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Objectives We aimed to identify the prevalence of feelings of guilt, censure, and concealment of smoking status among cancer patients and their family members who continued to smoke after the patient's diagnosis. Methods Among 990 patient-family member dyads, 45 patients and 173 family members who continued to smoke for at least 1 month after the patients' diagnoses were administered questions examining feelings of guilt, censure, and smoking concealment. Results Most patients who continued to smoke reported experiencing feelings of guilt toward their families (75.6%) and censure from their family members (77.8%), and many concealed their smoking from their family members (44.4%) or healthcare professionals (46.7%). Family members who continued to smoke also reported feelings of guilt with respect to the patient (63.6%) and that the patient was critical of them (68.9%), and many concealed their smoking from the patient (28.5%) or healthcare professionals (9.3%). Patients' feeling of guilt was associated with concealment of smoking from family members (55.9% vs. 10.0%) or health care professionals (55.9% vs. 20.0%). Family members who reported feeling guilty (36.5% vs. 16.3%) or censured (34.5% vs. 16.7%) were more likely to conceal smoking from patients. Conclusion Many patients and family members continue to smoke following cancer diagnosis, and the majority of them experience feelings of guilt and censure, which can lead to the concealment of smoking status from families or health care professionals. Feelings of guilt, censure, and concealment of smoking should be considered in the development and implementation of smoking cessation programs for cancer patients and family members. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea. Methods: Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis. Results: The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30–0.87), recurrence (OR = 0.64, 95% CI = 0.50–0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39–0.72). Conclusion: There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage. [ABSTRACT FROM AUTHOR]

Objective: The assessment of a caregiver's needs is a critical step for determining appropriate support services, providing high quality care, and achieving caregiver satisfaction. However, a systematic assessment of family caregiver's needs is rarely practiced. This study reports the development and validation of a comprehensive needs assessment tool for cancer caregivers (CNAT-C). Methods: Items of CNAT-C were generated through literature review and refined through expert consultation and caregiver interview, and pilot test. Final 41-item needs assessment tool for cancer was developed and validated in a large-scale multi-center survey involving 600 cancer patients-family caregiver dyads in 10 cancer centers fairly distributed throughout Korea. Results: The content validity of CNAT-C was established throughout the development process. Principal component analysis resulted in a seven-factor structure explaining 66.4% of the total variance: (1) health and psychological problems (6 items), (2) family/social support (5 items), (3) health-care staff (8 items), (4) information (8 items), (5) religious/spiritual support (2 items), (6) hospital facilities and services (6 items), and (7) practical support (6 items). The Cronbach alpha was 0.96 for the total scale, and those for the subscales ranged from 0.79 to 0.95. Caregiver needs were not highly correlated with patient needs when compared domain-by-domain. Known-group validity was also supported by the tool's ability to detect significant differences according to various patient and caregiver characteristics. Conclusions: The CNAT-C appears to be a valid and reliable measure to assess comprehensive and multidimensional needs in caregivers of cancer patients. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: As the number of working cancer patients increases, workplace discrimination and its relationship to changes in employment status among cancer patients is becoming an increasingly important social concern. The aim of this study is to provide a comprehensive overview of the relationship between changes in employment status and discrimination following a diagnosis of cancer. Methods: A total of 748 cancer patients, aged 18 years and older, who were employed before receiving a diagnosis of cancer, were enrolled in this study. Patients were recruited from ten cancer centers in Korea. Sociodemographic data, work-related data, and clinical information, as well as information on changes in employment status and incidences of discrimination, were collected from all patients. Results: A change in employment status was reported by 73.4% of the sample, with unemployment being the most common change (46.4%). Forty-two (5.6%) patients reported that they had experienced discrimination in the workplace. Reports of discrimination were only weakly correlated with changes in employment status, but were significantly correlated with forced unemployment. Additional analyses revealed that being female, being from a lower socioeconomic status group and having a disability were risk-factors for unemployment, while being male, being from a higher socioeconomic status group and having a disability were risk-factors for workplace discrimination or forced unemployment. Conclusions: More attention should be paid to vulnerable who are diagnosed with cancer. An individualized and culture-based approach should be taken to minimize undesirable changes in employment status and to reduce discrimination among patients receiving a diagnosis of cancer. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article discusses the suggestion given by an Italian group of researchers regarding the development of cancer survivorship clinics within the oncology departments of cancer hospitals. It says that physician supply, geographic conditions, and health care delivery system were some of the factors which the best model of care delivery depend. Moreover, the concern expressed by the oncologists with the primary care physicians (PCPs) is also mentioned.

Background: Evidence suggests that people with disabilities are more likely to suffer from depression. Previous studies have focused on depressive disorders in specific disability types or age groups using small-scale cross-sectional samples. We investigated longitudinal trends in the prevalence and incidence of depressive disorders according to disability types and severity levels in the entire Korean adult population. Methods: The age-standardised prevalence and incidence of depressive disorders were investigated using National Health Insurance claims data from 2006 to 2017. The odds of depressive disorders by type and severity were examined using logistic regression after adjusting for sociodemographic characteristics and comorbidities based on merged 2006 to 2017 data. Results: Both the incidence and prevalence of depressive disorders were higher among the disabled than the non-disabled, with the prevalence gap being larger than the incidence gap. In regression analyses, adjusting for sociodemographic characteristics and comorbidities considerably reduced the odds ratios, particularly for incidence. The severity of disabilities was inversely associated with the incidence of depressive disorders. Brain injury and disabilities in major internal organs were associated with lower odds of developing depressive disorders than in non-disabled individuals. Conclusions: A significant proportion of depressive disorders in disabled individuals are caused by financial hardships or comorbidities rather than disabilities themselves. We must pay special attention to those who cannot access healthcare services due to severe disabilities and those whose depressive disorders are misdiagnosed as intellectual disabilities. More research is required to elucidate the causal mechanisms underlying depressive disorders in people with various types and severities of disabilities. [ABSTRACT FROM AUTHOR]

Objective: Accurate understanding of the extent of disease, treatment goal, and prognosis is a prerequisite for patients with cancer and their caregivers to make informed decision. We sought to evaluate patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure taking their own physician's evaluation as reference.Methods: A national survey was performed with 750 patient-caregiver dyads (75.5% participation rate) recruited by 134 oncologists in 13 cancer centers (93% participation rate) in South Korea. Both patients and caregivers were asked to report their knowledge of patient's cancer stage, treatment goal, and chance of cure. Concordance was evaluated with percentage agreement and weighted κ, and predictors of discordance of patient and caregiver's response with that of physician's were explored by multivariate regression analyses with mixed effect model.Results: The agreement rates between patient-physician and caregiver-physician were 63.0% and 65.9% for disease stage, 69.0% and 70.0% for treatment goal, and 41.4% and 45.1% for chance of cure. When discordance occurs, patients and caregivers often had an optimistic view. Distant stage, older age, female sex, and absence of depression were associated with optimistic view of patients, and there was significant between-physician variance for all 3 outcomes.Conclusion: The discordance revealed that our study suggests the need for better communication between physician and patients, as well as the caregivers. Research is needed to develop a comprehensive strategy to improve the understanding of the patients and family so that treatment decisions are made based on realistic estimation. [ABSTRACT FROM AUTHOR]

Few studies have examined the association between disability and chronic obstructive pulmonary disease (COPD). We compared the trends in the annual COPD prevalence between people with and without disabilities, and examined the association between disability and COPD. We linked the National Health Information Database (2008–2017) with the National Disability Registration Database, which includes more than 2 million people with disabilities every year. In the 2017 dataset, people with disabilities had a higher prevalence of COPD than those without disabilities (30.6% vs. 12.5%, P < 0.001). The age-standardized prevalence rate of COPD among people without disabilities increased from 4.2 in 2008 to 10.9% in 2017 (change of 6.7%), whereas that among those with disabilities increased from 7.0 to 17.1% (change of 10.1%). In multivariate analysis, compared to people without disabilities, those with disabilities had a higher probability of having COPD (adjusted odds ratio, 1.42; 95% confidence interval 1.42–1.43). The results of subgroup analysis by disability characteristics suggested that disabilities due to failure of an organ, such as the kidney, lung, heart, or liver, and severe disabilities were particularly vulnerable to COPD. In conclusion, people with disabilities are more likely to have COPD compared to people without disabilities. Further longitudinal studies that examine cause-and-effect relationship between disability and COPD are needed to clarify this relationship and to further investigate any potential negative effects associated with the coexistence of these conditions. [ABSTRACT FROM AUTHOR]

Objective: When cancer hits a family, the entire family members start to adapt to the new status. This study aimed to investigate the main issue of the family with cancer patient and their way of solving it.Methods: In-depth interviews were conducted as a qualitative research. Thirty-three participants described their experience either as cancer patients or as family caregivers.Results: Guided by the grounded theory, we identified the main concern of the families being primary caregiver selection. The primary caregiver was determined by the conditions of the patient and the family, but the primary caregiver accepted his/her role believing no alternative was plausible in the family. The processes of the entire family have change since cancer showed their "adapting living," which was identified as the core variable.Conclusions: On the basis of the current study's limitations, suggestions were made for future studies in which cultural attributes are distinguished from the medical system attributes. [ABSTRACT FROM AUTHOR]

Background: Insulin resistance (IR) is an important contributor to the development of hypertension (HTN), and the triglyceride-glucose (TyG) index has been proposed as a simple, reliable marker of IR. This study investigated the association between the TyG index and blood pressure (BP) elevation in a large general population. Methods: The study enrolled 15,721 adults with no history of cardiometabolic diseases from the 2016–2019 Korea National Health and Nutrition Examination Survey. Participants were classified into quartiles based on the TyG index and BP was categorized as normal BP, elevated BP, pre-HTN, and HTN. The associations of the TyG index with BP categories were assessed using multivariate multinomial logistic regression models with normal BP as the reference group. Results: The mean systolic/diastolic BP and prevalence of HTN increased with the TyG index (P for trend < 0.001). The continuous TyG index had a strong dose-response relationship with increased odds of elevated BP, pre-HTN, and HTN. Compared with the lowest TyG index quartile, the highest TyG index quartile was significantly associated with higher odds of having elevated BP (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.24–1.87; P for trend < 0.001), pre-HTN (OR, 2.22; 95% CI, 1.95–2.53; P for trend < 0.001), and HTN (OR, 4.24; 95% CI, 3.49–5.16; P for trend < 0.001). Conclusion: We found that a higher TyG index was positively associated with the risk of increased BP in normal healthy individuals. This study suggests that the TyG index might serve as a potential predictor of HTN. However, further studies with larger sample sizes and various target populations in longitudinal designs are needed. [ABSTRACT FROM AUTHOR]

Background Identifying psychosocial needs and satisfying them are important issues to many cancer patients. The aim of this study was to investigate the psychosocial needs of cancer patients and its related factors, based on a nationwide sample of cancer patients in Korea. Methods A multi-center survey was administered to 2661 cancer patients from 10 cancer centers in Korea. The survey measured the needs for psychosocial support, using the Comprehensive Needs Assessment Tool in Cancer, and potential correlates, such as socio-demographic and clinical factors. Multivariate ordinal regression and binary logistic regression were conducted to identify factors that may predict psychosocial needs. Results On the measure for psychosocial needs, the median score of psychological problems was 2.73 points and that of social support was 1.92 points, as the standardized score on a scale of 10 points. Needs for psychological problems were positively correlated with intensive treatment, degree of stress, problems with EQ5-D, needs for information and education, needs for hospital facilities/services and needs for physical symptoms. The need for social support was positively correlated with problems with EQ5-D and other unmet needs of cancer patients. Income levels and the number of years since diagnosis were negatively correlated with the need for social support. Conclusion Unmet psychosocial needs were common in cancer patients and have varied according to patients' socio-demographic and clinical factors. These results suggest that a psychosocial approach to treatment should be applied comprehensively and that such an approach should be matched to patients' socio-demographic and clinical circumstances. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We analyzed the patterns of diagnosis, treatment, and prognoses of acute myeloid leukemia (AML) patients with and without disabilities. The data were collected from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claim database. We built a cohort of 2 776 450 people with disabilities and a nondisabled cohort of 8 329 350 people who were selected at a ratio of 1:3 by matching age and sex. From this population, adult patients who were diagnosed with AML were analyzed. The number of patients with AML were 26.74 per 100 000 in people without disabilities and 20.39 per 100 000 in those with disabilities (P <.0001). The proportion of AML patients receiving chemotherapy and those of patients receiving transplants were significantly lower in the disabled population than that of nondisabled populations (71.2% vs 77.1%, P =.0031, and 17.5% vs 26.9%, P =.002). This trend was more pronounced in subgroups of communication disability and major internal organ disorder. The median survival was 10.8 months for patients with disabilities, which was significantly shorter than 17.1 months for those without a disability (P =.002). Individuals with disabilities have a low diagnosis rate of AML and undergo less active treatment, which results in inferior prognosis. [ABSTRACT FROM AUTHOR]

Background and aim: Using the national disability registration linked to the cancer screening database in Korea, we examined (1) trends in the gastric cancer screening rate among people with disabilities over time, and (2) whether gastric cancer screening participation and modalities differed according to presence, severity, and type of disability. Methods: We examined gastric cancer screening participation rates among individuals with registered disability, from 2006 to 2015. Results: The age- and sex-adjusted rate for gastric cancer screening in people with disabilities increased from 25.9% in 2006 to 51.9% in 2015 (change: + 26.0%). During the same period, screening rates among people without disability improved from 24.7 to 56.5% (change: + 31.8%). Disability was associated with a screening rate [adjusted odds ratio (aOR) 0.89, 95% confidence interval (CI), 0.88–0.89]. Screening rates were markedly lower among people with severe disabilities (aOR 0.58, 95% CI 0.57–0.58) and people with autism (aOR 0.36, 95% CI 0.25–0.52), renal failure (aOR 0.39, 95% CI 0.38–0.39), brain injury (aOR 0.41, 95% CI 0.40–0.41), ostomy problems (aOR 0.53, 95% CI 0.51–0.55), intellectual disabilities (aOR 0.54, 95% CI 0.53–0.54), or mental disorders (aOR 0.55, 95% CI 0.54–0.56). The use of gastroscopy as the initial screening modality in people with disabilities was lower than in people without a disability. Conclusions: In spite of the availability of national gastric cancer screening program, we found significant disparities in gastric cancer screening participation, especially among people with severe disabilities and those with renal failure or brain-related/mental disabilities. [ABSTRACT FROM AUTHOR]

Background: Health disparities among individuals with disabilities remain underrecognized. The objective of the current study was to investigate: 1) whether disparities exist in breast cancer screening rates among women with disabilities compared with women without disabilities; 2) whether breast cancer screening rates vary according to the type and severity of disabilities; and 3) trends in breast cancer screening disparities according to disability status over time.Methods: Using national administrative databases concerning disability status and national cancer screening programs in Korea, age-standardized participation rates were calculated according to the type and severity of disabilities.Results: The age-standardized rate for breast cancer screening in individuals with disabilities increased from 30.2% in 2006 to 53.7% in 2015 (change of +23.5%), whereas that among those without a disability increased from 29.3% to 60.1% (change of +30.8%). In general, disability was associated with slightly lower breast cancer screening rates (adjusted odds ratio [aOR], 0.824; 95% CI, 0.820-0.828). However, screening rates were especially low in women with severe disabilities (aOR, 0.465; 95% CI, 0.461-0.469) and among women with autism (aOR, 0.235; 95% CI, 0.143-0.388), renal failure (aOR, 0.342; 95% CI, 0.337-0.348), brain injury (aOR, 0.349; 95% CI, 0.346-0.352), intellectual disabilities (aOR, 0.403; 95% CI, 0.397-0.410), mental disorders (aOR, 0.494; 95% CI, 0.488-0.501), or ostomies (aOR, 0.529; 95% CI, 0.512-0.546).Conclusions: Even without a cost barrier, significant disparities were found in breast cancer screening participation, especially in women with severe disabilities and brain-related and/or mental disabilities. Policy efforts, such as ensuring the accessibility of information and equipment, transportation support, and access to a usual source of care, should be made to decrease this disparity. [ABSTRACT FROM AUTHOR]

Purpose: Despite the theoretical and empirical significance of positive aspects of caregiving in caregiver well-being, relatively little is known regarding family-related predictors of caregiver positivity. This study examines whether patient-family communication (p-f communication) mediates the relation between family hardiness and caregiver positivity and whether the mediating effects of p-f communication are moderated by the levels of caregiver depression and anxiety. Design/Sample: This study used secondary data obtained from a large-scale cross-sectional national survey conducted in South Korea. Participants were 544 spousal cancer patient-caregiver dyads recruited from the National Cancer Center and nine government-designated regional cancer centers in South Korea. Methods: To test the hypotheses, a simple mediation model and two moderated mediation tests were conducted using the PROCESS macro for SPSS. Findings: Higher family hardiness was related to higher p-f positive communication and higher caregiver positivity. The effects of family hardiness were partially mediated by p-f communication, controlling for caregiver sex, education, health status, depression and anxiety, time spent caregiving, and patient depression and anxiety, cancer stage, and time since diagnosis. The mediating effects of p-f communication were not significantly moderated by caregiver depression and anxiety. Conclusions/Implications: Health care professionals could consider p-f communication as a reasonable target of intervention to increase caregiver positivity, even for caregivers with heightened depression and anxiety. [ABSTRACT FROM AUTHOR]

Purpose: There is growing interest in integrating electronic patient-reported outcome (PRO) measures into routine oncology practice for symptom monitoring. Here, we evaluated the feasibility and accessibility of electronic PRO measures using a smartphone (PRO-SMART) for cancer patients receiving routine chemotherapy.Methods: The proposed PRO-SMART application obtains daily personal health record (PHR) data from cancer patients via a smartphone. An analysis report of cumulative PHR data is provided to the clinician in a format suitable for upload to electronic medical records (EMRs). Cancer outpatients who had received at least two cycles of chemotherapy and who were scheduled for two more cycles were enrolled.Results: Between February 2015 and December 2016, 111 patients were screened and 101 of these were included. One-hundred patients used PRO-SMART at least once and were included in the final analysis (90.1% overall accessibility among all screened patients). The number of symptomatic adverse events (AEs) related to chemotherapy recorded in EMRs (mean ± standard deviation [SD]) increased from 0.92 ± 0.80 to 2.26 ± 1.80 (P < 0.001), and grading of AEs increased from 0.81 ± 0.69 to 1.00 ± 0.62 (P = 0.029). After using PRO-SMART, the numeric rating scale for pain (mean ± SD) increased from 0.20 ± 0.72 to 0.99 ± 1.55 (P < 0.001). A patient-reported questionnaire revealed that 64.2% of patients found it useful and 83% found it easy to use.Conclusions: This study suggests that the proposed PRO-SMART is feasible and accessible for assessment of symptomatic AEs in cancer patients receiving chemotherapy for a prospective randomized trial. [ABSTRACT FROM AUTHOR]

Purpose: We assessed cost communication between cancer patients, caregivers, and oncologists and identified factors associated with communication concordance.Methods: A national, multicenter, cross-sectional survey of patient-caregiver-oncologist triads was performed, and 725 patient-caregiver pairs, recruited by 134 oncologists in 13 cancer centers, were studied. Discordance in preferences and experiences regarding cost communication between patients, caregivers, and oncologists were assessed. Hierarchical generalized linear models were used to identify predictors of concordance and to identity the possible association of concordance with patient satisfaction and degree of trust in the physician.Results: Although the oncologists thought that patients would be affected by the cost of care, only half of them were aware of the subjective burden experienced by their patients, and the degree of concordance for this parameter was very low (weighted kappa coefficient = 0.06). Caregivers consistently showed similar preferences to those of the patients. After controlling for covariates, the education level of patients [adjusted odds ratio (aOR) for > 12 vs. < 9 years, 2.92; 95% confidence interval (CI), 1.87-4.56], actual out-of-pocket costs [aOR for ≥ 8 million vs. < 2 million Korean Won, 0.56; 95% CI, 0.34-0.89], and physician age (aOR for ≥ 55 vs. < 45 years, 1.83; 95% CI, 1.04-3.21) were significant.Conclusions: The results show underestimation by oncologists regarding the subjective financial burden on a patient, and poor patient-physician concordance in cost communication. Oncologists should be more cognizant of patient OOP costs that are not indexed by objective criteria, but instead involve individual patient perceptions. [ABSTRACT FROM AUTHOR]

Adolescents who reenter school after treatment for cancer may face certain challenges, such as social exclusion by their peers and difficulties in cognitive functioning, due to the cancer treatment and its psychosocial sequelae. Such challenges may have an impact on their mental health. This cross-sectional study examined the impact of peer exclusion-victimization and cognitive functioning on depression among adolescent survivors of childhood cancer. A total of 175 adolescent survivors of childhood cancer between the ages of 13 and 19 years completed a self-reported questionnaire. Their mean age was 15.33 years (SD = 1.65), the mean time since diagnosis was 7.97 years (SD = 3.91), and 49.7% experienced at least 1 kind of peer exclusion in school. Multiple regression analysis was conducted to examine the effects of survivors' experiences related to peer exclusion-victimization and cognitive functioning on depression, controlling for demographic (age and gender) and cancer-related (cancer type, time since diagnosis, recurrence) characteristics. The model with peer exclusion-victimization and cognitive functioning as predictors accounted for 27.9% of the variance in depression. More experiences in peer exclusion-victimization (β = .200, p = .024) and lower cognitive functioning (β = -.465, p < .001) were associated with greater levels of depression. Understanding the impact of survivors' experiences of peer exclusion-victimization and cognitive functioning on their mental health will help professionals to provide appropriate counseling services to moderate peer exclusion-victimization as well as resources for academic performance for those cancer survivors at risk for depression. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Background: To investigate how cancer patients, family caregiver, and their treating oncologist view the risks and benefits of family involvement in cancer treatment decision making (TDM) or the degree to which these perceptions may differ.Patients and Methods: A nationwide, multicenter survey was conducted with 134 oncologists and 725 of their patients and accompanying caregivers. Participant answered to modified Control Preferences Scale and investigator-developed questionnaire regarding family involvement in cancer TDM.Results: Most participants (>90%) thought that family should be involved in cancer TDM. When asked if the oncologist should allow family involvement if the patient did not want them involved, most patients and caregivers (>85%) thought they should. However, under this circumstance, only 56.0% of oncologists supported family involvement. Patients were significantly more likely to skew their responses toward patient rather than family decisional control than were their caregivers (P < .003); oncologists were more likely to skew their responses toward patient rather than family decisional control than caregivers (P < .001). Most respondents thought that family involvement is helpful and neither hamper patient autonomy nor complicate cancer TDM process. Oncologists were largely positive, but less so in these ratings than either patients or caregivers (P < .002).Conclusions: Patients, family caregivers, and, to a lesser degree, oncologists expect and valued family involvement in cancer TDM. These findings support a reconsideration of traditional models focused on protection of patient autonomy to a more contextualized form of relational autonomy, whereby the patient and family caregivers can be seen as a unit for autonomous decision. [ABSTRACT FROM AUTHOR]

Purpose: Patients with cancer are reported to experience high anxiety and depression related to their medical status. The current study aimed to investigate the effects of avoidance of cancer communication and of social support from family and medical professionals on the patients' anxiety and depression.Methods: A national survey was conducted through regional branches of the National Cancer Center of South Korea, which yielded 296 patient-caregiver dyads. Patients' medical records complemented their self-report survey data.Results: Patients' anxiety was predicted by the family's avoidance of cancer communication and the level of emotional support from family. Patients' depression was predicted by the stage of cancer (Surveillance, Epidemiology, and End Results), the family's avoidance of cancer communication, the emotional support from family, and the medical professionals' respect. Interaction effects were not statistically significant.Conclusion: The implications of the findings are discussed in terms of the psycho-oncological and psycho-social interventions. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Family caregivers of cancer patients are anticipated to serve multiple roles but the factors that influence their reaction to caregiving have not gotten much attention. The current study aimed to investigate the effects of cancer patient's needs level and the family hardiness on the caregivers' reaction.Methods: A national survey was conducted through regional branches of the National Cancer Center of South Korea, yielding 990 patient-caregiver dyads. Patients and caregivers provided self-report questionnaires. Patient's medical records complemented the self-report survey data.Results: On all five domains of caregiver reaction, which were schedule, esteem, support, health, and finance, family hardiness was a significant predictor. Male, older, low-income caregivers reported more burden in caregiving with some. The interaction effect of patient's needs and family hardiness was found only on esteem.Conclusions: The implications based on the findings are discussed in terms of the psycho-oncological and psycho-social interventions for the cancer patients and their family caregivers. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare the views of cancer patients, family caregivers, and oncologists about the disclosure of side effects in respect to their probability of occurrence, severity, and treatment purpose. We also compared attitudes toward potential harm of side effect disclosure, patients' perceived ability to understand the risk of the side effects, and informed decision-making regarding side effects. Methods: A national survey was performed with 750 patient-caregiver dyads (75.5% participation rate) recruited by 134 oncologists in 13 cancer centers (93% participation rate). Attitudes toward communication of side effects were assessed in terms of drug purpose, severity of potential complications, and probability of harm. Results: Most patients (82.1-87.0%) and caregivers (75.9-81.5%) thought they should be informed of all possible drug side effects regardless of risk, severity, or drug purpose and wanted these risks to be communicated explicitly. Patients and their caregivers believed that detailed explanations of side effects did not harm patients, and further, they believed that patients could understand risks and make treatment decision based on that information. In contrast, oncologists held less positive attitudes toward providing detailed information about drug side effects, especially if they were not severe and if the drugs were designed for supportive care. Conclusion: Cancer patients and family members had different perspectives and preferences regarding communication of drug side effects from their oncologists. The data from our study can serve as a guide for oncologists in presenting side effects information to their patients, as well as a basis for physician training. [ABSTRACT FROM AUTHOR]

Objective: Recently, caregiver burden (CB) has emerged as an important issue in the area of palliative medicine. However, patients' feelings related to being a burden to their families (i.e., self-perceived burden [SPB]) is also a significant issue. We evaluated the relation of CB and SPB as preference for palliative care.Methods: A national, multicenter, cross-sectional survey of 326 patient-caregiver dyads was performed. A set of paired questionnaires evaluating CB and SPB (five domain items assessed on a four-point Likert scale) were independently administered to patients and their caregivers. Among the respondents, only the patients with distant stage cancer and their caregivers were included. Multivariate analyses were conducted to identify the associations between CB and SPB and preference for palliative care.Results: Caregivers and patients who preferred palliative care to life sustaining treatment reported higher CB and SPB scores, respectively. Caregivers who felt more of a burden were more likely to prefer palliative care over life sustaining treatment for their patients (adjusted odds ratio [aOR] = 1.67, 95% CI: 1.21-2.31). In addition, patients who perceived their caregivers' burden as large tended to prefer palliative care (aOR = 1.61, 95% CI: 1.16-2.22).Conclusions: Both CB and SPB increased preference for palliative care. This could be interpreted that high CB can lead to preference for palliative care in both patients and their caregivers, potentially threatening patient autonomy. Efforts to relieve CB and SPB are needed. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Communication between cancer patients and caregivers is often suboptimal. The Cancer Communication Assessment Tool for Patient and Families (CCAT-PF) is a unique tool developed to measure congruence in patient-family caregiver communication employing a dyadic approach. We aimed to examine the cross-cultural applicability of the CCAT in the Korean healthcare setting. Methods Linguistic validation of the CCAT-PF was performed through a standard forward-backward translation process. Psychometric validation was performed with 990 patient-caregiver dyads recruited from 10 cancer centers. Results Mean scores of CCAT-P and CCAT-F were similar at 44.8 for both scales. Mean CCAT-PF score was 23.7 (8.66). Concordance of each items between patients and caregivers was low (weighted kappa values <0.20 for all items and Spearman's rho <0.18 for scale scores). Scale scores did not differ significantly across a variety of cancer types and stages. The CCAT-P or CCAT-F score was weakly associated with mental health and quality of life outcomes. The CCAT-PF was correlated weakly with both patient-perceived and caregiver-perceived family avoidance of cancer care scales. Conclusion The CCAT-PF Korean version showed similar psychometric properties to the original English version in the assessment of communication congruence between cancer patient and family caregivers. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background The complexity of end-of-life (EOL) communication in cancer care is often increased by family caregivers, who frequently affect the information and decision-making process. We assessed cancer patient preferences (PP), family caregiver preferences (FCP), and family caregiver predictions of patient preferences (FCPPP) regarding the disclosure of terminal status, family involvement in the disclosure process, and EOL choices, and we evaluated the concordances among them. Methods A national, multicenter, cross-sectional survey of 990 patient-caregiver dyads (participation rate = 76.2%) was performed. A set of paired questionnaires was independently administered to patients and their caregivers. Results While patients and family caregivers had wide spectra of preferences, patients significantly preferred disclosure, direct disclosure by a physician, and palliative care options (all P < 0.001). Family caregiver predictions were similar to PP with regard to terminal disclosure ( P = 0.35) but significantly different with regard to family involvement in the disclosure process and EOL choices ( P < 0.001). The concordances of PP and FCP ( κ = 0.08-0.13), and those of PP and FCPPP ( κ = 0.09-0.17), were poor. The concordances of FCP and FCPPP were fair to moderate ( κ = 0.35-0.67). Discrepancies between PP and FCP and between PP and FCPPP were associated with dysfunctional family communication. Conclusions Family caregivers do not generally concur with patients in their preferences, nor do they reliably predict PP. Open dialogue between patient and family caregivers would reduce the discrepancy. More emphasis on incorporating family caregivers in EOL communication is needed from clinical, research, and training perspectives. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the health behaviors of people with retinitis pigmentosa (RP) in the Republic of Korea. Methods: An online questionnaire was used to survey members of the Korean Retinitis Pigmentosa Society (KRPS), over 3 months from December 2010 to February 2011. Controls were selected from participants of the 4th Korean National Health and Nutrition Examination Survey and were matched with people with RP using the propensity score method to optimize comparative analysis. A semi-structured interview was also conducted with five members of the KRPS to identify potential reasons for physical inactivity and unhealthy diet and to develop effective interventions. Results: A total of 194 eligible people with RP responded to the online survey, and 187 individuals were matched with the control population by propensity score matching. RP subjects reported a lower rate of current smoking and greater use of preventive healthcare services. However, people with RP were more physically inactive (50.8% vs 27.3%, p < 0.001) and consumed more fast food (69.5% vs 58.3%, p = 0.024) than the control population. Conclusion: Physical inactivity and fast food consumption were more frequently reported in people with RP than the general population. Efforts to understand the possible reasons and develop interventions to improve these health behaviors are warranted. [ABSTRACT FROM AUTHOR]

The article presents a study which verifies the feasibility, validilty, and reliability of the Korean version of Caregiver Reaction Assessment Scale (CRA-K) among caregivers of cancer patients. It details the design methodology with statistical and factor analysis of the CRA-K of the multi-trait of caregivers. The findings indicate that CRA-K is a viable, reliable, and valid tool in assessing the positive and negative aspects of caregiving for cancer patients.

Background Despite the important role that family caregivers play in providing emotional and practical support to cancer patients, relatively little is known about the family caregiver's role in treatment decision-making (TDM). We sought to investigate patients' and family caregivers' preferences for and experiences of family involvement in TDM and factors associated with preference concordance. Method A national survey was performed with 990 patient-caregiver dyads (participation rate:76.2%). Questions examining preferences for and experiences of family involvement in TDM were administered independently to patients and family caregivers. Concordance was calculated with weighted kappa. Logistic regression analyses were used to identify predictors of patients' and caregivers' preferences for family involvement in TDM and concordance between them. Results Few patients or family caregivers expressed a preference for unilateral decision-making; however, there was considerable variation and poor agreement within dyads in regard to whether the patient or family caregivers should take the lead in decision-making with input from the other (weighted kappa between respondents for TDM preferences and experiences = 0.10 and κ = 0.18, respectively). Greater TDM preference concordance was associated with higher patient education, whereas lower levels of concordance were evident for younger patients, less educated caregivers, adult child patient dyads (as opposed to a spouse-patient dyads) and problematic family communication about cancer. Conclusions Most patients and family caregivers valued and expected family involvement in TDM. However, there is little explicit agreement in regard to which party in the dyad should take decisional leadership and who should play a supporting role. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective Cancer patients are more likely to experience depression than the general population. This study aims to evaluate the possible association between cancer stigma and depression among cancer patients. Methods As a part of the Korean government's program to develop comprehensive supportive care, we conducted a nationwide survey in 2010 at the National Cancer Center and in nine regional cancer centers across Korea. Cancer stigma was assessed by using a set of 12 questions grouped in three domains-impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination. Depression was measured by using the Hospital Anxiety and Depression Scale. Results A total of 466 cancer patients were included in the study. Over 30% of the cancer survivors had negative attitudes toward cancer and held stereotypical views of themselves: about 10% of the participants experienced social discrimination due to cancer, and 24.5% reported clinically significant depressive symptoms. Patients who had or experienced cancer stigma were 2.5 times more likely to have depression than patients with positive attitudes. Conclusions Regardless of highly developed medical science and increased survivorship, cancer survivors had cancer stigmas, and it was significantly associated with depression. Impact Our findings emphasize the need for medical societies and health professionals to pay more attention to cancer stigma that patients are likely to experience during treatment. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the prevalence and predictors of anxiety and depression among family caregivers of patients with cancer in Korea. Methods: A national, multicenter, cross-sectional survey was conducted with 897 family caregivers. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression in patient-family caregiver dyads. Results: The prevalence of anxiety in family caregivers was 38.1 %:20.3 % reported mild anxiety, 13.3 % reported moderate anxiety, and 4.6 % reported severe anxiety. The prevalence of depression was 82.2 %:40.4 % reported mild depression, 25.5 % reported moderate depression, and 16.3 % reported severe depression. Family caregivers who were younger, were caring for male patients, or had a low quality of life (QOL) in relation to three of the variables measured in the Korean Caregiver Quality of Life Index-Cancer (CQOLC-K): burden, disturbance, and financial concerns reported increased anxiety. Becoming unemployed during caregiving, being the spouse of a patient and having low QOL in relation to three of the variables measured by the CQOLC-K: burden, disturbance, and positive adaptation were associated with depression among family caregivers. The predictive validity of the selected variables were 0.861 (95 % CI: 0.844-0.892) for anxiety and 0.794 (95 % CI: 0.751-0.828) for depression. Conclusions: Family caregivers of patients with cancer experienced high levels of anxiety and depression. Socio-demographic factors and QOL were predictors of anxiety and depression in family caregivers. [ABSTRACT FROM AUTHOR]

Objective We investigated whether and how perceived social support is associated with depression and quality of life among patients with various cancer diagnoses. Methods Data were collected from 1930 cancer patients treated at the National Cancer Center and nine regional cancer centers across Korea. The Duke-UNC functional social support scale was used to measure the perceived social support, and the PHQ-9 and the EORTC QLQ-C30 were used to measure the cancer patients' depression levels and quality of life, respectively. Results Subjects with low perceived social support reported significantly higher levels of depression, lower scores on all functional scales, higher scores on all three symptom scales, lower global health/quality of life scale scores, and higher scores on most single items than subjects with high perceived social support. There was no interaction between potential stressors and perceived social support, supporting the main effect model as the mechanism that the perceived social support reduce the adverse psychological outcomes. Conclusion Perceived social support was associated with mental health and quality of life in cancer patients, through direct effect rather than stress-buffering effect. Interventions to enhance perceived social support might be helpful for improving mental health and QOL in cancer patients. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence of suicidal ideation and suicide attempts in family caregivers (FCs) of patients with cancer and to identify the factors associated with suicidal ideation and suicide attempts in FCs with anxiety or depression. Methods: A national, multicenter survey administered to 897 FCs asked questions concerning suicidal ideation and suicide attempts during the previous year and assessed anxiety, depression, socio–demographic factors, caregiving burden, patient factors, and quality of life (QOL). Results: A total of 17.7% FCs reported suicidal ideation, and 2.8% had attempted suicide during the previous year. Among FCs with anxiety, 31.9% had suicidal ideation and 4.7% attempted suicide; the corresponding values for FCs with depression were 20.4% and 3.3%, respectively. Compared with FCs without anxiety and depression, FCs with anxiety or depression showed a higher adjusted odds ratios (aOR) for suicidal ideation (aOR  = 4.07 and 1.93, respectively) and attempts (OR  = 3.00 and 2.43, respectively). Among FCs with anxiety or depression, being female, unmarried, unemployed during caregiving, and having a low QOL were associated with increased odds of suicidal ideation. FCs with anxiety who became unemployed during caregiving constituted a high-risk group for suicide. Being unmarried and having a low QOL with respect to financial matters were associated with increased suicide attempts among FCs with depression. Conclusion: FCs with anxiety or depression were at high risk of suicide. Interventions to enhance social support and to improve perceived QOL may help prevent suicide and manage suicidal ideation in FCs with anxiety or depression. [ABSTRACT FROM AUTHOR]

BACKGROUND: The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (β, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy. Cancer 2011. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Shared decision making and an integrative approach is expected to result in better outcomes, but might require more time. While ensuring that sufficient consultation time is essential to quality cancer care, it is not clear whether cancer patients feel that the amount of consultation time with their oncologists is sufficient. Methods: Data were collected from 2,556 cancer patients on their perceived and preferred consultation time, and included potential predictors, such as socio-demographics, clinical, behavioral, and quality-of-life factors, as well as potential outcomes, including unmet patient needs, trust in doctor, and satisfaction. The feeling of insufficient consultation time was defined as the perception that consultation time is less than the preferred consultation time; multivariate analyses were used for identification of predictors and comparison of outcomes. Results: Overall, 37.1% felt that consultation time was less than preferred. Younger age, female sex, higher education level, having national health insurance, having been diagnosed with less common cancers, and having anxiety/depression were significantly associated with feelings of insufficient consultation time. Subjects with a feeling of insufficient consultation time reported higher current needs for information, physical symptoms, and psychological problems. They also reported less trust in their physician, lower overall satisfaction, and lower intention to continue treatment at the current cancer center. Conclusion: This study illustrated that high-quality cancer care, characterized by shared decision making and an integrative approach, seems to be related to sufficient consultation time that meets the individual's subjective needs, and measures should be taken to ensure sufficient consultation time. [ABSTRACT FROM AUTHOR]

Purpose: Although later-onset disability has been associated with poor self-rated health (SRH), factors mediating differences in SRH related to age at onset of disability remain unclear. The present study was designed to identify the variables explaining poor SRH in later-onset disability. We examined chronic disease and functional status as alternatives to psychosocial adaptation as explanatory variables. Method: Our data were taken from the seventh National Survey for People with Disabilities among Korean individuals ≥18 years of age ( n =5311). Results: Those with later-onset disability (onset ages 20-40, 41-64 and ≥65 years) showed higher age-adjusted odds ratios (ORs) for poor SRH compared with those with earlier-onset disability (onset ages 0-19 years). The ORs for poor SRH in individuals with later-onset disability were not substantially changed after adjusting for confounding variables including alternatives to psychosocial adaptation (chronic diseases and functional status) as explanatory variables. Conclusions: Failure to explain poor SRH in later-onset disability with explanatory variables other than psychosocial adaptation indirectly supports the role of psychosocial adaptation in differences in SRH related to age at onset. Because we could not include appropriate measures of psychosocial adaptation, the use of additional instruments should be considered in future studies. [ABSTRACT FROM AUTHOR]

Objectives: Psychological distress is common in cancer patients, and the need to develop a system for assessing and managing distress is widely recognized. This project developed recommendations that are feasible for Korean cancer patients and the Korean healthcare system. Methods: Based on the findings from a series of studies in the context of this project, we developed guidelines following the steps and parameters recommended by the Scottish Intercollegiate Guidelines Network (SIGN). The Development Group consisted of individuals from several professions, including psychiatrists, psychologists, nurses, social workers, a health policy expert, and a methodologist. Opinions from various healthcare providers, patients, and related societies were also reflected in the guidelines. Results: The main recommendations for distress management in cancer patients were the following: (1) a concept of distress in Korean cancer patients, screening tools, management algorithms, and triage approaches was developed and (2) four symptom-specific guidelines with management algorithms were proposed for depression, anxiety, insomnia, and delirium. Conclusion: This is the first effort to develop recommendations for distress management in psycho-oncology in Korea. These guidelines offer standards for psychosocial care for cancer patients in Korea. We have made a significant step toward integrated cancer care that incorporates the psychosocial care of patients as an essential component of patient care in a Korean oncology context. This version will be updated constantly to keep up with emerging evidence from empirical research and clinical experience. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: While knowledge and risk perception have been associated with screening for second primary cancer (SPC), there are no clinically useful indicators to identify who is at risk of not being properly screened for SPC. We investigated whether the mode of primary cancer detection (i.e. screen-detected vs. non-screen-detected) is associated with subsequent completion of all appropriate SPC screening in cancer survivors. Methods: Data were collected from cancer patients treated at the National Cancer Center and nine regional cancer centers across Korea. A total of 512 cancer survivors older than 40, time since diagnosis more than 2 years, and whose first primary cancer was not advanced or metastasized were selected. Multivariate logistic regression was used to examine factors, including mode of primary cancer detection, associated with completion of all appropriate SPC screening according to national cancer screening guidelines. Results: Being screen-detected for their first primary cancer was found to be significantly associated with completion of all appropriate SPC screening (adjusted odds ratio, 2.13; 95% confidence interval, 1.36–3.33), after controlling for demographic and clinical variables. Screen-detected cancer survivors were significantly more likely to have higher household income, have other comorbidities, and be within 5 years since diagnosis. Conclusions: The mode of primary cancer detection, a readily available clinical information, can be used as an indicator for screening practice for SPC in cancer survivors. Education about the importance of SPC screening will be helpful particularly for cancer survivors whose primary cancer was not screen-detected. [ABSTRACT FROM AUTHOR]

Purpose: Needs assessment is an important step toward quality and patient-centered cancer care, as it identifies patient need, guiding evidence-based cancer care policy, and maximizing care outcome. This study reports on the development and validation of comprehensive needs assessment tool in cancer (CNAT).Methods: The CNAT, 59-item needs assessment tool for cancer was developed and validated in a large scale multi-center survey involving 2,661 cancer patients in ten fairly distributed cancer centers throughout Korea.Results: To ensure content validity of the CNAT, items were derived from major needs assessment tools and input from experts and patients. Exploratory factor analysis confirmed its construct validity and identified seven factors: health care staff, psychological problems, physical symptoms, information, social and religious/spiritual support, practical support, and hospital facilities/services. Cronbach's alpha for the scale was 0.97, and for subscales, it varied from 0.80 to 0.97. Convergent validity was demonstrated by its significant association with the EQ5D. Patients with elevated stress, depressive episodes, or suicidal ideation reported a significantly higher level of psychological and overall need. Known-group validity was also supported by its ability to detect significant differences according to age, gender, education, insurance status, months since diagnosis, and non-surgical anticancer treatment. Needs differed according to SEER stage and cancer type: advanced stage and breast and lung cancer were associated with a greater level of need.Conclusions: The CNAT constitutes a meaningful and valid response to the challenges of cancer care, enabling assessment of need in cancer with a comprehensive yet concise and psychometrically sound tool. [ABSTRACT FROM AUTHOR]

Abstract: Context: There is an increasing need for the comparative assessment of palliative care services; however, few systematic empirical studies have been performed to determine the most feasible, representative, efficient survey method. Objectives: To investigate the feasibility, representativeness, and efficiency of several survey methods. Methods: This study was performed as a part of a national initiative to develop a system to evaluate the quality of palliative care services. Three separate but related surveys of patients, caregivers, and bereaved family members were conducted. These surveys were designed to simulate an independent assessment in a nationwide quality evaluation project. Results: The effective response rates for the patient, caregiver, and bereavement surveys were 30.4% (105 of 344), 46.5% (160 of 344), and 20.9% (501 of 2398), respectively. Subjects who responded to the patient and caregiver surveys were likely to have better physical and mental conditions, whereas subjects who responded to the bereaved family survey did not differ significantly from nonrespondents in regard to patient characteristics, except for a small difference in patient gender (females: 47.2% vs. 41.7%, P =0.028). The average number of responses per institution was 3.2, 4.8, and 15.2, respectively. The cost of the patient and caregiver surveys was much higher than the cost of the bereaved family member survey. Conclusion: There were significant differences between the three methods. Despite the low response rate, our findings suggest that the bereaved family member survey has strengths in terms of feasibility and efficiency, and could be considered as a practical option for the comparative assessment of palliative care services by an independent body. [Copyright &y& Elsevier]

Purpose: Cancer survivors have been reported to receive less care for other conditions than the general population; however, it is not clear whether patients' behavior also contribute to this. The present study was performed to examine cancer survivors' adherence to antihypertensive medication and factors associated with it, compared to the general population.Methods: We used pharmacy claims and enrollment data from the National Health Insurance, which covers 97% of the Korean population. In total, 2,455,193 subjects, including 12,636 (0.5%) cancer survivors, who were prescribed antihypertensive medications during the calendar year 2004 were identified. A cumulative medication adherence of 80% or above was defined as appropriate medication adherence. Two separate multiple logistic regressions were developed to compare the proportion of appropriate adherence between two populations and to identify factors affecting medication adherence in cancer survivors.Results: Cancer survivors were less likely to have an appropriate medication adherence than the general population (adjusted odds ratio = 0.85; 95% CI, 0.82-0.88). Significant variation was observed in medication adherence according to cancer type. Several other factors, such as older age, low income, living in a rural area, and antihypertensive medication duration, also affected antihypertensive medication adherence. Contrary to the general population, younger survivors showed higher adherence.Conclusions: Clinicians involved in survivor care should check patient adherence to antihypertensive medication, as well as assess the possible reasons for nonadherence. Further studies are warranted to determine the reasons for nonadherence and to establish effective interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: A complete enumeration study was conducted to evaluate trends in national practice patterns and direct medical costs for prostate cancer (PCa) in Korea over a 10-year retrospective period using data from the Korean National Health Insurance Service.Methods: Reimbursement records for 874,924 patients diagnosed between 2002 and 2014 with primary PCa according to the International Classification of Disease (ICD) 10th revision code C61 were accessed. To assess direct medical costs for patients newly diagnosed after 2005, data from 68,596 patients managed between January 2005 and 31 December 2014 were evaluated.Results: From 2005 to 2014, the total number of PCa patients showed a 2.6-fold increase. Surgery and androgen deprivation therapy were the most common first-line treatment, alone or within the context of combined therapy. Surgery as a monotherapy was performed in 23.5% of patients in 2005, and in 39.4% of patients in 2014. From 2008, the rate of robot-assisted RP rose sharply, showing a similar rate to open RP in 2014. Average total treatment costs in the 12 months post-diagnosis were around 10 million Korean won. Average annual treatment costs thereafter were around 5 million Korean won. Out-of-pocket expenditure was highest in the first year post-diagnosis, and ranged from 12 to 17% thereafter.Conclusions: Between 2005 and 2014, a substantial change was observed in the national practice pattern for PCa in Korea. The present data provide a reliable overview of treatment patterns and medical costs for PCa in Korea. [ABSTRACT FROM AUTHOR]