Hong Yup Ahn

Factors associated with quality of life among family caregivers of terminally ill cancer patients

Limited research has examined the quality of life (QOL) and its correlates among family caregivers (FCs) during the final stage of terminal cancer. The purpose of this study was to investigate the determinants of overall QOL and its subdomains among Korean FCs at the very end of life.

Metformin Association with Lower Prostate Cancer Recurrence in Type 2 Diabetes: a Systematic Review and Meta-analysis

BACKGROUND Accumulating evidence suggests that metformin possesses anticarcinogenic properties, and its use is associated with favorable outcomes in several cancers. However, it remains unclear whether metformin influences prognosis in prostate cancer (PCa) with concurrent type 2 diabetes (T2D). MATERIALS AND METHODS We searched PubMed, EMBASE, and the Cochrane Library from database inception to April 16, 2014 without language restrictions to identify studies investigating the effect of metformin treatment on outcomes of PCa with concurrent T2D. We conducted a meta-analysis to quantify the risk of recurrence, progression, cancer-specific mortality, and all-cause mortality. Summary relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Publication bias was assessed by Beggs rank correlation test. RESULTS A total of eight studies fulfilled the eligibility criteria. We found that diabetic PCa patients who did not use metformin were at increased risk of cancer recurrence (RR, 1.20; 95%CI, 1.00-1.44), compared with those who used metformin. A similar trend was observed for other outcomes, but their relationships did not reach statistical significance. Funnel plot asymmetry was not observed among studies reporting recurrence (p=0.086). CONCLUSIONS Our results suggest that metformin may improve outcomes in PCa patients with concurrent T2D. Well-designed large studies and collaborative basic research are warranted.

Association between Metabolic Components and Subclinical Atherosclerosis in Korean Adults.

Background Many studies have attempted to develop relatively simple and easy noninvasive measurements of atherosclerosis (NIMA), and each NIMA assesses different atherosclerotic properties. We, therefore, investigated the association between metabolic syndrome (MetS) components and different NIMAs. Methods This study included 1,132 Korean subjects over 20 years of age who had visited a Health Promotion Center in Korea. Carotid injury (increased carotid intima-media thickness or plaques) was evaluated by ultrasonography and arterial stiffness by brachial-ankle pulse wave velocity. The MetS components were assessed according to the Asian criteria of the American Heart Association/National Heart, Lung, and Blood Institute. Results Both arterial stiffness and carotid injury gradually deteriorated with increase in the number of MetS components. Arterial stiffness and carotid injury were associated with different MetS components, each of which had varying impact. After adjustment for all possible confounders such as age, sex, and lifestyle, elevated blood pressure (BP) was found to have the strongest association with arterial stiffness, whereas central obesity, impaired fasting plasma glucose, and elevated BP had comparable connection with carotid atherosclerosis. Conclusion Individual MetS components were related with subclinical atherosclerosis in different ways. Elevated BP showed the strongest association with arterial stiffness, while central obesity, impaired fasting plasma glucose, and elevated BP showed good correlation with carotid atherosclerosis.

Caffeine as an Adjuvant Therapy to Opioids in Cancer Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

CONTEXT Opioid therapy often shows insufficient efficacy and substantial adverse events in patients with advanced cancer. OBJECTIVES To assess the efficacy of caffeine infusion as an adjuvant analgesic to opioid therapy in patients with advanced cancer. METHODS A double-blind, randomized, placebo-controlled trial was conducted in the palliative care wards of two teaching hospitals in South Korea. A total of 20 of 41 participants were assigned to the caffeine group and 21 to the placebo group. The participants received caffeine (200mg) or normal saline intravenously once a day for two days. The primary outcome was pain, which was measured using a 10-point rating scale. Other outcomes included drowsiness, confusion, nausea, sleep disturbance, fatigue, and sadness. RESULTS Three participants (two in the caffeine group and one in the placebo group) dropped out after the first intervention because of insomnia; thus, 38 participants completed the trial. Pain score was significantly lower in the caffeine group than in the placebo group after the second trial (P=0.038). The mean reduction in pain intensity in the caffeine group was 0.833 (95% confidence interval [CI] 0.601-1.066), whereas that in the placebo group was 0.350 (95% CI 0.168-0.532). Considering an improvement higher than 30% from baseline as the threshold value, drowsiness improved significantly in the caffeine group after the first trial (P=0.041). Adverse event rate did not differ between the two groups. CONCLUSION Caffeine infusion significantly reduced pain and drowsiness, but the reduction did not reach clinical significance in patients with advanced cancer undergoing opioid therapy. Further investigations are warranted.

Effects of CYP3A5, CYP2C19, and CYP2B6 on the clinical efficacy and adverse outcomes of sibutramine therapy: a crucial role for the CYP2B6*6 allele.

BACKGROUND Various cytochrome P450 isoforms modulate sibutramine activity and influence sibutramine plasma levels and pharmacokinetics. However, there are no available data to demonstrate the association of these polymorphisms with the clinical outcomes of sibutramine administration. METHODS This study was a sub-investigation of a 12-week, double-blind, placebo-controlled trial examining the additive effect of orlistat on sibutramine. The final analysis was restricted to 101 women who had fulfilled the protocol. We evaluated the effects of genetic polymorphisms of CYP3A5, CYP2C19 and CYP2B6 on the % weight loss and the occurrence of adverse events. RESULTS The change of pulse rate from baseline value was affected by both CYP2B6 and CYP3A5 genetic polymorphisms (P<.01 for CYP3A5 and P=.01 for CYP2B6). Both CYP2B6 and CYP3A5 showed gene-gene interactions (P<.01). After adjusting for significant variables in the backward stepwise regression model, the change of pulse rate and time-dependent weight reduction were significant only among the CYP2B6 genotypes (P=.027 and P<.01, respectively). CONCLUSION The CYP2B6*6 allele influences the extent of weight reduction and pulse rate changes in patients undergoing sibutramine treatment.

Oxidative stress level is not associated with survival in terminally ill cancer patients: a preliminary study

BackgroundWhile cancer patients have higher oxidative stress (OS) and lower antioxidant activity, evidence for the association of these parameters with survival in patients with terminally ill cancer is lacking.MethodsWe followed 65 terminal cancer patients prospectively. We assessed their performance status, some symptoms, and serum levels of vitamin C and OS level. The Gehan’s generalized Wilcoxon test was used to examine the association between survival times and variables.ResultsSubjects’ performance status was very poor and they had a high level of OS and a low level of vitamin C. No significant association of these two parameters with survival time was noted (p-value, 0.637 for high OS and 0.240 for low vitamin C). Poor performance status was independently related to high OS status after adjusting for potential confounders (adjusted OR, 4.45; p-value, 0.031).ConclusionsIn this study, OS was not associated with survival of terminally ill cancer patients and its prognostic role requires further study.

Random Serum Cortisol as a Predictor for Survival of Terminally Ill Patients With Cancer A Preliminary Study

Although previous research found that serum cortisol levels were associated with cancer prognosis, it is unclear whether this association remains robust even at the very end of life of patients with cancer. We conducted a retrospective chart review of 125 patients with terminal cancer to investigate the role of random serum cortisol levels in predicting the remaining life expectancy. The high random cortisol group had a significantly shorter survival time than the low random cortisol group (7.5 vs 26 days). After adjusting for potential confounders, key factors such as poor performance status, hypoalbuminemia, and high random cortisol level are associated with poor survival. Our results suggest that the random serum cortisol level is an independent predictor of survival time of patients with terminally ill cancer.

An optimal design for the study of palliative sedation—making somewhat better pictures

Palliative sedation refers to the use of sedatives to reduce the consciousness level of patients with the aim of relieving symptoms refractory to any other means of treatment [1]. Among the forms of palliative sedation, continuous deep sedation (CDS) is at the top of a debate concerning the possibility that the greatest effect of palliative sedation is the shortening of life [2]. CDS can trigger lethal pathophysiological cascades related to the pharmacological effects of high-dose sedatives on the respiratory and circulation system [3]. The clinical evidence currently available may set families and palliative care providers free of the guilty feelings associated with hastening a patient’s death [4]. In both ethics and practice, the clarification of whether a forced loss of consciousness curtails a patient’s survival is still of great value. Inarguably, the actual effects of CDS on patient survival cannot be completely understood until randomized controlled trials are performed; however, such trials are not feasible for ethical reasons [5]. Hence, a well-designed observational study is worthwhile. One difficulty in performing a prospective observational study of CDS with mortality as a primary end-point is that it is too difficult to obtain a control group of sufficient size. Such a study would require a nonsedated group (patients who refuse CDS) aswell as a sedated group (patients who accept CDS) to be recruited during a time of severe distress; who could be expected to refuse CDS at such a time?Hence, the best choice left to researchers is the use of existing data, such as a secondary analysis or a retrospective chart review. This issue might have been buried since a comprehensive systematic review [6] identified no significant differences in survival due to CDS. Recently, however, exceeding the limitations of prior research, Isseki Maeda and colleagues [7] reported no measureable effects of CDS on survival based on propensity score analyses of 1827 patients. They provided the best evidence to date regarding the life-shortening effect of CDS. The study left something to be desired; however [8], the fundamental flaw was a secondary analysis that lacked critical information such as the time point at which CDS was initiated and the indications for CDS. Because the time point of CDS initiation was not known, the authors used a logistic regression model, which did not consider the time of CDS initiation, to assess the probability of receiving CDS. Additionally, the authors selected the potential confounders entered into the model based on the results of previous studies (at the level of P < 0.2) and not from the cohort to which they applied the model. They had no assurance, however, that those variables (i.e., the presence of symptoms and the status of mental capacity or function) were measured at the time of CDS initiation. * In Cheol Hwang spfe0211@gmail.com

The relationship between pulmonary function and suicidal ideation in Korean adults: a nationwide survey

ABSTRACT Controversy surrounds the association between lung function and mental health in the general population, and previous reported results were confounded by the effect of other chronic illnesses. This study aimed to investigate whether reduced lung function was related to mental health issues, taking into consideration the relevant potential confounders. We used data from the 2008–2013 Korean National Health and Nutrition Examination Survey to examine the relationship between lung function and three mental issues (recognized stress, depressive mood, and suicidal ideation) among 22,068 Korean adults. A multiple logistic regression with adjustment for potential covariates including chronic illnesses revealed that a .5-L decrement of forced vital capacity increased the risk for suicidal ideation in both genders, but there was no significant association with recognized stress or depressive mood. We found an inverse relationship between lung function and suicidal ideation in the Korean general population.