Prognostic Value of Serum Ferritin in Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: Predicting life expectancy of terminally ill cancer patients is very important. In many studies, ferritin is detected at higher levels in the sera of cancer patients, and higher ferritin level correlates with aggressiveness of disease and poor outcomes of patients. This study evaluated a prognostic role of serum ferritin levels in terminally ill cancer patients. METHODS: This study enrolled 65 terminally ill cancer patients from March through June 2012. We assessed routine laboratory findings including serum ferritin levels as well as demographic and clinical characteristics of the patients. To examine the association between serum ferritin levels and patient's characteristics, we used Spearman's correlation analysis, Wilcoxon's rank sum test or Kruskal-Wallis test, as appropriately. For multivariate analysis, Cox's proportional hazard regression model was used to evaluate significance of serum ferritin levels as a prognostic factor. RESULTS: A negative correlation between serum ferritin levels and survival time was found. After adjusting for sex, age, performance status, creatinine levels and white blood cell counts, serum ferritin levels were significantly associated with survival time. CONCLUSION: Even at the very end of life of terminal cancer patients, serum ferritin levels were an independent prognostic factor for survival.

Factors Related to Serum Vitamin C Level in Terminally Ill Cancer Patients / 한국호스피스완화의료학회지

PURPOSE: Serum vitamin C is one of the indicators for antioxidant levels in the body and it is lower in cancer patients compared with the healthy population. However, there have been few studies on the levels of serum vitamin C in terminally ill cancer patients and related factors. METHODS: We followed 65 terminal cancer patients who were hospitalized in two palliative care units. We collected data of age, sex, cancer type, functional status, clinical symptoms, history of cancer therapy, and various laboratory findings including serum vitamin C level. Patients were categorized into two groups according to the quartile of serum vitamin C level (Q1-3 vs. Q4), which were compared each other. Stepwise multiple logistic regression analysis was used to identify factors related to serum vitamin C levels. RESULTS: The mean serum vitamin C level was 0.44 microg/mL, and all patients fell into the category of vitamin C deficiency. Univariate analysis showed that The serum vitamin C level was lower in non-lung cancer patients (P=0.041) and febrile patients (P=0.034). Multivariate analysis adjusted for potential confounders such as lung cancer, fever, dysphagia, dyspnea, C reactive protein, and history of chemotherapy demonstrated that odds for low serum vitamin C level was 3.7 for patients receiving chemotherapy (P=0.046) and 7.22 for febrile patients (P=0.02). CONCLUSION: Vitamin C deficiency was very severe in terminally ill cancer patients, and it was associated with history of chemotherapy and fever.

Vitamin D Deficiency and Related Factors in Patients at a Hospice / 한국호스피스완화의료학회지

PURPOSE: Although vitamin D deficiency is more commonly found in cancer patient than in non-cancer patients, there have been little data regarding the prevalence of vitamin D deficiency in cancer patients at the very end of life. We examined vitamin D deficiency in terminally ill cancer patients and related factors. METHODS: This study was based on a retrospective chart review of 133 patients in a hospice ward. We collected data regarding age, sex, serum 25-hydroxyvitamin D level, cancer type, physical performance, current medications and various laboratory findings. We investigated factors related to serum vitamin D levels after multivariate adjustment for potential confounders. Serum 25-hydroxyvitamin D<20 ng/mL was considered deficient and <10 ng/mL severely deficient. RESULTS: Ninety-five percent of the patients were serum vitamin D deficient. Severe vitamin D deficiency was more common in male patients, non-lung cancer patients, H2 blocker users and non-anticonvulsant users. Elevated levels of serum alanine aminotransferase (ALT) were also associated with low serum vitamin D levels. Multiple regression analysis showed that severe vitamin D deficiency was associated with male gender (aOR 3.82, 95% CI: 1.50~9.72, P=0.005), H2 blocker users (aOR 3.94, 95% CI: 1.61~9.65, P=0.003) and elevated serum ALT levels (aOR 4.52, 95% CI: 1.35~15.19, P=0.015). CONCLUSION: Vitamin D deficiency was highly prevalent among terminally ill cancer patients. Severe vitamin D deficiency was more common in male patients, H2 blocker users, and patients with elevated ALT levels.

Effect of a Needle Aspiration in Patients with Lymphedema / 한국호스피스완화의료학회지

PURPOSE: Lymphedemas are tissue fluid swellings, usually on the arms or legs, and occur as a result of impaired lymphatic drainage. Presently, the most effective treatment available is complete decongestive physiotherapy (CDP). However, this therapy is ineffective in some patients and surgery may be indicated. Herein, we examined the efficacy of minimally invasive needle aspiration of the most enlarged areas in hypodermic adipose tissues, of patients who had failed CDP. METHODS: We included 21 patients who were diagnosed with lymphedema stage II-III in the upper or lower extremities and visited the lymphedema clinic at a university hospital from September 1, 2003 to February 28, 2004. All patients had been treated with CDP at least once, but had failed to respond to the therapy for more than one year. Nine patients had breast cancer and 12 had cervical cancer. We identified the area with the most severe edema by using MRI and performed a 16-gauge angio-needle aspiration on the area. The patients were followed up for 3 months. Effectiveness of the treatment was evaluated by comparing the volume of edema before and after the treatment using Wilcoxon signed rank-test. RESULTS: The mean reduction ratio of the volume of edema comparison normal volume was 41.1+/-35.3% (P=0.001). There were no major or minor operative complications except localized hemorrhage. CONCLUSION: We conclude that a needle aspiration prior to other surgical treatments is relatively safe and effective for those patients who are unresponsive to CDP.

Changes of Terminal Cancer Patients' Health-related Quality of Life after High Dose Vitamin C Administration

Over the years there has been a great deal of controversy on the effect of vitamin C on cancer. To investigate the effects of vitamin C on cancer patients' health-related quality of life, we prospectively studied 39 terminal cancer patients. All patients were given an intravenous administration of 10 g vitamin C twice with a 3-day interval and an oral intake of 4 g vitamin C daily for a week. And then we investigated demographic data and assessed changes in patients' quality of life after administration of vitamin C. Quality of life was assessed with EORTC QLQ-C30. In the global health/quality of life scale, health score improved from 36+/-18 to 55+/-16 after administration of vitamin C (p=0.001). In functional scale, the patients reported significantly higher scores for physical, role, emotional, and cognitive function after administration of vitamin C (p<0.05). In symptom scale, the patients reported significantly lower scores for fatigue, nausea/vomiting, pain, and appetite loss after administration of vitamin C (p<0.005). The other function and symptom scales were not significantly changed after administration of vitamin C. In terminal cancer patients, the quality of life is as important as cure. Although there is still controversy regarding anticancer effects of vitamin C, the use of vitamin C is considered a safe and effective therapy to improve the quality of life of terminal cancer patients.

The Effect of Intravenous Vitamin C in People with Fatigue

BACKGROUND: Although fatigue is the most common symptom in primary care, both doctors and patients tend to overlook it. According to one study, 27% of the adults felt fatigued for one week and 6% of the adults complained of unexplained fatigue for over two weeks. Stress play an important role in the etiology of fatigue. Thus, antioxidants are currently taken by people who complain of fatigue. Vitamin C is one of the most common antioxidants. We intend to find out whether intrarenous vitamin C is really helpful or not in people who complain of fatigue. METHODS: We have investigated 19 outpatients who chiefly complained of fatigue and visited the department of family medicine at one university hospital from July 1, 2004 to Nov 30, 2005. The patients were treated by Vitamin C 10g and Vitamin B complex injection for 4 weeks, and they conducted a questionnaire survey concerning the severity of symptom before and after injection. The questionnaire with 9 questions consisted of 7 score index. The results were statistically analyzed with Wilcoxon Signed Ranks test and a P-value under 0.05 was considered significant. RESULTS: Three patients were males and 16 patients were females. The average age group was 47.7+/-13.6 years. While the fatigue severity score of the patients before vitamin C injection was 5.2 (3.0~7.0), the fatigue severity score after injection was 3.3 (1.4~4.8), which was significantly decreased (P<0.0001). CONCLUSION: We think that the vitamin C intravenous injectioned to people who complained of fatigue was helpful.

Reliability and Validity of the Korean Cancer Pain Assessment Tool (KCPAT)

The Korean Cancer Pain Assessment Tool (KCPAT), which was developed in 2003, consists of questions concerning the location of pain, the nature of pain, the present pain intensity, the symptoms associated with the pain, and psychosocial/spiritual pain assessments. This study was carried out to evaluate the reliability and validity of the KCPAT. A stratified, proportional-quota, clustered, systematic sampling procedure was used. The study population (903 cancer patients) was 1% of the target population (90,252 cancer patients). A total of 314 (34.8%) questionnaires were collected. The results showed that the average pain score (5 point on Likert scale) according to the cancer type and the at-present average pain score (VAS, 0-10) were correlated (r=0.56, p<0.0001), and showed moderate agreement (kappa=0.364). The mean satisfaction score was 3.8 (1-5). The average time to complete the questionnaire was 8.9 min. In conclusion, the KCPAT is a reliable and valid instrument for assessing cancer pain in Koreans.

The factual survey of using sedative agents in terminal cancer patients

BACKGROUND: In terminal cancer patients, alleviation of suffering is as important as the cure of disease. But their symptoms are often intractable. In such a case, sedation is usually considered to relieve these refractory symptoms. However, the decision to sedate has been an ethical concern to health care workers because of an effect on survival time of cancer patients. The aim of this study was to investigate the use of sedation in terminal cancer patients and its relationship with intractable symptoms. METHODS: One hundred and fifty six patients admitted to National Health Insurance Corporation Ilsan Hospital, Department of Family Medicine for hospice care from September 2000 to the end of October 2001 were enrolled in the study. Demographic data, clinical symptoms, the use of sedation, the choice of medication , reasons for administration, and frequency were recorded. RESULT: There were 81(51.9%) men and 75(48.1%) women. The mean age was 64.6+/-13.3 years. The primary sites of cancer were stomach 36(23.1%), lung 27(17.3%), and colo-rectal 19(12.2). Common symptoms were pain, nausea/vomiting, and dyspnea. Among the subjects 55(35.3%) received sedation. The drugs used for sedation were lorazepam in 37(67.3%), haloperidol in 21(38.2%), and diazepam in 18(32.7%). Sedation was administered to relieve insomnia in 20(36.4%), agitated delirium in 20(36.4%), severe pain in 9(16.4%), dyspnea in 5(8.0%), and nausea/vomiting in 1 (1.8%). CONCLUSION: Among the subjects, 55(35.3%) of 156 terminal cancer patients received sedation. Though most common symptoms were pain and dyspnea, the use of sedation was mostly limited to insomnia and delirium. Therefore, the use of sedation is not yet prevalent in Korea.

Localized edema

No abstract available.

The Medical Costs in Terminally Ill Cancer Patients

Increasing medical cost due to increasing number of terminally ill cancer patients is very important to be a national issue. Therefore, studies on effective cost reduction are being conducted actively throughout the world. An increase in medical cost means that treatment effect is lagging compared to medical cost. Medical cost includes all expenses used in medicine, and treatment effect is the effect from treating diseases. An analysis of studies in Korea and abroad in the past few years yielded two big issues. The first issue is the comparison between hospital hospice institution and home hospice institution. The second is the comparison between hospice institutions and non-hospice institutions. Many studies done on these two issues revealed that hospice treatment is more effective for the treatment of terminally ill cancer patients, compared with any other treatments. Especially, home hospice provides greater benefits from the economic standpoint. Various factors exist in increasing medical cost in terminally ill cancer patients. These factors in Korea, in short, are 'site of death, medical team, and alternative medicine'. Treatment plan for the terminally ill cancer patients through hospice and palliative care can be the way to solve this problem. On suggestion of this treatment plan, we believe that many cancer patients would rather live their remaining life at home rather than at hospital, So that un-necessary tests and treatments would be minimized, and no money would be wasted on alternative medicine that has not been proven scientifically. Acceptance of death as a natural process by patients and their families will eventually bring about a cost reduction in medicine.

The comparison of the medical costs and quality of life in terminal cancer patients by the types of medical facilities

BACKGROUND: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to exfended sarvival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management. METHOD: A total 159 patients(males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors. RESULTS: The mean cost of types of medical facilities during the last week of patients as 65332.5 won in charity hospital hospice unit, 105165.5 won in home hospice, 702083.4 won in university hospital hospice unit, and 1037358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2 +/- 3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain scor of home hospice as 1.7+/-1.7 and that of university hospital hospice as 1.2+/-1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depression's categorial scale of home hospice the score was 4.8+/-1.3, which was higher than those of free hospital hospice unit and university hospital non-hospice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities. CONCLUSION: The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.