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Our goal was to validate an instrument with which terminally ill patients could evaluate the quality of care they receive at the end of life (EOL). Questionnaire development followed a four-phase process: item generation and reduction, construction, pilot testing, and field-testing. Using relevance and priority criteria and pilot testing, we developed a 16-item questionnaire. Factor analyses of data from 235 patients resulted in the Quality Care Questionnaire-End of Life (QCQ-EOL) covering dignity-conserving care, care by health care professionals, individualised care, and family relationships. All subscales and total scores showed high internal consistency (Cronbach alpha range, 0.73-0.89). The ability of total score and selective subscale scores clearly differentiated patients on the basis of clinical situation, sense of dignity, and general rating of care quality. Correlations of scores between patients and caregivers were substantial. The QCQ-EOL can be adopted to assess the quality of care received by terminally ill patients.

Objectives: Symptoms other than their primary disease can interfere in the lives of terminal cancer patients. We sought to identify which of these symptoms is most important. Methods: We administered a questionnaire, including the M.D. Anderson Symptom Inventory (MDASI), to 142 terminal cancer patients at the National Cancer Center, Korea. The validity of the MDASI was tested by principal-axis factor analysis and Cronbach’s α coefficient. Stepwise multiple regression analysis was used to determine the symptoms that interfered most in terminal cancer patients’ lives. Results: Factor analysis showed that it was composed of two factors (symptom and interference scales). Cronbach’s α coefficients of symptom and interference scales were each >0.70. The patients had an average of 11 of 13 symptoms of the MDASI. Pain was the most common and severe, followed by feelings of distress and fatigue. Fatigue was the most highly correlated with interference sum. In stepwise multiple regression analysis, the most interfering symptom was fatigue. Conclusions: Although pain was the most common and severe symptom, fatigue was the most important symptom interfering in the lives of terminal cancer patients. In treating terminal cancer patients, healthcare providers should actively intervene to reduce both fatigue and pain.

Objective:There is scarce research on the short-term fluctuations in end-of-life (EoL) care planning for seriously ill patients. The aim of our study was to investigate the stability of preferences regarding treatment in an intensive care unit (ICU) and identify the factors associated with changes in preferences in terms of quality of life (QoL).Method:A prospective examination on preference changes for ICU care in 141 terminal cancer patients was conducted. Patients were categorized according to their change in preference during the final two months of their lives into four categories: (1) the keep–accept group, (2) the keep–reject group, (3) the change to accept group, and (4) the change to reject group. Using multiple logistic analyses, we explored the association between patient demographics, health-related QoL, and changes in ICU preference.Results:The overall stability of ICU preferences near the end of life was 66.7% (κ = 0.33, p < 0.001). Married patients were more likely to change their preference regarding ICU care [adjusted odds ratio (aOR) toward accept 12.35, p = 0.021; aOR toward reject 10.56, p = 0.020] than unmarried patients. Patients with stable physical function tended to accept ICU care (aOR = 5.05, p = 0.023), whereas those with poor performance (aOR = 5.32, p = 0.018), worsened QoL (aOR = 8.34, p = 0.007), or non-aggravated fatigue (aOR = 8.36, p = 0.006) were more likely to not accept ICU care.Significance of results:The attitudes of terminally ill cancer patients regarding ICU care at the end of life were not stable over time, and changes in their QoL were associated with a tendency to change their preferences about ICU care. Attention should thus be paid to patients' QoL changes to improve medical decision making with regard to EoL care.

Objectives: Most prospective cohort studies of lung cancer focus on the relative risk rather than the absolute risk of smoking. Methods: This prospective study included 437,976 Korean men (cohort for the National Health Insurance Cooperation Study), ≥40 years old, who were free of cancer and smoking-related chronic disease at the time of enrollment. Based on new incidence cases, relative risk and excess risk, and their 95% confidence intervals (95% CI), were estimated with the standard Poisson regression model after adjustment for age or other demographic factors and other confounders. Results: During the 6-year follow-up period of 3,142,451 person-years, 1,357 new lung cancer cases were identified. Based on the multivariate-adjusted relative risk for current smokers, the strongest association with smoking was shown for small-cell lung cancer (relative risk, 21.7; 95% CI, 8.0-58.5) followed by squamous cell carcinoma (relative risk, 11.7; 95% CI, 7.1-19.4) and then adenocarcinoma (relative risk, 2.1; 95% CI, 1.6-2.7). In current smokers with ≥40 pack-years of exposure, excess risk was highest for squamous cell carcinoma (excess risk, 33.8; 95% CI, 10.2-109.8) followed by adenocarcinoma (excess risk, 26.7; 95% CI, 10.3-64.4), and then small-cell carcinoma (excess risk, 16.3; 95% CI, 1.8-144.3). Conclusions: In Korean men, cigarette smoking was as important a risk factor for adenocarcinoma as it was for squamous cell and small-cell lung cancer.

Background: This study was undertaken to identify predictors of the prescription of strong opioids, which are important for the management of severe cancer pain, by Korean physicians. Methods: A questionnaire based on a hypothetical case designed to assess the prescription of morphine by physicians was administered to 800 specialists in the Korea Cancer Association, of whom 147 (18.4%) responded, and to 2200 specialists in the Korean Academy of Family Medicine, of whom 388 (17.6%) responded. We used a multidimensional approach to identify the predictors of prescription of morphine by physicians. Results: In the hypothetical case scenario, only 16.5% of the respondents stated that they would prescribe morphine for severe cancer pain. Multiple logistic regression analysis showed that physicians with a positive attitude regarding opioid addiction [odds ratio (OR) 2.62; 95% confidence interval (CI) 1.54 ‐ 4.46], experience of pain assessment (OR 2.09; 95% CI 1.13 ‐ 3.87), recent residency training (OR 2.27; 95% CI 1.30‐ 4.0) and positive self-evaluation as an oncology specialist (OR 2.60; 95% CI 1.41 ‐4.78) were more likely to prescribe morphine. None of the 13 variables in the knowledge dimension significantly predicted prescription of morphine for severe cancer pain. Conclusions: The results of the survey suggest that we need to develop strategies to develop a positive attitude toward opioids, to increase experience in pain assessment and to improve cancer pain

The effectiveness of cancer pain management (CPM) is influenced by nurses' willingness to maximize opioid analgesia for severe cancer pain. The purposes of this study were to identify the willingness of nurses to provide maximum-dose opioids whenever needed for CPM and to determine its associated predictors.This multicenter study was conducted among the entire total of registered nurses in seven large hospitals in Korea. Its overall response rate was 41.6%, and the data from 930 who responded (40.1%) were analyzed. We utilized a three-step, multidimensional, multiple logistic regression to identify the predictors of nurses' willingness.Only 255 nurses (27.4%) indicated that they recommended the maximum dose of opioids whenever it was needed. The respondents who were more likely to recommend morphine showed the following characteristics: older nurses (odds ratio, OR, 1.57; confidence interval, CI, 1.13-2.19); they knew the effectiveness of opioids for CPM (OR 1.53; CI 1.06-2.20); rarely concerned about a patient's addiction to opioids (OR 2.16; CI 1.48-3.15), or to a family member's addiction (OR 1.81; CI 1.20-2.73); prior experience with pain assessment tools (OR 1.62; CI 1.11-2.37); practical experience caring for cancer patients with pain over 51% (OR 1.55; CI 1.09-2.19).Our multicenter study suggested that in order to improve nurses' willingness to recommend opioids liberally in CPM: (1) attitudes about fear of opioid addiction must be changed; (2) the efficiency of opioids in CPM must be taught; and (3) implementation of pain assessment tools must be undertaken.

The goal of this study was to evaluate the reliability and validity of the Korean version of the Brief Fatigue Inventory (BFI-K). One hundred seventy-eight cancer patients and the same number of age- and sex-matched control subjects completed the BFI-K, the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30), the Beck Depression Inventory (BDI), and a Brief Pain Inventory (BPI). The Cronbach's alpha coefficient for the BFI-K was 0.956 in the cancer patient group and 0.955 in the control group. The global score and nine of the single item scores for the BFI-K were significantly correlated with the fatigue and global health status/QoL subscale of the EORTC QLQ-C30, BDI, and BPI (coefficient range 0.38-0.66). Discriminant validity showed that BFI-K could distinguish significant differences of performance status between subgroups of patients, and between the cancer patient group and the control group, as expected. Our study has shown that the BFI-K is a reliable, valid self-rating instrument in terms of its psychometric properties.

We conducted this prospective study to assess the changes in quality of life (QOL), anxiety and depression in patients receiving palliative chemotherapy for solid cancers.Patients were eligible if they had histologically confirmed metastatic or recurrent cancer and a life expectancy of more than 6 months, and were able to complete the self-administered questionnaires. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale (HADS) were used to measure the effects of chemotherapy on the patients' QOL, anxiety and depression at baseline and three times after every three cycles of chemotherapy.From July 2001 to October 2003, 146 patients were recruited, and of these 98 completed the questionnaires and 48 were withdrawn from the trial (27 lost to follow-up, 11 withdrew consent, 5 for toxicity, 5 for progression of the cancer). Their median age was 58 years (range 28-78 years) and the male to female ratio was 1.6. Of the 146 patients, 52 had gastric cancer, 39 non-small-cell cancer, 29 colorectal cancer, 11 breast cancer, and 15 had other cancers. Initial QOL scores were closely related to performance status. Compared with baseline, clinically meaningful relief (score decreased by more than 10) of symptoms such as pain and sleep disturbance was observed. There was significant improvement (score increased by more than 10) in the functional scales after the first cycle of chemotherapy, but these effects did not persist throughout the whole course of therapy. The incidences of probable anxiety and depression disorder before chemotherapy were 20% and 29%, respectively. The anxiety scores decreased throughout the period of intervention. Pretreatment anxiety and depression were negatively correlated with baseline QOL scores.Palliative chemotherapy treatment in patients with solid cancer improved cancer-related symptoms, lessened anxiety and did not disturb the QOL of cancer patients.

Objectives: We conducted this study to identify factors influencing the burdens cancer brings to a patient’s family and to evaluate the association between the burdens and the caregiver’s quality of life (QOL). Methods: Participants were drawn from the primary family caregivers of cancer patients at 6 university hospitals and the National Cancer Center in Korea. Of the 738 eligible caregivers, 704 (95.4%) completed the questionnaire packets (Family Impact Questions and Caregiver’s QOL-Cancer). Results: Caregivers, who were poor (OR, 2.11; 95% CI, 1.44–3.10), whose health status was poor (OR, 1.87; 95% CI, 1.29–2.70), who were married (OR, 1.75; 95% CI, 1.12–2.72), who provided care for a long time (OR, 2.29; 95% CI, 1.59–3.28), who cared for patients with poor performance status (OR, 1.35; 95% CI, 1.00–1.82), and who paid high medical expenses (OR, 1.70; 95% CI, 1.21–2.40), were more likely to lose their family savings. In multiple regression analysis, most burden variables – including requiring caregiving assistance, major life change, inability to function normally, loss of savings, loss of income, and altered educational plans – were associated with caregiver QOL. Loss of family income, which was related to economic issues, was most strongly associated with it (16.0%). Conclusions: Our study suggests that to improve caregiver QOL, we should give priority to decreasing the economic burden that cancer places on patient’s family.

We analyzed risk while adjusting for age, body mass index, frequency of moderate physical activity, alcohol consumption, preference for vegetables versus meats, and frequency of meat consumption in a multivariate analysis and based our findings on not mortality data but incidence data. 733,134 Korean men who were 30 years old or older, insured by the National Health Insurance Corporation, and had a medical evaluation in 1996 were included in the study and followed up through 2000. During the 4-year follow-up period of 3,590,872 person–years, we identified 7204 new cases. We used the Cox proportional hazards model to estimate adjusted relative risks (aRRs), 95% confidence intervals (CIs). The association of current cigarette smoking was significantly stronger as compared with never smokers; aRR was 1.49 (95% CI=1.39–1.59) for all cancers, 4.46 (2.32–8.57) for esophageal, 3.83 (2.97–4.94) for lung, 3.01 (1.58–5.72) for laryngeal, 2.24 (1.48–3.39) for urinary bladder, 1.62 (1.42–1.84) for gastric, 1.75 (1.12–2.74) for oral and pharyngeal, 1.58 (0.97–2.27) for pancreatic, and 1.50 (1.29–1.74) for liver cancer. Our findings, based on incidence data, confirmed that differences in smoking habit were responsible for most of the differences observed in smoking-related cancers.

Purpose To ascertain the attitude of cancer patients and their families toward disclosure of terminal illness to the patient. Patients and Methods We constructed a questionnaire that included demographic and clinical information and delivered it to 758 consecutive individuals (433 cancer patients and 325 families that have a relative with cancer) at seven university hospitals and one national cancer center in Korea. Results 380 cancer patients and one member from each of 281 families that have a relative with cancer completed the questionnaire. Cancer patients were more likely than family members to believe that patients should be informed of the terminal illness (96.1% v 76.9%; P < .001). Fifty percent of the family members and 78.3% of the patients thought that the doctor in charge should be the one who informs the patient. Additionally, 71.7% of the patients and 43.6% of the family members thought that patients should be informed immediately after the diagnosis. Stepwise multiple logistic regression indicated that the patient group was more likely than the family group to want the patient to be informed of the terminal illness (odds ratio [OR], 9.76; 95% CI, 4.31 to 22.14), by the doctor (OR, 4.00; 95% CI, 2.61 to 6.11), and immediately after the diagnosis (OR, 3.64; 95% CI, 2.45 to 5.41). Conclusion Our findings indicated that most cancer patients want to be informed if their illness is terminal, and physicians should realize that the patient and the family unit may differ in their attitude toward such a disclosure. Our results also reflect the importance of how information is given to the patient.

Purpose: To produce the nationwide 5-year survival rates of Korean cancer patients by primary cancer site. Materials and Methods: The study subjects were cancer patients diagnosed in 1995, as documented by the Korea Central Cancer Registry (KCCR) Program. This data was collected in 120 (93%) of 129 nationwide intern-and resident-training hospitals and 75 (94%) of the 80 Korean university hospitals. Follow-up was performed by obtaining information upon vital status (i.e., whether living or dead) from the government administered whole population files. Cumulative observed survival rate (OSR) was calculated by using the life table method and the relative survival rate (RSR) was computed using the life-time table for the years 1995, 1997, and 1999. Results: Of the 55,042 study subjects, the OSR for all Korean cancer patients was 61.4% at 1 year and 38.1% at 5 years. The RSR for all cancers was 62.5% at 1 year and 41.4% at 5 years, and the 5-year RSRs for all cancers in men and women were 32.6% and 53.2%, respectively. Conclusion: This is the first nationwide report upon 5-year cancer survival by primary site in Korea. Men showed a lower survival rate than women in most malignancies. Pancreatic and thyroid cancer had the lowest and highest 5-year survival rates, respectively.

In this Letter, we propose a novel type of spectroscopic ellipsometer, named spatially phase-retarded spectroscopic ellipsometry (SPARSE), based on the spatial polarization distribution opposed to the temporal polarization changes. SPARSE can collect all information necessary to characterize film structures with a single image acquisition, and it has the benefit of real-time measurements. For the verification, feasible experiments with single film-layered certificated reference materials and multi-layered film specimens were carried out.

24 Background: The aim of this study was to compare the serial changes of health-related quality of life (HRQOL) after Endoscopic submucosal dissection (ESD) with those after surgery in patients with early gastric cancer (EGC). Methods: Gastric cancer patients were prospectively enrolled from 2004 through 2007. HRQOLs of 161 EGC patients were prospectively assessed by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) and the stomach cancer-specific module EORTC-QLQ-STO22 at the baseline, 1, 6, 12, 18 and 24 months after treatments. Analysis was done using the generalized linear model and paired- ttests. Results: Of 161 patients, 48 (29.8%) underwent ESD (ESD group) and 113 (70.2%) underwent surgery (surgery group). The median age of stomach cancer patients was 57 years. Surgery group had poorer scores compared with those of ESD group in the most HRQOL factors one month after treatments ( P< 0.05), except for emotional and cognitive functioning, financial problems, anxiety, and hair loss. However, most of the functional and symptom scales after surgery subsequently improved and became insignificant until 24 months of follow up. Only 3 parameters including physical functioning, diarrhea and body image in ESD group still remained better until 24 months after treatment ( P< 0.05). Conclusions: Because poorer HRQOLs after surgery in the early post-treatment periods become insignificant during long-term follow-up, surgical treatment should not be discouraged in EGC treatment solely based on the QOL aspects.

The objective of this study was to evaluate the psychometric properties of the Smart Management Strategy for Health Assessment Tool (SAT), which we developed to enable cancer patients to assess their self-management (SM) strategies of health by themselves.The development of the questionnaire included four phases: item generation, construction, pilot testing, and field testing. To assess the instrument's sensitivity and validity, we recruited 300 cancer patients from three Korean hospitals who were 18 or more years old and accustomed to using the Internet or email. Using the appropriate and priority criteria for pilot and field testing, we tightened the content and constructed the first version of the SAT.We developed the core strategies with 28 items, preparation strategies with 30 items, and implementation strategies with 33 items. Factor analysis of data from 300 patients resulted in core strategies with four factors, preparation strategies with five factors, and implementation strategies with six factors. All the SAT subscales demonstrated a high reliability with good internal consistency. The total scores of the three SAT sets differentiated participant groups well according to their stage of goal implementation and proportions of action of the 10 Rules for Highly Effective Health Behavior. Each factor of the three SAT sets correlated positively with the scores for additional assessment tool.The SAT is a three-set, 16-factor, 91-item tool that assesses the SM strategies of health that patients use to overcome a crisis. Patients can use the SAT to assess their SM strategies of health and obtain feedback from clinicians in the practice setting.

1932-6203 Park, Sohee Kim, Yeonju Shin, Hai-Rim Lee, Boram Shin, Aesun Jung, Kyu-Won Jee, Sun Ha Kim, Dong Hyun Yun, Young Ho Park, Sue Kyung Boniol, Mathieu Boffetta, Paolo Journal Article United States PLoS One. 2014 Apr 10;9(4):e90871. doi: 10.1371/journal.pone.0090871. eCollection 2014.; International audience; BACKGROUND: Changes in lifestyle including obesity epidemic and reduced physical activity influenced greatly to increase the cancer burden in Korea. The purpose of the current study was to perform a systematic assessment of cancers attributable to obesity and physical inactivity in Korea. METHODOLOGY/PRINCIPAL FINDINGS: Gender- and cancer site-specific population-attributable fractions (PAF) were estimated using the prevalence of overweight and obesity in 1992-1995 from a large-scale prospective cohort study, the prevalence of low physical activity in 1989 from a Korean National Health Examination Survey, and pooled relative risk estimates from Korean epidemiological studies. The overall PAF was then estimated using 2009 national cancer incidence data from the Korea Central Cancer Registry. Excess body weight was responsible for 1,444 (1.5%) and 2,004 (2.2%) cancer cases among men and women, respectively, in 2009 in Korea. Among men, 6.8% of colorectal, 2.9% of pancreatic, and 16.0% of kidney cancer was attributable to excess body weight. In women, 6.6% of colorectal, 3.9% of pancreatic, 18.7% of kidney, 8.2% of postmenopausal breast, and 32.7% of endometrial cancer was attributable to excess body weight. Low leisure-time physical activity accounted for 8.8% of breast cancer, whereas the PAF for overall cancer was low (0.1% in men, 1.4% in women). Projections suggest that cancers attributable to obesity will increase by 40% in men and 16% in women by 2020. CONCLUSIONS/SIGNIFICANCE: With a significantly increasing overweight and physically inactive population, and increasing incidence of breast and colorectal cancers, Korea faces a large cancer burden attributable to these risk factors. Had the obese population of Korea remained stable, a large portion of obesity-related cancers could have been avoided. Efficient cancer prevention programs that aim to reduce obesity- and physical inactivity-related health problems are essential in Korea.

Background: To determine whether the Health Partner Program is effective in training long-term cancer survivors to be health coaches. Materials and Methods: We randomly assigned cancer survivors who were selected through a rigorous screening process to either the Health Partner Program or the waiting-list control group. The program consisted of 8 weeks of training in health management, leadership, and coaching. At baseline, 8, and 16 weeks, we measured primary outcomes using the Seven Habit Profile (SHP), the Korean Leadership Coaching Competency Inventory (KCCI), Ed Diner’s Satisfaction with Life Scale (SWLS), and the Posttraumatic Growth inventory (PTGI) and secondary outcomes using the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale-Revised (IES-R), and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF36). Results: We recruited 70 subjects and randomly assigned 34 to the intervention group. The Sharpen the Saw habit of the SHP increased significantly more in intervention group than in the control group (p = 0.049), as did most PTGI factors. The intervention group also showed a significantly greater enhancement of vitality (p = 0.015) and mental health (p = 0.049) SF-36 scores but no improvement in KCCI, SWLS, HADS, or IES-R scores. The intervention group also showed a greater clinically meaningful improvement in the “Think Win-Win” of SHP (p = 0.043) and in the personal strength score (p = 0.025) and total score (p = 0.015) of the PTGI. Conclusions: Long-term cancer survivors can benefit from the Health Partner Program to become health coaches.

To investigate factors that affect the place of death (POD) of terminal cancer patients.We recruited 702 consecutive patients (18 years) from 12 centers during July 2005 to October 2006, and 481 completed the questionnaire. In April 2011, we linked the data for 96.0% (n=462) of the deceased patients to the POD using the 2005-2009 death certificate data of Korea's National Statistical Office. The primary outcome variable was POD, and the predictive value of variables pertaining to patients and caregivers was evaluated using univariate and multivariate analyses.Most patients died in a hospital (91.5%, n=441) and age, education, preference for place of terminal care, wish to use hospice/palliative care services, terminal cancer awareness, time between diagnosis and death, and global quality-of-life subscale of the EORTC QLQ-C30 of patients, and education and preference for place of terminal care of caregivers were significant predictors in univariate analyses. On multivariate analysis, patients and caregivers who preferred hospital/palliative care as the terminal care option over home care [adjusted odds ratio (aOR), 2.68; 95% confidential interval (CI), 1.18- 7.04 and aOR: 2.65; 95%CI: 1.15-6.09 for patient and caregiver preferences, respectively] and caregivers who were highly educated (aOR, 3.19; 95%CI, 1.44-7.06) were predictors of POD.Most of the terminal cancer patients died in a hospital. Our findings indicate that major predictors of hospital deaths are preference of both the patient and caregiver for hospital/palliative care as the terminal care option and higher education of the caregiver.

Background In light of the Korean Supreme Court's 2009 ruling favoring a patient's right to die with dignity, we evaluated trends in aggressive care in a cohort of pediatric cancer patients. Methods We conducted a population-based retrospective study that used administrative data for patients who died in 2007–2010 among the 5,203 pediatric cancer patients registered at the Korean Cancer Central Registry (KCCR) during 2007–2009. Results In the time period covered, 696 patients died. The proportion who had received chemotherapy in the last 30 days of life decreased from 58.1% to 28.9% (P

Introduction Decitabine is a drug commonly used drug in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). The efficacy of decitabine compared to best supportive care or low dose cytarabine has been shown in previous studies. However, no comparison has been made between decitabine and intensive chemotherapy in fit elderly patients. Hence, in this study, we tried to uncover the cost-effectiveness of decitabine compared to cytotoxic chemotherapy in elderly AML patients using a big database, called the Korean National Health Insurance (KNHI) Claims Database. Methods Records from elderly (>=65 years) patients with AML who received chemotherapy were retrieved from the KNHI claims database between July 1st, 2010 and December 31st, 2014. We investigated survival outcome within 1 year after the administration of the first line chemotherapy, utilization of the emergency room, utilization of the intensive care unit (ICU), visit to out-patient clinics and in-patient units, and total medical cost (1USD=1,000KRW) within 6 months after the initial chemotherapy. Overall survival (OS) following chemotherapy was calculated using the Kaplan-Meier method. The log-rank test was carried out to compare survival curves. Results A total of 1,151 records from elderly patients who received chemotherapy for AML were retrieved from the database. Decitabine was administered as the first line therapy in 239 patients, while low dose cytarabine and cytarabine combination chemotherapy were given as the first line therapy in 258 and 654 patients, respectively. In older patients (age 65-74 years, n=821), the majority of patients received cytarabine combination chemotherapy (n=560), while 130 patients received decitabine as the first line therapy. In these patients, OS was not different between decitabine group (median OS 43.0 weeks) and cytarabine combination group (median OS 46.2 weeks). Patients who received cytarabine single agent showed significantly poorer survival with a median OS of 7.7 weeks compared to patients receiving other treatments (decitabine or cytarabine combination) (p In elderly patients (age over 75 years, n=330), one-third of patients received decitabine (n=109), and 127 patients received cytarabine single treatment as the first line therapy. In these patients, OS was not different between decitabine group (median OS 37.9 weeks) and cytarabine combination group (median OS 47.9 weeks). Patients who received cytarabine single agent showed significantly poorer survival with median OS of 6.3 weeks compared to patients receiving other treatments (decitabine or cytarabine combination) (p=0.0002). Although a similar survival outcome was observed between decitabine treatment and cytarabine combination treatment, decitabine treatment was associated with less need for intravenous antibiotic treatment (p=0.01) and less utilization of the ICU (p=0.02). The total medical cost per person was similar to decitabine arm (40,568 USD/person) and cytarabine combination arm (44,506 USD/person) (p=0.26). Decitabine treatment, however, was related to more frequent outpatient clinic visits (p Conclusion In conclusion, in elderly AML patients decitabine is a reasonable first line treatment regimen with less medical source utilization and better cost-effectiveness without negatively impacting survival outcomes. This study is funded by Janssen Korea Ltd. Disclosures Yun: Janssen: Research Funding.

Introduction Although most of the studies about health related quality of life (HRQoL) focuses on acute leukemia survivors, few studies compared the HRQoL in acute leukemia survivors with that of the general population. The objective of the present study was to evaluate the HRQoL of acute leukemia survivors in a case-control study using The Sixth Korean National Health and Nutrition Examination Survey (KNHANES VI). Method We enrolled 149 acute leukemia survivors from three Korean tertiary care centers from 1983 through 2014. Survivors completed a set of questionnaires which included the EuroQOL five dimensions questionnaire (EQ-5D), the EORTC Quality of Life Core Questionnaire (QLQ-C30), Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale for Korean (HADS-K), Brief Encounter Psychosocial Instrument (BEPSI), Abbreviated Dyadic Adjustment Score (ADAS), and Family APGAR. We identified 447 control subjects matched for age, sex, education status, marital status, and presence of any comorbidity from KNHANES VI database. The scores for EQ-5D and health behaviors regarding rate of smoking, drinking, health medical examination, cancer screening, and vaccination were compared with the general population. Other survey results including EORTC QLQ-C30 were analyzed among the leukemia survivors, to evaluate the impact on QoL of postremission treatment strategy (SCT or chemotherapy). We compared the adjusted QoL mean across groups by analysis of covariance. Result Median age of the study participants was 44 years (range, 16 - 78), and there were 75 men (50%) and 74 women (50%). Majority of the patients had acute myeloid leukemia (n = 121); others had acute lymphoblastic leukemia (n = 24) and acute biphenotypic leukemia (n = 4). Among the survivors, 93 received chemotherapy and 56 received SCT as postremission treatment. Median duration of time between treatment completion and the study survey was 59 months. Examination of each of the five dimensions of the EQ-5D showed that the acute leukemia survivor group was having more difficulties or problems compared with the general population. More than twice as many respondents with leukemia survivors reported having problems with usual activities (14.6% vs. 4.6%, p < 0.001), and anxiety or depression (23.6% vs. 9.1%, p < 0.001). Furthermore, a significant proportion of patients reported pain compared with their matched population (34.7% vs. 20.3%, p= 0.002). Among the survivors, SCT group had clinically significantly worse problems with role functioning, fatigue, and insomnia than chemotherapy group, measured by the QLQ-C30. SCT group also had statistically significantly worse problems with global health status/QoL, physical and emotional functioning, pain, dyspnea, and appetite loss. Depression was higher in the SCT patients compared with the chemotherapy patients (mean HADS-depression score 4.99 vs. 6.56, p= 0.024). There was no difference in the HADS-anxiety score, BFI, BEPSI, dyadic adjustment and family function between the subgroups. In terms of health behaviors, acute leukemia survivor group had lower rate of smoking (5.6% vs. 25.3%, p < 0.001) and drinking in recent 1 year (41.7% vs. 76.7%, p < 0.001), and higher rate of influenza vaccination (63.6% vs. 35.4%, p < 0.001). Only 17% of the leukemia survivors reported that they had been recommended to receive screening for other cancers from health care providers, and 27% and 40% reported that they thought they had lower risk and similar risk of other cancer than general population. However, this lack of a recommendation for second cancer screening and the misperception of second cancer risk did not have negative impact on cancer screening behaviors (cancer screening in recent 2 years, 45.9% for survivor group vs. 52.3% general population, p = 0.175; health examination, 61.0% vs. 63.2% for, p= 0.632). Conclusion These results indicate that, compared to the general population, survivors of acute leukemia have a significantly worse long-term impact on QoL. Moreover, patients who received SCT for postremission treatment had poorer QoL than those treated with chemotherapy. Health behaviors were comparable between the survivors and the general population. These results can increase the awareness of healthcare providers to the need for counseling and interventions among acute leukemia survivors and help them improve their impaired QOL. Disclosures Yun: Janssen: Research Funding.

We tried to evaluate the association of self-leadership, effective health behaviors, and posttraumatic growth with health-related quality of life (HRQOL).We recruited survivors of cancer from seven hospitals in Korea between 2011 and 2012. The patients completed the Seven Habits Profile (7HP) to evaluate leadership competency, the 10 rules for highly effective health behavior to evaluate health behavior, the Posttraumatic Growth Inventory (PTGI) to evaluate posttraumatic growth, the Short Form 36 (SF-36) to evaluate HRQOL, and the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression. We performed multiple logistic regressions to identify significant associations.A total of 668 patients with cancer participated in the study. Patients who scored high on the leadership subscales of Be Proactive, Begin with the End in Mind, Put First Things First, Think Win-Win, Synergize, and Sharpen the Saw in 7HP tried to practice and keep their health behaviors more. The Begin with the End in Mind, Put First Things First, Synergize, and Sharpen the Saw subscales of the 7HP were also significantly correlated with subscales on the PTGI. Patients who scored high on the leadership subscales of Life Balance, Be Proactive, Begin with the End in Mind, Think Win-Win, and Sharpen the Saw had higher physical and mental component scale scores on the SF-36 and lower anxiety and depression subscale scores on the HADS.Self-leadership, health behaviors, and posttraumatic growth are associated with QOL in survivors of cancer.

Few studies performed so far have weighed the health-related quality of life (HRQoL) of cancer survivors against that of cardiovascular disease (CVD) survivors. This study was based on data obtained from the Third Korean National Health and Nutrition Examination Survey. Of adults with available EuroQoL (EQ) information, a total 23 370 individuals (658 CVD survivors, 389 cancer survivors, and 22 323 controls) remained in the final analysis. Cancer survivors have the lowest HRQoL scales among the 3 groups, independent of age. The HRQoL of young cancer survivors was as impaired as that of older cancer survivors, whereas the HRQoL of CVD survivors and controls decreased with increasing age. Cancer survivors also have more problems in all domains of EQ-5D, especially domains of pain/discomfort and anxiety/depression. The study suggests that cancer survivors should receive more intensive attention to develop means of identifying them and to improve their quality of life.

We verified the reliability and validity of the Korean version of the Minneapolis-Manchester Quality of Life Instrument-Adolescent Form (KMMQL-AF) among Korean childhood cancer survivors. A total of 107 childhood cancer patients undergoing cancer treatment and 98 childhood cancer survivors who completed cancer treatment were recruited. To assess the internal structure of the KMMQL-AF, we performed multi-trait scaling analyses and exploratory factor analysis. Additionally, we compared each domains of the KMMQL-AF with those of the Karnofsky Performance Status Scale and the Revised Children's Manifest Anxiety Scale (RCMAS). Internal consistency of the KMMQL-AF was sufficient (Cronbach's alpha: 0.78-0.92). In multi-trait scaling analyses, the KMMQL-AF showed sufficient construct validity. The "physical functioning" domain showed moderate correlation with Karnofsky scores and the "psychological functioning" domain showed moderate-to-high correlation with the RCMAS. The KMMQL-AF discriminated between subgroups of different adolescent cancer survivors depending on treatment completion. The KMMQL-AF is a sufficiently reliable and valid instrument for measuring quality of life among Korean childhood cancer survivors.

Objective Little is known regarding cervical cancer survivors' employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life. The goal of this study was to assess the correlates of unemployment and evaluate the impact on the comprehensive quality of life in cervical cancer survivors. Methods We enrolled 858 cervical cancer survivors from the gynecologic oncology departments of multi-centers in Korea. Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different health-related quality of life domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and do not. Results After diagnosis and treatment, the percentage of unemployed survivors increased from 50.6% to 72.8%. Lower income (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.38 to 2.81), medical aid (aOR, 1.58; 95% CI, 1.05 to 2.38), two or more comorbidities (aOR, 1.80; 95% CI, 1.12 to 2.90), current alcohol drinkers (aOR, 2.33; 95% CI, 1.54 to 3.52), and employed at the time of diagnosis (aOR, 10.72; 95% CI, 7.10 to 16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being. Conclusion The proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively being associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cervical cancer survivors.

Background Our aim was to systematically review prospective studies of the association of plasma adiponectin levels with the risk of coronary heart disease (CHD) events, cardiovascular mortality and all-cause mortality. Methods We searched Medline, EMBASE, the Cochrane Library and CINAHL for reports published through October 2011. Search terms included 'adiponectin' AND 'cardiovascular disease' OR 'mortality'. We included prospective studies lasting more than 1 year with plasma adiponectin levels at baseline and all-cause mortality and/or major cardiovascular morbidity and mortality as outcomes. We used a random-effects model to pool the data and conducted additional subgroup meta-analyses according to the pre-existence of CHD. Pooled relative risk (RR) was estimated by a 1-SD increase in the logarithmically transformed circulating adiponectin levels. Results A total of 24 prospective studies were included in the meta-analysis. The pooled RR of adiponectin for CHD events (23 studies) was 1.03 [95% confidence interval (CI): 1.00, 1.06]. In subgroup analyses, the RR of adiponectin was 0.99 (95% CI: 0.94, 1.03) for new-onset CHD (17 studies), but there was an increased risk (RR = 1.12, 95% CI: 1.04, 1.22) for CHD recurrence (seven studies). A 10% increased risk (RR = 1.10, 95% CI: 1.04, 1.16) of all-cause mortality (six studies) and a 14% increased risk (RR = 1.14, 95% CI: 1.05, 1.23) of cardiovascular disease mortality (five studies) were observed. Conclusions No association was observed between adiponectin levels and CHD events. Our results suggest that higher circulating adiponectin levels may be associated with an increased risk of CHD recurrence and all-cause/CVD mortality.

Objective To investigate the employment status of lung cancer survivors and the work-related problems they face. Background Although the number of lung cancer survivors is increasing, little is known about their employment and work-related issues. Methods We enrolled 830 lung cancer survivors 12 months after lung cancer curative surgery (median time after diagnosis, 4.11 years) and 1000 volunteers from the general population. All participants completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core 30-item and a questionnaire that included items relating to their jobs. We used logistic regression analysis to identify independent predictors of unemployment. Results The employment rate of lung cancer survivors decreased from 68.6% at the time of diagnosis to 38.8% after treatment, which was significantly lower than the employment rate of the general population (63.5%; adjusted odds ratio = 2.31, 95% confidence interval: 1.66-3.22). The posttreatment unemployment rate was higher for women than for men. Among survivors, employment was inversely associated with older age, household income, number of comorbidities, and poor social functioning. Fatigue (78.6%) was the most common work-related problem reported by survivors. Conclusions Lung cancer survivors experienced more difficulties in employment than did the general population. Age, monthly household income, number of comorbidities, and social functioning appear to be important factors influencing employment status. These findings suggest that lung cancer survivors need support to cope with the financial impact of cancer.

Although the suicide rate of cancer survivors is higher than that of the general population, few studies have examined the potential risk factors. We assessed suicide ideation (SI) and investigated its correlates among survivors of stomach cancer, which is one of the most prevalent cancers in Korea.We surveyed 378 stage I-III stomach cancer survivors who had been disease free for at least 1 year. The survey contained demographic questions and quality of life assessments from the European Organization for Research and Treatment of Cancer QLQ-C30 and its stomach cancer-specific module, the McGill Quality of Life Questionnaire, the Brief Fatigue Inventory, and one question from the Beck Depression Inventory.We found that 131/378 stomach cancer survivors (34.7 %) experienced SI. Univariate analyses showed that SI was significantly associated with income, comorbidity, smoking, and the following quality of life factors: general health status, emotional functioning, fatigue, nausea/vomiting, dyspnea, appetite loss, constipation, diarrhea, financial problems, eating restriction, anxiety, dry mouth, trouble belching, hair loss, body image, existential well-being, and social support. Multivariate logistic regression confirmed that SI was independently associated with diarrhea (adjusted odds ratio (aOR) 2.84; 95 % confidence interval (CI) 1.44-5.62), hair loss (aOR 2.77; 95 % CI 1.04-7.36), existential well-being (aOR 6.18; 95 % CI 2.91-13.1), and usual fatigue (aOR 2.29; 95 % CI 1.30-4.06).Our findings reveal a high prevalence of SI among stomach cancer survivors and identify health-related quality of life issues such as diarrhea, hair loss, existential well-being, and fatigue as important risk factors of SI.

Background: Although caregiving to patients with terminal illness is known to be a stressful burden to family members, little attention has been focused on work-related problems. We aimed to investigate employment status and work-related difficulties of family caregivers of terminal cancer patients, comparing with the general population. Methods: Using structured questionnaires, we assessed family caregivers of 481 cancer patients determined by physicians to be terminally ill, from 11 university hospitals and the National Cancer Center in Korea. Results: Among 381 family caregivers of terminal cancer patients (response rate, 87.6%), 169 (43.9%) were not working before cancer diagnosis, but currently 233 (63.7%) were not working. Compared with the general population (36.5%), the percentage of not working among the family caregivers was higher (OR=2.39; 95%CI= 1.73-3.29). A major reason for not working was to provide assistance to the patients (71.6%). 40.6% of those who continued working and 32.3% of those who not working family members reported extreme fatigue. Caregivers of old age, those who were female, those with a lower household income, and those caring for patients with a low performance status were not working at a more significant rate. Conclusion: Family caregivers of terminal cancer patients suffer job loss and severe work-related difficulties, probably due to caregiving itself and to fatigue. We need to develop supportive programs to overcome the burden of caregivers of the terminally ill.

Objectives: Terminal cancer patients and their caregivers often experience traumatic stress and need many types of assistance. In the present study we interviewed terminally ill cancer patients and caregivers to determine how much burden they experienced and to find out what factors are most important for satisfaction. Design: We constructed a questionnaire including overall care burden and needs experienced, and administered it to 659 terminal cancer patients and 659 important caregivers at 11 university hospitals and 1 national cancer center in Korea. Results: Finally, 481 terminal cancer patients and 381 caregivers completed the questionnaire. Care burden was not insubstantial in both and the caregiver group felt more burden than the patient group (P

We propose a very simple and effective technique to eliminate the direction ambiguity and the dead zone, which limit the measurable range in spectrally resolved interferometry (SRI). By using a dispersive material, the nonlinear spectral phase caused by the dispersion can provide useful information and determine the direction of measuring distances. In addition, the dead zone is removed by two complementary measurement results in dichroic SRI. As the results of feasibility experiments, it was confirmed that the nonlinearity of the spectral phase successfully determined the direction of the measuring distances. Moreover, the final linear distances in the whole measurement range without the dead zone was obtained in dichroic SRI with two LEDs.

Objectives: To investigate in depth the use of complementary and alternative medicines (CAMs) by cancer patients at the end-of-life (EOL) and how they communicate with physicians about them. Design and location: In 17 hospitals in Korea between January and December 2004 we identified 4,042 families of cancer patients. Results: The prevalence of CAM use among cancer patients at the EOL was 37.0%, and 93.1% had used pharmacologic types of agents. The most frequent motive for CAM use was the recommendation of friends or a close relative (53.4%) or a physician (1.6%). Only 42.5% discussed CAM use with their physicians. Satisfaction with CAMS was recalled for 37.1% . The most common reason given for that satisfaction was improvement of emotional or physical well-being, while ineffectiveness was the most common reason given for dissatisfaction. The average cost of CAM during the last month of life was $US 900. CAM use was associated with longer disease periods, primary cancers other than liver, biliary, and pancreatic, and need of support from physicians or religion. Conclusions: CAM use among cancer patients at the EOL was common, not discussed with physicians, and associated with expectation of cure. Expectations were generally unmet while the treatments were a financial burden. Further studies evaluating the effects of CAM at the EOL and factors that enhance communication with the physician are needed.

Introduction Several in vitro studies have suggested the effects of adipokines and insulin resistance on breast cancer cell proliferation and survival. However, little is known about the clinical significance of these findings. Methods We examined associations between breast cancer recurrence and adiponectin, leptin, insulin resistance, and metabolic syndrome (MetS) in a cohort of 747 patients from 2001 to 2004. Results Adjusted hazard ratios showed an inverse trend across the quartiles for serum adiponectin concentration in estrogen receptor (ER)/progesterone receptor (PR) -negative patients (P for trend = 0.027) but not in ER/PR-positive patients. Compared to the highest quartile for adiponectin level, the lowest quartile showed a hazard ratio of 2.82 (1.03 to 7.68). Homeostasis model assessment for insulin resistance (HOMA-IR) showed a positive trend for recurrence in the ER/PR-negative group (P for trend = 0.087) and a negative trend in the ER/PR-positive group (P for trend = 0.081). Leptin did not show any associations (P for trend >0.05). A linear trend was observed with the number of components of MetS in ER/PR-negative patients (P for trend = 0.044). This association disappeared when adjusted for adiponectin and HOMA-IR. Conclusions Adiponectin and HOMA-IR have prognostic significance in breast cancer recurrence and interventions related to these factors may protect against recurrence in ER/PR-negative patients. These findings were not observed in the case of ER/PR-positive patients. Further evaluation of these insignificant associations is needed because it might be biased by adjuvant chemotherapy or other confounders.

Purpose/objectives To investigate the feasibility and preliminary effects of a simultaneous stage-matched exercise and diet (SSED) intervention in breast cancer survivors. Design Randomized, controlled trial. Setting Oncology outpatient treatment clinics at the National Cancer Center in South Korea. Sample 45 women with breast cancer who completed their cancer therapy. Methods Participants were assigned to the SSED intervention group (n = 23) or a control group (n = 22). Participants in the SSED group received a 12-week individualized intervention promoting prescribed exercise and a balanced diet through stage-matched telephone counseling and a workbook. Main research variables Program feasibility, behavioral outcomes (stage of motivational readiness for exercise and diet, physical activity, and diet quality), and quality-of-life (QOL) outcomes (functioning and global QOL, fatigue, anxiety, and depression). Findings Participant evaluations of the SSED intervention indicated that it was feasible and acceptable. All women felt that the overall intervention contents were appropriate, and 95% believed that the intervention helped to promote healthy behaviors. Objective data also supported the SSED intervention's feasibility (i.e., 91% completed the trial and 100% of intervention calls were received). When compared to control, the SSED intervention group showed significantly greater improvement in motivational readiness for exercise and diet, emotional functioning, fatigue, and depression. Conclusions Preliminary results suggest that the SSED intervention delivered via telephone counseling and workbook is feasible and beneficial for positive behavioral and QOL outcomes. Implications for nursing Nurse-led lifestyle interventions may improve QOL for cancer survivors.

Context Depression in cancer survivors affects the rest of their lives in many ways. Objectives To estimate the prevalence of depression and identify associated factors in disease-free stomach cancer survivors. Methods We enrolled 391 stomach cancer survivors who had been disease-free for at least one year after surgery from the cancer registries of two hospitals in Korea. Stomach cancer survivors were mailed a survey that included the Beck Depression Inventory, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and the associated stomach module, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach Cancer Module 22. Results Forty-four percent of survivors suffered from depression, and more women (49%) than men (42%) had high depression scores (Beck Depression Inventory >13). In multiple logistic regression analysis, lower income (odds ratio [OR] 2.49; 95% CI 1.64–3.78), problems with care before treatment (OR 1.92; 95% CI 1.23–2.98), body image change (OR 2.23; 95% CI 1.41–3.53), and symptoms of fatigue (OR 3.11; 95% CI 1.49–6.52), dyspnea (OR 2.57; 95% CI 1.48–4.45), or insomnia (OR 4.51; 95% CI 1.88–10.83) were associated with depression. Conclusion The prevalence of depression was high in stomach cancer survivors even after the completion of treatment, especially among those with problems amenable to treatment, and we identified the associated factors. We suggest that stomach cancer survivors should be screened for depression after the end of treatment.

Background: As the number of cancer survivors increases, suicide risk approaches that of the general population. We therefore investigated suicide rates and risk factors among Korean cancer patients. Methods: We observed 816,295 cancer patients for 3,007,294 person-years from 1993 to 2005 through a nationwide cancer registry. We calculated their sex- and age-standardized mortality ratios (SMR) and studied suicide risk factors using rate ratios (RR) based on a log-linear Poisson regression model. Results: Compared with the Korean general population, the suicide rate among cancer patients was high [SMR, 2.00; 95% confidence interval (95% CI), 1.91-2.08]. The rates were highest in the year following the cancer diagnosis (SMR, 3.45; 95% CI, 3.19-3.73) and were still elevated 5 years later (SMR, 1.23; 95% CI, 1.12-1.36). The clinical groups at highest risk were male pancreas cancer patients (SMR, 6.01; 95% CI, 4.33-8.33) and female lung cancer patients (SMR, 3.55; 95% CI, 2.55-4.94). The sociodemographic groups at highest risk were those who had no spouse versus those who were married (RR, 1.50; 95% CI, 1.35-1.68), those who were not employed versus those who were (RR, 1.39; 95% CI, 1.26-1.54), and those who did not have high school education versus those who had (RR, 1.52; 95% CI, 1.30-1.79). Conclusions: Korean cancer patients are at increased risk of suicide. Both clinical and sociodemographic factors play a role. Impact: There is a need for social support and suicide prevention strategies for cancer survivors in Korea. Cancer Epidemiol Biomarkers Prev; 19(8); 2097–105. ©2010 AACR.

To determine the quality of life (QoL) of breast cancer patients who underwent mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap (LD), and the oncological safety of the procedure. Between May 2001 and March 2007, 2,566 patients had breast cancer surgery at the National Cancer Center, Korea. Of the 2,566 patients, 1,699 had breast-conserving surgery (BCS) and 120 had a mastectomy with an immediate LD. We retrospectively compared the oncologic safety of the two techniques. We also assessed the QoL using the EORTC QLQ BR-23 and Zung's self-rating depression scale in 52 LD patients, 104 age- and stage-matched patients who underwent BCS, and 104 age-matched healthy women. The LD group had earlier stage disease than the BCS group at baseline, but following surgery, the groups did not differ in the rates of local recurrence or systemic metastases. Compared with the healthy group, the patient groups had poorer functioning and more depression (p0.001). Among the patient groups, the LD group reported lower scores for body image (p = 0.007) and future perspective (p = 0.023) than the BCS group. In the LD group, patients who received neoadjuvant chemotherapy reported lower scores for future perspective and higher scores for depression than those who did not receive neoadjuvant chemotherapy (p0.001). The BCS and LD groups did not differ in oncological outcome, and the QoL of patients in the LD group was not always good. Mastectomy with immediate reconstruction should be considered carefully and tailored to the patient's needs and characteristics.

To determine the quality of life (QoL) of breast cancer patients who underwent mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap (LD), and the oncological safety of the procedure. Between May 2001 and March 2007, 2,566 patients had breast cancer surgery at the National Cancer Center, Korea. Of the 2,566 patients, 1,699 had breast-conserving surgery (BCS) and 120 had a mastectomy with an immediate LD. We retrospectively compared the oncologic safety of the two techniques. We also assessed the QoL using the EORTC QLQ BR-23 and Zung’s self-rating depression scale in 52 LD patients, 104 age- and stage-matched patients who underwent BCS, and 104 age-matched healthy women. The LD group had earlier stage disease than the BCS group at baseline, but following surgery, the groups did not differ in the rates of local recurrence or systemic metastases. Compared with the healthy group, the patient groups had poorer functioning and more depression (p

Objective The goal of this study was to examine the knowledge, attitude, and practice on second cancer screening among cancer survivors. Methods Three focus group interviews were conducted with thirteen disease-free stomach, colorectal, breast and thyroid cancer survivors. Recurrent issues were identified and then placed into thematic categories. Results None of the study participants had heard SPC, and they could not differentiate SPC from ‘recurrence’ or ‘metastasis.’ Survivors believed that they had been cured, and they were not aware of their increased risk of SPC. Although they had high awareness of cancer screening, they could not make a distinction between ‘cancer screening’ and ‘routine surveillance test’ after cancer treatment. Survivors said that they would have had the screening for SPC if they had known about it. They preferred physicians as the most reliable source for screening information. Conclusion Cancer survivors had limited knowledge about SPC, and lack of information was the main barrier for SPC screening. Practice implications An educational intervention would help cancer survivors to understand their risk of SPC and the needs of screening after the first cancer.

Background: Clinical effectiveness of Helicobacter pylori eradication in gastric cancer survivors after endoscopic resection of early gastric cancer (EGC) was recently established in a randomized controlled trial. We aimed to establish long-term cost-effectiveness in gastric cancer survivors after endoscopic resection of EGC. Materials and Methods: A Markov model was constructed to compare the costs and outcomes of the two intervention strategies: (1) eradicate H. pylori after complete resection of EGC by endoscopy (2) do not eradicate. Estimates for variables in the model were obtained by extensive review of published reports. Analyses were made from the Korean public healthcare provider’s perspective. Results: Base-case analysis indicated H. pylori eradication costs less (US$ 29,780 vs. US$ 30,594) than no eradication, and save more lives (mean life expectancy from eradication: 13.60 years vs. 13.55 years). One-way and three-way sensitivity analyses showed the robustness of the cost-effectiveness results. Conclusion: In this selective population with very high risk of developing gastric cancer, H. pylori eradication should be considered for reimbursement with priority to prevent subsequent cancer and also reduce health care cost.

AIM: To identify a cost-effective strategy of second primary colorectal cancer (CRC) screening for cancer survivors in Korea using a decision-analytic model. METHODS: A Markov model estimated the clinical and economic consequences of a simulated 50-year-old male cancer survivors’ cohort, and we compared the results of eight screening strategies: no screening, fecal occult blood test (FOBT) annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years (COL10), every 5 years (COL5), and every 3 years (COL3). We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost-effectiveness ratio (ICER). RESULTS: In the base-case analysis, the non-dominated strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life-year saved (LYS), and did not exceed $10 000/LYS in one-way sensitivity analyses. If the risk of CRC in cancer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10 500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was less than $7400/LYS regardless of screening compliance. CONCLUSION: Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.

Background No clear data are available concerning the superiority of combination chemotherapy to sequential therapy using agents beyond 1st or 2nd line chemotherapy for treating patients with metastatic breast cancer. Methods Patients were randomized to receive a combination of gemcitabine and vinorelbine or gemcitabine until disease progression followed by vinorelbine monotherapy. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Results Forty-two patients were randomized to the combination arm and 40 were randomized to the sequential arm. Baseline characteristics were well balanced between the arms. The median number of chemotherapy cycles was 4 (range, 1–23) for the combination arm and 6 (range, 1–25) for the sequential arm. Patients receiving combination therapy had a higher composite response rate (26.8% vs. 12.5%; P = 0.106) but a shorter median time to treatment failure (3.6 vs. 4.4 months, P = 0.252) as compared to patients receiving sequential monotherapy. Median overall survival for the combination and sequential arms was 10.6 months and 8.9 months, respectively (P = 0.436). Toxicities were manageable and similar in both arms. Quality of life measurements in global health, role, and social function were superior in the combination arm (P < 0.05). Conclusions Combined gemcitabine and vinorelbine therapy appears comparable to sequential monotherapy for heavily pretreated patients with metastatic breast cancer as demonstrated by improved quality of life outcomes with similar therapeutic efficacies and incidences of adverse events.

To investigate the pattern of non-cancer deaths and to determine whether there is excess mortality from non-cancer causes among Korean long-term survivors of adult cancer.We merged national cancer registry data and national death registration data to determine non-cancer death patterns of 243,713 people who were diagnosed with cancer from 1993 to 2000 and who survivedor =5 years. We calculated standardized mortality ratios (SMRs) by an indirect standardization method.Of the patient population, 26,498 (10.9%) had died as of December 2005; the cause of death for 6,364 (24.0%) of those was not cancer. The proportion of non-cancer mortality increased with age at diagnosis and correlated with the 5-year survival rate (r = 0.336 for women, 0.571 for men). Although the risk for non-cancer death was lower among long-term survivors in general (SMR, 0.78; 95% CI, 0.76-0.80), it was higher among younger survivors (SMR, 1.23-2.50, for those who died before 50) than the general population. Survivors had an elevated suicide rate (SMR, 1.28; 95% CI, 1.15-1.42), especially male (SMR, 1.35; 95% CI, 1.19-1.53) and stomach cancer survivors (SMR, 1.38; 95% CI, 1.14-1.66).Appropriate medical attention for long-term adult cancer survivors, especially younger survivors, is warranted to prevent premature deaths from non-cancer causes.

Background Although some studies examined the association between shared decision-making (SDM) and type of breast cancer surgery received, it is little known how treatment decisions might be shaped by the information provided by physicians. The purpose of this study was to identify the associations between shared decision making (SDM) and surgical treatment received. Methods Questionnaires on SDM were administered to 1,893 women undergoing primary curative surgery for newly diagnosed stage 0-II localized breast cancer at five hospitals in Korea. Questions included being informed on treatment options and the patient's own opinion in decision-making. Results Patients more likely to undergo mastectomy were those whose opinions were respected in treatment decisions (adjusted odds ratio, aOR), 1.40; 95% confidence interval (CI), 1.14-1.72) and who were informed on chemotherapy (aOR, 2.57; CI, 2.20-3.01) or hormone therapy (aOR, 2.03; CI, 1.77-2.32). In contrast, patients less likely to undergo mastectomy were those who were more informed on breast surgery options (aOR, 0.34; CI, 0.27-0.42). In patients diagnosed with stage 0-IIa cancer, clinical factors and the provision of information on treatment by the doctor were associated with treatment decisions. In patients diagnosed with stage IIb cancer, the patient's opinion was more respected in treatment decisions. Conclusion Our population-based study suggested that women's treatment decisions might be shaped by the information provided by physicians, and that women might request different information from their physicians based on their preferred treatment options. These results might need to be confirmed in other studies of treatment decisions.

The goal of this study was to investigate the utilization of and attitudes toward life-sustaining treatments (LSTs) at the end of life. We identified 4,042 families of cancer patients who had died at any of 17 hospitals in Korea during 2004. Among those, we analyzed the interviews provided by 1,592 (39.4%) primary caregivers. Only women who provided information in baseline and follow-up point could be included for internal comparison. Most caregivers did not discuss with their patient the option of utilizing the intensive care unit (ICU; 92.7%) or cardiopulmonary resuscitation (CPR; 93.7%) to prolong an ending life. Logistic regressions indicated that the ICU was more likely to be utilized when patients experienced an unexpected medical problem before dying, discussed the ICU with the family caregiver, or were low-educated. CPR was more likely to be used if the patient died within 6 months of diagnosis or the family caregiver was

Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood.We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL).Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care.Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.

The purpose of this study was to evaluate the quality of life (QOL) after laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG) in patients with early gastric cancer.LADG has been beneficial in terms of pain, recovery, and morbidity when compared with open surgery with equal oncologic outcome. There has been no clinical study on QOL.From July 2003 to November 2005, 164 patients with newly diagnosed cT1N0M0 and cT1N1M0 distal gastric cancer were randomly assigned either to LADG or ODG. All patients were asked to complete the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 questionnaires preoperatively and postoperatively on regular follow-up visits.Statistically significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss (P0.001), total amount of analgesics used (P = 0.019), the size of the wound (P0.0001), postoperative hospital stay (P0.0001), and QOL parameters of global health (P0.0001). Most of the scales on patient functioning including physical (P0.0005), role (P = 0.0011), emotional (P0.0001), social (P0.0001), and symptom scales such as fatigue (P0.0001), pain (P0.0001), appetite loss (P = 0.031), sleep disturbance (P = 0.003), dysphasia (P = 0.0024), gastro-esophageal reflux (P = 0.0127), dietary restriction (P = 0.0004), anxiety (P = 0.0036), dry mouth (P = 0.0007), and body image (P0.0001) were also significantly better in the LADG group compared with the ODG group.Comparison of LADG to ODG in patients with early gastric cancer resulted in improved QOL outcomes in the patients followed for up to 3 months in the LADG group.

The aim of this study was to explore the cancer information needs, utilization, and source preferences in South Korean women with cervical cancer. This was a multicenter descriptive study comprising 968 cervical cancer patients (stages 0–IVb; mean age, 55 years; response rate, 34.4% of those who agreed to participate) who had been treated from 1983 through 2004 at any of the six South Korean hospitals. The study data were obtained through a mail-in self-response questionnaire that asked about the patients’ cancer information needs, cancer-information-seeking behavior, information sources, and type of information needed. It also collected data about anxiety and depression. Of the 968 cervical cancer patients, 404 (41.7%) had sought cancer information. When patients felt a need for information, their information-seeking behavior increased (overall risk = 4.053, 95% confidence interval = 2.139–7.680). Television and/or radio were the most frequently cited sources, and narratives about cancer experiences were the most easily understood forms of cancer information. More younger patients preferred booklets and pamphlets, while more older patients preferred television and radio. The most needed cancer information at the time of diagnosis and treatment involved diagnosis, stage, and prognosis while after treatment ended it involved self-care techniques. Cervical cancer patients’ need of cancer information varied with age and treatment phase. These findings should help guide the development of educational materials tailored to the needs of individual patients.