ABSTRACT
Background and Objective : Cancer of the nasopharynx (NPC), in Thailand patients are frequently diagnosed at a late stage, when practical treatment options are limited to radiotherapy. The factors affecting survival after late-stage radiation treatment have not been adequately studied.Objective : This study attempted to determine the factors associated with survival among NPC patients after radiation treatment in the Northeastern Thailand.Methods: A retrospective study was performed on the records of 1,129 patients, retrieved from the database of the Radiotherapy Unit, Faculty of Medicine, Khon Kaen University . The NPC patients receiving radiotherapy were recruited between January 1, 1994 and December 31, 2007. All of the patients had histologicaly proven NPC and were followed up until July 31, 2008. The potential factors affecting survival included: age, sex, stage of disease, histological grading, pathology type, lymph node, T4 parameters and distant metastases (including to the liver, brain, bone, lung and nodes). Survival analysis wereperformed by the Kaplan-Meier method. The Cox proportional Hazard Model was used to assess the association of independent variables with survival .Results: Overall, 719 patients died during the study, corresponding to a mortality (case-fatality) rate of 19.8 per 100 person-years (95%CI: 18.4-21.4). The Median follow up time was 7.5 years. The median survival after radiation treatment was 2.3 years (95% CI: 2.0 -2.5). The overall survival rates at 1-3-5 yrs, were 72.7% (95% CI: 70.0-75.3), 43.9 (95%CI: 41.0-45.9) and 34.5 (95%CI: 31.4-37.5). After adjusting for age, sex, stage, pathology type, and T4 parameters the significant predictors included age, sex, stage and T4 parameters. Conclusions: NPC patients could survive 3 yrs. and 2 months after radiation treatment, and had an increased mortality risk at the late stage, especially age more than 45 yrs.Keywords: Nasopharynx cancer, Prognostic factors, Radiation therapy
ABSTRACT
Background and Objective: Cholangiocarcinoma (CHCA) is the most common cancer in Thai people especially in the Northeast of Thailand. Primary prevention is very important for CHCA control. This study attempted to find the exposures associate with CHCA in order to develop a predictive statistical model for CHCA in people in Northeast Thailand.Methods: This study was carried out in 2007 as a nested case-control study within the Khon Kaen cohort study at Cancer Unit, Khon Kaen University. The cohort recruitment was performed during 1990 to 2001. There were 108 CHCA cases occurred in the cohort and individual matched control was randomly selected for each case (1:1), matched by age, sex and date of recruitment to the cohort.Results: For the predictive model, was: logit (CHCA) = 0.69 X Opisthorchis Viverrini, OV (egg in stool finding) with the precision of 56.48% (95%CI:= 51.25-61.71), sensitivity 54.02% (95%CI: = 46.32 - 61.59), specificity 66.67% (95%CI: = 50.45 - 80.43), positive predictive value 87.04% (95%CI:=79.21-92.73) and negative predictive value 25.93% (95%CI:=17.97-5.25).Conclusion: The results of this study suggested that OV infestation has high association with CHCA. To reduce the incidence of CHCA, liver fluke control is priority work for health policy.Keywords: Cholangiocarcinoma, Risk factors for cholangiocarcinoma, Predictive model for cholangiocarcinoma
ABSTRACT
Rationale: Stroke or the disease of cerebral blood vessel, or paralysis is a prevalent disease and a major public health problem of Thailand. Stroke is a chronic disease with prolonged development at all stages that leads to the paralytic state, the state that prevents the patient from doing their daily routine and thus have to rely on the others. This means an additional expense both from treatment at hospital and home care. The study of Neurological Institute in 1995 reported that the average expense of outpatients which involved transportation cost to receive their treatment at the hospital was 1,400 baht per person per day. Such expense has not been studied at Srinagarind Hospital before.Objective: To study the average direct and indirect expenses of the stroke outpatients at Srinagarind Hospital during the first trimester of 2008. Study design: Descriptive researchSetting: The Outpatient Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityMethods: 237 new and former stroke outpatients aged over 20 years old who received treatment from January 1 to March 31, 2008. The research tool was questionnaire.Results: The stroke outpatients in the sample group are from 20 to 91 years old, or an average age of 64+12.8 years. The most diagnosis result reveals cerebral infarction (31.6 percent), with a Modified Rankin Score of 1. Concurrent diseases diagnosed include hypertension, Dyslipidemia, and diabetes, respectively. The result shows the direct and indirect expenses of the outpatients’ final visit to the hospital. For the direct expense, the average cost of food is 172.89 baht, the average two-way transportation cost is 517.68 baht, and the average accommodation cost is 625.50 baht. As for the indirect expense, it was found that the outpatients take a two-day leave from work at a maximum, with a loss of an average of 500 baht of income per day. When the outpatients come to the hospital, they are accompanied by 1-3 relatives or an average of 1.16 persons, causing an average reduction of income of 489.15 baht per day. The average total direct and indirect expense becomes 1,959.85 baht per day per one outpatient.Conclusion: The expense of each stroke outpatient at Srinagarind Hospital is as high as 1,959.85 baht per day. Most of these expenses are accommodation, transportation, and a loss of income from work. It is recommended that community servicing be established in order to lessen the expense of stroke outpatients by not having to travel to the hospital.Keywords: expense of stroke and outpatient