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Purpose: To study the patient load, treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy. Materials and Methods: Data for patients with brain metastases treated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital information system database, and a population-based tumor registry database until death or at least 5 years after treatment and retrospectively reviewed. Results: The number of treatments for brain metastases gradually increased from 48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated with whole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overall median survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy was as follows: 52% at 3 months, 18% at 1 year and 3% at 5 years in males; and 66% at 3 months, 26% at 1 year and 7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalities had a better prognosis. Poor prognostic factors included primary cancer from the lung or gastrointestinal tract, emergency or urgent consultation, poor performance status (ECOG 3-4), and a hemoglobin level before treatment of less than 10 g/dl. Conclusions: This study identified an increasing trend of patient load with brain metastases. Possible over-treatment and under-treatment were demonstrated with a wide range of survival results. Practical prognostic scoring systems to assist in decision-making for optimal treatment of different patient groups is absolutely necessary; it is a key strategy for balancing good quality of care and patient load.

Context: Palliative care in Thailand was not well developed in the past. Previous studies showed that the actual prescription of opioids was underutilized in palliative care by physicians compared with the estimated opioid need of patients. However, there were no studies regarding the regulation of opioids in Thailand. Aims: To provide an up-to-date overview of the role of multidisciplinary teams in the regulation of opioids in Thai government hospitals. Settings and Design: A questionnaire survey study was conducted from January to April 2012. Materials and Methods: The questionnaire was distributed to entire population of government hospitals in Thailand and all private hospitals in Bangkok. There were 975 hospitals, including 93 private hospitals in Bangkok and 882 government hospitals. Statistical analysis used: Results are presented as a frequency and percentage. Results: Special opioid prescription forms must be signed by doctors for all opioid prescriptions. Three-fourths of hospitals totally prohibited prescribing oral opioids by palliative care Advance Practice Nurses. Pharmacists were permitted to correct the technical errors on a prescription of oral morphine only after notifying the prescribing doctor in nearly 60% of hospitals. In terminal patients who could not go to the hospitals, caregivers were permitted to collect the opioids on behalf of patients in nearly 80% of hospitals. Conclusion: Our results illustrate that the regulation of opioids in government hospitals is mainly dependent on physician judgment. Patients can only receive oral morphine at a hospital pharmacy.

Palliative care in Thailand was not well established in the past, but it is better supported by many organizations at present. Despite the change in the situation, the availability of essential drugs for palliative care has not been well studied.Our aim was to update the medical community on the current situation of essential drug availability for palliative care in Thai hospitals.The International Association for Hospice and Palliative Care (IAHPC) list of 34 essential drugs for palliative care was used in this survey.Five hundred and fifty-five hospitals replied to the questionnaire (response rate 57%). Eleven of the 24 nonopioid drugs were available above 90% in all hospitals. However, nonopioid drugs generally were less available in community hospitals (CH) and general hospitals (GH) than in large hospitals (LH). Tramadol was the most available weak opioid. Injectable morphine was the most available form of strong opioid in Thailand (96.9%). For the overall picture of oral morphine, immediate-release morphine was a less available form than the controlled-release form (32.2% versus 51.0%). Controlled-release oral morphine had a nearly two-fold better availability than immediate-release oral morphine in CH, GH, and LH, that is, cancer centers (CC), medical school hospitals (MH), regional hospitals (RH), and other government hospitals. In contrast, in private hospitals (PH), there was no difference between the availability of the controlled-release form and the immediate-release form. Transdermal fentanyl and methadone were also less available in Thailand (14.6% versus 16.5%, respectively).LH and PH have better overall nonopioid and opioid medication availability than CH and GH.

Background: Head and neck cancers are prevalent in Thailand, in particular in the southern region of the country. However, survival with a large data set has not been reported. The purpose of the present study was to evaluate the survival figures and the prognostic factors in a cohort of patients treated in a university hospital located in the south of Thailand. Patients and Methods: Consecutive new cases of primary carcinoma of the oral cavity, oropharyx, hypopharynx and larynx, treated at Songklanagarind Hospital during 2002 to 2004, were analyzed. The 5-year overall survival rates were obtained by the Kaplan-Meier method. Prognostic factors were identified through multivariate Cox regression analysis. Results: A total 1,186 cases were analyzed. Two-thirds (66.6%) of the cases were at advanced stage (stage III & IV) at presentation. The five-year overall survivals for the whole cohort, oral cavity, oropharynx, hypopharynx and larynx were 24.1%, 25.91%, 19.2%, 13.4%, 38.0% respectively. Stage and treatment type were strong prognostic factors for all sites. An age ≥ 80 years was associated with poor survival in oral cavity and larynx cancer. Conclusions: The results revealed remarkably poor outcomes of the patients in the series, indicating a strong need to increase the proportion of early stage presentations and maximize the treatment efficacy to improving outcomes. Very old patients are of particular concern for treatment care of oral cavity and larynx cancer.

Cancer is a leading cause of death in Thailand. Thai cancer patients often seek medical treatment while in advanced stages of the disease. This longitudinal qualitative study aimed to describe the suffering that patients with terminal advanced cancer experience in their everyday life. A series of interviews were conducted and patient observation performed with 15 patients with terminal advanced cancer. Thematic analysis was applied and the overriding theme of the end-of-life experiences was living with suffering. Five inter-related sub-themes regarding the experience of suffering were identified in the informants' accounts, including physical symptom distress, feeling of alienation, sense of worthlessness, sense of burden to others, and desire for hastened death. The findings of this study can be of value for health professionals in cancer care in Thailand. Comprehensive end-of-life care programmes are needed to alleviate suffering in this group of patients.

Background: To study the pattern of patient load, personnel and equipment resources from 30-years experience in Southern Thailand. Materials and Methods: This retrospective study collected secondary data from the Division of Therapeutic Radiology and Oncology and the Songklanagarind Hospital Tumor Registry database, Faculty of Medicine, Prince of Songkla University, during the period of 1982-2012. Results: The number of new patients who had radiation treatment gradually increased from 121 in 1982 to 2,178 in 2011. Shortages of all kinds of personnel were demonstrated as compared to the recommendations, especially in radiotherapy technicians. In 2011, Southern Thailand, with two radiotherapy centers, had 0.44 megavoltage radiotherapy machines (cobalt or linear accelerator) per million of population. This number is suboptimal, but could be managed cost-effectively by prolonging machine operating times during personnel shortages. Conclusions: This study identified a discrepancy between workload and resources in one medical school radiotherapy center in Southern Thailand. This information is crucial for future strategic planning both regionally and nationally.

Research on palliative care services in Thailand is incomplete. We conducted a countrywide cross-sectional postal survey to update the situation. We approached hospitals and asked them to respond to a questionnaire. The overall response rate of government hospitals was 61 percent (537 of 882 hospitals). Of these, 59 percent reported that they had personnel trained in palliative care; the majority had received less than a week of such training. In all, 60 percent of the hospitals reported that they offered palliative care services, but 25 percent of these services were delivered by staff who had no palliative care training. The criteria of having at least one trained doctor and nurse on staff was met by 17 percent of the hospitals. Only seven hospitals, most of them associated with medical schools, employed both a doctor and a nurse who had been trained in palliative care for one month or more; these professionals mainly provided hospital and home palliative care team services. Our survey reveals the lack of both health care personnel fully trained in palliative care and specialist palliative care services in Thailand.

To determine the feasibility and sensitivity of the WHOQOL-BREF-THAI assessment tool in measuring the quality of life in cancer patients treated with radiotherapy in routine clinical practice.A cross-sectional analytical study including the consecutive radiotherapy patients at Songklanagarind Hospital from October to December 2000 was conducted. The participants completed a Thai version of the brief form of the WHO quality of life assessment instrument (WHOQOL-BREF-THAI).The majority of the patients (80.7%) were able to complete the questionnaire, 19 (12.6%) by themselves, 4 (2.6%) with the help of their relatives and 128 (84.8%) through the interview. Almost all of them could understand the questions very well. The mean and standard deviation of time requirement in completing it were 13.0+/-4.0 minutes. The WHOQOL-BREF-THAI instrument was sensitive enough to discriminate the QOL in patients with differences in all analyzed clinical parameters, which were hospitalization, stage of disease, treatment aim and ECOG performance status.The present results supported the feasibility of using the WHOQOL-BREF- THAI assessment tool in radiotherapy cancer patients with good sensitivity and patient understanding within an acceptable time requirement. One practical barrier of concern was a low self-assessment percentage in this particular group of patients, necessitating the interviewer system.

Although radiotherapy usually implies a cancer diagnosis, no available study has been reported as to what proportion of Thai patients treated with radiotherapy know their diagnosis and how they want related information revealed. We questioned 106 patients in order to determine the proportion who knew their cancer diagnosis, and interviewed patients who knew the diagnosis and relatives of patients both who knew and did not know it with semi-structured questionnaires concerning how they wanted to be told. Sixty-seven patients (63.2%) knew their cancer diagnosis. Multivariate analysis showed that the patients with the following characteristics were inclined to know their diagnosis: younger than 70 years old, head and neck or gynecological cancer, no previous treatment before radiotherapy, no accompanying relatives during the treatment, and patients with relatives who wanted to disclose the information. 97.0% of patients who knew the diagnosis indicated that they had really wanted to know, 89.5% and 73.3%, respectively of relatives who accompanied patients who knew and did not know it expressed the same wish. No demographic factors could predict who wanted to be told the diagnosis. The majority of patients and relatives who wanted the diagnosis disclosed wanted to know all related information before treatment. They wanted to hear this directly from the doctor in the presence of their relatives.