Yoon Jung Chang

Symptoms in the lives of terminal cancer patients: which is the most important?

Objectives: Symptoms other than their primary disease can interfere in the lives of terminal cancer patients. We sought to identify which of these symptoms is most important. Methods: We administered a questionnaire, including the M.D. Anderson Symptom Inventory (MDASI), to 142 terminal cancer patients at the National Cancer Center, Korea. The validity of the MDASI was tested by principal-axis factor analysis and Cronbach’s α coefficient. Stepwise multiple regression analysis was used to determine the symptoms that interfered most in terminal cancer patients’ lives. Results: Factor analysis showed that it was composed of two factors (symptom and interference scales). Cronbach’s α coefficients of symptom and interference scales were each >0.70. The patients had an average of 11 of 13 symptoms of the MDASI. Pain was the most common and severe, followed by feelings of distress and fatigue. Fatigue was the most highly correlated with interference sum. In stepwise multiple regression analysis, the most interfering symptom was fatigue. Conclusions: Although pain was the most common and severe symptom, fatigue was the most important symptom interfering in the lives of terminal cancer patients. In treating terminal cancer patients, healthcare providers should actively intervene to reduce both fatigue and pain.

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.

Development and Formative Evaluation of a Web-Based Self-Management Exercise and Diet Intervention Program With Tailored Motivation and Action Planning for Cancer Survivors

Background Most dietary and exercise interventions developed to date for cancer survivors have employed intensive clinic-based face-to-face counseling sessions. However, when the clinic-based face-to-face intervention ends, the participants cannot receive feedback from the experts, and the motivation for regular exercise and diet practices decreases. One way to overcome the shortcomings of clinic-based face-to-face intervention is to employ the Internet to this end. To maximize effectiveness when providing Web-based interventions, action planning should be able to start at the right time, education should be tailored to motivational readiness, and self-efficacy should be enhanced at appropriate intervals. Objective The aim of this study was to develop a Web-based self-management diet and exercise intervention program with the aid of the transtheoretical model (TTM) and to conduct formative evaluations. Methods The Web-based self-management exercise and diet intervention program was developed employing a 5-phase system development life-cycle (SDLC) method. The 5 phases were 1) identification of user requirements, 2) system design, 3) system development, 4) system evaluation, and 5) system application. An expert group composed of 3 content experts, a Web developer, and 2 Web designers, evaluated the usability and accuracy of the content. The program was evaluated by 30 breast cancer survivors for perceived ease of use. Results The Web-based self-managed exercise and diet intervention program contained 5 components differing in screen layout. These components are introduction, assessment, education (tailored information provision), action planning (goal setting, scheduling, keeping a diary), and automatic feedback. Education, action planning, and automatic feedback were tailored to each participant through the assessment. The processes of change, self-efficacy, and decisional balance, which are the principal strategies encouraging behavioral change according to the TTM theory, were reflected in the education, and self-efficacy was also reflected in the automatic feedback. After iterative testing by experts on problems that arose in terms of usability and content accuracy during system operation, the perceived ease of use of the program was evaluated by 29 breast cancer survivors. The end users rated the program as being easy to understand and use (a total usability score of 81.3 points). In addition, program feasibility was evaluated using the percentage of patients (27/30, 90%) who consistently used the program. Conclusions The use of Internet technology allowed immediate and easy access to interventions, real-time monitoring of progress, online education, tailored action planning, and tailored short message services using mobile phones.

Health-related quality of life in disease-free survivors of surgically treated lung cancer compared with the general population.

Objective:We compared the health-related quality of life (HRQOL) of disease-free lung cancer survivors with those from the general population. Background:Although clinical research usually is focused on how to better identify the lung patients most likely to benefit from surgery in terms of survival, few studies have concentrated specifically on HRQOL in disease-free lung cancer survivors compared with that of the general population. Methods:We enrolled 830 disease-free cancer survivors (median time since diagnosis, 4.11 years) who had a past diagnosis of lung cancer and treated with curative surgery (stage from 0 to III) at either of 2 hospitals between 2001 and 2006, and 1000 subjects without a history of cancer were selected randomly from a representative sample of general Korean population. Subjects filled out a questionnaire that included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the lung cancer module. Results:There were no clinically meaningful differences between the disease-free lung cancer survivors and general population in terms of any of the functioning subscales and most of the symptoms. However, survivors exhibited clinically meaningful worse dyspnea and financial problems on the EORTC QLQ-C30 subscales and dyspnea, coughing, and pain in chest wall on the EORTC QLQ-LC13 subscales than the general population. There was no clinically significant difference between the survivor groups according to the survival time. Survivors receiving lung resection, radiotherapy, and chemotherapy had clinically meaningful worse dyspnea than survivors receiving only lung resection. Lung cancer survivors with a respiratory or cardiologic comorbidity showed clinically meaningful worse social functioning, fatigue, dyspnea, and financial problems. Conclusions:These findings afford useful information clinicians preparing patients for lung cancer treatment by providing them with an understanding of the potential outcomes, and also for potential intervention targeting supportive care needs.

Complementary and alternative medicine use among cancer patients at the end of life: Korean national study.

OBJECTIVES To investigate in depth the use of complementary and alternative medicines (CAMs) by cancer patients at the end-of-life (EOL) and how they communicate with physicians about them. DESIGN AND LOCATION: In 17 hospitals in Korea between January and December 2004 we identified 4,042 families of cancer patients. RESULTS The prevalence of CAM use among cancer patients at the EOL was 37.0%, and 93.1% had used pharmacologic types of agents. The most frequent motive for CAM use was the recommendation of friends or a close relative (53.4%) or a physician (1.6%). Only 42.5% discussed CAM use with their physicians. Satisfaction with CAMS was recalled for 37.1% . The most common reason given for that satisfaction was improvement of emotional or physical well-being, while ineffectiveness was the most common reason given for dissatisfaction. The average cost of CAM during the last month of life was

Development of the standard hospice and palliative care education program in Korea: results from the demonstration project.

US 900. CAM use was associated with longer disease periods, primary cancers other than liver, biliary, and pancreatic, and need of support from physicians or religion. CONCLUSIONS CAM use among cancer patients at the EOL was common, not discussed with physicians, and associated with expectation of cure. Expectations were generally unmet while the treatments were a financial burden. Further studies evaluating the effects of CAM at the EOL and factors that enhance communication with the physician are needed.

Burdens, Needs and Satisfaction of Terminal Cancer Patients and their Caregivers

PURPOSE To describe development of the Standard Hospice & Palliative Care Education Program in Korea, a basic training program for hospice & palliative care professionals, and to report preliminary results from the 2008-2009 demonstration project at 2 sites that support its effectiveness. METHOD We developed the Standard Hospice & Palliative Care Education Program, consisting of 19 modules, under the initiative and financial support of the Ministry of Health, Welfare, and Family Affairs. We adapted the train-the-trainer model and benchmarked the EPEC (Education in Palliative and End-of-life Care) course. In order to evaluate the effectiveness of the program, session evaluation, pre-post test of knowledge, and overall course evaluation were assessed by participants. RESULTS The demonstration program included a total of 105 participants. Overall rating by participants was 4.1 for relevance and usefulness of program contents (range, 4.1-4.2; 1 = strongly disagree, 5 = strongly agree) and 4.1 for the trainers teaching skills (range, 4.0-4.2). Participants demonstrated significant improvement in their knowledge on the pre-post test for 6 of the 17 modules, and reported that they had gained confidence in their ability to perform palliative care practices (overall mean ratings, 4.0, range; 3.6-4.3; 1 = very low, 5 = very high). Overall evaluation of the program was very high (very satisfied or satisfied; 86%). CONCLUSION Development of the Standard Hospice & Palliative Care Education Program was successful, and its preliminary effectiveness was shown by the demonstration program. Comments on our experience in Korea would be helpful to efforts in other countries, particularly those with limited resources for hospice and palliative care.

Factors That Affect Quality of Dying and Death in Terminal Cancer Patients on Inpatient Palliative Care Units: Perspectives of Bereaved Family Caregivers

OBJECTIVES Terminal cancer patients and their caregivers often experience traumatic stress and need many types of assistance. In the present study we interviewed terminally ill cancer patients and caregivers to determine how much burden they experienced and to find out what factors are most important for satisfaction. DESIGN We constructed a questionnaire including overall care burden and needs experienced, and administered it to 659 terminal cancer patients and 659 important caregivers at 11 university hospitals and 1 national cancer center in Korea. RESULTS Finally, 481 terminal cancer patients and 381 caregivers completed the questionnaire. Care burden was not insubstantial in both and the caregiver group felt more burden than the patient group (P <0.001). While the patient group needed financial support most (39.0%), the caregiver group placed greatest emphasis on discussion about further treatment plans (44.8%). Stepwise multiple logistic regression analyses showed that in the patient group, patients health status (OR, 2.03; 95% CI, 1.16-3.56) and burden (OR, 2.82; 95% CI, 1.76-4.50) influenced satisfaction about overall care, while in the caregiver group, high education level`(OR, 1.84; 95% CI, 1.76-4.50), burden (OR, 2.94; 95% CI, 1.75-4.93) and good family function (OR, 1.94; 95% CI, 1.24-3.04) were important. CONCLUSIONS Our study showed that burden was great in both terminal cancer patients and their caregivers and was perceived to be more severe by caregivers. Our study also showed that burden was the factor most predicting satisfaction about overall care in both groups.

What kind of cancer information do Internet users need

CONTEXT There is an increasing use of palliative care units (PCUs) for the treatment of terminally ill cancer patients. Thus, it is important to evaluate the care and quality of life of terminally ill cancer patients treated in PCUs so that improvements can be made. Limited research has investigated the quality of dying and death in PCUs. OBJECTIVES The aim of this study was to identify factors associated with the quality of dying and death for terminally ill cancer patients in PCUs. METHODS Data were collected from 570 bereaved family caregivers of terminally ill cancer patients. All patients were registered and died in one of the 40 inpatient PCUs designated by the Korean Ministry of Health and Welfare. We assessed the perceived timing of referral to a PCU; the quality of end-of-life cancer care with the Care Evaluation Scale; and the quality of dying and death with the Good Death Inventory. RESULTS The perception of appropriate timing of referral, use of a community-based PCU, and higher quality of cancer care as assessed by the Care Evaluation Scale were associated with good dying and death in all domains of the Good Death Inventory. CONCLUSION The good quality of end-of-life care in a PCU improves the quality of dying in terminally ill cancer patients. The data have the potential to guide the development of interventions aimed at achieving a good quality of dying for patients with terminal cancer.