Bong Yul Huh

Prediagnosis Smoking, Obesity, Insulin Resistance, and Second Primary Cancer Risk in Male Cancer Survivors: National Health Insurance Corporation Study

PURPOSEnSmoking, obesity, and insulin resistance are well-known risk factors for cancer, yet few epidemiology studies evaluate their role as risk factors for a second primary cancer (SPC).nnnPATIENTS AND METHODSnWe identified 14,181 men with a first cancer from the National Health Insurance Corporation Study cohort. We obtained data on fasting glucose level, body mass index (BMI), and smoking history from an enrollment interview (1996). We obtained SPC incidence data for 1996 through 2002 from the Korean Central Cancer Registry. We used the standard Poisson regression model to estimate the age- and multivariate-adjusted relative risk (RR) for SPCs in relation to smoking history, BMI, and insulin resistance before diagnosis.nnnRESULTSnWe observed 204 patients with SPC. The overall age-standardized incidence rate of SPC was 603.2 occurrences per 100,000 person-years, which was about 2.3 times higher than that of first cancer in the general male population. Multivariate regression revealed that lung (RR, 3.69; 95% CI, 1.35 to 10.09) and smoking-related (RR, 2.02; 95% CI, 1.02 to 4.03) SPCs were significantly associated with smoking. Obese patients (BMI > or = 25 kg/m2) had significantly elevated RRs for colorectal (RR, 3.45; 95% CI, 1.50 to 7.93) and genitourinary (RR, 3.61; 95% CI, 1.36 to 9.54) SPCs. Patients with a fasting serum glucose concentration > or = 126 mg/dL had a higher RR for hepatopancreatobiliary (RR, 3.33; 95% CI, 1.33 to 8.37) and smoking-related (1.93; 95% CI, 1.01 to 3.68) SPCs.nnnCONCLUSIONnPrediagnosis smoking history, obesity, and insulin resistance were risk factors for several SPCs. These findings suggest that more thorough surveillance and screening for SPCs is needed for the cancer survivors with these risk factors.

Multicenter Study of Pain and Its Management in Patients with Advanced Cancer in Korea

The aim of this study was to evaluate the prevalence, severity, and management of pain in Korean patients with advanced cancer, and to identify the predictors of inadequate management of cancer pain in Korea. From 8 university hospitals, 655 patients with advanced cancer were surveyed. Information concerning analgesics prescribed was acquired from the medical records by the investigator. Physicians, nurses and caregivers were asked to estimate patients pain. The Korean Brief Pain Inventory and the Barrier Questionnaire were completed by the patients. The Pain Management Index was estimated. Among all patients, 70.8% (464 of 655) reported pain. Among those who had pain, 63.6% (295 of 464) reported pain rated 5 or higher on a 0-10 scale. Thirty-nine percent of the patients had not received any analgesics and 53.2% were not receiving optimal pain management. Although there was a correlation between patients pain ratings and those of doctors, nurses, and caregivers, there was no significant correlation between patients ratings and health care providers ratings at pain levels above moderate intensity. Cancer pain was more poorly managed in advanced cancer than terminal cancer patients (OR:3.20, 95%C.I, 1.83-5.60), in patients with better performance(OR:3.17, 95%C.I, 1.64-6.11), and in those patients whose pain was underestimated by the doctor (OR:2.58, 95%C.I. 1.42-4.69). Despite the high prevalence and severity of pain in cancer patients, the assessment and management of cancer pain were found to be inadequate in Korea.

Effects of selenium supplements on cancer prevention: meta-analysis of randomized controlled trials.

This meta-analysis aimed to investigate the preventive effect of selenium supplements alone on cancer as reported by randomized controlled trials (RCTs). We searched PubMed, EMBASE, and the Cochrane Library in July 2009. Of the 461 articles searched, 8 articles on 9 RCTs, which included 152,538 total participants, 32,110 in antioxidant supplement groups, and 120,428 in placebo groups, were included. In a random-effects meta-analysis of all 9 RCTs, selenium supplementation alone was found to have an overall preventive effect on cancer incidence [relative risk (RR) = 0.76; 95% confidence interval (CI) = 0.58–0.99]. Among subgroup meta-analyses, the preventive effect of selenium supplementation alone on cancer was apparently observed in populations with a low baseline serum selenium level (<125.6 ng/mL) (RR = 0.64; 95% CI = 0.53 to 0.78; I2 = 45.5%; n = 7) and in high-risk populations for cancer (RR = 0.68; 95% CI = 0.58 to 0.80; I2 = 41.5%; n = 8). The meta-analysis of randomized controlled trials indicates that there is possible evidence to support the use of selenium supplements alone for cancer prevention in the low baseline serum selenium level population and in the high-risk population for cancer.

Effects of Beta-Carotene Supplements on Cancer Prevention: Meta-Analysis of Randomized Controlled Trials

This meta-analysis aimed to investigate the effects of beta-carotene supplements alone on cancer prevention as reported by randomized controlled trials (RCTs). We searched PubMed, EMBASE, and CENTRAL. Among the 848 articles searched, 6 randomized controlled trials, including 40,544 total participants, 20,290 in beta-carotene supplement groups, and 20,254 in placebo groups, were included in the final analysis. In a meta-analysis of 6 RCTs, beta-carotene supplements had no preventive effect on either cancer incidence [relative risk (RR) = 1.08, 95% confidence interval (CI) = 0.99–1.18] or cancer mortality (RR = 1.00, 95% CI = 0.87–1.15). Similar findings were observed in both primary prevention trials and secondary prevention trials. Subgroup analyses by various factors revealed no preventive effect of beta-carotene supplementation on cancer prevention and that it significantly increased the risk of urothelial cancer, especially bladder cancer (RR = 1.52, 95% CI = 1.03–2.24) and marginally increased the risk of cancer among current smokers (RR = 1.07, 95% CI = 0.99–1.17). The current meta-analysis of RCTs indicated that there is no clinical evidence to support the overall primary or secondary preventive effect of beta-carotene supplements on cancer. The potential effects, either beneficial or harmful, of beta-carotene supplementation on cancer should not be overemphasized.

Effectiveness of pharmacologic therapy for smoking cessation in adolescent smokers: meta-analysis of randomized controlled trials

PURPOSEnThe effectiveness of pharmacologic therapy for smoking cessation in adolescent smokers was evaluated.nnnMETHODSnIn this meta-analysis, the medical literature was searched for randomized controlled trials (RCTs) investigating the effect of pharmacologic therapy for smoking cessation in smokers age 20 years or younger. The overall effect of pharmacologic therapy was based on the longest follow-up data available in each study. The effects of pharmacologic therapy by follow-up period, type of pharmacologic therapy, and type of strategy analysis were also compared among RCTs. Secondary outcome measures were adverse events reported from each study.nnnRESULTSnSix RCTs involving 816 smokers age 12-20 years were included in the final analysis. No significant increase in abstinence rates was detected with pharmacologic therapy (relative risk [RR], 1.38; 95% confidence interval [CI], 0.92-2.07; I(2) = 0.0%) in a fixed-effects meta-analysis. Similarly, no significant increase in abstinence rates was found in subgroup meta-analyses of studies with both short-term (≤ 12 weeks) (RR, 1.23; 95% CI, 0.92-1.65) and mid-term (26 weeks) follow-up periods (RR, 1.60; 95% CI, 0.90-2.82). Although few serious adverse events were reported, there was no evidence directly linking these effects to the pharmacologic therapy used.nnnCONCLUSIONnA meta-analysis found that pharmacologic therapy for smoking cessation among adolescent smokers did not have a significant effect on abstinence rates at short-term and mid-term follow-up times of <26 weeks, and the RCTs examined found few adverse events. However, the results may have been affected by the limited number of participants in published trials.

Effects of Vitamin Treatment or Supplements with Purported Antioxidant Properties on Skin Cancer Prevention: A Meta-Analysis of Randomized Controlled Trials

Aims: To investigate the effect of vitamin treatment or supplements with purported antioxidant properties on the primary and secondary prevention of skin cancer using a meta-analysis of randomized controlled trials (RCTs). Methods: We searched PubMed, Embase and the Cochrane Library in June 2009. Among 398 articles searched, 11 articles on 10 RCTs were included in the final analysis. Results: In a fixed-effects meta-analysis of all 10 trials, vitamin treatment or supplements with purported antioxidant properties were found to have no preventive effect on skin cancer [relative risk (RR) = 0.98; 95% confidence interval (CI) = 0.94–1.03]. Similar findings were observed in a subgroup meta-analysis of 10 studies on both primary prevention trials (RR = 0.98; 95% CI = 0.93–1.03) and secondary prevention trials (RR = 0.97; 95% CI = 0.83–1.13). Further, subgroup meta-analyses revealed no preventive effect on cancer by type of antioxidant, type of cancer and the methodological quality of the studies. Conclusion: The current meta-analysis of RCTs indicated that there is no clinical evidence to support an overall primary and secondary preventive effect of vitamin treatment or supplements with purported antioxidant properties on skin cancer. The effect of vitamin supplements on skin cancer should not be overemphasized.

Nurses' willingness to maximize opioid analgesia for severe cancer pain, and its predictor

Goals of workThe effectiveness of cancer pain management (CPM) is influenced by nurses’ willingness to maximize opioid analgesia for severe cancer pain. The purposes of this study were to identify the willingness of nurses to provide maximum-dose opioids whenever needed for CPM and to determine its associated predictors.MethodsThis multicenter study was conducted among the entire total of registered nurses in seven large hospitals in Korea. Its overall response rate was 41.6%, and the data from 930 who responded (40.1%) were analyzed. We utilized a three-step, multidimensional, multiple logistic regression to identify the predictors of nurses’ willingness.Main resultsOnly 255 nurses (27.4%) indicated that they recommended the maximum dose of opioids whenever it was needed. The respondents who were more likely to recommend morphine showed the following characteristics: older nurses (odds ratio, OR, 1.57; confidence interval, CI, 1.13–2.19); they knew the effectiveness of opioids for CPM (OR 1.53; CI 1.06–2.20); rarely concerned about a patient’s addiction to opioids (OR 2.16; CI 1.48–3.15), or to a family member’s addiction (OR 1.81; CI 1.20–2.73); prior experience with pain assessment tools (OR 1.62; CI 1.11–2.37); practical experience caring for cancer patients with pain over 51% (OR 1.55; CI 1.09–2.19).ConclusionsOur multicenter study suggested that in order to improve nurses’ willingness to recommend opioids liberally in CPM: (1) attitudes about fear of opioid addiction must be changed; (2) the efficiency of opioids in CPM must be taught; and (3) implementation of pain assessment tools must be undertaken.