong, Republic of Korea.,Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea.,Daejeon Regional Cancer Center, Daejeon, Republic of Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Song Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Rha
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Hyuk Sohn
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joong-Bae Ahn
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gun Min Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beodeul Kang
- Yonsei Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea.,Division of Medical Oncology, Department of International Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Youn Jung Hu
- Palliative Care Center, Yonsei Cancer Center, Seoul, Republic of Korea
| | - Hye Jin Choi
- Palliative Care Center, Yonsei Cancer Center, Seoul, Republic of Korea.,Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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11
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Kim JS, Kwon JH, Rha SY, Lee SC, Chang YJ, Kwon IS, You KH, Yoon HY. Status of Using Complementary and Alternative Medicine among Patients with Cancer in Korea: an Online Survey of Online Cancer Support Groups (KCSG PC21-20). Cancer Res Treat 2022; 55:442-451. [PMID: 36596728 PMCID: PMC10101804 DOI: 10.4143/crt.2022.1483] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose An increasing number of patients with cancers are interested in complementary and alternative medicine (CAM), which lacks scientific evidence. This study aimed to determine how CAM was used and how media affected patients in online cancer support groups (OCSG). Materials and Methods Between August 18 and September 12, 2021, an online survey was conducted among the members of OCSG. The survey consisted of five parts: baseline characteristics, attitudes toward and experience with CAM, source of information and reliabilities, experience with anthelmintics, and online health information literacy and usage. Results Among the 644 responders, a total of 221 patients with cancer completed the survey, and 78.2% (173/221) used CAM. The users' median age was 52 years; 46.8% were males, and 43.9% had metastatic disease. Fifty-three CAM users (30.6%) discussed their physicians about CAM. In addition, 16.2% (28/173) of CAM users had the experience of anthelmintics. The use of anthelmintics in patients with cancers was associated with younger age (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84 to 0.95), metastatic disease (OR, 10.88; 95% CI, 3.39 to 34.86), previous exposure to CAM information (OR, 5.57; 95% CI, 1.01 to 30.72), experience with more types of CAM (OR, 1.98; 95% CI, 1.29 to 3.05), and side effects (OR, 5.10; 95% CI 1.46 to 17.75). Conclusion Use of anthelmintics, a CAM of which information is widespread online, is affected by several factors. This study will provide essential information for developing a CAM management strategy in this digital age.
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Affiliation(s)
- Jung Sun Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Sejong Chungnam National University Hospital, Sejong, Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Sejong Chungnam National University Hospital, Sejong, Korea.,Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.,Daejeon Regional Cancer Center, Daejeon, Korea
| | - Sun Young Rha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Cheol Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Yoon Jung Chang
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - In-Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Han You
- Department of Journalism and Communications, Jeonbuk National University, Jeonju, Korea
| | - Ho Young Yoon
- Division of Communication and Media, Ewha Womans University, Seoul, Korea
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12
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Yoon HY, You KH, Kwon JH, Kim JS, Rha SY, Chang YJ, Lee SC. Correction: Understanding the Social Mechanism of Cancer Misinformation Spread on YouTube and Lessons Learned: Infodemiological Study. J Med Internet Res 2022; 24:e44334. [PMID: 36427350 PMCID: PMC9736748 DOI: 10.2196/44334] [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: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.2196/39571.].
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Affiliation(s)
- Ho Young Yoon
- Division of Communication and MediaEwha Womans UniversitySeoulRepublic of Korea
| | - Kyung Han You
- Department of Media and Communication StudiesJeonbuk National UniversityJeonjuRepublic of Korea
| | - Jung Hye Kwon
- Division of Hemato-OncologyDepartment of Internal MedicineChungnam National University Sejong HospitalSejong-SiRepublic of Korea,Division of Hematology and OncologyDepartment of Internal Medicine, College of MedicineChungnam National UniversityDaejeonRepublic of Korea,Daejeon Regional Cancer CenterDaejeonRepublic of Korea
| | - Jung Sun Kim
- Division of Hemato-OncologyDepartment of Internal MedicineChungnam National University Sejong HospitalSejong-SiRepublic of Korea
| | - Sun Young Rha
- Division of Medical OncologyYonsei University College of MedicineSeoulRepublic of Korea,Yonsei Cancer Center, Yonsei University Health SystemSeoulRepublic of Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Center KoreaDepartment of Cancer Control and Population HealthNational Cancer Center Graduate School of Cancer Science and PolicyGoyangRepublic of Korea
| | - Sang-Cheol Lee
- Division of Hematology and OncologyDepartment of Internal MedicineSoonchunhyang University Hospital CheonanCheonanRepublic of Korea
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13
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Yoon HY, You KH, Kwon JH, Kim JS, Rha SY, Chang YJ, Lee SC. Understanding the Social Mechanism of Cancer Misinformation Spread on YouTube and Lessons Learned: Infodemiological Study. J Med Internet Res 2022; 24:e39571. [PMID: 36374534 PMCID: PMC9699593 DOI: 10.2196/39571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/30/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background A knowledge gap exists between the list of required actions and the action plan for countering cancer misinformation on social media. Little attention has been paid to a social media strategy for disseminating factual information while also disrupting misinformation on social media networks. Objective The aim of this study was to, first, identify the spread structure of cancer misinformation on YouTube. We asked the question, “How do YouTube videos play an important role in spreading information about the self-administration of anthelmintics for dogs as a cancer medicine for humans?” Second, the study aimed to suggest an action strategy for disrupting misinformation diffusion on YouTube by exploiting the network logic of YouTube information flow and the recommendation system. We asked the question, “What would be a feasible and effective strategy to block cancer misinformation diffusion on YouTube?” Methods The study used the YouTube case of the self-administration of anthelmintics for dogs as an alternative cancer medicine in South Korea. We gathered Korean YouTube videos about the self-administration of fenbendazole. Using the YouTube application programming interface for the query “fenbendazole,” 702 videos from 227 channels were compiled. Then, videos with at least 50,000 views, uploaded between September 2019 and September 2020, were selected from the collection, resulting in 90 videos. Finally, 10 recommended videos for each of the 90 videos were compiled, totaling 573 videos. Social network visualization for the recommended videos was used to identify three intervention strategies for disrupting the YouTube misinformation network. Results The study found evidence of complex contagion by human and machine recommendation systems. By exposing stakeholders to multiple information sources on fenbendazole self-administration and by linking them through a recommendation algorithm, YouTube has become the perfect infrastructure for reinforcing the belief that fenbendazole can cure cancer, despite government warnings about the risks and dangers of self-administration. Conclusions Health authorities should upload pertinent information through multiple channels and should exploit the existing YouTube recommendation algorithm to disrupt the misinformation network. Considering the viewing habits of patients and caregivers, the direct use of YouTube hospital channels is more effective than the indirect use of YouTube news media channels or government channels that report public announcements and statements. Reinforcing through multiple channels is the key.
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Affiliation(s)
- Ho Young Yoon
- Division of Communication and Media, Ewha Womans University, Seoul, Republic of Korea
| | - Kyung Han You
- Department of Media and Communication Studies, Jeonbuk National University, Jeonju, Republic of Korea
| | - Jung Hye Kwon
- Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Daejeon Regional Cancer Center, Daejeon, Republic of Korea
| | - Jung Sun Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong-Si, Republic of Korea
| | - Sun Young Rha
- Division of Medical Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Center Korea, Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Sang-Cheol Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Republic of Korea
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14
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Lee SH, Kwon JH, Won YW, Kang JH. Palliative Sedation in End-of-Life Patients in Eastern Asia: A Narrative Review. Cancer Res Treat 2022; 54:644-650. [PMID: 35436813 PMCID: PMC9296933 DOI: 10.4143/crt.2022.187] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/17/2022] [Indexed: 11/21/2022] Open
Abstract
Although palliative sedation (PS) is a common practice in the palliative care of cancer patients in Western countries, there is little related research on the practice in Korea. PS can be classified into several categories according to sedation level and continuity. PS is clearly distinct from euthanasia. While euthanasia is illegal and regarded as unethical in Korea, there is little ethical and legal controversy about PS in terms of the doctrine of double effect. Most studies have asserted that PS does not shorten the survival of terminal cancer patients. Since preference for PS heavily depends on stakeholder value, it should be preceded by shared decision-making through full communication among the patient, family members, and medical team. This is a narrative review article analyzing previous studies, especially from the three Eastern Asian countries, Korea, Japan and Taiwan, which share similar cultures compared with Western countries. Practical issues concerning PS—for example, prevalence, type and dosage of medications, salvage medication, timing of its initiation, and assessment—are described in detail.
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Affiliation(s)
- Seung Hun Lee
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Young-Woong Won
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
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15
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Hiratsuka Y, Suh SY, Won SH, Kim SH, Yoon SJ, Koh SJ, Kwon JH, Park J, Ahn HY, Cheng SY, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, Mori M, Inoue A. Prevalence and severity of symptoms and signs in patients with advanced cancer in the last days of life: the East Asian collaborative cross-cultural study to elucidate the dying process (EASED). Support Care Cancer 2022; 30:5499-5508. [PMID: 35304634 DOI: 10.1007/s00520-022-06969-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/10/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Few large-scale studies have focused on the prevalence of symptoms and signs during the last days of patients diagnosed with advanced cancer. Identifying the patterns of specific symptoms according to cancer type is helpful to provide end-of-life care for patients with advanced cancer. We investigated the prevalence and severity of symptoms and signs associated with impending death in patients with advanced cancer. METHODS In this secondary analysis of an international multicenter cohort study conducted in three East Asian countries, we compared the severity of symptoms and signs among dying patients in the last 3 days of life according to the type of primary cancer using one-way analysis of variance (ANOVA). Post hoc analysis was conducted for multiple comparisons of each symptom according to the type of primary cancer. RESULTS We analyzed 2131 patients from Japan, Korea, and Taiwan. The prevalence of most symptoms and signs were relatively stable from 1 week after admission to the last 3 days of life. According to cancer type, edema of the lower extremities was the most common symptom and fatigue/ ascites were the most severe symptoms in digestive tract cancer. For lung cancer, respiratory secretion was the most prevalent and dyspnea/respiratory secretion were the most severe symptoms. CONCLUSION We demonstrated the prevalence and severity of symptoms and signs associated with the impending death of patients with advanced cancer in East Asia. Our study can enable clinicians to recognize the specific symptoms and signs at the very end of life.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
- Department of Medicine, Dongguk University Medical School, Pildong 1-30, Jung-gu, Seoul, South Korea.
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Su-Jin Koh
- Department Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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16
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Kim JW, Ahn HK, Choi JG, Chae YS, Lee GW, Park KU, Lee E, Sim SH, Kim JH, Park YH, Kim M, Park JH, Kim JE, Kim HJ, Ahn MS, Oh SY, Kim MH, Koh SJ, Lee KE, Kang MJ, Byun JH, Ha JY, Kwon JH, Jung JY, Lee SE, Park I, Park KH. Abstract P5-16-03: Phase II study of trastuzumab biosimilar (Herzuma®) plus gedatolisib in patients with HER-2 positive metastatic breast cancer who progressed after 2 or more HER-2 directed chemotherapy (BR 18-13, KM-10A): Interim analysis. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-16-03] [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: Prognosis of patients with HER-2 positive metastatic breast cancer (MBC) has been revolutionized with the development of monoclonal antibodies targeting HER-2 and antibody-drug conjugate, but resistance to anti-HER-2 therapy is inevitable ultimately. PI3K-AKT-mTOR pathway aberration is known to be one of the key resistance mechanisms. BR18-13(KM-10A) study is a phase 2 clinical trial evaluating efficacy and safety of Herzuma® (trastuzumab biosimilar) plus Gedatolisib (dual PI3K/mTORC inhibitor) in patients with HER-2 positive MBC who progressed after multiple lines of therapy. Methods: Patients with HER-2 positive MBC with known PIK3CA pathologic mutation or amplification whose disease progressed after more than 2 HER-2 directed therapy were enrolled in the study. They received Herzuma® (8mg/kg IV for 1st cycle loading dose, and then 6mg/kg IV every 3 weeks) plus Gedatolisib (180mg on D1, 8, 15 of every 21 days). We evaluated efficacy of the combination treatment as interim analysis. The data cutoff of this interim analysis was June 8, 2021. Results: 17 patients were enrolled and followed for a median of 6.2 months. At data cutoff, 17 patients were eligible for response assessment. All patients were confirmed to have pathologic PIK3CA aberrations: 9 kinase mutations (H1047X), 5 helical mutations (E545X), 2 other point mutations, and 1 amplification. Overall, response rate was 64.7% and disease control rate was 82.4%. Eleven patients reached partial response (PR) as their best response, three were stable disease (SD), and three had progressive disease (PD). Two patients who have reached PR remain on investigational treatment until the data cutoff point, and the longest one is on treatment for 12.0 months. The median progression-free survival assessed in data cutoff time was 5.9 months. One patient ended treatment due to CNS disease progression, but her visceral metastatic lesions were decreased with experimental treatment. No fatal adverse events related to trial medication were reported. Conclusion: In this phase 2 study, Trastuzumab biosimilar plus Gedatolisib presented 64.7% of response rate with manageable toxicity in patients with HER-2 positive MBC with PIK3CA mutation. Clinical trial information: NCT03698383 Acknowledgement: this research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &Welfare, Republic of Korea (Grant number: HI17C2206).
Citation Format: Ju Won Kim, Hee Kyung Ahn, Jong Gwon Choi, Yee Soo Chae, Gyeong-Won Lee, Keon Uk Park, Eunmi Lee, Sung Hoon Sim, Jee Hyun Kim, Yeon Hee Park, Miso Kim, Jin Hyun Park, Jeong Eun Kim, Han Jo Kim, Mi Sun Ahn, So Yeon Oh, Min Hwan Kim, Su-Jin Koh, Kyoung Eun Lee, Myoung Joo Kang, Jae Ho Byun, Joo Young Ha, Jung Hye Kwon, Joo Young Jung, Su Ee Lee, Inhae Park, Kyong Hwa Park. Phase II study of trastuzumab biosimilar (Herzuma®) plus gedatolisib in patients with HER-2 positive metastatic breast cancer who progressed after 2 or more HER-2 directed chemotherapy (BR 18-13, KM-10A): Interim analysis [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-16-03.
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Affiliation(s)
- Ju Won Kim
- Korea University Anam Hospital, Seoul, Korea, Republic of
| | - Hee Kyung Ahn
- Gachon University Gil Medical Center, Incheon, Korea, Republic of
| | - Jong Gwon Choi
- Konyang University Hospital, Deajeon, Korea, Republic of
| | - Yee Soo Chae
- Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
| | - Gyeong-Won Lee
- Gyeongsang National University Hospital, Daegu, Korea, Republic of
| | - Keon Uk Park
- Keimyung University Dongsan Hospital, Daegu, Korea, Republic of
| | - Eunmi Lee
- Kosin University Gospel Hospital, Busan, Korea, Republic of
| | | | - Jee Hyun Kim
- Seoul National University Bundang Hospital, Bundang, Korea, Republic of
| | | | - Miso Kim
- Seoul National University Hospital, Seoul, Korea, Republic of
| | - Jin Hyun Park
- Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea, Republic of
| | | | - Han Jo Kim
- SoonChunHyang University Hospital, Cheonan, Korea, Republic of
| | - Mi Sun Ahn
- Ajou University Hospital, Suwon, Korea, Republic of
| | - So Yeon Oh
- Pusan National University Yangsan Hospital, Busan, Korea, Republic of
| | | | - Su-Jin Koh
- Ulsan University Hospital, Ulsan, Korea, Republic of
| | - Kyoung Eun Lee
- Ewha Womans University Medical Center, Seoul, Korea, Republic of
| | - Myoung Joo Kang
- Inje University Haeundae Paik Hospital, Busan, Korea, Republic of
| | - Jae Ho Byun
- The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea, Republic of
| | - Joo Young Ha
- Chung-Ang University Hospital, Seoul, Korea, Republic of
| | - Jung Hye Kwon
- Kangdong Sacred Heart Hospital, Seoul, Korea, Republic of
| | - Joo Young Jung
- Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea, Republic of
| | - Su Ee Lee
- Dong-A University Hospital, Busan, Korea, Republic of
| | - Inhae Park
- Korea University Guro Hospital, Seoul, Korea, Republic of
| | - Kyong Hwa Park
- Korea University Anam Hospital, Seoul, Korea, Republic of
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Kim S, Kim BJ, Kim I, Kim JH, Kim HK, Ryu H, Choi DR, Hwang IG, Song H, Kwon JH, Jung JY, Han B, Zang DY. A phase II study of chemotherapy in combination with telomerase peptide vaccine (GV1001) as second-line treatment in patients with metastatic colorectal cancer. J Cancer 2022; 13:1363-1369. [PMID: 35281880 PMCID: PMC8899359 DOI: 10.7150/jca.70385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background: GV1001 is a human telomerase peptide vaccine that induces a CD4/CD8 T-cell response against cancer cells, thereby affording an immunological anti-tumor effect. Here, we evaluated the efficacy and safety of GV1001 in combination with chemotherapy in patients with metastatic colorectal cancer who had failed first-line chemotherapy. Methods: This multicenter, non-randomized, single-arm phase II study recruited recurrent or metastatic colorectal cancer patients with measurable disease who had failed first-line chemotherapy. Patients received GV1001 and chemotherapy concomitantly based on a pre-established schedule. Cytotoxic chemotherapy and targeted agents (bevacizumab, cetuximab, or aflibercept) were allowed to be used at the discretion of the investigator. The primary endpoint was the disease control rate; secondary endpoints were the objective response rate, progression-free survival, overall survival, and safety outcomes. The baseline serum eotaxin level (a potential predictive biomarker of GV1001) was analyzed. To determine whether an adequate immune response had been induced, a delayed-type hypersensitivity test and a T-cell proliferation test were performed. Results: From May 13, 2015 to October 13, 2020, 56 patients with recurrent or metastatic colorectal cancer treated in seven hospitals of South Korea were enrolled. The median patient age was 64 years (range, 29-82 years); 67.9% were men. Of all patients, 66.1% had left-side colorectal cancer and the RAS mutation was present in 25%. The disease control rate and the objective response rates were 90.9% (95% confidence interval [CI]: 82.4-99.4%) and 34.1% (95% CI, 20.1-48.1%), respectively. The median progression-free survival was 7.1 months (95% CI, 5.2-9.1 months) and the median overall survival was 12.8 months (95% CI, 9.9-15.8 months). The most common all-grade adverse events were neutropenia (48.2%), nausea (26.8%), neuropathy (25.0%), stomatitis (21.4%), and diarrhea (21.4%). Immune response analysis showed that no patient had positive delayed-type hypersensitivity test results; antigen-specific T-cell proliferation was observed in only 28% of patients. The baseline eotaxin level was not associated with any efficacy outcome. Conclusion: Although no clear GV1001-specific immune response was observed, the addition of GV1001 vaccination to chemotherapy was tolerable and associated with modest efficacy outcomes.
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Kang EJ, Lee YG, Keam B, Choi JH, Kim JS, Park KU, Lee KE, Kim HJ, Lee KW, Kim MK, Ahn HK, Shin SH, Lee JB, Kwon JH, Kim HR, Kim SB, Yun HJ. Characteristics and treatment patterns in older patients with locally advanced head and neck cancer (KCSG HN13-01). Korean J Intern Med 2022; 37:190-200. [PMID: 34929077 PMCID: PMC8747907 DOI: 10.3904/kjim.2020.636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/30/2020] [Accepted: 10/05/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND/AIMS Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. METHODS Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III-IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. RESULTS Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. CONCLUSION Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.
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Affiliation(s)
- Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Seoul,
Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University Hospital, Suwon,
Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Keon Uk Park
- Department of Hemato-Oncology, Keimyung University Dongsan Medical Center, Daegu,
Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Mokdong Hospital, Seoul,
Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Min Kyoung Kim
- Department of Hematology-Oncology, Yeungnam University Medical Center, Daegu,
Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan,
Korea
| | - Jii Bum Lee
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
| | - Hye Ryun Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - Sung-Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
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Yeon SH, Lee MW, Duong TT, Kang S, Jee S, Ahn SY, Ryu H, Lee HJ, Kwon JH, Yun HJ, Jo DY, Song IC. Cardiopulmonary Exercise Test With Comorbidity Index Before Allogeneic Hematopoietic Stem Cell Transplantation. Integr Cancer Ther 2022; 21:15347354221134249. [DOI: 10.1177/15347354221134249] [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: 11/19/2022] Open
Abstract
Purpose: To evaluate the role of the cardiopulmonary exercise test (CPET) with comorbidity index as a predictor of overall survival (OS) and non-relapse mortality (NRM) in patients with hematological malignancies who undergo allogeneic hematopoietic stem cell transplantation (HSCT). Methods: We retrospectively analyzed consecutive adult patients with hematological malignancies who underwent HLA-matched donor-HSCT at Chungnam National University Hospital (Daejeon, South Korea) between January 2014 and December 2020. Maximal oxygen consumption (VO2max) was classified using the recommendations of the Mayo Clinic database. Results: Of 72 patients, 38 (52.8%) had VO2max values lower than the 25th percentile (VO2max ≤ 25th) of an age- and sex-matched normal population. Patients with VO2max ≤ 25th had no significant differences both OS and NRM (30 month OS 29.8% vs 41%, P = .328; and 30 month NRM 16% vs 3.3%, P = .222), compared with other patients. VO2max ≤ 25th was assigned a weight of 1 when added to the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to form a composite comorbidity/CPET index (HCT-CI/CPET). Patients with HCT-CI/CPET scores of 0 to 1 demonstrated significantly better OS and NRM than did patients with HCT-CI/CPET scores ≥2 [median OS not reached vs 6 months, P < .001 and 30 month NRM 7.4% vs 33.3%, P = .006]. An HCT-CI/CPET score ≥2 was the only adverse risk factor for NRM on multivariate analysis [hazard ratio (HR) of NRM 10.36 (95% CI 1.486-2.25, P = .018)]. Conclusion: The composite HCT-CI/CPET score can predict the survival and mortality of patients with hematological malignancies who undergo allogeneic HSCT.
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Affiliation(s)
- Sang Hoon Yeon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Myung-Won Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Thi Thuy Duong
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea
- Brain Korea 21 FOUR Project for Medical Science, Chungnam National University, Daejeon, Korea
| | - Sora Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sungju Jee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - So-Young Ahn
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyewon Ryu
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyo-Jin Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hwan-Jung Yun
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Deog-Yeon Jo
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ik-Chan Song
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea
- Brain Korea 21 FOUR Project for Medical Science, Chungnam National University, Daejeon, Korea
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Kim D, Lee HJ, Yu SY, Kwon JH, Ahn HK, Kim JH, Seo S, Maeng CH, Lim S, Kim DY, Shin SJ. Awareness of Doctors' Shared Decision-Making in Life-Sustaining Care Decisions. J Hosp Palliat Care 2021; 24:204-213. [PMID: 37674642 PMCID: PMC10180072 DOI: 10.14475/jhpc.2021.24.4.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 08/18/2023]
Abstract
Purpose At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.
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Affiliation(s)
- Dalyong Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hyun Jung Lee
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Soo-Young Yu
- Department of Nursing Science, Jeonju University, Jeonju, Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Hee Kyung Ahn
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jee Hyun Kim
- Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seyoung Seo
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chi Hoon Maeng
- Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seungtaek Lim
- Department of Hemato-Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Do Yeun Kim
- Division of Hematology & Medical Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Sung Joon Shin
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Kang JH, Jung CY, Park KS, Huh JS, Oh SY, Kwon JH. Community Care for Cancer Patients in Rural Areas: An Integrated Regional Cancer Center and Public Health Center Partnership Model. J Hosp Palliat Care 2021; 24:226-234. [PMID: 37674641 PMCID: PMC10180073 DOI: 10.14475/jhpc.2021.24.4.226] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 09/08/2023]
Abstract
Purpose The accessibility of medical facilities for cancer patients affects both their comfort and survival. Patients in rural areas have a higher socioeconomic burden and are more vulnerable to emergency situations than urban dwellers. This study examined the feasibility and effectiveness of a cancer care model integrating a regional cancer center (RCC) and public health center (PHC). Methods This study analyzed the construction of a safety care network for cancer patients that integrated an RCC and PHC. Two public health institutions (an RCC in Gyeongnam and a PHC in Geochang County) collaborated on the development of the community care model. The study lasted 13 months beginning in February 2019 to February 2020. Results The RCC developed the protocol for evaluating and measuring 27 cancer-related symptoms, conducted education for PHC nurses, and administered case counseling. The staff at the PHC registered, evaluated, and routinely monitored patients through home visits. A smartphone application and regular video conferences were incorporated to facilitate mutual communication. In total, 177 patients (mean age 70.9 years; men 59%) were enrolled from February 2019 to February 2020. Patients' greatest unmet need was the presence of a nearby cancer treatment hospital (83%). In total, 28 (33%) and 44 (52%) participants answered that the care model was very helpful or helpful, respectively. Conclusion We confirmed that a combined RCC-PHC program for cancer patients in rural areas is feasible and can bring satisfaction to patients as a safety care network. This program could mitigate health inequalities caused by accessibility issues.
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Affiliation(s)
- Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Chang Yoon Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jung Sik Huh
- Department of Urology, Jeju National University, Jeju, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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Park Y, Suh SY, Kim SH, Park J, Yoon SJ, Kim YJ, Kang B, Kwon JH, Park K, Hui D, Kim HJ, Lee S, Ahn HY. Development of a One-item Screening Question to Assess Spiritual Well-Being for Advanced Cancer Inpatients in Korea. J Pain Symptom Manage 2021; 62:910-917. [PMID: 34000335 DOI: 10.1016/j.jpainsymman.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Spiritual well-being (SWB) is significant for patients with life-limiting illnesses. Thus, shortened versions of questions would be helpful in approaching SWB. OBJECTIVES Our goal was to develop a one-item screening question to assess the SWB of advanced cancer inpatients. METHODS This was a cross-sectional, multicenter study involving adult advanced cancer inpatients from seven palliative care units in South Korea. The candidate one-item questions were three questions scored using numeric rating scales from 0 to 10: feeling at peace (Are you at peace?), self-rated spirituality (Do you think of yourself as a spiritual person?), and self-rated religiosity (Do you think of yourself as a religious person?). The Functional Assessment of Chronic Illness Therapy-Spirituality 12 (FACIT-Sp-12) comprised of two subscales Meaning/Peace and Faith was used to assess SWB. Pearson's correlation test was conducted to determine the relationship between the three questions, the total FACIT-Sp-12 score, and its subscales. RESULTS A total of 202 patients were enrolled. A strong correlation was observed between self-rated spirituality (r = 0.732 and 0.790; P < 0.001 and < 0.001 respectively) and religiosity (r = 0.708 and 0.758; P < 0.001 and < 0.001 respectively) with the total FACIT-Sp-12 scores and faith subscale scores. Feeling at peace showed a moderate correlation with the total of FACIT-Sp-12 scores (r = 0.505, P < 0.01). All three questions had a moderate correlation with the meaning/peace subscale. CONCLUSION Self-rated spirituality and religiosity showed better convergence validity than feeling at peace. Therefore, we recommend self-rated spirituality or religiosity as a one-item question for screening SWB in inpatients with advanced cancer.
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Affiliation(s)
- Youngmin Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea.
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Jeanno Park
- Hospice & Palliative Care Center, Bobath Memorial Hospital, Seongnam, South Korea
| | - Seok Joon Yoon
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Beodeul Kang
- Department of Internal Medicine, Division of Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Kwonoh Park
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hyeon Jeong Kim
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Sanghee Lee
- Department of Cancer Control and Population Health, National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
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Won YW, Kim HJ, Kwon JH, Lee HY, Baek SK, Kim YJ, Kim DY, Ryu H. Life-Sustaining Treatment States in Korean Cancer Patients after Enforcement of Act on Decisions on Life-Sustaining Treatment for Patients at the End of Life. Cancer Res Treat 2021; 53:908-916. [PMID: 34082495 PMCID: PMC8524027 DOI: 10.4143/crt.2021.325] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE In Korea, the "Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life" was enacted on February 4, 2018. This study was conducted to analyze the current state of life-sustaining treatment decisions based on National Health Insurance Service (NHIS) data after the law came into force. MATERIALS AND METHODS The data of 173,028 cancer deaths were extracted from NHIS qualification data between November 2015 and January 2019. RESULTS The number of cancer deaths complied with the law process was 14,438 of 54,635 cases (26.4%). The rate of patient self-determination was 49.0%. The patients complying with the law process have used a hospice center more frequently (28% vs. 14%). However, the rate of intensive care unit (ICU) admission was similar between the patients who complied with and without the law process (ICU admission, 23% vs. 21%). There was no difference in the proportion of patients who had undergone mechanical ventilation and hemodialysis in the comparative analysis before and after the enforcement of the law and the analysis according to the compliance with the law. The patients who complied with the law process received cardiopulmonary resuscitation at a lower rate. CONCLUSION The law has positive effects on the rate of life-sustaining treatment decision by patient's determination. However, there was no sufficient effect on the withholding or withdrawing of life-sustaining treatment, which could protect the patient from unnecessary or harmful interventions.
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Affiliation(s)
- Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul,
Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong,
Korea
| | - Ha Yeon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, National Medical Center, Seoul,
Korea
| | - Sun Kyung Baek
- Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang,
Korea
| | - Hyewon Ryu
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
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Hiratsuka Y, Suh SY, Kim SH, Cheng SY, Yoon SJ, Koh SJ, Park SA, Seo JY, Kwon JH, Park J, Park Y, Hwang SW, Lee ES, Ahn HY, Hui D, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, Mori M, Inoue A. Factors related to spiritual well-being in the last days of life in three East Asian countries: An international multicenter prospective cohort study. Palliat Med 2021; 35:1564-1577. [PMID: 34148395 DOI: 10.1177/02692163211022179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some factors associated with spiritual well-being in dying patients have previously been reported. However, there has been no cross-cultural study comparing factors related to spiritual well-being. The current investigation may shed light on this under-investigated area through a comparison of diverse factors. AIM We aimed to (1) examine factors associated with spiritual well-being in the last days and (2) compare those factors across three East Asian countries. DESIGN This is an international multicenter prospective cohort study. SETTING/PARTICIPANTS Newly admitted inpatients with far advanced cancer in palliative care units in Japan, Korea and Taiwan were enrolled. Each patient was classified into one of two groups based on spiritual well-being score in the last days of life. Univariate and multivariate analyses were performed to identify the factors related to better spiritual well-being score in each country. RESULTS A total of 1761 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. Seven variables were significant in Japan, three in Korea, and five in Taiwan. "Good death scale [acceptance]," "fatigue" and "expressed wish for hastened death" were unique in Japan. "Visit from a pastoral care worker within 48 h of death" was unique in Korea. "Patient's preferences for place of death," "dyspnea" and "continuous deep sedation" were unique in Taiwan. CONCLUSIONS This study found novel factors related to spiritual well-being in the last days of life, several of which differed according to country. Recognition of factors associated with spiritual well-being can improve the quality of palliative care.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea.,Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Su-Jin Koh
- Department Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Shin Ae Park
- Hospice & Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Ji-Yeon Seo
- Hospice & Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Youngmin Park
- Department of Family Medicine, Hospice and Palliative Care Center, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Eunpyeong-gu, Seoul, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang-si, Gyeonggi-do, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
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25
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Kang EJ, Ahn MJ, Ock CY, Lee KW, Kwon JH, Yang Y, Choi YH, Kim MK, Ji JH, Yun T, Nam BH, Kim SB, Keam B. Randomized Phase II Study of Axitinib versus Observation in Patients with Recurred or Metastatic Adenoid Cystic Carcinoma. Clin Cancer Res 2021; 27:5272-5279. [PMID: 34315722 DOI: 10.1158/1078-0432.ccr-21-1061] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The role of chemotherapy in adenoid cystic carcinoma (ACC) is controversial because ACC is usually stable without chemotherapy and the lack of randomized trials. Here, we conducted the first randomized trial to evaluate the efficacy of axitinib as compared with observation in ACC. PATIENTS AND METHODS In this multicenter, prospective phase II trial, we enrolled patients with recurrent or metastatic ACC whose cancer had progressed within the past 9 months. Patients were randomly assigned to either axitinib (5 mg twice daily) or observation at a 1:1 ratio. Crossover from observation to axitinib was permitted after progression. The primary endpoint was a 6-month progression-free survival (PFS) rate. The secondary endpoints included objective response rate (ORR), overall survival (OS), PFS, duration of response, and adverse events. RESULTS Sixty patients were allocated to the axitinib or observation group, with response evaluation conducted in 54 patients. With a median follow-up of 25.4 months, the 6-month PFS rate was 73.0% with axitinib and 23.0% with observation. Median PFS was longer in the axitinib arm (10.8 months vs. 2.8 months, P < 0.001). The ORR of axitinib was 0.0%, but the disease control rate was 100.0% with axitinib and 51.9% with observation. Median OS was not reached with axitinib, but was 27.2 months with observation (P = 0.226). The most frequently reported adverse events for axitinib were oral mucositis and fatigue. CONCLUSIONS In this first randomized trial in patients with ACC, axitinib significantly increased the 6-month PFS rate as compared with observation. (ClinicalTrials.gov number, NCT02859012).
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Affiliation(s)
- Eun Joo Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan-Young Ock
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keun-Wook Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jung Hye Kwon
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yaewon Yang
- Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk University Hospital, Chungbuk University College of Medicine, Cheongju, Republic of Korea
| | - Yoon Hee Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea
| | - Min Kyoung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jun Ho Ji
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Tak Yun
- Division of Hematology-Oncology, Rare Cancers Clinic, Center for Specific Organs Cancer, National Cancer Center, Goyang, Republic of Korea
| | | | - Sung-Bae Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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26
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Lee YP, Yoon SE, Song Y, Kim SJ, Yoon DH, Chen TY, Koh YI, Kang KW, Lee HS, Wei KTK, Lim ST, Poon M, Irawan C, Zhao W, Do YR, Lee MH, Ng SC, Lee WS, Guo Y, Zhang H, Kang HJ, Yun HJ, Kim HJ, Lung DTC, Kwak JY, Han JJ, Mun YC, Oh SY, Shim H, Kwon JH, Sohn BS, Park SK, Jo JC, Ko YH, Jun Z, Kim WS. Cutaneous T-cell lymphoma in Asian patients: a multinational, multicenter, prospective registry study in Asia. Int J Hematol 2021; 114:355-362. [PMID: 34302593 DOI: 10.1007/s12185-021-03179-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a group of T-cell lymphomas with low incidence. Due to their indolent characteristics, treatment strategies have not yet been established for advanced CTCLs. In this study, relative incidence of CTCLs in Asia was estimated and the therapeutic outcomes presented based on various treatments currently used in clinics for advanced CTCLs. As part of a prospective registry study of peripheral T-cell lymphoma (PTCL) conducted across Asia, including Korea, China, Taiwan, Singapore, Malaysia, and Indonesia, subgroup analysis was performed for patients with CTCLs. Among 486 patients with PTCL, 37 with CTCL (7.6%) were identified between April 2016 and February 2019. Primary cutaneous ALK-negative anaplastic large cell lymphoma (ALCL, 35.1%) was the most common subtype. With a median follow-up period of 32.1 months, median progression-free survival (PFS) was 53.5 months (95% CI 0.0-122.5), and overall survival was not reached. 14 patients (48.2%) underwent subsequent treatment after the first relapse, but the response rate was 20% with a PFS of 2.2 months (95% CI 0.3-4.0). Six patients received autologous stem cell transplantation (auto-SCT). However, auto-SCT did not result in better outcomes. Additional studies are needed on standard care treatment of advanced or refractory and relapsed CTCLs.
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Affiliation(s)
- Yong-Pyo Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Dok Hyun Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tsai-Yun Chen
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - Young Il Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Ka Won Kang
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ho Sup Lee
- Division of Hematology-Oncology, Kosin University Gospel Hospital, Busan, South Korea
| | | | | | - Michelle Poon
- Department of Haematology-Oncology, National University Health System, Queenstown, Singapore
| | - Cosphiadi Irawan
- Indonesia Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Indonesia
| | | | - Young Rok Do
- Division of Hematology and Oncology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, South Korea
| | - Mark Hong Lee
- Department of Hematology-Oncology, Konkuk University Medical Center, Seoul, Korea
| | - Soo Chin Ng
- Subang Jaya Medical Center, Kuala Lumpur, Malaysia
| | - Won-Sik Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ye Guo
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Huilai Zhang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hye-Jin Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Hyo Jung Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | | | - Jae-Yong Kwak
- Division of Hematology-Oncology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University, Chonju, South Korea
| | - Jae Joon Han
- Department of Hematology and Medical Oncology, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Yeung-Chul Mun
- Division of Hematology-Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, South Korea
| | - Sung Yong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Hyeok Shim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Division of Hemato-Oncology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Byeong Seok Sohn
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Seong Kyu Park
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Puchon, South Korea
| | - Jae Cheol Jo
- Division of Hematology and Oncology, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Zhu Jun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-Gu, Seoul, 06351, Korea.
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27
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Kim HJ, Kim YJ, Kwon JH, Won YW, Lee HY, Baek SK, Ryu H, Kim DY. Current Status and Cardinal Features of Patient Autonomy after Enactment of the Life-Sustaining Treatment Decisions Act in Korea. Cancer Res Treat 2021; 53:917-925. [PMID: 34082494 PMCID: PMC8524031 DOI: 10.4143/crt.2021.324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose The main purpose of the Life-Sustaining Treatment Decisions Act recently enacted in Korea is to respect the patient’s self-determination. We aimed to investigate the current status and features of patient self-determination after implementation of the law. Materials and Methods Between February 2018 and January 2019, 54,635 cancer deaths were identified from the National Health Insurance Service (NHIS) database. We analyzed the characteristics of decedents who complied with the law process by self-determination compared with decedents with family determination and with decedents who did not comply with the law process. Results In multivariable analysis, patients with self-determination were younger, were less likely to live in rural areas, were less likely to belong to the highest income quintile, were less likely to be treated in general hospitals, and were more likely to show a longer time from cancer diagnosis compared with patients with family determination. Compared with patients who did not comply with the law process, patients with self-determination were younger, lived in Seoul or capital area, were less likely to belong to the highest income quintile, were treated in general hospitals, were less likely to have genitourinary or hematologic malignancies, scored higher on the Charlson comorbidity index, and showed a longer time from cancer diagnosis. Patients with self-determination were more likely to use hospice and less likely to use intensive care units (ICUs) at the end-of-life (EOL). Conclusion Decedents with self-determination were more likely to be younger, reside in the Seoul or capital area, show a longer time from cancer diagnosis, and were less likely to belong to the highest income quintile. They utilized hospice more frequently, and received less ICU care at the EOL.
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Affiliation(s)
- Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Chungnam National University College of Medicine, Daejeon, Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ha Yeon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Sun Kyung Baek
- Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyewon Ryu
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Do Yeun Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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28
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Baek SK, Kim HJ, Kwon JH, Lee HY, Won YW, Kim YJ, Baik S, Ryu H. Preparation and Practice of the Necessary Documents in Hospital for the "Act on Decision of Life-Sustaining Treatment for Patients at the End-of-Life". Cancer Res Treat 2021; 53:926-934. [PMID: 34082493 PMCID: PMC8524011 DOI: 10.4143/crt.2021.326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Six forms relating to decisions on life-sustaining treatment (LST) for patients at the end-of-life (EOL) in hospital are required by the “Act on Decision of LST for Patients at the EOL.” We investigated the preparation and creation status of these documents from the database of the National Agency for Management of LST. Materials and Methods We analyzed the contents and details of each document necessary for decisions on LST, and the creation status of forms. We defined patients completing form 1 as “self-determined” of LST, and those whose family members had completed form 11/12 as “family decision” of LST. According to the determination subject, we compared the four items of LST on form 13 (the paper of implementation of LST) and the documentation time interval between forms. Results The six forms require information about the patient, doctor, specialized doctor, family members, institution, decision for LST, and intention to use hospice services. Of 44,381 who had completed at least one document, 36,693 patients had form 13. Among them, 11,531, 10,976, and 12,551 people completed forms 1, 11, and 12, respectively. The documentation time interval from forms 1, 11, or 12 to form 13 was 8.6±13.6 days, 1.0±9.5 days, and 1.5±9.7 days, respectively. Conclusion The self-determination rate of LST was 31% and the mean time interval from self-determination to implementation of LST was 8.6 days. The creation of these forms still takes place when the patients are close to death.
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Affiliation(s)
- Sun Kyung Baek
- Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Chungnam, Korea
| | - Ha Yeon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sujin Baik
- Korea National Institute for Bioethics Policy, Seoul, Korea
| | - Hyewon Ryu
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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29
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Lee HY, Kim HJ, Kwon JH, Baek SK, Won YW, Kim YJ, Baik SJ, Ryu H. The Situation of Life-Sustaining Treatment One Year After Enforcement of the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life in Korea: Data of National Agency for Management of Life-Sustaining Treatment. Cancer Res Treat 2021; 53:897-907. [PMID: 34082496 PMCID: PMC8524023 DOI: 10.4143/crt.2021.327] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life” was enacted on February 3, 2016 and went into effect on February 4, 2018 in Korea. This study reviewed the first year of determination to life-sustaining treatment (LST) through data analysis of the National Agency for Management of Life-Sustaining Treatment. Materials and Methods The National Agency for Management of LST provided data between February 4, 2018 and January 31, 2019 anonymously from 33,549 patients. According to the forms patients were defined as either elf-determinants or family-determinants. Results The median age of the patient was 73 and the majority was male (59.9%). Cancer patients were 59% and self-determinants were 32.1%. Cancer patients had a higher rate of self-determinants than non-cancer (47.3% vs. 10.1%). Plan for hospice service was high in cancer patients among self-determinants (81.0% vs. 37.5%, p < 0.001). In comparison to family-determinants, self-determinants were younger (median age, 67 years vs. 75 years; p < 0.001) and had more cancer diagnosis (87.1% vs. 45.9%, p < 0.001). Decision of withholding or withdrawing of LSTs in cancer patients was higher than non-cancer patients in four items. Conclusion Cancer patients had a higher rate in self-determination and withholding or withdrawing of LSTs than non-cancer patients. Continued revision of the law and education of the public will be able to promote withdrawing or withholding the futile LSTs in patients at end-of-life. Further study following the revision of the law should be evaluated to change of end-of-life care.
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Affiliation(s)
- Ha Yeon Lee
- Division of Hematology and Oncology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Sejong Chungnam National University Hospital, Sejong, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyung Baek
- Division of Hematology and Oncology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Su Jin Baik
- Korea National Institute for Bioethics Policy, Seoul, Korea
| | - Hyewon Ryu
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Chungnam National University College of Medicine, Daejeon, Korea
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30
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Pyo J, Ock M, Lee M, Kim J, Cheon J, Cho J, Kwon JH, Kim H, Im HS, Min YJ, Koh SJ. Unmet needs related to the quality of life of advanced cancer patients in Korea: a qualitative study. BMC Palliat Care 2021; 20:58. [PMID: 33849508 PMCID: PMC8045373 DOI: 10.1186/s12904-021-00749-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has recently been emphasized that the unmet needs of cancer patients should be evaluated more holistically, for example, by exploring caregivers' perspectives and cross cultural differences. This study explored additional domains or items of unmet needs among Korean cancer patients in reference to the Sheffield Profile for Assessment and Referral to Care (SPARC). METHODS We conducted four focus group discussions (FGDs) with 15 cancer patients, following a semi-structured format to elicit participants' health perceptions, comments on SPARC, and opinions on the roles of medical professionals to improve the health-related quality of life of cancer patients. We analyzed the verbatim transcripts using a content analysis method. RESULTS The following themes were derived: living as a cancer patient, striving to overcome cancer, changing attitudes toward life after the cancer diagnosis, and ways to live a better life as a cancer patient. The participants asserted the significance of providing adequate treatment information that is easily understood by cancer patients during the conversation between patients and medical professionals. Besides the physical symptoms identified by SPARC, the participants struggled with numbness in their hands and feet and hair loss. Korean cancer patients prominently wished to avoid burdening their family or others in their daily life. They considered the improvement of health behaviors, such as diet and exercise, as part of the treatment, which was not limited to drugs. Furthermore, it was essential to evaluate the value of cancer patients' lives, as they desired to be helpful members of their families and society. CONCLUSIONS This study identified additional domains and items of unmet needs of Korean cancer patients and broadened the understanding of unmet needs among cancer patients.
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Affiliation(s)
- Jeehee Pyo
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.,Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
| | - Mina Lee
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Juhee Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Jaekyung Cheon
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Juhee Cho
- Samsung Comprehensive Cancer Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Chungnam, Republic of Korea
| | - Hyeyeoung Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Young Joo Min
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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Kim JW, Ahn HK, Choi JG, Chae YS, Lee GW, Park KU, Lee EM, Sim SH, Kim JH, Park YH, Kim MS, Park JH, Kim JE, Kim HJ, Ahn MS, Oh SY, Kim MH, Koh SJ, Lee KE, Kang MJ, Byun JH, Ha JY, Kwon JH, Jung JY, Lee SE, Park IH, Park KH. Abstract PS11-39: Phase II pilot study of trastuzumab biosimilar (herzuma®) plus gedatolisib in patients with HER-2 positive metastatic breast cancer who progressed after 2 or more HER-2 directed chemotherapy [KM-10A/KCSG18-13 interim analysis]. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-39] [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: Prognosis of patients with HER-2 positive metastatic breast cancer (MBC) has been revolutionized with the development of dual antibodies targeting HER-2 and antibody-drug conjugate, but resistance to anti-HER-2 therapy is inevitable ultimately. PI3K-AKT-mTOR pathway aberration is known to be one of the resistance mechanisms. This randomized phase 2 pilot study evaluated safety and efficacy of Herzuma® (trastuzumab biosimilar) plus Gedatolisib (dual PI3K/mTORC inhibitor) in patients with HER-2 positive MBC who progressed after multiple lines of therapy. Methods: Patients with HER-2 positive MBC with known PIK3CA pathologic mutation or amplification whose disease progressed after more than two HER-2 directed therapy were enrolled in the study. They received Herzuma® (8mg/kg IV for 1st cycle loading dose, and then 6mg/kg IV every 3 weeks) plus Gedatolisib (180mg on D1, 8, 15 of every 21 days). We evaluated efficacy of the combination treatment as interim analysis. The data cutoff of this interim analysis was Aug 4, 2020. Results: As a pilot study, 15 patients were enrolled and followed for a median of 2.3 months. At data cutoff, 11 patients were eligible for response assessment. All patients were confirmed to have pathologic PIK3CA aberrations: H1047R, H1047L, E542Q, E542K, E453K, N345K, and PIK3CA amplification. Five patients reached partial response (PR) as their best response, three were stable disease (SD), and three had progressive disease (PD). All patients who have reached PR remain on investigational treatment at the data cutoff point, and the longest one is on treatment for 7.8 months. One of the SD patients ended treatment due to disease progression, and the other two have been undergoing treatment. Overall, response rate was 45.5% and disease control rate was 72.7%. No fatal adverse events related to trial medication were reported. Conclusion: In this phase 2 pilot study, Trastuzumab biosimilar plus Gedatolisib presented 45.5% of response rate with manageable toxicity in patients with HER-2 positive MBC with PIK3CA aberration. Clinical trial information: NCT03698383 Acknowledgement: this research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &Welfare, Republic of Korea (Grant number: HI17C2206).
Citation Format: Ju Won Kim, Hee Kyung Ahn, Jong Gwon Choi, Yee Soo Chae, Gyeong Won Lee, Keon Uk Park, Eun Mi Lee, Sung Hoon Sim, Jee Hyun Kim, Yeon Hee Park, Mi So Kim, Jin Hyun Park, Jeong Eun Kim, Han Jo Kim, Mi Sun Ahn, So Yeon Oh, Min Hwan Kim, Su-Jin Koh, Kyoung Eun Lee, Myoung Joo Kang, Jae Ho Byun, Joo young Ha, Jung Hye Kwon, Joo Young Jung, Su Ee Lee, In Hae Park, Kyong Hwa Park. Phase II pilot study of trastuzumab biosimilar (herzuma®) plus gedatolisib in patients with HER-2 positive metastatic breast cancer who progressed after 2 or more HER-2 directed chemotherapy [KM-10A/KCSG18-13 interim analysis] [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-39.
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Affiliation(s)
- Ju Won Kim
- 1Korea University Anam Hospital, Seoul, Korea, Republic of
| | - Hee Kyung Ahn
- 2Gachon University Gil Medical Center, Incheon, Korea, Republic of
| | - Jong Gwon Choi
- 3Konyang University Hospital, Daejeon, Korea, Republic of
| | - Yee Soo Chae
- 4Kyungpook National University Chilgok Hospital, Daegu, Korea, Republic of
| | - Gyeong Won Lee
- 5Gyeongsang National University Hospital, Changwon, Korea, Republic of
| | - Keon Uk Park
- 6Keimyung University Dongsan Hospital, Daegu, Korea, Republic of
| | - Eun Mi Lee
- 7Kosin University Gospel Hospital, Busan, Korea, Republic of
| | | | - Jee Hyun Kim
- 9Seoul National University Bundang Hospital, Bundang, Korea, Republic of
| | | | - Mi So Kim
- 11Seoul National university Hospital, Seoul, Korea, Republic of
| | - Jin Hyun Park
- 12Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea, Republic of
| | | | - Han Jo Kim
- 14SoonChunHyang University Hospital Cheonan, Cheon-An, Korea, Republic of
| | - Mi Sun Ahn
- 15Ajou University Hospital, Seoul, Korea, Republic of
| | - So Yeon Oh
- 16Pusan National University Yangsan Hospital, Busan, Korea, Republic of
| | | | - Su-Jin Koh
- 18Ulsan University Hospital, Ulsan, Korea, Republic of
| | - Kyoung Eun Lee
- 19Ewha Womans University Medical Center, Seoul, Korea, Republic of
| | - Myoung Joo Kang
- 20Inje University Haeundae Paik Hospital, Busan, Korea, Republic of
| | - Jae Ho Byun
- 21The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea, Republic of
| | - Joo young Ha
- 22Chung-Ang University Hospital, Seoul, Korea, Republic of
| | - Jung Hye Kwon
- 23Kangdong Sacred Heart Hospital, Seoul, Korea, Republic of
| | - Joo Young Jung
- 24Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea, Republic of
| | - Su Ee Lee
- 25Dong-A University Hospital, Busan, Korea, Republic of
| | - In Hae Park
- 26Korea University Guro Hospital, Seoul, Korea, Republic of
| | - Kyong Hwa Park
- 1Korea University Anam Hospital, Seoul, Korea, Republic of
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Hwang IG, Kwon M, Kim JW, Kim SH, Lee YG, Kim JY, Koh SJ, Ko YH, Shin SH, Hong S, Kim TY, Kim SY, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Lee KH, Bae SH, Koo DH, Kim JH, Woo IS. Prevalence and Predictive Factors for Upfront Dose Reduction of the First Cycle of First-Line Chemotherapy in Older Adults with Metastatic Solid Cancer: Korean Cancer Study Group (KCSG) Multicenter Study. Cancers (Basel) 2021; 13:cancers13020331. [PMID: 33477423 PMCID: PMC7829741 DOI: 10.3390/cancers13020331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Arbitrary upfront dose reduction (UDR) of palliative chemotherapy has often been performed according to the judgement of the physician of older adults with metastatic solid cancer in current practice. UDR might decrease treatment efficacy in older adults but may be helpful for palliation, so selecting older adults who benefit from UDR and the identification of predictors of UDR are required. The authors investigated the prevalence and predictors of UDR through variables of geriatric assessment (GA). Chemotherapy compliance between the UDR and standard dose patient groups was also compared. The results of this study demonstrated that approximately 60% of older adults with metastatic solid cancer received UDR. Poor performance status (PS) and living without a spouse were predictive factors of UDR of first-line palliative chemotherapy, and patients with UDR better-tolerated chemotherapy compared with patients with standard doses. Abstract Old age alone does not reflect an intolerability to chemotherapy. However, upfront dose reduction (UDR) of the first cycle of first-line palliative chemotherapy has sometimes been chosen by physicians for older adults with metastatic cancer due to concerns regarding adverse events. The development of predictive factors for UDR of palliative chemotherapy would be helpful for treatment planning among older adults. This was a secondary analysis of a study on predicting adverse events of first-line palliative chemotherapy in 296 patients (≥70 years) with solid cancer. We assessed the prevalence of UDR of the first cycle of first-line chemotherapy and the association of UDR with the variables of geriatric assessment (GA) and chemotherapy compliance. Among the 296 patients, 177 (59.8%) patients were treated with UDR. The mean percentage of UDR for the total patient group was 19.2% (range: 4–47%) of the standard dose. In a multivariate analysis, poor performance status (PS) and living without a spouse were independent predictive factors of UDR of first-line palliative chemotherapy in older adults. Patients with UDR showed fewer grade 3–5 adverse events versus the standard dose group. Study completion as planned was significantly higher in the UDR group versus the standard dose group. Older adults with UDR better tolerated chemotherapy than patients with a standard dose.
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Affiliation(s)
- In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea; (I.G.H.); (M.K.)
| | - Minsuk Kwon
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea; (I.G.H.); (M.K.)
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.W.K.); (S.H.K.); (J.H.K.)
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.W.K.); (S.H.K.); (J.H.K.)
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (Y.-G.L.); (D.-H.K.)
| | - Jin Young Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, College of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Yoon Ho Ko
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03476, Korea;
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan 49267, Korea;
| | - Soojung Hong
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (Y.S.H.)
| | - Hyun Jung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea;
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary’s Hospital, Cancer Research Institute, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 35015, Korea;
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (Y.S.H.)
| | - Kyung Hee Lee
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Sung Hwa Bae
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu 42472, Korea;
| | - Dong-Hoe Koo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (Y.-G.L.); (D.-H.K.)
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.W.K.); (S.H.K.); (J.H.K.)
| | - In Sook Woo
- Division of Medical Oncology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
- Correspondence: ; Tel.: +82-2-3779-1574; Fax: 82-2-780-3132
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Oh SN, Kim YA, Kim YJ, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Lee SN, Maeng CH, Kang EJ, Do YR, Yun HJ, Jung KH, Yun YH. The Attitudes of Physicians and the General Public toward Prognostic Disclosure of Different Serious Illnesses: a Korean Nationwide Study. J Korean Med Sci 2020; 35:e401. [PMID: 33289368 PMCID: PMC7721562 DOI: 10.3346/jkms.2020.35.e401] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. METHODS We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. RESULTS For most illnesses, most physicians (adjusted proportions - end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was "the patient's right to know his/her condition" (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was "psychological burden such as anxiety and depression" (35.8%), while for the physicians it was "disclosure would have no beneficial effect" (42.4%). CONCLUSION Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.
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Affiliation(s)
- Si Nae Oh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Yonsei University Graduate School, Seoul, Korea
| | - Young Ae Kim
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, Korea
| | - Eun Kee Song
- Division of Hematology/Oncology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Oh S, Yun YH, Kim YA, Kim YJ, Shim H, Song E, Kang JH, Kwon JH, Lee JL, Lee SN, Maeng CH, Kang EJ, Do YR, Yun H, Jung KH. The attitudes of physicians and the general public toward prognostic disclosure of different serious illnesses: A nationwide survey. Alzheimers Dement 2020. [DOI: 10.1002/alz.038772] [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: 11/06/2022]
Affiliation(s)
- Sinae Oh
- Seoul National University Hospital Seoul South Korea
| | - Young Ho Yun
- Seoul National University College of Medicine Seoul South Korea
| | | | - Yu Jung Kim
- Seoul National University Bundang Hospital Seongnam South Korea
| | - Hyun‐Jeong Shim
- Chonnam National University School of Medicine Hwasun South Korea
| | - Eun‐Kee Song
- Chonbuk National University Medical School Jeonju South Korea
| | | | - Jung Hye Kwon
- Hallym University College of Medicine Seoul South Korea
| | | | - Soon Nam Lee
- Ewha Woman’s University College of Medicine Seoul South Korea
| | - Chi Hoon Maeng
- Kyung Hee University College of Medicine Seoul South Korea
| | - Eun Joo Kang
- Korea University College of Medicine Seoul South Korea
| | - Young Rok Do
- Keimyung University School of Medicine Daegu South Korea
| | - Hwan‐Jung Yun
- Chungnam National University Hospital Daejeon South Korea
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Kwon JH, Kim JS. Transcatheter Arterial Embolisation of Acute Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Haemostasis. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017013] [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: 11/05/2022] Open
Affiliation(s)
- JH Kwon
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - JS Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
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Kwon JH, Baek SK, Kim DY, Kim YJ, Lee MA, Choi HJ, Byun JM, Jeong JY, Ahmedzai SH, Jang GD. Pilot study for the Psychometric Validation of the Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients. Cancer Res Treat 2020; 53:25-31. [PMID: 32878428 PMCID: PMC7812019 DOI: 10.4143/crt.2020.235] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. Materials and Methods The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS). RESULTS Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach's α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and -0.130 (p=0.493) for the social domain. CONCLUSION This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.
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Affiliation(s)
- Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jin Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Young Jeong
- Hallym Research Institute of Clinical Epidemiology, Hallym University, Chuncheon, Korea
| | - Sam H Ahmedzai
- National Institute for Health Research, Clinical Research Network - Cancer, University of Leeds, Leeds, UK
| | - Geun-Doo Jang
- Division of Hemato-Oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
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Lee YG, Kang EJ, Keam B, Choi JH, Kim JS, Park KU, Lee KE, Kwon JH, Lee KW, Kim MK, Ahn HK, Shin SH, Kim HR, Kim SB, Yun HJ. Treatment strategy and outcomes in locally advanced head and neck squamous cell carcinoma: a nationwide retrospective cohort study (KCSG HN13-01). BMC Cancer 2020; 20:813. [PMID: 32854649 PMCID: PMC7450571 DOI: 10.1186/s12885-020-07297-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 06/03/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background By investigating treatment patterns and outcomes in locally advanced head and neck squamous cell carcinoma (LA-HNSCC), we aimed at providing valuable insights into the optimal therapeutic strategy for physicians in real-world practice. Methods This is a multi-institutional study enrolled the patients with stage III to IVB LA-HNSCC, except for nasopharyngeal carcinoma, from 2004 to 2015 in thirteen referral hospitals capable of multidisciplinary care. Results A total of 445 LA-HNSCC patients were analyzed. The median age was 61 years (range, 24–89). The primary tumor location was the oropharynx in 191 (43%), oral cavity in 106 (24%), hypopharynx in 64 (14%), larynx in 57 (13%) and other sites in 27 (6%). The most common stage was T2 in 172 (39%), and N2 in 245 (55%). Based on treatment intents, 229 (52%) of the patients received definitive concurrent chemoradiotherapy (CCRT) and 187 (42%) underwent surgery. Approximately 158 (36%) of the study population received induction chemotherapy (IC). Taken together, 385 (87%) of the patients underwent combined therapeutic modalities. The regimen for definitive CCRT was weekly cisplatin in 58%, 3-weekly cisplatin in 28% and cetuximab in 3%. The preferred regimen for IC was docetaxel with cisplatin in 49%, and docetaxel, cisplatin plus fluorouracil in 27%. With a median follow-up of 39 months, one-year and two-year survival rates were 89 and 80%, respectively. Overall survival was not significantly different between CCRT and surgery group (p = 0.620). Conclusions In patients with LA-HNSCC, the majority of patients received combined therapeutic modalities. Definitive CCRT, IC then definitive CCRT, and surgery followed by adjuvant CCRT or radiotherapy are the preferred multidisciplinary strategies in real-world practice.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University Hospital, Suwon, Republic of Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Keon Uk Park
- Department of Hemato-Oncology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Hospital, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Min Kyoung Kim
- Department of Hematology-Oncology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Hye Ryun Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Keam B, Kang EJ, Ahn MJ, Ock CY, Lee KW, Kwon JH, Yang Y, Choi YH, Kim MK, Ji JH, Yun T, Nam BH, Kim SB. Randomized phase II study of axitinib versus observation in patients with recurred or metastatic adenoid cystic carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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
6503 Background: Adenoid cystic carcinoma (ACC) does not respond to cytotoxic chemotherapy. Several anti-angiogenic agents were evaluated in single arm phase II trials. However, the role of chemotherapy is still controversial, because of natural stable disease course without chemotherapy and lack of randomized trial. We firstly conducted a randomized trial to evaluate the efficacy of axitinib compared to observation. Methods: In this multicenter, prospective phase II trial, we enrolled recurred, metastatic ACC patients who progressed within 9 months. Patients were randomly assigned either axitinib (5mg twice daily) or observation arm with 1:1 ratio. Crossover to the axitinib arm was permitted for patients in the observation arm who had disease progression. The primary endpoint was 6-month progression-free survival (PFS) rate. The secondary endpoints included objective response rate (ORR), overall survival (OS), PFS, duration of response and adverse events. Results: A total of 60 patients randomly allocated to axitinib (N=30) and observation arm (N=30) and response evaluation was conducted in 57 patients. With a median follow-up of 25.4 months, the 6-month PFS rate was 73.2% (95% confidence interval [CI], 54.8 to 88.1%) in the axitinib arm and 23.2% (95% CI, 9.3 to 41.1%) in the observation arm (hazard ratio, 0.19; 95% CI, 0.08 to 0.45; P < 0.001). Median PFS was 10.8 months in axitinib arm and 2.8 months in observation arm ( P < 0.001). The ORR was 3.3% (95% CI, 0.1 to 17.2%) in the axitinib arm, and 0% (95% CI, 0 to 12.8%) in the observation arm. The disease control rate was 100% (95% CI, 88.4 to 100%) in the axitinib arm and 51.9% (95% CI, 32.0 to 71.3%) in the observation arm. After crossover, ORR of axitinib in the observation arm was 11.1% (95% CI, 2.4 to 29.2%). Median OS was not reached in axitinib arm, 28.5 months in observation arm ( P = 0.688). The most frequently reported adverse events of axitinib were grade 1 or 2 oral mucositis and fatigue. Detailed data of adverse events and mutational profile data will be presented. Conclusions: In this first randomized trial in patients with recurred or metastatic ACC, axitinib significantly increased 6-month PFS rate compared to observation. Clinical trial information: NCT02859012 .
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Affiliation(s)
- Bhumsuk Keam
- Seoul National University Hospital, Seoul, South Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Keun Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk Univeristy Hospital, Chungbuk University College of Medicine, Cheongju, South Korea
| | - Yoon Hee Choi
- Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, South Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Jun Ho Ji
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Tak Yun
- Rare Cancers Clinic, Center for Specific Organs Cancer, National Cancer Center, Goyang-Si, Gyeonggi-Do, South Korea
| | - Byung-Ho Nam
- HERINGS, The Institute of Advanced Clinical and Biomedical Research, Seoul, South Korea
| | - Sung-Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Kang JH, Kwon JH, Lee YG, Park KU, An HJ, Sohn J, Seol YM, Lee H, Yun HJ, Ahn JS, Yang JH, Song H, Koo DH, Kim JY, Kim GM, Kim HJ. Ramosetron versus Palonosetron in Combination with Aprepitant and Dexamethasone for the Control of Highly-Emetogenic Chemotherapy-Induced Nausea and Vomiting. Cancer Res Treat 2020; 52:907-916. [PMID: 32192275 PMCID: PMC7373869 DOI: 10.4143/crt.2019.713] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/20/2019] [Accepted: 03/17/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to compare ramosetron (RAM), aprepitant (APR), and dexamethasone (DEX) [RAD] with palonosetron (PAL), APR, and DEX [PAD] in controlling highly-emetogenic chemotherapy (HEC)-induced nausea and vomiting. Materials and Methods Patients were randomly assigned (1:1) to receive RAD or PAD:RAM (0.3 mg intravenously) or PAL (0.25 mg intravenously) D1, combined with APR (125 mg orally, D1 and 80 mg orally, D2-3) and DEX (12 mg orally or intravenously, D1 and 8 mg orally, D2-4). Patients were stratified by sex, cisplatin-based chemotherapy, and administration schedule. The primary endpoint was overall complete response (CR), defined as no emesis and no rescue regimen during 5 days of HEC. Secondary endpoints were overall complete protection (CP; CR+nausea score < 25 mm) and total control (TC; CR+nausea score < 5 mm). Quality of life was assessed by Functional Living Index Emesis (FLIE) questionnaire on D0 and D6. RESULTS A total of 279 patients receiving RAD (n=137) or PAD (n=142) were evaluated. Overall CR rates in RAD and PAD recipients were 81.8% and 79.6% (risk difference [RD], 2.2%; 95% confidence interval [CI], -7.1 to 11.4), respectively. Overall CP and TC rates for RAD and PAD were 56.2% and 58.5% (RD, -2.3%; 95% CI, -13.9 to 9.4) and 47.5% vs. 43.7% (RD, 3.8%; 95% CI, -7.9 to 15.5), respectively. FLIE total score ≥ 108 (no impact on daily life) was comparable between RAD and PAD (73.9% vs. 73.4%, respectively). Adverse events were similar between the two groups. CONCLUSION In all aspects of efficacy, safety and QOL, RAD is non-inferior to PAD for the control of CINV in cancer patients receiving HEC.
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Affiliation(s)
- Jin Hyoung Kang
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jung Hye Kwon
- Division of Hemato-Oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yun-Gyoo Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Uk Park
- Division of Hematology/Oncology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Ho Jung An
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joohyuk Sohn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Mi Seol
- Division of Hemato-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyunwoo Lee
- Department of Hematology-Oncology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Hwan-Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Seok Ahn
- Division of Hematology & Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyun Yang
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hunho Song
- Division of Hemato-Oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Young Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Gun Min Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim MS, Lee J, Sim JA, Kwon JH, Kang EJ, Kim YJ, Lee J, Song EK, Kang JH, Nam EM, Kim SY, Yun HJ, Jung KH, Park JD, Yun YH. Erratum: Correction of the Text in the Article "Table": Discordance between Physician and the General Public Perceptions of Prognostic Disclosure to Children with Serious Illness: a Korean Nationwide Study. J Korean Med Sci 2020; 35:e74. [PMID: 32056405 PMCID: PMC7025909 DOI: 10.3346/jkms.2020.35.e74] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This corrects the article on e327 in vol. 33, PMID: 30505258.
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Affiliation(s)
- Min Sun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jihye Lee
- Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ah Sim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Junglim Lee
- Department of Hemato-Oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Eun Kee Song
- Division of Hematology and Oncology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Si Young Kim
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Yun
- Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Kang E, Kang JH, Koh SJ, Song EK, Shim HJ, Keam B, Maeng CH, Kim YJ, Yun HJ, Jung KH, Kwon JH, Lee SN, Lee JL, Do YR, Min J, Lee J, Choo J, Yun YH. The Impacts of Prognostic Awareness on Mood and Quality of Life Among Patients With Advanced Cancer. Am J Hosp Palliat Care 2020; 37:904-912. [PMID: 32052654 DOI: 10.1177/1049909120905789] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient's satisfaction and increase depression. AIM The purpose of this study is to assess whether patients' prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancer. DESIGN AND PARTICIPANTS In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients' prognostic awareness at baseline, 3 months, and 6 months. RESULTS This study found significant differences in changes of QoL based on patients' prognostic awareness. From baseline to 3 months, emotional functioning (P = .039), pain (P = .042), existential well-being (P = .025), and social support (P = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning (P = .037), emotional functioning (P = .002), nausea/vomiting (P = .048), and constipation (P = .039) subscale scores and existential well-being scores (P = .025). No significant difference between the groups was found in terms of depression. CONCLUSION Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.
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Affiliation(s)
- EunKyo Kang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Institute for Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, School of Medicine, Gyeongsang University, Jinju, Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Eun-Kee Song
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chi-Hoon Maeng
- Division of Hemato-Oncology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University College of Medicine, Chungnam, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-Oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - JeongHee Min
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jihye Lee
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jiyeon Choo
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
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Hong S, Lee JH, Chun EK, Kim KI, Kim JW, Kim SH, Lee YG, Hwang IG, Kim JY, Koh SJ, Ko YH, Shin SH, Woo IS, Kim TY, Baek JY, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Ryoo HM, Kim JH. Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy. Oncologist 2019; 25:e502-e511. [PMID: 32162799 DOI: 10.1634/theoncologist.2019-0085] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug-drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. SUBJECTS, MATERIALS, AND METHODS This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first-line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first-line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi-comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment-related toxicity, and hospitalization using logistic regression and Cox regression analyses. RESULTS In total, 301 patients (median age 75 years; range, 70-93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0-14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18-2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment-related toxicity. CONCLUSION Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. IMPLICATIONS FOR PRACTICE This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug-drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.
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Affiliation(s)
- Soojung Hong
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ju Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Kyeong Chun
- Department of Pharmacy, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, College of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan, Republic of Korea
| | - In Sook Woo
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Baek
- Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Yun YH, Kim KN, Sim JA, Kang E, Lee J, Choo J, Yoo SH, Kim M, Kim YA, Kang BD, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Lee SN, Maeng CH, Kang EJ, Do YR, Choi YS, Jung KH. Correction to: Priorities of a "good death" according to cancer patients, their family caregivers, physicians, and the general population: a nationwide survey. Support Care Cancer 2019; 27:3921-3926. [PMID: 31309297 DOI: 10.1007/s00520-019-04985-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While recently extending that research, however, we discovered that 236 members of the general population were mistakenly duplicated by the investigating agency (Word Research) and 1241 were reported rather than 1005. Here, we present corrections and discuss the relevant data.
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Affiliation(s)
- Young Ho Yun
- Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea. .,Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyoung-Nam Kim
- Public Health Medical Service, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea
| | - EunKyo Kang
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jihye Lee
- Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiyeon Choo
- Department of Biomedical Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea
| | - Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Ae Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Beo Deul Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, South Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, South Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, South Korea
| | - Soon Nam Lee
- Department of Internal Medicine, EwhaWomans University College of Medicine, Seoul, South Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, South Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Huh SJ, Oh SY, Lee S, Lee JH, Kim SH, Lee GW, Kim SJ, Kim WS, Lee HS, Jo JC, Kim MJ, Kwon JH, Kim HJ. The Glasgow Prognostic Score is a significant predictor of peripheral T-cell lymphoma (PTCL) treated with CHOP-based chemotherapy and comparable with PTCL prognostic scores. Int J Hematol 2019; 110:438-446. [PMID: 31250282 DOI: 10.1007/s12185-019-02693-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/18/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022]
Abstract
The Glasgow Prognostic Score (GPS) serves a prognostic role in several lymphomas. The objectives of the present study were to determine whether GPS predicts clinical outcomes and to compare the utility of four prognostic scores, including GPS, in patients diagnosed with peripheral T-cell lymphoma (PTCL). We selected for this retrospective study 96 patients consecutively diagnosed with PTCL according to the World Health Organization classification from January 2002 to February 2013 and followed up in five different institutions. Low GPS was a good prognostic biomarker of progression-free survival (PFS, P = 0.030) and overall survival (OS, P = 0.013). Estimated 3-year OS rates (low-risk vs. intermediate- or high-risk) by the International Prognostic Index (IPI), the Prognostic Index for T-cell lymphoma (PIT), the International Peripheral T-cell Lymphoma Project (IPTCLP) score, and GPS were 83% vs. 44% (P < 0.001), 68% vs. 37% (P = 0.004), 71% vs. 26% (P < 0.001) and 68% vs. 51% (P = 0.031), respectively. These results indicate that GPS has prognostic value for PTCL. In addition, all four prognostic scores demonstrate their usefulness in assessing PTCL outcomes.
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Affiliation(s)
- Seok Jae Huh
- Department of Internal Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, South Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, South Korea.
| | - Suee Lee
- Department of Internal Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, South Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, South Korea
| | - Sung Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, South Korea
| | - Gyeong-Won Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
| | - Seok Jin Kim
- Department of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Won Seog Kim
- Department of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, South Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Don-gu, Ulsan, 44033, South Korea.
| | - Moon Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Myongji Hospital, Goyang-si, Gyeonggido, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Hyo-Jin Kim
- Department of Internal Medicine, Dong-A University College of Medicine, 26 Daeshingongwon-ro, Seo-gu, Busan, 49201, South Korea
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Kwon JH, Lee SC, Lee MA, Kim YJ, Kang JH, Kim JY, Lee HJ, Bae WK, Kim MJ, Chie EK, Kim J, Kim YH, Chung HC, Rha SY. Behaviors and Attitudes toward the Use of Complementary and Alternative Medicine among Korean Cancer Patients. Cancer Res Treat 2019; 51:851-860. [PMID: 31208165 PMCID: PMC6639220 DOI: 10.4143/crt.2019.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/11/2019] [Accepted: 06/07/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose A cross-sectional survey was conducted to explore the current awareness and use of complementary and alternative medicine (CAM), as well as attitudes toward CAM, in patients with cancer and their family members in South Korea. Materials and Methods Between September 21 and October 31, 2017, a 25-item questionnaire regarding CAM experiences among cancer patients and their family members was conducted in 10 oncology clinics in South Korea after institutional review board approval at each institution. Results In total, 283/310 patients were analyzed. The median age was 60 years, and 60% were male. Most of the patients were actively receiving anticancer treatment at the time of the survey. A total of 106 patients (37%) had experienced a median of two types (interquartile range, 1 to 3) of CAM. Belief in CAM (odds ratio [OR], 3.015; 95% confidence interval [CI], 1.611 to 5.640) and duration of disease (OR, 1.012; 95% CI, 1.004 to 1.020) were independent factors for using CAM in multivariable analysis. Belief in CAM was significantly associated with current use of CAM (OR, 3.633; 95% CI, 1.567 to 8.424). Lay referral was the most common reason for deciding to use CAM, and only 25% of patients (72/283) discussed CAM with their physicians. Conclusion Patient attitudes toward and confidence in CAM modalities were strongly associated with their CAM experiences, and only a small number of patients had an open discussion about CAM with their physicians. A patient education program for CAM is needed.
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Affiliation(s)
- Jung Hye Kwon
- Division of Hemato-Oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang-Cheol Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Young Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Mi-Jung Kim
- Division of Medical Oncology, Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yeul Hong Kim
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Kwon JH, Baek SK, Kim BS, Koh SJ, Ahn HK, Lim JH, Lim C, Kim DY. Surrogate decision making of chemotherapy consent: do we really provide informed consent of chemotherapy for patients? Korean J Intern Med 2019; 34:626-633. [PMID: 29843493 PMCID: PMC6506731 DOI: 10.3904/kjim.2017.252] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/06/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIMS Despite increased demand for cancer patient's to make their own decisions based on an adequate understanding of what is involved in chemotherapy, the primary signing agent and the reasons for surrogate signing have not been appropriately evaluated. METHODS The ethics committee of the palliative medicine subgroup of the Korean Cancer Study Group designed this study and solid cancer patients to whom chemotherapy was offered, from seven institutions, were evaluated. The details relating to surrogate's signing of chemotherapy consent were evaluated. Then, we analyzed the factors associated with surrogate's signing according to patient's demographics and characteristics related to chemotherapy consent. RESULTS Surrogate's signing was noted for 20.7% (84/405) of patient and over half of surrogate signings were performed by the patients' son or daughter (60.7%). Two main reasons for surrogate signing were patient's incapacity (34.5%) and taking over authorization from patients (33.3%). The factors associated with more frequent surrogate's signing were absence of spouse, lower education level, outpatient, and when residents played a role as a principle provider of chemotherapy consent. CONCLUSION This study suggests the lack of patients' own decision making for chemotherapy in some situations. This ethical dilemma must be considered for adequately informed decision making for chemotherapy while ensuring the patients' autonomy is maintained.
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Affiliation(s)
- Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Joo Han Lim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Chiyeon Lim
- Department of Biostatistics, Dongguk University School of Medicine, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Correspondence to Do Yeun Kim, M.D. Department of Internal Medicine, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea Tel: +82-31-961-7143 Fax: +82-31-961-7141 E-mail:
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Park HY, Kim YA, Sim JA, Lee J, Ryu H, Lee JL, Maeng CH, Kwon JH, Kim YJ, Nam EM, Shim HJ, Song EK, Jung KH, Kang EJ, Kang JH, Yun YH. Attitudes of the General Public, Cancer Patients, Family Caregivers, and Physicians Toward Advance Care Planning: A Nationwide Survey Before the Enforcement of the Life-Sustaining Treatment Decision-Making Act. J Pain Symptom Manage 2019; 57:774-782. [PMID: 30593911 DOI: 10.1016/j.jpainsymman.2018.12.332] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022]
Abstract
CONTEXT To respect a patient's wish for end-of-life care, "the Act on Decisions on Life-Sustaining Treatment for Patients at the End-of-Life" was enacted in South Korea in 2016. Current understanding of people who would be involved in advance care planning (ACP) is crucial to disseminate it systematically. OBJECTIVES The objective of this study was to investigate awareness and attitudes toward ACP in South Korea. METHODS A multicenter, nationwide cross-sectional study was conducted, a survey regarding ACP among four groups that would have different positions and experiences: 1001 cancer patients, 1006 family caregivers, 928 physicians, and 1241 members of the general public. RESULTS A total of 15% of the general population, 33% of the patients and caregivers, and 61% of the physicians had knowledge of advance directives. More than 64% of the general population, above 72% of the patients and caregivers, and 97% of the physicians were willing to do so when the disease status was aggravated or terminal. The possibility for changing the plan, uncertainty as to whether directives would actually be followed, and psychological discomfort were common reasons for not wanting to engage in ACP. Routine recommendations for a specific medical condition, heightened accessibility, and health insurance support were common factors that could help facilitate ACP. CONCLUSION Our findings suggest that strategies for promoting ACP should reflect different perspectives among the general public, patients, family caregivers, and physicians. Public advocacy, resources for approaching and integrating ACP into routine health care, as well as systematic support provisions are needed.
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Affiliation(s)
- Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ae Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jihye Lee
- Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyewon Ryu
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Chi Hoon Maeng
- Department of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Mi Nam
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jeong Shim
- Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun-Kee Song
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Joo Kang
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Republic of Korea
| | - Young Ho Yun
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Health Policy and Management, Seoul National University, Seoul, Seoul, Republic of Korea.
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Kim YS, Song HN, Ahn JS, Koh SJ, Ji JH, Hwang IG, Yun J, Kwon JH, Kang JH. Sedation for terminally ill cancer patients: A multicenter retrospective cohort study in South Korea. Medicine (Baltimore) 2019; 98:e14278. [PMID: 30702591 PMCID: PMC6380862 DOI: 10.1097/md.0000000000014278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/26/2022] Open
Abstract
Sedation therapy is a potential solution to providing relief from refractory symptoms at end of life. The aim of this study was to investigate actual sedation practice and physician characteristics associated with the use of sedation for terminally ill cancer patients in South Korea.A retrospective review was conducted on consecutive patients who had died from cancer at seven tertiary medical centers between January 2010 and October 2015. The use of sedation was defined as the administration of sedative agents to relieve intolerable symptoms within the last 2 weeks preceding death. Patients and physician characteristics and information on the use of sedation were collected.A total of 8309 patients were included in the study. Sedatives were administered in 1334 patients (16.1%) for the following indications: delirium in 39.3%, intractable pain in 23.1%, and dyspnea in 21.9%. Median duration of sedation from initiation to death was 3 days. The use of sedation depended on physician specialty and experience. Family physicians used sedation most often (57.6%), followed by medical oncologists (13.9%), other internists (10.7%), and surgical oncologists (9.4%). The use of sedation was highest for physicians with >5 to 10 years practice experience (22.1%) and lowest for those in practice for 5 years or less (10.2%). The proportion of patients receiving sedation also varied markedly across participating institutions (range, 7.0%-49.7%).This large cohort study provides insight into sedation practice for terminally ill cancer patients in South Korea. Our study shows that the use of sedation depends on physician background and institution. A nation-wide guidelines and continued education on end-of-life sedation are required in South Korea.
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Affiliation(s)
- Young Saing Kim
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Haa-Na Song
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Jun Ho Ji
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - In Gyu Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul
| | - Jina Yun
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon
| | - Jung Hye Kwon
- Division of Hemato-oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul
| | - Jung Hun Kang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju
- Institute of Health Science, College of Medicine, Gyeongsang National University, Jinju, South Korea
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Kim MS, Lee J, Sim JA, Kwon JH, Kang EJ, Kim YJ, Lee J, Song EK, Kang JH, Nam EM, Kim SY, Yun HJ, Jung KH, Park JD, Yun YH. Erratum: Correction of Ethics Statement: Discordance between Physician and the General Public Perceptions of Prognostic Disclosure to Children with Serious Illness: a Korean Nationwide Study. J Korean Med Sci 2019; 34:e30. [PMID: 30662391 PMCID: PMC6335119 DOI: 10.3346/jkms.2019.34.e30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
[This corrects the article e327 in vol. 33, PMID: 30505258.].
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50
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Kim JW, Kim SH, Lee YG, Hwang IG, Kim JY, Koh SJ, Ko YH, Shin SH, Woo IS, Hong S, Kim TY, Baek JY, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Ryoo HM, Lee KH, Kim JH. Prospective Validation of The Korean Cancer Study Group Geriatric Score (KG)-7, a Novel Geriatric Screening Tool, in Older Patients with Advanced Cancer Undergoing First-line Palliative Chemotherapy. Cancer Res Treat 2019; 51:1249-1256. [PMID: 30653746 PMCID: PMC6639235 DOI: 10.4143/crt.2018.451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/08/2018] [Accepted: 12/30/2018] [Indexed: 12/27/2022] Open
Abstract
Purpose The purpose of this study was to prospectively validate the Korean Cancer Study Group Geriatric Score (KG)-7, a novel geriatric screening tool, in older patients with advanced cancer planned to undergo first-line palliative chemotherapy. Materials and Methods Participants answered the KG-7 questionnaire before undergoing geriatric assessment (GA) and first-line palliative chemotherapy. The performance of KG-7 was evaluated by calculating the sensitivity (SE), specificity (SP), positive and negative predictive value (PPV and NPV), balanced accuracy (BA), and area under the curve (AUC). Results The baseline GA and KG-7 results were collected from 301 patients. The median age was 75 years (range, 70 to 93 years). Abnormal GA was documented in 222 patients (73.8%). Based on the ≤ 5 cut-off value of KG-7 for abnormal GA, abnormal KG-7 score was shown in 200 patients (66.4%). KG-7 showed SE, SP, PPV, NPV, and BA of 75.7%, 59.7%, 84.4%, 46.0%, and 67.7%, respectively; AUC was 0.745 (95% confidence interval, 0.687 to 0.803). Furthermore, patients with higher KG-7 scores showed significantly longer survival (p=0.006). Conclusion KG-7 appears to be adequate in identifying patients with abnormal GA prospectively. Hence, KG-7 can be a useful screening tool for Asian countries with limited resources and high patient volume.
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Affiliation(s)
- Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Young Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yoon Ho Ko
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - In Sook Woo
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soojung Hong
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeon Baek
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Kyung Hee Lee
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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