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This descriptive study aimed to evaluate the antiemetic protection of metoclopramide plus dexamethasone in a sample of 33 Chinese breast cancer patients who were receiving doxorubicin and cyclophosphamide. The antiemetic protection effect was not satisfactory. The results showed that the worst nausea and vomiting was experienced on the third day, with 87.9% of patients reporting nausea and 63.6% experiencing vomiting on that day. In almost one-third of the sample antiemetic medication failed to protect against either acute vomiting or delayed vomiting (i.e. patients continued to experience more than five emetic episodes). Complete protection from acute vomiting was seen in 36.4% of patients, whereas complete protection from delayed vomiting was seen in only one-third of the patients. There was an association between acute nausea/vomiting and delayed nausea/vomiting. Different types of antiemetics need to be offered to Chinese patients receiving chemotherapy (i.e. 5-HT3 receptor antagonists or a combination of antiemetics), but more research should be directed to this area. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is endemic in parts of Asia and Africa and most patients are not suitable for treatment with a curative approach. Little is known about the cost of palliative care for HCC.Objective: To determine: (i) patient-specific costs of palliative care of HCC; and (ii) individual factors that drive patient-specific costs and to develop a model of cost per case under alternative circumstances.Methods: 204 patients with inoperable HCC were prospectively tracked from first hospitalisation until death for health service utilisation. A societal perspective of cost was taken, including costs of formal and informal services incurred by payers, caregivers and patients. Observational data from a large Hong Kong cancer care programme were used. A regression analysis was performed using formal costs only, with the cost per observed day as the dependent variable.Results: The median survival was 95 days and the mean observation period was 153 days. The mean value per person for formal healthcare cost was 30 983 Hong Kong dollars [$HK] ($US3872, 1998 values). The distribution of cost values were positively skewed. The regression analysis showed that age, days of observation and survival were negatively related to cost per observed day, and the Child-Pugh grading of severity of liver cirrhosis was positively related to cost per observed day. A sensitivity analysis based on the regression equation indicated that nonsurvivorship doubles the cost per case, increased severity as measured by the Child-Pugh Index adds about 50% to the cost, and chemotherapy increases cost 2-fold.Conclusions: The relatively modest average cost per patient with HCC in Hong Kong reflects the short median survival and subsequently the limited use of inpatient care and chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Measurement of alpha-fetoprotein (AFP) is widely used in diagnosing hepatocellular carcinoma (HCC). However, moderately elevated AFP levels are also found in patients with chronic liver diseases. Separated by isoelectric focusing, AFP isoforms appearing as Band + II have been found to be specific for HCC. Recently, the Band + II isoforms have been identified to be monosialylated AFP (msAFP), which has one sialic acid residue fewer than the predominant AFP isoforms associated with liver cirrhosis. The beta-galactoside alpha-2,6-sialyltransferase (ST2,6Gal I) is the key liver enzyme to transfer terminal sialic acid to the carbohydrate side chain of AFP. Methods: To investigate whether decrease of ST2,6Gal I expression and/or enzyme activity is the underlying cause for the formation of msAFP, serum sample, tumour and nontumour samples were collected from 19 HCC patients for the measurement of serum msAFP percentage, tissue ST2,6Gal I activity, and ST2,6Gal I mRNA. Results: Serum msAFP percentage was negatively correlated with absolute ST2,6Gal I activity in the tumour tissue (r = -0.423, P = 0.07) and with the percentage change of enzyme activity (r = -0.540, P < 0.02). Positively correlation between the enzyme activity and the mRNA level of ST2,6Gal I was found in nontumour tissues (r = 0.643, P < 0.01), but not in tumour tissues. Conclusion: These results suggest that decrease of ST6Gal I activity in tumours is a possible cause for the formation of HCC-specific hyposialylated AFP isoforms. In contrast to nontumour tissues, the down-regulation of the ST6Gal I activity in HCC may not be regulated at the transcription level. [ABSTRACT FROM AUTHOR]