Hong-Wen Chen

Demoralization syndrome among cancer outpatients in Taiwan

GoalsThis paper aims to explore characteristics of demoralization syndrome as well as the relationship between demoralization syndrome and psychosocial issues as seen through examinations of cancer outpatients in Taiwan.Materials and methodsOutpatients with different cancer types were enrolled in this study. The Demoralization Scale Mandarin Version (DS-MV), Patient Health Questionnaire, Beck Hopelessness Scale, and McGill Quality of Life Questionnaire—Taiwan Version were used as instruments. All data were analyzed using SPSS 18.0.ResultsAmong the 234 patients studied (97 men and 223 women), the majority had cervical cancer (29.1%), followed by breast cancer (26.5%) and head and neck cancer (24.3%). The mean score of DS-MV was 31.05 (SD 14.87). The results of ANOVA analysis showed a significant effect of occupation F(4.209) = 7.145 (p < 0.001), cancer diagnosis F(7.206) = 3.795 (p < 0.001), and treatment F(8.206) = 3.553 (p < 0.001) on DS-MV.ConclusionsDemoralization syndrome was found to be related to psychosocial issues, different cancer types, and treatments. Further studies are recommended to better understand causes and impacts of demoralization in the quality of life and care of cancer patients.

Establishing a ‘physician's spiritual well-being scale’ and testing its reliability and validity

The purpose of this study was to develop a Physicians Spiritual Well-Being Scale (PSpWBS). The significance of a physicians spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physicians characteristics; medical practice challenges; response to changes; and overall well-being. The explainable total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician.

Comparison of the efficacy and toxicity of two dose levels of cisplatin/5-fluorouracil as the chemoradiotherapy regimen for the treatment of locally advanced squamous cell carcinoma of the head and neck

Abstract Conclusion: The low-dose regimen brought less grade 3–4 neutropenia and mucositis with similar treatment efficacy. It should be further investigated in prospective randomized clinical trials to confirm its effectiveness and tolerability. Objectives: This nonrandomized study compared the efficacy and toxicity profiles of two dose levels of cisplatin/5-fluorouracil (5-FU) as the chemoradiotherapy regimen for the treatment of locally advanced squamous cell carcinoma of the head and neck. Methods: Concurrent chemotherapy consisted of two dose levels: a low dose (cisplatin 12 mg/m2 + 5-FU 600 mg/m2 per day) or a high dose (cisplatin 15 mg/m2 + 5-FU 750 mg/m2 per day). Both were administered as a 5-day continuous infusion in week 1 and week 5 during radiotherapy. Results: With a median follow-up of 44 months, the overall survival and disease-free survival were 35 months and 22 months (n = 67) for the low-dose group and 36 months and 33 months for the high-dose group (n = 96). The 2-year locoregional control rate was 67.2% for the low-dose and 66.8% for the high-dose group. No statistically significant differences were demonstrated in the treatment efficacy end points. The high-dose regimen resulted in significantly more grade 3–4 neutropenia (31.5% vs 10.9%, p = 0.003) and a trend towards more mucositis (62.1% vs 49.3%, p = 0.066).

A Good Ending-Holistic Care for Patients with Head and Neck Cancers

Terminal head and neck cancer is one of the most distressing ways a person may die as it affects the patients quality of life widely. The comprehensive multidisciplinary management of patients’ physical, psychosocial, and spiritual needs will enhance the possibility of patients and their families obtaining the best quality of life. This includes adequate symptom control, being treated as a whole person and achieving a sense of completion. By such holistic care, patients will experience a peaceful ending.

Concurrent Chemoradiotherapy Using Cisplatin and 5-Fluorouracil Alone or with Paclitaxel Followed by Adjuvant Cisplatin and 5-Fluorouracil in Nasopharyngeal Carcinoma

Purpose: The purpose of this study was to analyze the treatment outcome of patients with nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT) with or without paclitaxel. Materials and Methods: Seventy-seven patients with NPC received treatment at Mackay Memorial Hospital from 2002 to 2004. All of patients were treated with CCRT. Sixty-seven patients received chemotherapy of cisplatin and 5-fluorouracil (PF arm), and 10 patients received chemotherapy of paclitaxel, cisplatin and 5-fluorouracil (TPF arm). All patients received adjuvant PF after CCRT. Kaplan-Meier estimates were calculated for the overall and disease-free survival rates. Log-rank test was used to determine significant difference between the two arms. Results: With a median follow-up of 43 months, 5-year overall survival rates (OS) and disease-free survival rates (DFS) for all patients were 72% and 65%, respectively. The 5-year OS in the PF arm and TPF arm were 71% and 80%, respectively (P=0.65). The 5-year DFS in the PF arm and TPF arm were 64% and 70%, respectively (P=0.61). There was no statistically significant difference between these two arms. Locoregional recurrence was found in 2 patients after the completion of treatment, and distant metastasis was found in 4 patients. Conclusions: Our study failed to demonstrate the benefit of adding paclitaxel in CCRT of NPC. Standard PF regimen incorporated into radiation is still the treatment of choice for NPC.

Treatment Outcome in Oropharyngeal Carcinoma-Preliminary Report

Purpose: The aim of this study is to assess the result and the effect of concurrent chemoradiotherapy for oropharyngeal carcinoma. Materials and Methods: A retrospective survey of patients who underwent chemotherapy and radiation for oropharyngeal carcinoma at Mackay Memorial Hospital. Collected data include age, tumor site, therapy protocol and result of the treatment, which is assessed with RECIST method. Results: Totally 35 patients were diagnosed with oropharyngeal carcinoma during 2002 and 2006; the average age at diagnosis was 52.16 years and the average follow up period was 29.09 months. No distant metastasis was found at diagnosis. Eight patients received decreased chemotherapic dosage due to toxic effect. Overall 2-year survival rate was 66.62% and the survival rate between each stage was ranged from 16.67% to 100%. Complete remission was observed on 14 patients (40.0%). Distant metastasis after treatment was found on 3 patients and local recurrence was found on 1 patient. No significant difference of the well-response rate between the patients who received full dosage of chemotherapy and those who received decreased dosage. Conclusions: In this article we present the experience for the treatment of the oropharyngeal carcinoma. The suggested policies of management in oropharyngeal carcinoma is concurrent chemoradiation in priority. There is no negative effect in reduced dosage of chemotherapy with less side effect.

The Effect and Safety of Transdermal Fentanyl for Concurrent Chemoradiation Therapy-Induced Mucositis Pain in Head and Neck Cancer Patients

Purpose: This prospective, longitudinal study was to evaluate the efficacy and the safety of using TTS-fentanyl for severe oral mucositis pain induced by concurrent chemoradiotherapy (CCRT) in head and neck cancer (HNC) patients. Materials and Methods: Patients diagnosed as HNC and scheduled for concurrent chemoradiotherapy were eligible for this study. TTS-fentanyl was given with the initial dose of 25 μg/h when severe mucositis pain (numeric rating scale [NRS]≧7) occurred in spite of nonsteroid anti-inflammatory drugs (NSAID) and topical steroidal ointment use. The pain intensity was assessed every week and if severe pain persisted, another dose of 25 μg/h TTS-fentanyl was given. The adverse effects were recorded every week according to Common Toxicity Criteria (CTC) Version 2.0. Results: From October 2002 to March 2003, 21 male and 1 female receiving CCRT with HNC were recruited to this study. The mean NRS for pain significantly decreased from 7.65±0.99 (baseline) to 3.9±1.29 within the first week. In the fifth week, the NRS raised to 4.79±1.18 but was still lower than the baseline (p=0.003). The sufficient analgesia was achieved in 15 cases with a dose of 25 μg/h, in 5 cases with a dose of 50 μg/h, and in 1 case with a dose of 100 μg/h. One patient withdrew the TTS-fentanyl due to intolerable skin rash and vomiting in the second week. Besides, no one developed respiratory depression, mental clouding, or grade Ⅲ/IV gatrointestinal toxicities. Conclusion: TTS-fentanyl is effective and safe in the treatment of mucositis-induced pain which is resistant to NSAID in HNC patients receiving CCRT. TTS-fentanyl also spares the need to swallow pain killers in these patients suffering from odynophagia and/or dysphagia, as well as the time for titration of conventional analgesic drugs. Further larger series with randomized setting is warranted to evaluate the efficacy and safety of TTS-fentanyl for oral mucositis pain.