• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7669-7674
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• 2013

Background: The hypothesis that patients who primarily progress on two consecutive chemotherapy regimens without evidence of clinical benefit may opt for supportive care was investigated. The purpose was to determine the quality of life in recurrent ovarian cancer patients choosing to receive salvage chemotherapy in addition to supportive care or palliative care alone. A secondary objective was to evaluate factors that affect quality of life in ovarian cancer patients. Materials and Methods: A descriptive study was conducted in patients who had histological confirmed epithelial ovarian cancer and failed to respond to at least one regimen of chemotherapy, coming for treatment at the King Chulalongkorn Memorial Hospital in Bangkok, Thailand over a six-month period from August 2012-March 2013. Each patient was asked to complete the FACT-G and a general personal questionnaire. The median quality of life score was analyzed. The Mann Whitney U Test was used to compare the difference between salvage chemotherapy and palliative care groups, and the Kruskal Wallis was used to evaluate other variables. Results: Thirty-eight ovarian cancer patients were identified who failed to respond to chemotherapy. Of the 38, 30 chose salvage chemotherapy and eight palliative care for further treatment. By histology the carcimnomas were predominantly endometrioid subtype and poorly differentiated. The majority of patients in this study had FIGO stage III, and ECOG status 0-1. The median quality of life score was 76.3 (35.8-94.0), with no significant differences between the groups. Factors associated with the quality of life were the ECOG score and number of chemotherapeutic courses. Conclusions: In the setting of refractory or recurrent epithelial ovarian cancer, patients who receive salvage chemotherapy have comparable quality of life scores with patients treated with palliative care alone, providing a contrast with previous studies.

• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.93-102
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• 2020

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

• Journal of Gastric Cancer
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• 제20권4호
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• pp.421-430
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• 2020

Purpose: Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. Materials and Methods: We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019. Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. Results: There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. Conclusions: We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

• Journal of Hospice and Palliative Care
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• 제25권4호
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• pp.198-203
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• 2022

Purpose: To grasp public opinion accurately, we conducted an opinion poll on beliefs and attitudes toward physician-assisted suicide (PAS). Methods: A randomized telephone survey ensuring a representative sample was conducted, 1,007 participants aged 18 years or older (response rate, 9.5%). Results: The main results are as follows: i) 61.1% of participants thought that the current social support system for terminally ill patients and their families is insufficient; ii) 60% of participants did not recognize the term "hospice and palliative care"; iii) 81.7% of participants would not like to receive life-sustaining treatment if there is no possibility of recovery; iv) 58.4% of participants would like to receive hospice and palliative care if they are diagnosed with a terminal illness; v) the priorities for dignified dying were preparing a support system to reduce the burden of care (28.6%), economic support including reduction of medical expenses (26.7%), expansion of hospice and palliative care services (25.4%), and legalization of PAS (13.6%); and vi) 58.3% of participants agreed that the expansion of hospice and palliative care should precede the legalization of PAS. Conclusion: Koreans currently want other efforts, including expansion of hospice and palliative care services, instead of the legalization of PAS.

• Journal of Hospice and Palliative Care
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• 제25권4호
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• pp.139-197
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• 2022

Patients with terminal cancer experience very severe symptoms during the end of life, and palliative sedation (PS) may be considered if those symptoms are refractory to any other treatment. This brief report presents ethical considerations, practices, and recent concerns on PS. PS is quite different from euthanasia. There is a lack of consensus and standards on protocols, but its notable effects have been reported in hospice care settings. Most studies to date have reported no difference in survival between patients receiving PS and those not, and PS must be conducted proportionally with the lightest level of sedation. The most common indication for PS is delirium, and midazolam is the main sedative used. It is recommended that information regarding PS should be provided to patients and their caregivers repeatedly as early as possible. Existential suffering alone is not an indication for PS, and there is a lack of evidence on bispectral analysis. Additional research on PS is needed in Korea.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.6173-6180
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• 2013

Background: Our objective was to determine the knowledge and attitudes of Thai generalists (general physicians) toward palliative terminal cancer care (PC) in a primary care setting. Materials and Methods: We performed a cross-sectional descriptive survey using a self-administered questionnaire. The total number of completed and returned questionnaires was 63, giving a 56% response rate. Data analysis was based on these (Cronbach's alpha=0.82) and percentages and mean values were assessed using the Fisher's exact test to determine the correlation of variables. Results: Overall, attitude and knowledge levels were slightly satisfactory. Results indicated that general physicians had moderate scores in both attitudes (84.1%) and knowledge (55.7%) regarding palliative terminal cancer care. However, they had insufficient knowledge regarding truth telling, pain control and management with morphine, emergency management in terminal cancer care and treatment of fluid intake in terminal stages. Attitude and knowledge scores were statistically correlated (p=0.036). Knowledge scores were further positively associated with being taught palliative care in their medical curriculum (p=0.042). Conclusions: Formal education in palliative care and development of palliative care services are very much needed in Thailand to provide holistic care to terminally ill patients.

• Radiation Oncology Journal
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• 제18권4호
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• pp.283-292
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• 2000

목적 : 1990년부터 1996년 사이에 담낭암으로 진단받은 72명의 환자를 대상으로 각 치료방법에 따른 생존율 및 예후인자를 분석하기 위하여 후향적 연구를 시행하였다. 대상 및 방법 : 대상 환자는 치료방법에 따라 4개의 군으로 분류하였는데, 1군은 고식적 수술 단독으로 치료한 27명의 환자가 포함되었고 2군은 고식적 수술후 방사선치료를 시행한 환자 11명, 3군은 수술적 절제가 불가능하여 조직검사나 우회수술(bypass surgery)만 시행한 환자 18명, 4군은 3군과 같은 수술 시행후 방사선치료를 시행하였던 환자 16명을 포함하였다. 대상환자의 연령은 35~80세(평균 63세)이었고 병기는 TNM 병기 및 Nevin 병기체계에 따라 분류하였는데, 대부분 병기 111 이상으로 진행된 병기임을 알 수 있었다. 고식적 수술이 시행되었던 38명중 11명에서 추가적인 방사선치료가 시행되었으며 수술이 시행되지 않은 34명중 16명에서 방사선치료를 시행하였다. 방사선치료는 10 MV 선형가속기를 이용하여 종양 및 주변 림프절에 45$\~$61.2 Gy를 조사하였다. 항암약물치료는 5-FU를 근간으로 한 복합약제를 사용하여 25명의 환자에서 시행하였다. 결과 : 중앙 생존기간은 10.3개월이었으며 3년 생존율은 8.3$\%$ 이었다 치료방법에 따른 생존율을 살펴보면 고식적 수술 단독의 경우 3년 생존율은 2.5$\%$인 반면에 고식적 수술후 방사선치료를 시행한 경우에는 45.5$\%$이었다. 치료를 시행하지 않았던 환자의 3년 생존율은 8.3$\%$이었고 방사선치료 시행한 환자에서는 13.1$\%$이었다. 각 군간의 생존율은 통계학적으로 의미있는 차이를 보였다(p=0.0009, p=0.022). 치료방법 이외에 의미있는 예후인자로서 단변량분석에서는 종양의 형태 및 TNM 병기이었고 다변량분석에서는 종양의 형태 및 황달 유무임을 알 수 있었다. 결론: 방사선치료는 국소적으로 진행되어 근치적 수술이 불가능한 담낭암에서 생존율의 향상을 기대할 수 있는 효과적인 치료방법으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6381-6384
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• 2015

Background: The purpose of this retrospectively study was to examine the effectiveness and tolerability of a radiotherapy technique for the palliation of symptomatic liver metastases. Materials and Methods: Twentyseven patients with liver metastases were enrolled and received targeted whole liver irradiation consisting of mean 1, 8 Gy in five to twelve fractions to a total mean dose 17Gy. Symptoms at baseline were hepatic pain (26 patients), lost of weight (6), lack of appetite (2), and night sweats (1). Seventeen patients (63%) had failed previous treatment with chemotherapy and/or high-dose steroids. Results: Individual symptom response rates were 100% at 4 weeks. Partial or complete global symptomatic responses were noted in 11 patients (40%) after 2 months. After 3 months, 8 patients (28%) reported loss of pain. The treatment was well tolerated with one patient (3%) experiencing grade 3 toxicity (one vomiting and one diarrhoea). Overall the median survival time was 4.9 months (range 1 - 14 months). One year survival was 39%. Conclusions: This is simple and well-tolerated treatment but to achieve good palliation effects we should carefully selected patients whose conventional treatment does not bring good analgesic control.

• Journal of Hospice and Palliative Care
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• 제23권2호
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• pp.85-92
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• 2020

Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with end-stage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

• Journal of Hospice and Palliative Care
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• 제18권3호
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• pp.227-234
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• 2015

목적: 본 연구에서는 일반인을 대상으로 죽음준비교육 프로그램이 연명치료중단 및 호스피스 완화의료에 대한 인식에 미치는 효과를 규명하기 위해 수행되었다. 방법: 본 연구의 죽음준비교육 프로그램은 총 5주에 걸쳐 진행되었으며 연구 대상자는 서울시 소재 일개구청과 대학교의 협력사업으로 진행한 죽음준비교육 참여자로 실험군 35명, 대조군 40명으로 총 75명이었고 사전 사후 측정은 자가 보고식 설문지를 이용하여 자료를 수집하였다. 결과: 죽음준비교육 후 호스피스 완화의료에 대한 인식은 실험군과 대조군에서 유의한 차이를 보이지 않았으나 연명치료중단 인식정도는 실험군이 대조군보다 유의하게 높은 결과를 보였다. 결론: 인간은 의미를 추구하는 존재로서 늘어나는 기대수명에 맞춰 삶의 질을 높이려는 욕구 또한 증가하고 있으며 자신의 삶의 마지막을 결정할 권리가 있는데, 본 연구결과는 인생의 마지막 순간에 자신의 삶을 결정하는 것에 대한 이론적 근거가 되었다고 본다. 또한, 일반인들에게 호스피스 완화의료에 대한 인식에 긍정적으로 영향을 줄 수 있는 죽음준비교육 프로그램 개발과 적절한 교육과정과 기간 및 교육방법에 대한 평가연구가 계속되어야겠다.