Chih-Hsun Wu

Symptom patterns of advanced cancer patients in a palliative care unit.

This study involved longitudinal evaluations of symptom severity and describes the symptom patterns of 77 terminal cancer patients (median age: 62 years; 61% female), selected from 537 consecutive patients admitted to the Palliative Care Unit of the National Taiwan University Hospital. The most common primary cancer sites in these patients were lung (23.4%), liver (15.6%), and stomach (13%). Nineteen physical and psychological symptoms were assessed using different scales. The median number of symptoms was 11 (range: 1-18) on admission, among which weakness, fatigue, anorexia, pain, and depression were the most common. A comparison of the initial symptom severity scores with those at one week after admission and two days before death suggested six symptom change patterns: A: continuous static (restless/heat, abdominal fullness, constipation, dizziness, and insomnia); B: static-increase (fatigue, weakness, nausea/vomiting, taste alteration, dysphagia, diarrhea, dry mouth, and night sweats); C: decrease-static (pain and depression); D: decrease-increase (anorexia and dyspnea); E: static-decrease (aggression); and F: gradually decrease (anxiety). These six symptom patterns can be divided into two categories on the basis of the relative severity of symptoms between one week after admission and two days before death. The first category included patterns A, C, E and F, and the symptoms improved with palliative care. However, the symptoms in the second category (patterns B and D), which were associated with the anorexia-cachexia syndrome and dyspnea, did not show improvement. As symptom management is an essential component of palliative care, holistic care, which encompasses physical, psychosocial and spiritual aspects, represents a rational approach for the relief of these incurable symptoms at the end stage of life for these patients.

Can a Good Death and Quality of Life Be Achieved for Patients with Terminal Cancer in a Palliative Care Unit

BACKGROUND Lack of evidence supporting the claim that palliative care can improve quality of life and promote good death in patients with terminal cancer. OBJECTIVES This study was designed to evaluate the change of quality of life and quality of death over time and between patients of long and short survival in a palliative care unit. METHODS Patient demography, cancer sites, Eastern Cooperative Oncology Group (ECOG) status were collected at admission. Quality of life, including physical and psychological symptoms, social support, and spirituality was assessed daily after admission. Quality of death was assessed by a Good Death Scale (GDS) at admission and retrospectively for 2 days before death. RESULTS A total of 281 patients (52% women) were admitted and died in the study period. One hundred forty-five patients (51.6%) died within 3 weeks. Although those with short survival (<3 weeks) had more physical symptoms during the first week, there was no difference in quality of life dimensions at admission, at 1 week, and at 2 days before death between survival groups. Physical conditions deteriorated with time but other dimensions continued to improve until death. GDS and subdimensions continued to improve until death. Although those with long survival (≥3 weeks) have better scores for awareness, acceptance, timeliness, comfort, and GDS at admission, there was no difference between the two groups at 2 days before death. CONCLUSION Under comprehensive palliative care, patients with terminal cancer can have good quality of life and experience a good death even with short survival.

Social relations and PTSD symptoms: a prospective study on earthquake-impacted adolescents in Taiwan.

This prospective longitudinal study examined two competing models, a traditional social support model and a supportive and detrimental social relations model, to clarify the association of PTSD symptoms with supportive and detrimental social relations. Seven-hundred five adolescents living near the epicenter of the Taiwan Chi-Chi Earthquake participated in the study. The models were evaluated and cross-validated using structural equation modeling. The supportive and detrimental social relations model appeared to be a better fit. After further evaluation of three nested versions of the supportive and detrimental social relations model, detrimental social relations was found to partially mediate the relationship between PTSD symptoms 1 and 2 years following the earthquake. The findings suggest that helping adolescents deal with detrimental social relations can contribute to postdisaster adjustment.

Plasma Adiponectin Levels Correlate Positively with an Increasing Number of Components of Frailty in Male Elders

Objective Frailty is an important geriatric syndrome. Adiponectin is an important adipokine that regulates energy homeostasis. The aim of this study is to investigate the relationship between plasma adiponectin levels and frailty in elders. Methods The demographic data, body weight, metabolic and inflammatory parameters, including plasma glucose, total cholesterol, triglyceride, tumor necrosis factor alpha (TNF-α), c-reactive protein (CRP) and adiponectin levels, were assessed. The frailty score was assessed using the Fried Frailty Index (FFI). Results The mean (SD) age of the 168 participants [83 (49.4%) men and 85 (50.6%) women] was 76.86 (6.10) years. Judged by the FFI score, 42 (25%) elders were robust, 92 (54.7%) were pre-frail, and 34 (20.3%) were frail. The mean body mass index was 25.19 (3.42) kg/m2. The log-transformed mean (SD) plasma adiponectin (µg/mL) level was 1.00 (0.26). The log-transformed mean plasma adiponectin (µg/mL) levels were 0.93 (0.23) in the robust elders, 1.00 (0.27) in the pre-frail elders, and 1.10 (0.22) in the frail elders, and the differences between these values were statistically significant (p  = 0.012). Further analysis showed that plasma adiponectin levels rose progressively with an increasing number of components of frailty in all participants as a whole (p for trend  = 0.024) and males (p for trend  = 0.037), but not in females (p for trend  = 0.223). Conclusion Plasma adiponectin levels correlate positively with an increasing number of components of frailty in male elders. The difference between the sexes suggests that certain sex-specific mechanisms may exist to affect the association between adiponectin levels and frailty.

Diabetes mellitus and functional impairment in Taiwanese older men and women

Type 2 diabetes mellitus is strongly related to many kinds of functional impairment, even after adjusting for demographic and comorbid conditions. The current study examined sex differences in the relationships between Type 2 diabetes mellitus and functional impairment in an Asian population sample. Data were obtained from a national survey, the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. A total of 652 older adults aged > or =65 years were included in the study. Pearsons chi(2)-test and multiple logistic regression analysis were used to examine the relationships between diabetes and functional impairments in older men and women. The reported numbers of impairments were significantly higher in women, in those aged > or =75 years, and in those with diabetes. There were sex and age differences in the relationships between diabetes and functional difficulties. Even after adjustment for age, education, and co-morbid conditions, men with diabetes were about four times more likely to have difficulties related to self-care, and women with diabetes were about two to three times more likely to have difficulties related to higher functioning than their non-diabetic counterparts. Sex differences should be considered when understanding the relationships between diabetes and functional impairments in older adults.

Correlates of Fatigue Phenomenon in Palliative Care Patients with Advanced Cancers in Taiwan

BACKGROUND Fatigue is a multidimensional phenomenon that has different meanings according to different societal and cultural settings. This study aims to decipher fatigue in Taiwanese patients with cancer. METHODS We recruited 440 patients with advanced cancer admitted consecutively to the palliative care unit of a major medical center in Taiwan. The data were collected at admission, 1 and 2 weeks after admission, and 2 days before death. RESULTS The subject group consisted of 51.8% males and 48.2% females with a median age of 67 years (ranging from 27 to 93 years). The leading primary tumor sites among these patients were lung (20.2%), liver (18.0%), and colon-rectum (10.7%), and the median survival was 15 days, with a range of 1 to 418 days. All symptoms improved 1 week after admission, but most of them significantly worsened 2 days before death. In general, the physical signs manifested variation patterns similar to those of symptoms. The severity of psychosocial distress and death fear was lower after admission and retained the same level at 2 days before death, defying the consistent patterns found in other symptoms and signs. In the correlation analysis, most symptoms were correlated with fatigue during admission, with weakness being the most significant one. Although self-efficacy and emotion were correlated with fatigue both on admission and 1 week after admission, social support and death fear were not correlated with fatigue at all times. CONCLUSION The meaning of fatigue is mainly associated with physical factors among these patients. Education of complexities in fatigue in tandem with psychosocial and spiritual care may help alleviate this symptom, and promote quality of life.