Factors of Patient Satisfaction with Pain Management in Cancer Patients

BACKGROUND: For cancer patients, pain is the most common symptom and the most important factor that seriously affects their treatment and quality of life. The purpose of the research was to determine the controllable factors for pain management in order to increase patients' satisfaction for pain management. METHOD: This study was based on the survey answers and medical records of 464 cancer patients, in 8 hospitals in Korea from March until September 2000. RESULTS: As shown by Chi-square test, according to the degree of satisfaction for cancer pain management, those patients who were "satisfied" with pain treatment showed better activity rate (P=0.007) than the "unsatisfied" group. Additionally, the frequency of using painkillers according to WHO step-ladder, Pain Management Index (PMI), or patients own knowledge and attitude toward cancer pain control was not found to be relevant to patients satisfaction (P=0.106, P=0.382, P>0.05). But, in the "satisfaction" group, more patients were informed of the importance of pain management (P=0.004) and reported less pain (P<0.05). A close relationship between higher satisfaction and lower pain interference rate was discovered, but no correlation was found for activity, mood, or gate. The average of interference rate was lower in the "satisfaction" group (P<0.05). CONCLUSION: For higher satisfaction rate for pain management among cancer patients, high activity rate, patient education of importance of pain management, less severity of pain, and low interference rate in life are found to be the determinants.

High Dose Chemotherapy Using CD34+ Hematopoietic Stem Cells / 대한혈액학회지

BACKGROUND: Recently, CD34 antigen expressed on hematopoietic stem cells which is not detected on non-Hodgkin lymphoma (NHL), multiple myeloma and most solid tumors, is identified. In autologous bone marrow transplantation (BMT), positive selection of CD34+ cells may be used to provide hematopoietic stem cells capable of engraftment but depleted of tumor cells. And it can be used to depletion of T lymphocytes to prevent the graft versus host disease (GVHD) in allogeneic BMT. So we performed this study to evaluate the efficacy of purification of CD34+ stem cells with CEPRATE SC Stem Cell Concentration System (CellPro Inc.) and to assess the influence of CD34+ stem cells on engraftment. METHODS: Peripheral blood stem cells were mobilized with cyclophosphamide (except one patient with malignant lymphoma) and G-CSF and harvested using CS-3000 (Fenwall). CD34+ stem cells counted by FACScan (Becton-Dickinson). The conditioning regimens were ICE (Ifosphamide/Carboplatin/Etoposide) in breast cancer, high dose melphalan in multiple myeloma, BEAC (BCNU/Etoposide/Ara-C/Cyclophosphamide) in NHL, TBI (total body irradiation) with cyclophosphamide in acute lymphocytic leukemia (ALL) and busulfan with cyclophosphamide in myelodysplastic syndrome (MDS). We used G-CSF (10 microgram/kg) after transplantation in all patients. RESULTS: Eleven patients, six with high risk or metastatic breast cancer, one with refractory multiple myeloma, one with acute lymphocytic leukemia (transformed from lymphoblasticlymphoma), two with relapsed malignant lymphoma, one with myelodysplastic syndrome (HLA one-locus mismatched allogeneic BMT case, for T lymphocyte depletion) were treated. Hematopoietic stem cells were harvested from autologous peripheral blood in all patients except one patient with MDS whose stem cells were harvested from allogeneic bone marrow. Median duration and number of peripheral blood stem cell (PBSC) harvest were 15 days (13~22) and 3 times (2~8), respectively. The mean number of total stem cells and CD34+ stem cells harvested per pheresis were 204.8 (17.4~797.9)x106/kg and 3.0 (0.3~11.9)x106/kg, respectively. The mean efficacy of CD34+ hematopoietic stem cell selection by CEPRATE SC Stem Cell Concentration System was 47.7% (1.4~99.0%). The number of infused CD34+ stem cells per patient ranged from 0.34 to 4.8x106/kg (mean 2.3x106/kg). After transplantation, the median day of achieving granulocyte counts of >0.5x109/L was 10.5 days and platelet counts of >50x109/L was 14 days. CONCLUSION: CD34+ stem cells separated with CEPRATE SC Stem Cell Concentration System provided reliable and timely hematopoietic reconstitution.

COPP/ABV Hybrid Chemotherapy in Pateints with Hodgkin's Disease / 대한암학회지

PURPOSE: MOPP/ABV hybrid regimen incorporates MOPP and ABVD into a single regimen on the tenets of the Goldie-Coldman hypothesis. This study was performed to determine the efficacy of COPP/ABV hybrid regimen, in which cyclophosphamide was substituted for mechlorethamine, in patients with advanced Hodgkin's disease. MATERIALS AND METHODS: Patients with advanced Hodgkin's disease were treated with cyclophosphamide(600 mg/m2 iv, Dl), vincristine(1.4 mg/m2 iv, D1), procarbazine(100 mg/m2/d po, D1-7), prednisolone(40 mg/m2/d po D1-14), doxorubicin(35 mg/m2 iv, D8), bleomycin(10 mg/m2 iv, D8) and vinblastine(6 mg/m2 iv, D8). The treatment was repeated every 4 weeks. RESULTS: Between Aug. 1989 and Aug. 1996, 28 patients were enrolled. The median age was 33 years. Twenty one(75%) were previously untreated, newly diagnosed patients and 7(25%) were those who had relapsed after previous radiotherapy(RT). The common histologic types were nodular sclerosis(46%) and mixed cellularity(36%). Twenty three (82%) patients achieved complete remission(CR), three(11%) with the assistance of involved-field RT. Only one patient was primary treatment failure. The median follow-up duration was 56 months. Of the 23 patients achieving CR, three(13%) relapsed. Five-year relapse-free survival was 84.4%. Eight patients died. Five-year overall survival rate was 66.6% and 5-year failure-free survival rate was 66.3%. The survival rate of those who had relapsed after previous RT was significantly lower than that of newly diagnosed patients(P=0.03). The hematologic toxicities were common, but nonhernatologic toxicities were uncommon. Five patients died of treatment-related pneumonia or sepsis. Among them, four were those who had relapsed after previous RT. CONCLUSION: COPP/ABV hybrid regimen could cure significant proportion of patients with advanced Hodgkin's disease but the treatment-related mortality was high, especially in those who had relapsed after previous RT. Another regimen should be considered for those who received previous RT.