• Journal of Preventive Medicine and Public Health
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• v.57 no.4
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• pp.407-419
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• 2024

Objectives: This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients. Methods: This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking. Results: The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT. Conclusions: FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

• Archives of Plastic Surgery
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• v.51 no.3
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• pp.304-310
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• 2024

Background Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. This study aimed to assess impact of a psychiatric diagnosis on patients treated for HS. Methods Patients with HS were retrospectively identified at a single institution from 2010 to 2021. Cohorts were stratified by the presence of a psychiatric disorder. Demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the procedural interventions and emergency department (ED) visits. Financial distress was assessed via the COST-FACIT Version 2 survey. Results Out of 138 patients, 40 (29.0%) completed the survey of which 19 (47.5%) had a preexisting psychiatric diagnosis. No demographic differences were found between cohorts. Mean follow-up was 16.1 ± 11.0 months. The psychiatric cohort had a higher median number of surgeries received (7.0 vs. 1.5, p < 0.001), a higher median number of ED visits (1.0 vs. 0, p = 0.006), and a similar hospital length of stay (p = 0.456). The mean COST-FACIT score of the overall study population was 19.2 ± 10.7 (grade 1 financial toxicity). The psych cohort had a lower mean COST-FACIT score (16.8 vs. 21.3, p = 0.092) and reported greater financial hardship (3.3 vs. 1.7, p < 0.001). On multivariate analysis, a psychiatric diagnosis was predictive of lower credit scores, more ED visits, and a higher number of surgeries. Conclusion Preexisting psychiatric conditions in patients with HS are associated with increased health care utilization and surgical intervention with substantial financial distress. Plastic surgeons should be cognizant of such comorbid disorders to facilitate holistic care addressing all patient needs.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.7167-7170
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• 2015

Background: Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction. Objective: To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from $1^{st}$ June 2012 to $31^{st}$ July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart. Results: The median follow-up period in the study was 24 months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity. Conclusions: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.10
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• pp.299-307
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• 2020

Purpose: The purpose of this study was to investigate the financial hardships affecting the quality of life of cancer survivors. Method: Data were collected from five convalescent hospitals using self-administered questionnaires, and 422 questionnaires were used for the final analysis. We used a 5-step hierarchical multiple-regression analysis by entering each sociodemographic variable, medical variable, and three types of financial hardship (a material situation, the psychological response, and coping behavior coming from cancer treatment cost) into each step. Results: The results of statistical analysis indicate that the most influential factor in the quality of life was the financial difficulty, which was the frustration that they could not work as usual or support their family financially. In addition, the performance of physical activity, accompanying diseases, women patients, psychological burden on cancer treatment cost, the satisfaction of communication with medical staff for medical expenses, and the feeling unsuccessful financial coping strategy were predictors for the quality of life of cancer survivors. Conclusion: This study provides a blueprint for the development of intervention programs in practice to improve the quality of life of cancer patients, clinical intervention plans, and health policies.

• Korean Journal of Weed Science
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• v.13 no.4
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• pp.195-202
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• 1993

The benefits of pesticides in improving the food quantity and quality requirements for an increasing world population are significant, and they can be described in agronomic, economic and social terms. The risks are assessed from the hazards which are likely to occur in practice ; the hazards are defined by the toxicity of the pesticide to non-target organisms at various exposure levels. There are ways of reducing the risks (mainly by reducing exposure in practice) and improving the benefits of pesticides ; these are known as risk management and benefit management respectively. The overall risk-benefit assessment is facilitated if each component can be expressed in financial terms, but it must be made nationally or locally on a sound technical basis against the prevailing agronomic, socio-economic and political circumstances. Paraquat is used to illustrate the risk-benefit assessment process in general terms, and the conclusion is that the benefits greatly outweigh the risks. It is important to keep the risks of pesticides in perspective with those associated with other naturally occurring chemicals in our diet and with other everyday aspects of life. In an overall context, the pesticide risk is small.

• Journal of Preventive Medicine and Public Health
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• v.54 no.5
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• pp.376-379
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• 2021

Elemental mercury exposure can result in significant toxicity. Source decontamination and remediation are often required after larger elemental mercury exposures, but the details of these processes are infrequently reported. In the case described herein, a 64-year-old woman and her husband were exposed to elemental mercury in their home after the husband purchased it online for the purpose of recreational barometer calibration. After the mercury reportedly spilled during the calibration process, a vacuum cleaner was used to decontaminate the affected surface; this led to extensive mercury contamination of the home. The couple was relocated from the home while remediation occurred over the course of several weeks. Vacuum cleaning of an elemental mercury spill can lead to extensive volatilization and recirculation of mercury vapor. For smaller mercury spills, careful removal of visible mercury beads by using an eyedropper, cardboard, and masking tape is recommended. Larger spills require professional decontamination and remediation and may necessitate involvement of governmental resources. Vacuum cleaning should not be used as an initial method of decontamination after elemental mercury exposure. Careful attention to source decontamination can reduce the emotional and financial costs associated with extensive remediation after elemental mercury exposure.

• Journal of Environmental Health Sciences
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• v.42 no.6
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• pp.375-384
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• 2016

Objectives: This paper analyzes the intersection of tort law and environmental health in a recent court decision. Methods: This paper analyzes Supreme Court Decision 2011Da7437, Decided on September 4, 2014 and related lower court decisions. Results: The plaintiffs sought financial compensation from the defendants, arguing that air pollutants in gases emitted by vehicles produced by the defendants had caused them to acquire respiratory diseases. The district court highlighted the need to mitigate the burden of proof for the plaintiffs, but proceeded to review whether the plaintiffs proved the actual toxicity levels of the air pollutants, whether the defendant's vehicles were the main source of the emissions, the plaintiff's level of exposure to the pollutants, and causation between the emissions and the injury. By doing so, the district court required the plaintiffs to prove both indirect and direct facts of causation, increasing burden of proof for plaintiffs. The appellate court upheld the district court's decision, adding that the defendant's conduct did not constitute an illegal act because it did not violate the emissions standards set by environmental law. The Supreme Court upheld the appellate court's decision, reasoning that the epidemiological evidence cannot establish a direct causation for diseases that lack specificity. Conclusion: This case demonstrates that discussions in environmental health have significance in tort lawsuits. For each fact that the plaintiffs and defendants attempted to prove, environmental health research studies were offered as evidence. In addition, the courts decided the legality of the defendant's conduct based on emission standards set by environmental law.

• Journal of Aquaculture
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• v.11 no.3
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• pp.285-294
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• 1998

When Cochlodinium polykrikoides came into the culture tanks through influent cultivated water during the red tides, hundred thousands of commercial flounders were concomitantly killed and many culturists suffered from a great deal of financial loss in the east coast of Korea. It is charactrized by high sinking rate after sunset and the formatino of clump which results in oxygen deficiency by its respiration at tank bottom under condition. We investigated the efficacy of hydrogen peroxide and chlorine dioxide, known to form radicals, for extermination of red tide organism C. polykrikoides. When C. polykrikoides seawater with a density of 6,000 cells/$m\ell$ was treated with 14, 28 and $42mg/\ell$ of hydrogen peroxide, its survival rate was markedly decreased to 9.8, 0.8 and 0.3% respectively immediately after 6 hours of treatments whereas when it was treated with 1.5, 2.1 and $3.0mg/\ell$ chlorine dioxide, its survival rate showed 87.7, 81.3 and 80.1 and 80.1% respectively at the same treatment time. Hydrogen peroxide was the effective agent since it has scarcely injured the cultured olive flounder when exposed to the tested concentration range of $14~28mg/\ell$ with the extermination of almost3 C. polykrikoides during the experimental period of 5 days and has shown the oxygen increase of approximately $1.23mg/\ell$ 2 hours immediately after the flounder by C. polykrikoides in the land-based culture tank is assumed to be not by the toxicity of itself but by oxygen dificiency from the rapid respiration of dinoflagellate clump sunken to the tank bottom.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.281-290
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• 2019

This study analyzed the recognition types of the economic burden for cancer treatment and the characteristics of each recognition type by employing Q methodology. For this study, we determined the final 45 Q statements by conducting literature surveys, internet searches and in-depth interviews. The P samples are 35 people of cancer patients, their family members, and experts. The Q statements were classified according to the forced normal distribution method and the collected data was analyzed using the PC QUANL program. For the analysis results, we extracted four recognition types on the economic burden of cancer treatment, and we named them 'uncertain anxiety', 'acceptance by family burden', 'object to challenge with active response' and 'insurance preparation', depending on their characteristics. The results of this study can be used as a basis for preparing the clinical intervention plan and the policies for cancer patients and the families involved in the fields of medicine, nursing and social welfare.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4777-4781
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• 2012

Objective: To investigate the relationship between the efficacy and safety of different doses of thalidomide (Thal) plus dexamethasone (Dex) as the initial therapy in elderly patients with newly diagnosed multiple myeloma (MM). Methods: Clinical data of 28 elderly patients with newly diagnosed MM who underwent the TD regimen as the initial therapy were analyzed retrospectively. The patients were divided into two groups according to the maximal sustained dose of Thal: lower dose (group A) and higher dose (group B). The overall response rate (ORR), progression free survival (PFS), overall survival (OS), and adverse events (AES) were compared between the two groups. Results: A total of 28 patients were followed up with a median of 18 months. The ORR was 60.1%. The median response time and PFS were 2.0 and 17.0 months, respectively. The mean sustained dose of Thal in group B was significantly higher than group A (292.9 mg v 180.4 mg, P=0.01). There was no significantly difference in ORR (57.1% v 64.3%, P=1.00) and PFS (9.63months v 17.66 months, P=0.73) between groups A and B. During the follow up, only five patients died (<40%) and, therefore, median OS values were not available. It is estimated, however, that the mean survival time in the two groups was 35.6 and 33.4 months (P>0.05), respectively. All of the patients tolerated the treatment well. The incidence of AES in patients with a grading above 3 in group B was significantly higher than in group A (P=0.033). Conclusions: The TD regimen results in a high response rate and manageable AES as the initial therapy in elderly patients with MM. TD should be considered as the front line regimen for the treatment of elderly patients with MM in areas with financial constraints. The clinical response can be achieved at a low dose Thal with minimal toxicity.