Eunmi Ahn

Suicide rates and risk factors among Korean cancer patients, 1993-2005.

Background: As the number of cancer survivors increases, suicide risk approaches that of the general population. We therefore investigated suicide rates and risk factors among Korean cancer patients. Methods: We observed 816,295 cancer patients for 3,007,294 person-years from 1993 to 2005 through a nationwide cancer registry. We calculated their sex- and age-standardized mortality ratios (SMR) and studied suicide risk factors using rate ratios (RR) based on a log-linear Poisson regression model. Results: Compared with the Korean general population, the suicide rate among cancer patients was high [SMR, 2.00; 95% confidence interval (95% CI), 1.91-2.08]. The rates were highest in the year following the cancer diagnosis (SMR, 3.45; 95% CI, 3.19-3.73) and were still elevated 5 years later (SMR, 1.23; 95% CI, 1.12-1.36). The clinical groups at highest risk were male pancreas cancer patients (SMR, 6.01; 95% CI, 4.33-8.33) and female lung cancer patients (SMR, 3.55; 95% CI, 2.55-4.94). The sociodemographic groups at highest risk were those who had no spouse versus those who were married (RR, 1.50; 95% CI, 1.35-1.68), those who were not employed versus those who were (RR, 1.39; 95% CI, 1.26-1.54), and those who did not have high school education versus those who had (RR, 1.52; 95% CI, 1.30-1.79). Conclusions: Korean cancer patients are at increased risk of suicide. Both clinical and sociodemographic factors play a role. Impact: There is a need for social support and suicide prevention strategies for cancer survivors in Korea. Cancer Epidemiol Biomarkers Prev; 19(8); 2097–105. ©2010 AACR.

Cross-Cultural Application of the Korean Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module

Objectives: This study was conducted to evaluate the psychometric properties of the Korean version of the Quality of Life questionnaire cervical cancer module (QLQ-CX24), developed by the European Organization for Research and Treatment of Cancer (EORTC). Methods: The EORTC QLQ-CX24 and the core questionnaire (the EORTC QLQ-C30) were administered to 860 Korean disease-free survivors of cervical cancer and 494 female control subjects from the general Korean population. The construct reliability and validity of the EORTC QLQ-CX24 questionnaire were assessed via factor analysis, multitrait scaling analyses and known group comparisons. Results: Factor structure of the Korean version of the EORTC QLQ-CX24 questionnaire agreed with the originally hypothesized scale structure. Scale reliability was confirmed by Cronbach’s α coefficients for internal consistency, which ranged from 0.78 to 0.87. Convergent and discriminant validity was confirmed by multitrait scaling analysis, which revealed scaling errors of 0.9. The clinical validity of the Korean version of the EORTC QLQ-CX24 was demonstrated by the ability to discriminate among controls and patient subgroups of different stages, treatments and overall health status. Conclusions: The Korean version of the EORTC QLQ-CX24 was found to be a reliable and a valid measure of quality of life among survivors of cervical cancer when administered in a large survey setting.

Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language?

Purpose Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients’ cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. Materials and Methods A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don’t know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. Results Only 411 respondents (20.6%) chose “advanced,” while most respondents (74.5%) chose “terminal stage” as the stage of the hypothetical patient, and a small proportion of respondents chose “early stage” (0.7%) or “don’t know” (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. Conclusion A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.

Association Between Change in Serum Aminotransferase and Mortality: A Nationwide Cohort Study in Korea.

AbstractThere is little information on how the change in serum aminotransferase affects mortality. We investigated the association between changes in serum aminotransferase levels and mortality from all causes, cardiovascular disease (CVD), and liver disease.Three percent of men from the Korean National Health Insurance database were sampled randomly at the end of 2002. After excluding patients with cancer, CVD, CVD risk factors, or liver disease, those who participated in 2 consecutive rounds of the national health screening examination were included (n = 68,431). The primary outcome was CVD mortality. Secondary outcomes were liver disease mortality and all-cause mortality. Change in metabolic profiles was analyzed based on changes in liver enzyme levels. Elevated levels of serum aminotransferase were associated with CVD, liver disease, and all-cause mortality. Men who had sustained elevation of serum aminotransferase during 2 subsequent liver enzyme tests showed a significantly higher risk of CVD mortality (adjusted hazard ratio [aHR] 1.95; 95% confidence interval [CI] 1.07–3.56, 2.29; 1.27–4.12) than the sustained normal group. In contrast, the normalization group (aHR 1.52, 95% CI 0.82–2.81 for aspartate aminotransferase [AST]; aHR 1.35, 95% CI 0.70–2.61 for alanine aminotransferase [ALT]) and the new elevation group (aHR 1.27, 0.66–2.44 for AST; aHR 0.99, 95% CI 0.49–2.20 for ALT) were not different from the sustained normal group in CVD mortality.Individuals with serum aminotransferase elevation, particularly when sustained, are at higher risk of mortality, and should receive appropriate medical attention.

Validation of the Energy Conservation Strategies Inventory (ECSI)

CONTEXT In applying good energy conservation strategies to relieve cancer-related fatigue, it is critical to first identify cancer patients who are at a high risk for poor energy conservation. However, instruments have not been developed to evaluate energy conservation strategies in an oncology setting. OBJECTIVES The aim of this study was to validate an instrument that cancer patients may use to evaluate energy conservation strategies to overcome cancer-related fatigue. METHODS The questionnaire development followed a four-phase process: 1) item generation and reduction, 2) construction, 3) pilot testing, and 4) field testing. Using relevant and priority criteria, as well as pilot testing, we developed a 25-item questionnaire. After field testing, five items were discarded. Finally, 20 items were included in the Energy Conservation Strategies Inventory (ECSI). Factor analysis, multitrait scaling analysis, and Cronbachs α were used to determine the construct validity and reliability. RESULTS Factor analyses of data from 140 cancer patients resulted in the ECSI, which covers activities related to planning, overcoming distractions, labor saving, burden reducing, and comfort. All subscales (Cronbachs α range, 0.69-0.78) and total scores (Cronbachs α=0.87) were found to possess acceptable internal consistency. CONCLUSIONS The good psychometric properties of the ECSI instrument show that it may be useful for measuring the frequency of energy conservation strategies used by cancer patients.

Decursinol Angelate Inhibits LPS-Induced Macrophage Polarization through Modulation of the NFκB and MAPK Signaling Pathways

Inflammation is considered the root cause of various inflammatory diseases, including cancers. Decursinol angelate (DA), a pyranocoumarin compound obtained from the roots of Angelica gigas, has been reported to exhibit potent anti-inflammatory effects. In this study, the anti-inflammatory effects of DA on the MAP kinase and NFκB signaling pathways and the expression of pro-inflammatory cytokines were investigated in phorbol 12-myristate 13-acetate (PMA)-activated human promyelocytic leukemia (HL-60) and lipopolysaccharide (LPS)-stimulated macrophage (Raw 264.7) cell lines. PMA induced the activation of the MAP kinase-NFκB pathway and the production of pro-inflammatory cytokines in differentiated monocytes. Treatment with DA inhibited the activation of MAP kinases and the translocation of NFκB, and decreased the expression and exogenous secretion of IL-1β and IL-6. Furthermore, LPS-stimulated Raw 264.7 cells were found to have increased expression of M1 macrophage-associated markers, such as NADPH oxidase (NOX) and inducible nitric oxide synthase (iNOS), and the M2 macrophage-associated marker CD11b. LPS also activated pro-inflammatory cytokines and Erk-NFκB. Treatment with DA suppressed LPS-induced macrophage polarization and the inflammatory response by blocking Raf-ERK and the translocation of NFκB in Raw 264.7 cells. Treatment with DA also inhibited the expression of pro-inflammatory cytokines, such as IL-1β and IL-6, NOX, and iNOS in Raw 264.7 cells. These results suggest that DA has the potential to inhibit macrophage polarization and inflammation by blocking the activation of pro-inflammatory signals. These anti-inflammatory effects of DA may contribute to its potential use as a therapeutic strategy against various inflammation-induced cancers.