The Realities and Associated Factors of Palliative Chemotherapy Near the End of Life in the Patients Enrolled in Palliative Care Unit

정다은,황선진,유현정,이정권 대한가정의학회 2012 Korean Journal of Family Medicine Vol.33 No.1

Background: It is important to know and decide when to end regimen for the quality of life of the patients. However, there is currently no clear agreement on when to terminate palliative chemotherapy. We investigated the duration between the last chemotherapy and death, and associated factors affecting patients receiving palliative care after the last chemotherapy. Methods: We studied 242 patients who were put into palliative care ward after receiving chemotherapy and died during hospitalization from 2008 to 2009. Electronic medical records were used to gather information on demographic characteristics,types of primary cancer, and palliative chemotherapy. Then we analyzed the relationship between the clinical characteristics of patients and interval between last chemotherapy and death. Results: The average survival time of patients after referral to palliative care was 17.5 days; survival time after discontinuation of chemotherapy was 103 days. Also, 104 (43.0%) patients died within 3 months and 14 (5.8%) patients died within 1 month of persistent palliative chemotherapy. Chemotherapy on patients within 3 months from their death was not associated with the social characteristics of the population. Conclusion: The patients who were referred to palliative care were found to have continued to receive chemotherapy within 3months before death. However, only a small number of patients received chemotherapy within 1 month before death, which confirms that futile chemotherapy that extends to the end of life was less frequent. Doctors should be able to recognize the implications of excessive and aggressive use of chemotherapy and should actively communicate with patients about therapeutic choices.

Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D₂ Resection for Stage III Gastric Cancer

Yu, Yuanyuan,Zhang, Zicheng,Meng, Qianhao,Wang, Ke,Li, Qingwei,Ma, Yue,Yao, Yuanfei,Sun, Jie,Wang, Guangyu The Korean Gastric Cancer Association 2022 Journal of gastric cancer Vol.22 No.2

Purpose: We aimed to explore whether the prognosis of patients treated with capecitabine and oxaliplatin (XELOX) or S-1 and oxaliplatin (SOX) regimens who received fewer cycles of chemotherapy after D2 radical resection for gastric cancer (GC) would be non-inferior to that of patients who received the standard number of cycles of chemotherapy. Materials and Methods: Data on patients who received XELOX or SOX chemotherapy after undergoing D2 radical resection at Harbin Medical University Cancer Hospital between January 2011 and May 2016 were collected. Results: In patients who received 4, 6, and 8 cycles of chemotherapy, the 5-year overall survival (OS) rates were 59.4%, 64.8%, and 62.7%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (hazard ratio [HR], 0.882; 95% confidence interval [CI], 0.599-1.299; P=0.52) or 8 cycles (HR, 0.882; 95% CI, 0.533-1.458; P=0.62) of chemotherapy did not exhibit significantly prolonged OS. The 3-year disease-free survival (DFS) rate of patients who received 4, 6, and 8 cycles of chemotherapy was 62.1%, 67.2%, and 60.8%, respectively. Compared to patients who received 4 cycles of chemotherapy, those who received 6 cycles (HR, 0.835; 95% CI, 0.572-1.221; P=0.35) or 8 cycles (HR, 0.972; 95% CI, 0.606-1.558; P=0.91) of chemotherapy did not show significantly prolonged DFS. However, the 3-year DFS and 5-year OS rates of patients who received 6 cycles of chemotherapy appeared to be superior to those of patients who received 4 and 8 cycles of chemotherapy. Conclusions: For patients with stage III GC, 4 to 6 cycles of XELOX or SOX chemotherapy may be a favorable option. This study provides a rationale for further randomized clinical trials.

외래 항암 화학요법 주사실 모델의 적정성 분석

송정흡 한국의료QA학회 2004 한국의료질향상학회지 Vol.11 No.1

Background: Although the number of cancer patients increase, the resources for cancer management are not increased. If the outpatient chemotherapy administration room is operated, the shift of patients from inpatient to outpatient is occurred. So the capacities for chemitherapy incrcased and the shifted rooms were occupied with new non-chcmotherapy patients. The incotne of the hospital increased. The purpose of this study was to assess usefulness and cost-effectiveness of the outpatient-chemotherapy adminstration model. Method: There are six beds, two chairs and two nurses and one personnel in the outparient chemotherapy room. The satisfaction study by patients/family and doctors and the cost analysis over 12 months, by comparing costs of chemotherapy administration at outpatient chemotherapy room with inpatient at ward and inpatient-nonchemotherapy at ward were done. Results: The 97.1 percent of patients/family and the 94.4 percent of doctor who involved chemotherapy were satisfied with outoatient chemotherapy administration. The 91.7% of doctors said there were vo differences in treatment outcome between outpatient and onpatient chemotherapy administration. The average number of patients in outpatient chemotherapy room increased from 10.7 to 15.4 but in inpatient from 19.4 to 18.3. The average number of inpatient chemotherapy were not changed related to increase of the average number of outpatient chemotherapy. The profit between outpatient chemitherapy and inpatient chemotherapy administration was 45,344,710 won and the profit between outpatient chemotherapy and non chemotherapy treatment was - 185,294,614 won. Conclusion: The outpatient chemitherapy administration model is good for patients/family, doctors and hospital partially. But the hypothesis described above was not correct. The process of cancer patients treatment were from diagnosis and treatment to first administration of chemotherapy. So the shift from inpatient to uotpatent was not occurreed. In econornic aspect, the profit between outpatient chemotherapy and non chemotherapy treatment was in the red. As the level of health care fees was so low, the hospitals hesitate operating the room of uotpatient chemotherapy. It is necessary to raise the level of health case fees for oupatient chemotherapy administration.

Long-Term Survival Analysis of Intraperitoneal versus Intravenous Chemotherapy for Primary Ovarian Cancer and Comparison between Carboplatin- and Cisplatin-based Intraperitoneal Chemotherapy

어경진,이정윤,남은지,김성훈,김영태,김상운 대한의학회 2017 Journal of Korean medical science Vol.32 No.12

In epithelial ovarian cancer (EOC), intraperitoneal (IP) administration of chemotherapy is an effective first-line treatment and may improve outcomes, compared with intravenous (IV) chemotherapy. We used Kaplan-Meier survival analysis to compare long-term survival between propensity score-matched patients with advanced EOC receiving IP (n = 34) vs. IV (n = 68) chemotherapy. Additionally, clinical features associated with carboplatin-based (n = 21) and cisplatin-based (n = 16) IP chemotherapy were analyzed and compared with those associated with IV chemotherapy. The IP and IV chemotherapy groups had a median follow-up duration of 67 (range, 3–131) and 62 (range, 0–126) months, respectively, with no significant difference in progression-free survival (PFS) (P = 0.735) and overall survival (OS) (P = 0.776). A significantly higher proportion of patients in the IV (91.2%) than in the IP (67.6%) chemotherapy group (P = 0.004) received ≥ 6 cycles. However, the frequency of toxic events (anemia, granulocytopenia, nausea/vomiting, abdominal pain, hepatotoxicity, neuromuscular effects) was significantly higher in the IP than in the IV group. Within the IP group, no significant differences were observed in PFS (P = 0.533) and OS (P = 0.210) between the cisplatin-based and carboplatin-based chemotherapy subgroups. The 10-year OS was 28.6% and 49.2% in carboplatin-based and cisplatin-based IP chemotherapy groups, respectively. Toxic events (granulocytopenia, leukopenia, nausea/vomiting, abdominal pain, hepatotoxicity, neuromuscular effects) were significantly more common in the cisplatin-based subgroup. In patients with EOC, cisplatin-based IP chemotherapy may be an acceptable alternative to IV chemotherapy regarding long-term survival, but toxicity must be addressed.

재발 또는 불응성 비호즈킨 림프종 환자에서 CDME 구제항암화학요법 후 고용량 항암화학요법 및 자가말초혈액 조혈모세포이식의 효과

김세형,한강원,배상병,김찬규,이남수,이규택,박성규,원종호,홍대식,박희숙 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Background and objectives : The long-term survival in patients with non-Hodgkin's lymphoma (NHL) after conventional dose chemotherapy is about 35% and the rest of the patients tend to have relapse. So, in relapsed or refractory NHL, we compared the outcome of patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell transplantation(APBSCT) with only salvage chemotherapy of cisplatin, dexamethasone, mitoxantrone, and etoposide(CDME). Materials and methods : From June 1993 to December 1999, 25 patients with relapsed or resistant NHL were treated with CDME regimen as salvage chemotherapy. Twelve patients were received four cycles of CDME chemotherapy, and 13 patients were received high-dose chemotherapy with APBSCT following two cycles of CDME chemotherapy. Results : The median follow-up duration was 12.8 months(range:4-68). The overall response rate was 41.7% (complete response rate 25%, partial response rate 16.7%) in 12 patients with CDME only. Thirteen patients who were treated with high-dose chemotherapy with APBSCT achieved 61.5% complete response rate and 15.4% partial response rate, with an overall response rate of 76.9%. The estimated 3-year progression-free survival rate was significantly higher among patients who received high-dose therapy than patients who received CDME only(41.5% vs 20.0%, p<0.05). And, 3-year overall survival rate was significantly higher among patients who received high-dose therapy(51.3% vs 25.0%, p <0.05). Conclusions : In relapsed or refractory NHL, CDME chemotherapy is an effective salvage chemotherapy and allow peripheral blood stem cell collection. Also, high-dose chemotherapy with APBSCT following CDME is superior to CDME salvage chemotherapy only.

Computer-Aided Evaluation of Breast MRI for the Residual Tumor Extent and Response Monitoring in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

류채연,조나리야,김선미,장미정,박정선,백승연,문우경 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.1

Objective: To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Materials and Methods: Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics. Results: For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 ± 1.7 cm) was significantly smaller than the mean histological diameter (2.6 ± 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 ± 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confi dence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confi dence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106). Conclusion: CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement. Objective: To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. Materials and Methods: Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics. Results: For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 ± 1.7 cm) was significantly smaller than the mean histological diameter (2.6 ± 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 ± 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confi dence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confi dence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106). Conclusion: CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement.

전이성 유방암 환자에서 Cisplatin과 Etoposide 항암화학요법을 이용한 치료

김미,이진선 한국유방암학회 2017 Journal of Breast Disease Vol.5 No.2

Purpose: Both the incidence of breast cancer as well as, the number of patients with metastatic breast cancer has increased. Taxane and anthracycline chemotherapy is known to be effective in metastatic breast cancer; however, the subsequent treatment option when such treatment fails remains unestablished. The aim of the present study was to analyze the effect and response of cisplatin and etoposide treatment along with the predictive factor for patients who failed taxane and anthracycline chemotherapy for metastatic breast cancer. Methods: Forty-three patients with breast cancer whose regimen was changed to cisplatin and etoposide chemotherapy from taxane and anthracycline chemotherapy owing to treatment failure were included in this study. The chemotherapy regimen consisted of intravenous injection of 100 mg/m2 etoposide and 70 mg/m2 cisplatin on day 1 and then intravenous injection of 100 mg/m2 etoposide on days 2 and 3. This cisplatin and etoposide chemotherapy was repeated at 3 week intervals, and patients were assessed after the 2nd or 3rd cycle of therapy to evaluate the tumor response. Results: The average cycle and progression-free survival of cisplatin and etoposide chemotherapy were 4±3.1 (range, 1–16) and 12±14.2 weeks (range, 0–60 weeks), respectively. The average overall survival was 44±33.9 months (range, 11–149 months). The treatment response group consisted of 23 patients (53.5%) who continuously received cisplatin and etoposide chemotherapy for over four cycles, while the non-response group consisted of 20 patients (46.5%) who underwent three or fewer cycles of chemotherapy. Patients with excellent response to cisplatin and etoposide chemotherapy also showed good response to taxane and anthracycline chemotherapy (p=0.011). Conclusion: In patients who show good response to taxane and anthracycline chemotherapy, cisplatin and etoposide chemotherapy is also expected to have a positive result.

Quality of life changes during adjuvant chemotherapy in patients with colon cancer

Seo Hee Lee(이서희),Taek-Gu Lee(이택구),Moo Jun Baek(백무준),Jang Jin Kim(김장진),Sung-Su Park(박성수),Sang-Jeon Lee(이상전) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.1

Purpose: The survival of advanced colon cancer patients has increased due to the development of surgical techniques and adjuvant chemotherapy. The administration of adjuvant chemotherapy after curative resection is generally accepted as a standard of care. The primary endpoint of chemotherapy should include not only tumor response and survival, but also impact on the quality of life (QoL). We evaluated changes in QoL during adjuvant chemotherapy in patients with colon cancer. Methods: Between October 2009 and February 2012, 56 patients with stage II and III colon cancer received the combination adjuvant chemotherapy 5-flurouracil/folinic acid with oxaliplatin (FOLFOX). Patients were asked to complete the QoL questionnaire QLQ-C30 version 3 before and after 6 cycles of adjuvant chemotherapy. Results: There was no significant difference in the QoL between the start of chemotherapy and after the completion of 6 cycles. After completion of 6 cycles, global QoL was worse in patients >70 years of age. The functional scale score was low in patients with chemotherapy schedules delayed more than 2 times due to adverse events. Patients with body weight increases greater than 5% scored lower on symptom scales. Interestingly, patients with peripheral neuropathy scored higher on symptom scales. Conclusion: QoL changes during adjuvant chemotherapy did not show significant differences. After the sixth chemotherapy, QoL was affected by age, body weight gain, delay of the scheduled chemotherapy, and peripheral neuropathy. Therefore, the proper attitude of physicians focused on reassurance and education of patients is very important during chemotherapy.

Results of Curative Radiation Therapy with or without Chemotherapy for Stage III Unresectable Non-Small Cell Lung Cancer

안성자,김영철,김규식,Kyung-Ok Park,정웅기,남택근,나병식,송주영,윤미선 대한암학회 2005 Cancer Research and Treatment Vol.37 No.5

Purpose: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy.Materials and Methods: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14females, and their median age was 64 years (range 38 ∼83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy wasgiven and the radiation dose ranged from 50∼70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%).Results: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of thepatients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81).Conclusions: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved thesurvival compared to the patients who received radiotherapy alone. Purpose: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy.Materials and Methods: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14females, and their median age was 64 years (range 38 ∼83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy wasgiven and the radiation dose ranged from 50∼70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%). Results: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of thepatients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81).Conclusions: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved thesurvival compared to the patients who received radiotherapy alone.

복강경 결직장암 수술 후 조기 항암치료의 안전성에 관한 실험군: 대조군 비교연구

신승호,이선일,최동진,우시욱,김진,민병욱,문홍영,김선한 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.6

Purpose: Since micrometastasis is generally inhibited by primary cancer, surgical ablation of the tumor may stimulate the growth of residual cancer cells, if they exist. This supports the importance of early administration of postoperative chemotherapy. Methods: We reviewed the cases of patients who underwent a laparoscopic resection and then received chemotherapy (5 fluorouracil+leucovorin or FOLFOX4) between September 2006 and May 2008. The chemotherapy was scheduled on the 7th or the 8th postoperative day, but was postponed when a final pathologic report was delayed or patients were discharged early. The safety of chemotherapy was evaluated in two ways. Early safety, such as the presence of surgical complications and medical toxicity, was prospectively assessed just before the beginning of the second cycle of chemotherapy. Late safety, such as medical toxicity, was retrospectively estimated from the 2nd to the last cycle. These safeties were compared between the two groups: the early chemotherapy group (n=50) for which chemotherapy started on the 7th or 8th postoperative day as scheduled and the delayed chemotherapy group (n=31) for which chemotherapy started after the 14th postoperative day. Results: Patient demographics were not different between the two groups. With regards to early safety, no differences in surgical complications existed between the two groups. In medical toxicities, there were no differences, except for a higher rate of nausea in the early chemotherapy group (20 percent vs. 10 percent, P=0.01). With regards to late safety, the two groups were not different in the development of medical toxicities. Conclusion: Because nausea is an easily controllable toxicity, we conclude that chemotherapy is safely started on the 7th or the 8th day after a laparoscopic colorectal cancer resection. Purpose: Since micrometastasis is generally inhibited by primary cancer, surgical ablation of the tumor may stimulate the growth of residual cancer cells, if they exist. This supports the importance of early administration of postoperative chemotherapy. Methods: We reviewed the cases of patients who underwent a laparoscopic resection and then received chemotherapy (5 fluorouracil+leucovorin or FOLFOX4) between September 2006 and May 2008. The chemotherapy was scheduled on the 7th or the 8th postoperative day, but was postponed when a final pathologic report was delayed or patients were discharged early. The safety of chemotherapy was evaluated in two ways. Early safety, such as the presence of surgical complications and medical toxicity, was prospectively assessed just before the beginning of the second cycle of chemotherapy. Late safety, such as medical toxicity, was retrospectively estimated from the 2nd to the last cycle. These safeties were compared between the two groups: the early chemotherapy group (n=50) for which chemotherapy started on the 7th or 8th postoperative day as scheduled and the delayed chemotherapy group (n=31) for which chemotherapy started after the 14th postoperative day. Results: Patient demographics were not different between the two groups. With regards to early safety, no differences in surgical complications existed between the two groups. In medical toxicities, there were no differences, except for a higher rate of nausea in the early chemotherapy group (20 percent vs. 10 percent, P=0.01). With regards to late safety, the two groups were not different in the development of medical toxicities. Conclusion: Because nausea is an easily controllable toxicity, we conclude that chemotherapy is safely started on the 7th or the 8th day after a laparoscopic colorectal cancer resection.