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Although the relationship between subjective well-being (SWB) and suicidal ideation (SI) has been illustrated in previous research, few studies have conceptualized SWB as a comprehensive measure of life satisfaction in multiple domains, nor have they considered possible mediators such as depressive symptoms. Therefore, the present study aimed to identify dimensions of SWB correlated with SI, and to analyze associations among SWB sub-domains, depressive symptoms, and SI in a community population. A total of 1200 community adults in South Korea, aged 20-86 years, completed self-report questionnaires on demographics, depressive mood (Patient Health Questionnaire-9 [PHQ-9]), SI (item 9 of the PHQ-9), and 14 SWB sub-domains (Subjective Well-Being Inventory). Factors associated with SI, and interactions among SI, depressive mood, and SWB, were identified by logistic regression and phenotype network analyses, respectively. The five main factors influencing the regularized partial correlation network were life satisfaction, self-blame, job, hopelessness, and fatigue. Pathways were observed from work-life balance and life satisfaction to hopelessness; from self-blame and fatigue to safety and health; and from sleep disturbance, concentration difficulties, self-blame, and hopelessness to SI. Making job activities more emotionally rewarding, the potential for career progression and regular work hours could address anhedonia, hopelessness and sleep disturbance, respectively, thus enhancing SWB and reducing SI in the community population.

Self-management has become the dominant care model for chronic disease management. This study aimed to investigate the effect of changes in self-management strategies on the clinical outcomes of chronic diseases. Two hundred ninety-seven patients with one or more chronic disease (diabetes, dyslipidemia, or hypertension) were registered and followed in this prospective cohort study. We compared differences in the changes in clinical outcomes from baseline to 6 months according to the improvement of self-management strategies by analysis of covariance. Diabetic patients with improved self-management strategies showed a significantly greater change in HbA1c levels compared to patients without improvement of self-management strategies (group difference in HbA1c = 0.51%). In hypertensive patients, systolic and diastolic blood pressure (BP) showed a significant decline in the patients with improved self-management strategies (group difference in systolic BP = 6.2 mmHg and in diastolic BP = 5.5 mmHg). Clinical outcomes improved significantly when self-management strategies improved in people with a poor self-management strategy at baseline. This study suggests that improvements in self-management strategies are associated with an improvement in clinical outcomes among patients with chronic diseases, especially for those with an initially poor self-management strategy.

OBJECTIVES To investigate the efficacy of health coaching and a web-based program on survivor physical activity (PA), weight, and distress management among stomach, colon, lung and breast cancer patients. METHODS This randomised, controlled, 1-year trial conducted in five hospitals recruited cancer survivors within 2 months of completing primary cancer treatment who had not met ≥1 of these behavioural goals: (i) conducting moderate PA for at least 150 minutes/week or strenuous exercise for over 75 minutes per week or, in the case of lung cancer patients, low or moderate intensity exercise for over 12.5 MET per week, (ii) maintaining normal weight, and (iii) attaining a score >72 in the Post Traumatic Growth Inventory (PTGI). Participants were randomly assigned to one of three groups: the control group, a web-only group, or a health coaching + web group. The primary endpoint was based on a composite of PA, weight, and PTGI score at 12 months. RESULTS Patients in the health coaching + web group (difference = 6.6%, P = .010) and the web-only group (difference = 5.9%, P = .031) had greater overall improvements across the three-outcome composite than the control group. The health coaching + web group had greater overall improvement in PTGI (difference = 12.6%; P

Objective Colorectal cancer (CRC) is the fourth most common site for cancer death in the Republic of Korea. The aim of this study was to describe the trends of colorectal cancer mortality by region. Methods CRC mortality trends in Republic of Korea were described by region using a Joinpoint regression model in both sexes. The annual percent changes (APCs) were calculated for each segment. Visualization of the changes in mortality rate of colorectal cancer death rates by 16 geographic areas in both sexes between 2000-2004 and 2009-2013 were also conducted. Results CRC mortality rates of men showed decreasing trend after increase in Daegu, Gyeongsangnam-do, and Chungcheongbuk-do between 2000 and 2013 based on the joinpoint model, while Gwangju, Jeollabuk-do, Jeollanam-do, and Gyeongsangbuk-do showed increase in CRC mortality during the same period. For women, CRC mortality of Seoul, Incheon, Daejeon, and Gyeongsangnam-do started to decrease in 2005, 2003, 2007, and 2006, respectively. The mortality rate for CRC in the eastern regions, which had relatively low rates of CRC among men in 2000 through 2004, reached a level similar to that in the northwestern regions of 2009 through 2013, while the highest CRC mortality rates in women was observed in Chungcheongbuk-do. Conclusions Reduction in CRC mortality varied across 16 metropolitan cities and provinces in men, and the visualization pattern showed that the east side of South Korea had the least progress in mortality reduction.

We identify the most associative factors among existential well-being, health-related quality of life, and health behaviors' sub-factors for cancer patients' suicidal ideation (SI) to develop practical intervention tools for general cancer patients in South Korea.We surveyed 766 cancer patients from two hospitals in South Korea. The eligibility criteria were as follows: 18 years of age or older, diagnosed with cancer, aware of the stage, and capable of understanding the purpose of the study.We performed a multidimensional multivariate analysis to find the factors that are most associated with SI for cancer patients.The results showed that life worthwhile (adjusted odds ratio (aOR), 3.946; 95% CI, 1.64-9.48), social functioning (aOR, 2.817; 95% CI, 1.19-6.65), and living with loved ones (aOR, 0.353; 95% CI, 0.15-0.84) were the most predictive factors for SI.To prevent SI in cancer patients, it might be necessary to help them feel that their lives are worthwhile while helping them maintain a high degree of social health.It is important to help cancer patients value their life and lead the high-quality social life to reduce their SI.

Self-management strategies are essential for improving prognosis in chronic illnesses. This study aimed to investigate the association between comorbidity and self-management strategies. A total of 700 patients with one or more chronic diseases including diabetes, dyslipidemia, hypertension, osteoporosis, chronic lung disease, chronic kidney disease and arthritis were enrolled. A questionnaire including the Smart Management Strategy for Health Assessment Tool Short Form (SAT), the Short Form-12, the McGill Quality of Life questionnaire, and the Patient Health Questionnaire-9 was administered to participants. The trend of each SAT according to number of comorbidities was evaluated, and the difference in quality of life and depression according to self-management strategies was examined in the model classified by the number of diseases. Self-management strategy scores tended to decrease as the number of comorbidities increased from one to four (p-value: 0.001 to 0.008). Regardless of the number of comorbidities, the MQOL score was higher in the good self-management strategy group (p

BACKGROUND: For chronic disease management, self-management strategies are essential to achieve sustained improvement. OBJECTIVE: Our study evaluated the efficacy of health coaching and a self-management strategy–based electronic program on self-management strategies for patients with osteoporosis, chronic respiratory disease, or arthritis. DESIGN: Three-arm randomized controlled trial, pilot study PARTICIPANTS: Fifty-four participants INTERVENTIONS: The first intervention group (n = 53) received a self-management strategy–based electronic program and 12 weeks of health coaching (20 sessions). The second intervention group received the information and communications technology (ICT) program; the control group received usual care and an educational booklet about self-management of chronic diseases. MAIN MEASURES: The primary outcome was the difference in the change of the mean of self-management strategy scores. Secondary outcomes included depression (PHQ-9), physical activity (Godin Leisure Exercise Questionnaire), and health habit maintenance (transtheoretical model) after 12 weeks in the program. KEY RESULTS: The combination of health coaching and ICT was superior to control group (change 18.5 vs. − 2.6, adjusted difference = 24.5, p < 0.001); however, the ICT alone group was not superior to the control group (change 8.0 vs. − 2.6, adjusted difference = 8.0, p = 0.156). As a result of evaluating the change in the percentage of people with positive stage changes in the transtheoretical model of health habits, regular exercise (p = 0.008), a balanced diet (p = 0.005), helping others (p = 0.001), and living with loved ones (p = 0.038) showed significant differences. There was no significant difference in the changes in percentage of patients with depressive symptoms in comparison with control group; however, there was in comparison with control group among groups (p = 0.033). Compared to the control group, the proportion of patients who achieved an exercise amount of 12.5 MET or higher was significantly higher (p = 0.028) in the health coaching and ICT group. CONCLUSIONS: The combination of ICT + health coaching led to improvement in self-management as well as in increasing exercise, and several healthy behaviors. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03294057

In Korean adults aged 50 years and older, the overall risk of fractures increased with greater BMI variability among both men and women, specifically, spinal fractures for men and both spinal and hip fractures for women. The bone-health-related outcome, such as fractures due to BMI fluctuation, has been understudied within Asian populations. In this large-scale, population-based cohort study in Korea, we aimed to investigate the relationship between variability in body mass index (BMI) and the risk of fractures. The study included 166,932 subjects aged ≥ 50 years from the National Health Insurance Service-Health Screening Cohort. The BMI variability value from three follow-up examinations during 2002–2007 was categorized into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of BMI variability on the risk of admission from hip, spine, and upper extremity fractures during 2008–2015 were evaluated using a Cox proportional hazards regression analysis. Compared to those in the lowest BMI variability (1st quartile), men in the highest BMI variability (4th quartile) showed an increased risk of spinal fractures (aHR 1.21, 95% CI 1.07–1.36) with a significant linear trend (P for trend = 0.021). Compared to those in the lowest BMI variability (1st quartile), women in the highest BMI variability (4th quartile) showed an increased risk of hip and spinal fractures (aHR 1.35, 95% CI 1.05–1.69; aHR 1.16, 95% CI 1.05–1.28) with significant linear trends (P for trend = 0.021; P for trend = 0.003, respectively). There was no association between BMI variability and incidents of upper extremity fractures for men or women. Association between BMI variability and increased fracture risk depended on sex and fracture types. BMI maintenance, instead of high BMI fluctuation, may be beneficial in terms of lowering the overall fracture risk for Korean adults over 50 years old.

The primary goal of this study was to evaluate the major roles of health-related quality of life (HRQOL) in a 5-year lung cancer survival prediction model using machine learning techniques (MLTs). The predictive performances of the models were compared with data from 809 survivors who underwent lung cancer surgery. Each of the modeling technique was applied to two feature sets: feature set 1 included clinical and sociodemographic variables, and feature set 2 added HRQOL factors to the variables from feature set 1. One of each developed prediction model was trained with the decision tree (DT), logistic regression (LR), bagging, random forest (RF), and adaptive boosting (AdaBoost) methods, and then, the best algorithm for modeling was determined. The models’ performances were compared using fivefold cross-validation. For feature set 1, there were no significant differences in model accuracies (ranging from 0.647 to 0.713). Among the models in feature set 2, the AdaBoost and RF models outperformed the other prognostic models [area under the curve (AUC) = 0.850, 0.898, 0.981, 0.966, and 0.949 for the DT, LR, bagging, RF and AdaBoost models, respectively] in the test set. Overall, 5-year disease-free lung cancer survival prediction models with MLTs that included HRQOL as well as clinical variables improved predictive performance.

Background Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. Methods We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. Results For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). Conclusion Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results., Graphical Abstract

Understanding the concept of a "good death" is crucial to end-of-life care, but our current understanding of what constitutes a good death is insufficient. Here, we investigated the components of a good death that are important to the general population, cancer patients, their families, and physicians.We conducted a stratified nationwide cross-sectional survey of cancer patients and their families from 12 hospitals, physicians from 12 hospitals and the Korean Medical Association, and the general population, investigating their attitudes toward 10 good-death components.Three components-"not be a burden to the family," "presence of family," and "resolve unfinished business"-were considered the most important components by more than 2/3 of each of the three groups, and an additional three components-"freedom from pain," "feel that life was meaningful," and "at peace with God"-were considered important by all but the physicians group. Physicians considered "feel life was meaningful," "presence of family," and "not be a burden to family" as the core components of a good death, with "freedom from pain" as an additional component. "Treatment choices' followed, "finances in order," "mentally aware," and "die at home" were found to be the least important components among all four groups.While families strongly agreed that "presence of family" and "not be a burden to family" were important to a good death, the importance of other factors differed between the groups. Health care providers should attempt to discern each patient's view of a good death.

Little is known about people’s attitudes toward death. We aimed to examine attitudes toward death and to investigate their associations with health status in various participant groups. We administered nationwide questionnaires to a total of 4,107 individuals including general Korean population, cancer patients, family caregivers, and physicians. Association of attitudes toward five aspects of dying and death—the ending of life, fearing death because it is painful, anticipating an afterlife, preparing to practice charity and being remembered—and physical, mental, social, and spiritual health status were also analyzed. Attitudes differed. Most (63.4%-76.2%) accepted that death is the ending of life, 45.6%-58.8% feared a painful death, 47.6%-55.0% anticipated an afterlife, 88.5%-93.0% expected to forgive, and 89.9%-94.1% expected to be remembered after death. The general population, cancer patients, and family caregivers had similar attitudes but had more positive attitudes than physicians on the ending of life, fearing a painful death, and anticipating an afterlife. Accepting death as the ending of life and fear of death pain were inversely associated with mental, social, spiritual, or general health status, but participants anticipating an afterlife, expecting to forgive, or expecting to be remembered showed better social, spiritual, or general health status. This nationwide study of various participant groups shows that attitudes toward dying and death were associated with mental, social, spiritual, or general health, but not physical health status. These data suggest that sensitive and skillful discussions of death and dying might contribute to peaceful end of life.

PurposeMale cancer survivors have a higher risk of cancer than the general population, which might be caused by an increased prevalence of obesity or susceptibility to obesity-related carcinogenesis. We assessed the effects of obesity before the diagnosis of a first cancer on the development of secondary primary cancers (SPCs).MethodsThe study population consisted of 239,615 Korean male cancer survivors between January 2003 and December 2010. Incident SPCs were assessed throughout follow-up until December 2011. Cox proportional hazards models were used to calculate the hazard ratios of SPCs associated with prediagnosis body mass index (BMI), which were compared with those of first cancers in all cohort participants.ResultsAfter 1,614,583 person-years of follow-up, we observed 4,799 patients with SPC. The age-standardized incidence rate of cancer in cancer survivors was 1.1 times higher than that of the general population. We found positive linear trends between prediagnosis BMI and risk of all-combined, colorectal, liver, lymphoma, biliary tract, kidney, and obesity-related SPCs. The magnitude of the BMI-SPC risk association in male cancer survivors was stronger than that for first cancers in the general population, whereas the mean BMI was similar in both groups. In the severely obese category (BMI ≥ 30 kg/m2), the adjusted hazard ratios for SPCs among cancer survivors (1.41; 95% CI, 1.15 to 1.74) were significantly higher than those for first cancers among all cohort participants (1.12; 95% CI, 1.09 to 1.16; Pheterogeneity< .01).ConclusionPrediagnosis obesity is a risk factor for overall and individual SPCs, and the strength of the BMI-cancer association is slightly stronger in male cancer survivors than in the general population.

Background In addition to medication, health behavior management is crucial in patients with multiple risks of cardiovascular mortality. Objective This study aimed to examine the efficacy of a 3-month Smart Management Strategy for Health–based electronic program (Smart Healthing). Methods A 2-arm randomized controlled trial was conducted to assess the efficacy of Smart Healthing in 106 patients with at least one indicator of poor disease control and who had hypertension, diabetes, or hypercholesterolemia. The intervention group (n=53) took part in the electronic program, which was available in the form of a mobile app and a Web-based PC application. The program covered 4 areas: self-assessment, self-planning, self-learning, and self-monitoring by automatic feedback. The control group (n=53) received basic educational material concerning disease control. The primary outcome was the percentage of participants who achieved their clinical indicator goal after 12 weeks into the program: glycated hemoglobin (HbA1c) Results The intervention group showed a significantly higher success rate (in comparison with the control group) for achieving each of 3 clinical indicators at the targeted goal levels (P Conclusions A short-term self-management strategy-based electronic program intervention may improve clinical outcomes among patients with cardiovascular risks. Trial Registration ClinicalTrials.gov NCT03294044; https://clinicaltrials.gov/ct2/show/NCT03294044

Background It is difficult to decide whether to inform the child of the incurable illness. We investigated attitudes of the general population and physicians toward prognosis disclosure to children and associated factors in Korea. Methods Physicians working in one of 13 university hospitals or the National Cancer Center and members of the general public responded to the questionnaire. The questionnaire consisted of the age appropriate for informing children about the prognosis and the reason why children should not be informed. This survey was conducted as part of research to identify perceptions of physicians and general public on the end-of-life care in Korea. Results A total of 928 physicians and 1,241 members of the general public in Korea completed the questionnaire. Whereas 92.7% of physicians said that children should be informed of their incurable illness, only 50.7% of the general population agreed. Physicians were also more likely to think that younger children should know about their poor prognosis compared with the general population. Physicians who opposed incurable illness disclosure suggested that children might not understand the situation, whereas the general public was primarily concerned that disclosure would exacerbate the disease. Physicians who were women or religious were more likely to want to inform children of their poor prognosis. In the general population, gender, education, comorbidity, and caregiver experience were related to attitude toward poor prognosis disclosure to children. Conclusion Our findings indicate that physicians and the general public in Korea differ in their perceptions about informing children of poor prognosis., Graphical Abstract

Background In this study, we aimed to identify demographic and clinical variables that correlate with perceived information provision among cancer patients and determine the association of information provision with decisional conflict (DC). Patients and methods We enrolled a total of 625 patients with cancer from two Korean hospitals in 2012. We used the European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire (QLQ-INFO26) to assess patients' perception of the information received from their doctors and the Decisional Conflict Scale (DCS) to assess DC. To identify predictive sociodemographic and clinical variables for adequate information provision, backward selective logistic regression analyses were conducted. In addition, adjusted multivariate logistic regression analyses were carried out to identify clinically meaningful differences of perceived level of information subscales associated with high DC. Results More than half of patients with cancer showed insufficient satisfaction with medical information about disease (56%), treatment (73%), other services (83%), and global score (80%). In multiple logistic regression analyses, lower income and education, female, unmarried status, type of cancer with good prognosis, and early stage of treatment process were associated with patients' perception of inadequate information provision. In addition, Information about the medical tests with high DCS values clarity [adjusted odds ratio (aOR), 0.54; 95% confidence interval (CI) 0.30–0.97] and support (aOR, 0.53; 95% CI 0.33–0.85) showed negative significance. For inadequate information perception about treatments and other services, all 5 DCS scales (uncertainty, informed, values clarity, support, and effective decision) were negatively related. Global score of inadequate information provision also showed negative association with high DCS effective decision (aOR, 0.43; 95% CI 0.26–0.71) and DCS uncertainty (aOR, 0.46; 95% CI 0.27–0.77). Conclusion This study found that inadequate levels of perceived information correlated with several demographic and clinical characteristics. In addition, sufficient perceived information levels may be related to low levels of DC.

Regular exercise and dietary practices have been shown to affect the health-related quality of life (HRQOL) and survival of breast cancer patients.The current study aimed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients.A 12-week randomized, controlled trial.Oncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea.Fifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0-III cancers within 2 years prior to the study were recruited.Participants were randomly assigned to either the intervention group, which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies (n=29), or to the control group, which used a 50-page educational booklet on exercise and diet (n=28). The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables (FV) per day, dietary quality, HRQOL, anxiety, depression, fatigue, motivational readiness, and self-efficacy.The proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week; ate 5 servings of FV per day; and had overall improvements in dietary quality, physical functioning and appetite loss (HRQOL), fatigue, and motivational readiness was greater in the intervention group than in the control group. The self-efficacy with respect to exercise and FV consumption was greater in the intervention group than in the control group. A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy, although further research with a larger sample size is required to enable definitive conclusions.

The aim of this study was to develop and validate a short form (SF) of the Smart Management Strategy for Health Assessment Tool (SAT) for cancer patients. Data for item reduction were derived from cancer patient data (n = 300) previously used to develop the original SAT. We used regression methods to select and score the new SAT-SF. To assess the instrument’s reliability and validity, we recruited another 354 cancer patients from the same hospitals who were older than 18 years and accustomed to using the web. All results were compared with that of the long-form SAT (original SAT). The SAT-SF used is the shorter version, a 30-item (from the original 91-item) instrument, to measure cancer patient’s health. The 30-item SAT-SF explained 97.7% of total variance of the full 91-item long-form SAT. All SAT-SF subscales demonstrated a high reliability with good internal consistency compared with the original SAT. The total short-form scores of the three SAT sets (SAT-Core, SAT-Preparation, SAT-Implementation) differentiated participant groups according to their stage of goal implementation and percentage of actions taken in the 10 Rules for Highly Effective Health Behavior. We found acceptable correlations between the three SAT-SF sets and the additional assessment tools compared with the original SAT. The 30-item SAT-SF had a satisfactory internal consistency and validity for cancer patients with minimal loss of information compared with the original SAT.

Background Lung cancer survivors are more likely to develop colorectal and stomach cancer than the general population. However, little is known about the current status of gastrointestinal cancer screening practices and related factors among lung cancer survivors. Methods We enrolled 829 disease-free lung cancer survivors ≥40 years of age, who had been treated at two hospitals from 2001 to 2006. The patients completed a questionnaire that included stomach and colorectal cancer screening after lung cancer treatment, as well as other sociodemographic variables. Results Among lung cancer survivors, correlations with stomach and colorectal screening recommendations were 22.7 and 25.8%, respectively. Of these, 40.7% reported receiving physician advice to screen for second primary cancer (SPC). Those who were recommended for further screening for other cancers were more likely to receive stomach cancer screening [adjusted odds ratios (aOR) = 1.63, 95% confidence interval (CI), 1.16–2.30] and colorectal cancer screening [aOR = 1.37, 95% CI, 0.99–1.90]. Less-educated lung cancer survivors were less likely to have stomach and colorectal cancer screenings. Conclusions Lack of a physician’s advice for SPC screening and lower educational status had negative impact on the gastrointestinal cancer screening rates of lung cancer survivors. Electronic supplementary material The online version of this article (10.1186/s12885-017-3583-z) contains supplementary material, which is available to authorized users.

Objective To compare the effects of fatigue, anxiety, and depression on health-related quality of life (HRQoL) in survivors of surgically resectable lung cancer Methods In total, 830 lung cancer survivors participated in the study. They completed a questionnaire consisting of items pertaining to sociodemographic characteristics, clinical variables, and HRQoL. We calculated prevalence rates for fatigue, anxiety, and depression and performed multiple logistic regression and general linear modeling to determine the main factors affecting HRQoL. Results The prevalence rates for moderate fatigue (Brief Fatigue Inventory mean score: ≥4), borderline depression (Hospital Anxiety and Depression Scale-Depression score: ≥8), and borderline anxiety (Hospital Anxiety and Depression Scale-Anxiety score: ≥8) were 42.2%, 38.9%, and 20.9%, respectively. The main factor was fatigue, which demonstrated the strongest explanatory power for HRQoL including all five functional HRQoL components (i.e., physical, role, emotional, cognitive, and social functioning) and global health status (partial R2 range: .13 to .19). However, anxiety (partial R2 = .21) and fatigue (partial R2 = .19) both demonstrated strong explanatory power for emotional HRQoL. In addition, depression demonstrated weak explanatory power for HRQoL including emotional HRQoL. Conclusions Relative to depression and anxiety, fatigue exerted a stronger effect on lung cancer survivors’ HRQoL. Health professionals should consider the reduction of fatigue a priority in improving cancer patients’ HRQoL following the completion of cancer treatment.

BACKGROUND:Treating patients with cancer within a family setting is the accepted standard of care and a hallmark of end-of-life (EoL) quality of care (QoC). OBJECTIVE:The aim of this study was to determine whether family caregiver functioning predicts EoL QoC received by terminally ill patients with cancer. METHODS:Family caregivers of terminally ill patients with cancer (n = 264) were enrolled from oncology inpatient and outpatient units of 12 large hospitals located in different regions throughout South Korea. Caregivers were administered self-reported questionnaires about family functioning and EoL QoC at the time of an incurable cancer diagnosis, 4 to 6 weeks later, and again 2 to 3 months later. Family functioning and QoC were measured using the family Apgar and Quality Care Questionnaire-End of Life scales, respectively. RESULTS:Improved adaptability to resource sharing and attention received predicted improved family relationships for the 3 time points. Increased participation in decision making and communication predicted improved individualized care and family relationships for the 3 time points. Increased affection predicted improvements in dignity-conserving care and family relationships for the 3 time points. Improved resolution regarding sharing time and satisfaction with commitments predicted increases in all QoC domains for the 3 time points, including dignity-conserving care, care by healthcare professionals, individualized care, and family relationships. CONCLUSIONS:Family functioning may contribute to improved EoL QoC of patients with terminal cancer. IMPLICATIONS FOR PRACTICE:Patients' family caregivers are a valued source of affection and communicative support, improving EoL QoC. More family-oriented cancer support systems can better maintain the effectiveness of QoC until EoL.

Objective:This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL).Method:We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire–End of Life (QCQ–EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation).Results:Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ–EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG–PS) scores were significantly associated with survival.Significance of results:Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG–PS are needed to help patients experience a dignified and comfortable death.

Although early detection and improved treatment have increased the number of long-term survivors, little is known about the prevalence and associations of clinically relevant fatigue (CRF) in disease-free stomach cancer survivors. Because no effective CRF management strategy yet exists, understanding CRF risk factors is important for developing treatment approaches. Stomach cancer survivors (N = 374) completed a mailed survey that included the Brief Fatigue Inventory, Beck Depression Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire and its gastric module QLQ-STO22. We assessed sociodemographic, clinical, and symptom characteristics using multivariate logistic regression models to identify CRF-associated factors. Approximately half of disease-free stomach cancer survivors reported CRF, which was associated with female gender, low economic status, rural residence, current smoker, early tumor progress, current depression, and poor performance. Significant relationships of CRF with current depression and poor performance status remained robust after adjusting for potential confounders. Most functional and symptom scores of fatigued survivors deteriorated more than in non-fatigued survivors. Additionally, congruence between tumor progress and surgery type might influence CRF severity. In disease-free stomach cancer survivors, CRF is a common problem that is strongly associated with quality of life and other symptoms. Current depression, poor performance, and perceived understanding regarding postoperative condition are important CRF risk factors. Thus, CRF management in this population should focus on identifying these factors.

Background. Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. Methods. A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. Results. A “6-month life expectancy” was the most common understanding of terminal cancer (45.6%), followed by “treatment refractoriness” (21.1%), “metastatic/recurrent disease” (19.4%), “survival of a few days/weeks” (11.4%), and “locally advanced disease” (2.5%). The combined proportion of “treatment refractoriness” and “6-month life expectancy” differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as “survival of a few days/weeks” showed more negative attitudes toward disclosure of terminal status compared with participants who chose “treatment refractoriness” (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22–0.79 for patients; aOR 0.34, 95% CI 0.18–0.63 for caregivers). Caregivers who understood terminal cancer as “locally advanced” or “metastatic/recurrent disease” showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose “treatment refractoriness” (aOR 0.19, 95% CI 0.07–0.54 for locally advanced; aOR 0.39, 95% CI 0.21–0.72 for metastatic/recurrent). Conclusions. The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.

The purpose of this study was to investigate Korean attitudes toward advance directives (ADs) among cancer patients, family caregivers, oncologists, and the general public. A multicenter survey study explored the attitudes of participants to ADs, and hospice–palliative care (HPC) was conducted. A total of 1,242 cancer patients, 1,289 family caregivers, 303 oncologists, and 1,006 members of the general public participated in the survey. The majority of patients, family caregivers, oncologists, and general public agreed with the necessity of ADs. However, oncologists regard “when became terminal status” as an optimal timing for completion of ADs (52.2 %), while other groups regard earlier periods as it. More than 95 % oncologist answered that cardiopulmonary resuscitation and mechanical ventilator are necessity items for ADs form, while around 70 % of other groups answered so. Multivariate analysis revealed that several factors including agreement with terminal disclosures and a positive attitude toward HPC were independently associated with necessity of ADs. We found that attitudes toward ADs among cancer patients, family caregivers, oncologists, and the general public were significantly different. Our study also suggests that favorable attitudes toward comfort end-of-life care and HPC are keys that influence the perceived need for ADs.

OBJECTIVE: Little is known about how quality of life (QOL) changes over time after gastrectomy. We prospectively examined changes of QOL in Korean patients with gastric cancer after curative resection. BACKGROUND: As early detection and improved treatment have led to higher survival rates and an increasing number of long-term survivors, the importance of QOL has increased. METHODS: Patients newly diagnosed with gastric cancer, who were expected to undergo curative resection, were studied. QOL was assessed, using the European Organization for Research and Treatment of Cancer QLQ-C30 and its gastric module QLQ-STO22, before and after 3 and 12 months of gastrectomy. RESULTS: In total, 465 patients were included in the study, and 377 and 88 patients underwent subtotal gastrectomy and total gastrectomy, respectively. For most of the functional or symptom scales, the mean score deteriorated at 3 months and generally improved during follow-up period. Patients with total gastrectomy had more functional and symptomatic problems related to QOL than those with subtotal gastrectomy during the follow-up. For both groups, there were temporal, unrecovered, improved, and unchanged problems in QOL. Fatigue; digestive symptoms such as diarrhea, dysphagia, and eating restrictions; body image disturbance; and cognitive functioning were the representative unrecovered problems, which persisted at 12 months after surgery. CONCLUSIONS: Our findings show that there are various functional and symptomatic problems, which health care providers need to manage during the postsurgical period. We need to continuously address fatigue, diarrhea, dysphagia, eating restrictions, body image disturbance, and cognitive functioning. In addition, it would be necessary to inform patients about possible QOL outcomes while they are receiving information about surgery and signing informed consent for surgery.

Background: We aimed to evaluate the prognostic value of quality of life (QOL) for predicting survival among disease-free survivors of surgically-treated lung cancer after the completion of cancer treatment. Methods: We administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Quality of Life Questionnaire Lung Cancer Module (QLQ-LC13), Hospital Anxiety and Depression Scale (HADS), and Posttraumatic Growth Inventory (PTGI) to 809 survivors who were surgically-treated for lung cancer at two hospitals from 2001 through 2006. We gathered mortality data by linkage to the National Statistical Office through December 2011. We used Cox proportional hazard models to compute adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs) to estimate the relationship between QOL and survival. Results: Analyses of QOL items adjusted for age, sex, stage, body mass index, and physical activity showed that scores for poor physical functioning, dyspnea, anorexia, diarrhea, cough, personal strength, anxiety, and depression were associated with poor survival. With adjustment for the independent indicators of survival, final multiple proportional hazard regression analyses of QOL show that physical functioning (aHR, 2.39; 95 % CI, 1.13-5.07), dyspnea (aHR, 1.56; 95 % CI, 1.01-2.40), personal strength (aHR, 2.36; 95 % CI, 1.31-4.27), and anxiety (aHR, 2.13; 95 % CI, 1.38-3.30) retained their independent prognostic power of survival. Conclusion: This study suggests that patient-reported QOL outcomes in disease-free survivors of surgically-treated lung cancer after the completion of active treatment has independent prognostic value for long-term survival.

ObjectivesHealth-related quality-of-life (HRQOL) issues of cancer patients are considered an important clinical outcome. We aimed to investigate the prognostic value of HRQOL on long-term survival outcomes in disease-free cervical cancer survivors (CCSs).MethodsThe study sample consisted of 860 disease-free CCSs from 6 Korean cancer hospitals recruited for HRQOL survey during 2005 (median time from diagnosis, 5.9 years). Health-related quality-of-life measures included the European Organization for Research and Treatment of Cancer QLQ-C30 and its Cervical Cancer Module (CX24). Survival data were retrieved from the Korean Statistical Office after 6 years from the survey. Health-related quality-of-life domains along with sociodemographic and clinicopathologic variables were analyzed as prognostic factors for survival from the date of survey.ResultsDuring the median follow-up period of 6.3 years after the survey, 30 (3.5%) patients died from all causes. Age, time since diagnosis, and physical activity were independent prognostic factors, which constituted the baseline model along with cancer stage. When HRQOL domains were tested separately against the baseline model, functional scales (physical, role, social, and emotional functioning), global health status, symptom scales (pain and appetite loss), and cervical cancer module items (body image, sexual inactivity, and sexual worry) were significantly associated with survival (P < 0.05).ConclusionsThese findings suggest that, in addition to well-known prognostic factors, including age, time since diagnosis, and physical activity, HRQOL scores obtained from disease-free CCSs are associated with survival.

We conducted a population-based retrospective cohort study to investigate the influence of hospital volume, delay of surgery, and both together on the long-term survival of postoperative cancer patients.Using information from the Korea Central Cancer Registry from 2001 through 2005 and the National Health Insurance claim database, we determined survival for 147 682 patients who underwent definitive surgery for any of six cancers.Regardless of cancer site, surgical patients in low- to medium-volume hospitals showed significantly worse survival [adjusted hazard ratio (aHR) = 1.36-1.86] than those in high-volume hospitals in multivariable analyses. Among the latter, treatment delays1 month were not associated with worse survival for stomach, colon, pancreatic, or lung cancer but were for rectal [aHR = 1.28; 95% confidence interval (CI), 1.17-1.40] and breast (aHR = 1.59; 95% CI, 1.37-1.84) cancer. For patients in low- to medium-volume hospitals, treatment delay was associated with worse survival for all types of cancer (aHR = 1.78-3.81).Our findings suggest that the effect of hospital volume and surgical treatment delay on overall survival of cancer patients should be considered in formulating or revising national health policy.

Objective: We compared the health-related quality of life (HRQOL) of disease-free lung cancer survivors with those from the general population. Background: Although clinical research usually is focused on how to better identify the lung patients most likely to benefit from surgery in terms of survival, few studies have concentrated specifically on HRQOL in diseasefree lung cancer survivors compared with that of the general population. Methods: We enrolled 830 disease-free cancer survivors (median time since diagnosis, 4.11 years) who had a past diagnosis of lung cancer and treated with curative surgery (stage from 0 to III) at either of 2 hospitals between 2001 and 2006, and 1000 subjects without a history of cancer were selected randomly from a representative sample of general Korean population. Subjects filled out a questionnaire that included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the lung cancer module. Results: There were no clinically meaningful differences between the diseasefree lung cancer survivors and general population in terms of any of the functioning subscales and most of the symptoms. However, survivors exhibited clinically meaningful worse dyspnea and financial problems on the EORTC QLQ-C30 subscales and dyspnea, coughing, and pain in chest wall on the EORTC QLQ-LC13 subscales than the general population. There was no clinically significant difference between the survivor groups according to the survival time. Survivors receiving lung resection, radiotherapy, and chemotherapy had clinically meaningful worse dyspnea than survivors receiving only lung resection. Lung cancer survivors with a respiratory or cardiologic comorbidity showed clinically meaningful worse social functioning, fatigue, dyspnea, and financial problems. Conclusions: These findings afford useful information clinicians preparing patients for lung cancer treatment by providing them with an understanding of the potential outcomes, and also for potential intervention targeting supportive care needs. (Ann Surg 2012;255:1000–1007)

Purpose To determine whether an Internet-based tailored education program is effective for disease-free cancer survivors with cancer-related fatigue (CRF). Patients and Methods We randomly assigned patients who had completed primary cancer treatment within the past 24 months in any of four Korean hospitals and had reported moderate to severe fatigue for at least 1 week to participate in a 12-week, Internet-based, individually tailored CRF education program or to receive routine care. We based the program on the CRF guidelines of the National Comprehensive Cancer Network (NCCN) and incorporated the transtheoretic model (TTM). At baseline and 12 weeks, we used the Brief Fatigue Inventory (BFI) and Fatigue Severity Scale (FSS) as primary outcomes and the Hospital Anxiety and Depression Scale (HADS) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) for secondary outcomes. Results We recruited 273 participants and randomly assigned 136 to the intervention group. Compared with the control group, the intervention group had an improvement in fatigue as shown by a significantly greater decrease in BFI global score (−0.66 points; 95% CI −1.04 to −0.27) and FSS total score (−0.49; 95% CI, −0.78 to −0.21). In secondary outcomes, the intervention group experienced a significantly greater decrease in HADS anxiety score (−0.90; 95% CI, −1.51 to −0.29) as well as global quality of life (5.22; 95% CI, 0.93 to 9.50) and several functioning scores of the EORTC QLQ-C30. Conclusion An Internet-based education program based on NCCN guidelines and TTM may help patients manage CRF.

Purpose We tested whether a decision aid explaining how to discuss the approach of death with a family member with cancer would help family caregivers decide to discuss a terminal prognosis. Patients and Methods We randomly assigned caregivers of terminally ill patients with cancer to a group that received a video and a companion workbook that showed either how they can discuss the prognosis with their patient (experimental arm) or how cancer pain can be controlled (control arm). At baseline and 1 month, we evaluated the decision to discuss terminal prognosis as the primary outcome. At 0, 1, 3, and 6 months, we assessed the caregivers' decisional conflict and satisfaction as secondary outcomes using a Decision Conflict Scale (DCS). Results We found no difference in changes in the decision to discuss terminal prognosis between the two groups. Conflict (P = .003), uncertainty (P = .019), and value clarity (P = .007) subscale scores and total DCS score (P = .008) improved from baseline to 1 month significantly more in the experimental arm than in the control arm. Over 6 months, the significant between-group differences continued for the conflict (P = .031), uncertainty (P = .014), and value clarity (P = .039) subscale scores and total DCS score (P = .040). Conclusion Decision aids can help caregivers, with the aid of trained professionals, to communicate with patients about their terminal illness.

Background: Many patients near death report an interest in knowing their prognoses. Patients’ awareness of disease status may lead to more appropriate care and maintained or improved quality of life. However, it is not known whether advanced cancer patients’ awareness of disease status is associated with patients’ quality of life. Aim: We aimed to examine the effect of patients’ awareness of disease status on the health-related quality of life (HRQOL) among advanced cancer patients undergoing palliative chemotherapy. Design: In this prospective cohort study, patients were followed-up at 4–6 weeks and 2–3 months after the initial palliative chemotherapy. Patients’ awareness of disease status, and demographic and clinical characteristics were assessed at baseline, and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) and HRQOL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were assessed three times. Setting / participants: In total, 100 patients with advanced cancer starting palliative chemotherapy were recruited from two tertiary university hospitals and from the Korea National Cancer Center. Results: Patients with advanced cancer undergoing palliative chemotherapy experienced deteriorated HRQOL. Of these, the patients who were aware of their disease status as incurable had significantly higher role ( p=0.002), emotional ( p=0.025), and social functioning ( p=0.002), and lower fatigue ( p=0.008), appetite loss ( p=0.039), constipation ( p=0.032), financial difficulties ( p=0.019), and anxiety ( p=0.041) compared with patients unaware of disease status. Conclusion: Our findings demonstrate the importance of patients’ awareness of disease status to HRQOL.

Our purpose was to evaluate the effect of cancer patients’ awareness of their incurable disease status on decisional conflict and satisfaction with treatment choice. In this prospective cohort study, advanced cancer patients who were offered palliative chemotherapy completed questionnaires on their knowledge of their condition, their treatment decision conflicts, and their satisfaction with their treatment decisions. We enrolled 98 patients; 94 reported that they were aware of their advanced status and 50 were not. Decisional conflicts for all patients showed a significant decrease after treatment, but aware patients were significantly more satisfied with their decision (P = 0.02). Patients’ awareness of their incurable status was associated with greater satisfaction with their decision to receive palliative chemotherapy.

Purpose We conducted this study to evaluate the validity of the perception that awareness of their terminal prognosis and use of palliative care or nonuse of an intensive care unit (ICU) causes patients to die sooner than they would otherwise. Patients and Methods In this prospective cohort study at 11 university hospitals and the National Cancer Center in Korea, we administered questionnaires to 619 consecutive patients immediately after they were determined by physicians to be terminally ill. We followed patients during 6 months after enrollment and assessed how their survival was affected by the disclosure of terminal illness and administration of palliative care or nonuse of the ICU. Results In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased patients. Nineteen percent of the patients died within 1 month, while 41.3% lived for 3 months, and 17.7% lived for 6 months. Once the cancer was judged terminal, the median survival time was 69 days. On multivariate analysis, neither patient awareness of terminal status at baseline (adjusted hazard ratio [aHR], 1.20; 95% CI, 0.96 to 1.51), use of a palliative care facility (aHR, 0.96; 95% CI, 0.76 to 1.21), nor general prostration (aHR, 1.23; 95% CI, 0.96 to 1.57) was associated with reduced survival. Use of the ICU (aHR, 1.47; 95% CI, 1.06 to 2.05) and poor Eastern Cooperative Oncology Group performance status (aHR, 1.37; 95% CI, 1.10 to 1.71) were significantly associated with poor survival. Conclusion Patients' being aware that they are dying and entering a palliative care facility or ICU does not seem to influence patients' survival.

Background: Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions. Methods: We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions — withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes. Results: A total of 3840 individuals — 1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population — participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%–94.0%) and use of active pain control (89.0%–98.4%). A smaller majority (60.8%–76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide. Interpretation: Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide).

Objective: To compare the health-related quality of life (HRQOL) of disease-free breast cancer survivors at the time of diagnosis and 1 year later with that of the general population (GP) and to examine the predictors of HRQOL change. Background: Although studies that examine the changes HRQOL in breast cancer survivors with cohort design is increasing, few studies compared the HRQOL of breast cancer survivors from baseline (immediately after diagnosis) with that of the GP. Methods: We administered European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Quality of Life Questionnaire BR23 HRQOL immediately after diagnosis to evaluate a population-based cohort of 286 women with breast cancer. We compared HRQOL scores of subjects internally and with reference data from the GP externally. Results: We found no significant change in HRQOL internally except for diarrhea. In the external comparison, however, breast cancer survivors reported poorer HRQOL scores than the GP at baseline and a year later; clinically meaningful detriments were found for emotional and social functioning and for the symptoms of fatigue and insomnia, financial difficulties, and most of the breast cancer-specific domains (P < 0.01 for all). Multiple linear regression analysis revealed that menopausal status and the sociodemographic characteristics of education level, employment status, and physical activity at baseline and increased symptom problems were significantly associated with functioning changes. Conclusion: Immediately after the diagnosis of breast cancer, patients reported a lower HRQOL than the GP, and they continued to do so a year later. Increased levels of fatigue, pain, and insomnia were the main symptoms responsible.

ObjectivesThis study determined attitudes of four groups—Korean patients with cancer, their family caregivers, physicians and the general Korean population—towards five critical end-of-life (EOL) interventions—active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide.Design and settingWe enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a ‘good death’ with critical interventions at EoL care.ResultsAll participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling ‘life was meaningful’ (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing ‘freedom from pain’ negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, ‘not being a burden to the family’ was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89).ConclusionGroups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.

Social support may influence the impact of stressful life events on breast cancer patients’ psychological state. However, the precise status of depressive mood in breast cancer during the first year after diagnosis is not yet known. Perceived social support, health-related quality of life, and depressive mood were assessed at enrollment and 1 year after breast cancer diagnosis in 286 women newly diagnosed with stages I–III breast cancer. Breast cancer patients’ social support and depressive mood at diagnosis and 1 year after diagnosis were compared with the general female population (GFP), and predictors of worsened depressive mood were identified. All subscales of social support and depressive mood among breast cancer patients were significantly lower at one after diagnosis than at diagnosis (all p

Purpose:With increasing survival rates of women with cervical cancer, quality of life of the survivors becomes a more important issue. However, little is known about the mental health of cervical cancer survivors (CCSs). This study investigated the prevalence of anxiety and depression in CCSs compared with healthy controls and identified factors associated with multidimensional model including sociodemographic, clinical, functioning and well-being, and symptom variables.Methods:The participants included 828 CCSs (mean time since treatment, 6.9 years) enrolled at 6 tertiary hospitals from 1983 to 2004 and 500 control subjects selected randomly from a representative sample of Korean women. Subjects completed the following questionnaires: the Hospital Anxiety and Depression Scale, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire-C30, its Cervical Cancer module, and the McGill Quality of Life Questionnaire.Results:Hospital Anxiety and Depression Scale-defined anxiety in CCSs did not differ from that in healthy controls (39.5% and 32.2%, respectively; P = 0.218). Anxiety was significantly more prevalent in younger CCSs (≤50 years) than in controls (40% vs 26.4%, respectively; P < 0.001). Hospital Anxiety and Depression Scale-defined depression was even lower in CCSs than in controls (34.6% vs 48.0%, respectively; P < 0.001). In multivariate analyses, the Hospital Anxiety and Depression Scale-defined anxiety and depression in CCSs were commonly associated with financial difficulty, poor body image, sexual inactivity, and low existential well-being. Low support and insomnia were uniquely related to anxiety, with older age and decrement role function uniquely related to depression. However, disease-related clinical factors were not related to either anxiety or depression.Conclusions:Cervical cancer survivors showed relatively good mental health compared with healthy controls; however, women who have low functioning and well-being could be at high risk of anxiety or depression or both.

Although cancer survivors are at increased risk for developing cancers at other sites, little is known about the current status of second cancer (cancers other than the index cancer) screening practices and related factors in cervical cancer survivors. We enrolled 809 cervical cancer survivors aged ≥40 years who had been treated at six hospitals from 1983 to 2004. Subjects filled out a questionnaire that included the practices of second cancer screening (breast, stomach, and colorectum) and other sociodemographic variables. Among subjects, 38.9% had been recommended to receive screening for other cancers from health care providers, and 27.4% reported that they thought they had lower risk of other cancer than general population. Older (age ≥65 years) and poor (family income

The aim was to evaluate the correlates of existential well-being (EWB) and investigate the relationship between EWB and health-related quality of life (HRQOL) according to the McGill Quality of Life Questionnaire (MQOL) in breast cancer survivors (BCS) and in the general population. BCS (N = 1,933) recruited from five large hospitals completed a mailed survey, which included the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30), Quality of Life Questionnaire Breast Cancer Module (QLQ-BR23) and the MQOL. Reference data were derived from a representative sample of the Korean adult population composed of 500 women selected by a nationwide random route technique. Multiple logistic regression analysis showed that members of the general population with a lower educational status were more likely to report poor EWB. However, among BCS, correlates that were associated with poor EWB included lower monthly income, lower educational status, unemployment and comorbidities. Almost all factors listed on the HRQOL questionnaire were correlated with EWB in BCS as well as in the general population (P < 0.001). Factors listed on the QLQ-C30 that were correlated to a clinically meaningful extent with EWB in the general population included physical functioning, nausea and vomiting, and appetite loss, whereas among BCS, insomnia and distress over hair loss were meaningfully correlated with EWB. Compared with general population, BCS showed different EWB correlates and distinct associations with HRQOL findings. Our data suggest that socio-economic status and comorbidities influence on their EWB.

Purpose The purpose of this study was to explore the prevalence of and to identify the predictors of depression in family caregivers of cancer patients. Patients and Methods We enrolled 310 caregivers of cancer patients from the National Cancer Center, Korea, on this study and obtained demographic information for both patients and caregivers. To assess caregiver depression and its predictors, we used the Beck Depression Inventory (BDI), the Caregiver Quality of Life Index–Cancer, and the Family Impact Questionnaire. We used logistic regression analysis to identify independent predictors of caregiver depression. Results The majority (67%) of caregivers had high depression scores (BDI > 13), and 35% had very high depression scores (BDI > 21). In a multiple logistic regression model, caregivers who were women, the spouse of the patient, in poor health, feeling burdened, adapting poorly, unable to function normally, or caring for a patient with poor Eastern Cooperative Oncology Group performance status were more likely to experience depression (P < .01 for all values). Conclusion Depression was highly prevalent among cancer patient family caregivers, and care burden was its best predictor. Interventions aimed at reducing the psychiatric effects of cancer should focus not only on the patient but also on the caregiver.

We investigated the impacts of breast cancer diagnosis and treatment on employment status and the ability to perform occupational and housekeeping tasks. We performed a cross-sectional study to compare Korean breast cancer survivors (n = 1,594) who had been working before cancer diagnosis with a group of 20 to 60-year-old women from the general Korean population (n = 415). Employment decreased from 47.6% to 33.2% after cancer treatment. It was significantly smaller relative to the general population (52.1%) [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI): 1.35-2.11). There was an inverse association between employment and low levels of education, low household income, multiple comorbidities, disease stage, and mastectomy. In addition, women who lived with a spouse were more likely to quit working after treatment compared to women who had no spouse. Fatigue and exhaustion were the most frequent difficulties encountered during occupational work (by 46.8% of cancer survivors) and housework (64.6%). Our findings suggest that breast cancer has a greater impact on employment among Korean women than among women in previously studied Western populations. Our data suggest that socio-cultural factors, as well as certain clinical characteristics, influence the decisions of Korean women to return or to not return to work after surviving breast cancer.

Little was known about work situation and work-related difficulties, including housework after stomach cancer diagnosis. We aimed to compare employment status and work-related difficulties between stomach cancer survivors and the general population. We enrolled 408 stomach cancer survivors from two hospitals 28 months after diagnosis and 994 representative volunteers from the general population from 15 geographic districts. Working was defined as being employed (including self-employed) and nonworking as being retired or a homemaker. Nonworking was significantly higher among stomach cancer survivors (46.6%) than in the general population (36.5%). Compared with the general population, the survivors had more fatigue in performing both housework (adjusted odds ratio (aOR)=2.08; 95% confidence interval (95% CI)=1.01-4.29) and gainful work (aOR=4.02; 2.55-6.33). More cancer survivors had reduced working hours (aOR=1.42; 95% CI=4.60-28.35) and reduced work-related ability (aOR=6.11; 95% CI=3.64-10.27) than did the general population. The association of nonworking with older age and being female was significantly more positive for survivors than for the general population. Among survivors, poorer Eastern Cooperation Oncology Group Performance Status and receiving total gastrectomy were positively associated with nonworking. Stomach cancer survivors experienced more difficulties in both housework and gainful employment than did the general population. Our findings on stomach cancer survivors' work-related difficulties and the predictors of nonworking will help physicians guide patients towards more realistic postsurgical employment plans.

Objectives: We aimed to investigate the prevalence of comorbidities in cervical cancer survivors compared with the general population and to identify risk factors and impact on their quality of life (QoL). Methods: 860 female cervical cancer survivors enrolled at six tertiary hospitals and 994 women from the general population were surveyed on current comorbidities and QoL (EORTC QLQ-C30 and QLQ-CX24). Results: Compared with the general female population, the cervical cancer survivors reported higher prevalence of comorbidities (0.93 ± 2.91 vs. 0.37 ± 0.67, p < 0.01), significantly more heart disease (adjusted odds ratio (aOR), 2.64; 95% confidence interval (CI), 1.38–5.07), liver disease (aOR, 3.29; 95% CI, 1.54–7.02), hypertension (aOR, 1.72; 95% CI, 1.30–2.27), gastrointestinal disease (aOR, 1.79; 95% CI, 1.37–2.33) and musculoskeletal disease (aOR, 1.94; 95% CI, 1.45–2.59). Heart and renal disease significantly influenced QoL in many subscales. Patients with diabetes or cerebrovascular disease had an increased likelihood of sexual problems. Conclusions: The cervical cancer survivors had more comorbidities than the general population, and that in turn affected their QoL. Vigilant follow-up of comorbidities should be incorporated into in the care of cancer survivors.