• Title/Summary/Keyword: 말기 암 환자

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Medical Expenses during the last 6 Months of Life in Cancer Patients (암 환자의 사망 전 6개월의 의료비용)

  • Park, No-Rai;Yun, Young-Ho;Shin, Soon-Ae;Jeong, Eun-Kyeong
    • Journal of Hospice and Palliative Care
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    • v.2 no.2
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    • pp.109-113
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    • 1999
  • Purpose : Because we don't have inappropriate health care system for the terminal cancer patients, there were abnormal behavior patterns of health care utilization. So, There were needs to develop the comprehensive care for terminal cancer patients. Increased attention is being paid to the futility of life-sustaining treatment and high cost of management of terminal cancer patients Materials and Methods : This study was performed on cancer patients, registered in 1996 Central Cancer Registry, who were as insured person of Korea Medical Insurance and died from January 1997 to June 1998. We studied the day of medical care and medical expenses of 151 cancer patients evaluable. Results : The mean day of inpatient care was 39 days, and the mean days of outpatient care was 14 days in study subjects. Mean expenses per day of medical care, day of inpatient, and day of outpatients care were 85,392 won, 105,908 won, and 40,173 won. 95% of medical expenses is paid to the general hospital, and 85% of medical expenses was paid for inpatient care. About half of all medical expenses in th last 6 months were incurred in the last 60 days of life, and about 30 percent were incurred in the last 30 days. Expenses of outpatients care increased between 6 month and 3 months, after which they decreased. Expenses of inpatients care increased during all last 6months Conclusion : The distribution or medical expenses during the last 6 months in our study is similar to the distribution of American Medicare costs. We need to study medical expenses during the last year of life with large scale and details in order to develop the plan about the management of terminal cancer patient.

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Analysis of the Perception of Hospice and Narcotic Analgesics by Family Caregivers of Terminal Cancer Patient (말기 암 환자 보호자의 호스피스와 마약성 진통제에 대한 인식도 분석)

  • Kwak, Kyung-Sook;Chun, Sung-Ho;Ha, Jung-Ok;Lee, Kyung-Hee
    • Journal of Hospice and Palliative Care
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    • v.9 no.2
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    • pp.106-111
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    • 2006
  • Purpose: In terminal cancer patients, pain control with narcotic analgesics and supportive care by hospice are very useful treatment modality. However, many patients and their caregivers are poorly compliant in using narcotic analgesics for fear of addiction and tolerance. And also many patients and family caregivers are reluctant to accept hospice, presuming that hospice means patient's condition is no longer reversible and progressively deteriorating. The purpose of this study was to evaluate and analyze the perception of using narcotic analgesics and hospice by family caregivers of terminal cancer patients who play a critical role in health care in Korean culture. Methods: A total of 54 terminal ranter patient's family caregivers participated in this study. Questionnaire consisted of 15 questions about narcotic analgesics and hospice. Results: The study revealed following results. 1) family caregivers who are not aware of hospice are more than half (56.7%). 2) 81.8% of family caregivers agreed that hospice care is beneficial to terminal cancer patients. 3) 85.1% of family caregivers were under financial burden. 4) 83.2% of patient complained pain in 24 hours. 3) while 88.5% of family caregivers believed that narcotic analgesics can control pair, 79.1% and 79.6% of them also believed that use of narcotic analgesics would result in addiction and tolerance, respectively. Conclusion: There still exist barriers to family caregivers in using narcotic analgesics for pain control. And also, terminal cancer patient's family caregivers have poor information about hospice. Therefore, educational intervention about narcotic analgesics by pharmacist and doctors are needed for proper pain control for terminal ranter patients. In addition, more precise information about hospice care should be provided for terminal cancer patients and their family caregivers.

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Prediction of Life Expectancy for Terminally Ill Cancer Patients Based on Clinical Parameters (말기 암 환자에서 임상변수를 이용한 생존 기간 예측)

  • Yeom, Chang-Hwan;Choi, Youn-Seon;Hong, Young-Seon;Park, Yong-Gyu;Lee, Hye-Ree
    • Journal of Hospice and Palliative Care
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    • v.5 no.2
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    • pp.111-124
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    • 2002
  • Purpose : Although the average life expectancy has increased due to advances in medicine, mortality due to cancer is on an increasing trend. Consequently, the number of terminally ill cancer patients is also on the rise. Predicting the survival period is an important issue in the treatment of terminally ill cancer patients since the choice of treatment would vary significantly by the patents, their families, and physicians according to the expected survival. Therefore, we investigated the prognostic factors for increased mortality risk in terminally ill cancer patients to help treat these patients by predicting the survival period. Methods : We investigated 31 clinical parameters in 157 terminally ill cancer patients admitted to in the Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital between July 1, 2000 and August 31, 2001. We confirmed the patients' survival as of October 31, 2001 based on medical records and personal data. The survival rates and median survival times were estimated by the Kaplan-Meier method and Log-rank test was used to compare the differences between the survival rates according to each clinical parameter. Cox's proportional hazard model was used to determine the most predictive subset from the prognostic factors among many clinical parameters which affect the risk of death. We predicted the mean, median, the first quartile value and third quartile value of the expected lifetimes by Weibull proportional hazard regression model. Results : Out of 157 patients, 79 were male (50.3%). The mean age was $65.1{\pm}13.0$ years in males and was $64.3{\pm}13.7$ years in females. The most prevalent cancer was gastric cancer (36 patients, 22.9%), followed by lung cancer (27, 17.2%), and cervical cancer (20, 12.7%). The survival time decreased with to the following factors; mental change, anorexia, hypotension, poor performance status, leukocytosis, neutrophilia, elevated serum creatinine level, hypoalbuminemia, hyperbilirubinemia, elevated SGPT, prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (aPTT), hyponatremia, and hyperkalemia. Among these factors, poor performance status, neutrophilia, prolonged PT and aPTT were significant prognostic factors of death risk in these patients according to the results of Cox's proportional hazard model. We predicted that the median life expectancy was 3.0 days when all of the above 4 factors were present, $5.7{\sim}8.2$ days when 3 of these 4 factors were present, $11.4{\sim}20.0$ days when 2 of the 4 were present, and $27.9{\sim}40.0$ when 1 of the 4 was present, and 77 days when none of these 4 factors were present. Conclusions : In terminally ill cancer patients, we found that the prognostic factors related to reduced survival time were poor performance status, neutrophilia, prolonged PT and prolonged am. The four prognostic factors enabled the prediction of life expectancy in terminally ill cancer patients.

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A Clinical Observation of Oriental Medicine-Based Long Care for Terminal Rectal Cancer Patient with Multiple Metastasis

  • Bang, Sun-Hwi;Son, Chang-Gue
    • The Journal of Internal Korean Medicine
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    • v.29 no.3
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    • pp.567-573
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    • 2008
  • Cancer is now the leading fatal disease in every developed country. Due to very low efficiency of conventional cancer therapeutics and important aspect of quality of life (QOL), complementary/alternative medicine (CAM) has been accepted worldwide, especially by late-staged cancer patients. Oriental medicine traditionally has stressed not only the tumor itself but the body having cancer, improving cancer-related immunity and extending survival period. Herein, we report one case of a terminal staged rectal cancer patient having spread-metastasis but showing a meaningful clinical course of around four years with Oriental medicine therapies. This study aimed to report the clinical capacity of Oriental medicine for patients with cancerous disease, to help development of Oriental medicine-derived anticancer treatments.

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Development of a CD Program Applied Logotherapy for Psycho.Spiritual Care of Late Adolescents with Terminal Cancer (청소년 후기 말기 암 환자의 정서적.영적 돌봄을 위한 의미요법 CD 프로그램 개발)

  • Kang, Kyung-Ah;Kim, Shin-Jeong;Song, Mi-Kyung
    • Journal of Hospice and Palliative Care
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    • v.12 no.2
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    • pp.61-71
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    • 2009
  • Purpose: The purpose of this study was to develop a CD program of applied logotherapy for psycho spiritual care of late adolescents with terminal cancer. Methods: Keller & Song's ARCS theory and a model for developing learning materials was applied to develop this program composed four distinct phases: planning, designing, developing, and evaluation stages. Results: This program was entitled 'Finding meaning in my life' and consisted of 5 sessions and its educational contents were made up as follows: "First Secret" is 'learning three natures of the human mind', "Second Secret" is 'learning creative values first method to find meaning of life', "Third Secret" is 'learning experiential value as second method to find meaning of life', "Fourth Secret" is 'learning attitudinal value as third method to find meaning of life', and "Fifth Secret" is 'Becoming the master of my life'. The sub-menu was made up of 'Beginning', 'Opening mind', 'Learning'. 'Laughing Song', 'Experiencing'. Conclusion: This CD program applied logotherapy with flash animation technique as an emotional and spiritual nursing intervention program for easier and more scientific application in pediatric oncology and hospice care area.

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Antibiotics Use in Infected Patients with Terminal Stage of Cancer - Based on Seminar of Korean Family Medicine Palliative Medicine Research Group - (말기 암 환자에서 감염에 대한 항생제 사용 - 대한가정의학회 완화의학연구회 세미나에 기초한 -)

  • Jeong, Hwee-Soo;Kim, Dae-Young;Song, Kyoung-Po;Korean Family Medicine Palliative Medicine Research Group, Korean Family Medicine Palliative Medicine Research Group;Suh, Sang-Yeon
    • Journal of Hospice and Palliative Care
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    • v.10 no.1
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    • pp.43-47
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    • 2007
  • Decision-making of antibiotics use in infected patients with terminal stage of cancer was difficult for physicians, because of responsibility of solving a medical problem and burden on patients distressed by worthless life expansion. Korean Family Medicine Palliative Medicine Research Group discussed this subject using a case of a 65 year-old male having terminal stage of sigmoid colon cancer with extended cutaneous infection who was treated local antibiotics, improved but expired at the 12th hospital day. We reviewed related literatures and proposed a guide for antibiotics use in inferred patients with terminal stage of cancer. Antibiotics should be used for symptom control as major indication, especially when patients suffered from urinary symptoms. Appropriate antibiotics should be chosen based or sensitivity test. the most important considering factor should be patient and family members' wish about antibiotics use.

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The Effects of Depression on the Survival of Terminal Cancer Patients in a Palliative Care Unit (완화병동에 입원한 말기 암 환자에서 우울증이 생존기간에 미치는 영향)

  • Son, Ji-Sung;Kim, Won-Hyoung;Lee, Jeong-Seop;Kim, Hye-Young;Kang, Sang-Gu;Choi, Seo-Hyeon;Bae, Jae-Nam
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.2
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    • pp.138-146
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    • 2019
  • Objectives : This study examined the association between depression and survival time in terminal cancer patients admitted to the palliative care unit. Emotional problems are important for terminal cancer patients in the palliative care unit, and evaluation of patients' depression plays an important role in treatment planning. Methods : From October 2015 to August 2018, we conducted a retrospective study of 291 terminal cancer patients admitted to a palliative care unit at a university hospital and evaluated depression with PHQ-9 at admission. Of the 291 patients, 146 (50.2%) completed PHQ-9 but 145 (49.8%) were not evaluated due to loss of consciousness or rejection. Results : 4-week survival rate in the Kaplan-Meier survival analysis were 45.4% in the non-depressed group (PHQ-9<10) and 18.7% in the depressed group (PHQ-9≥10). According to the severity of depression, in the Cox proportional hazard model, the risk of mortality in moderate, moderately sever and severe group was 2.778, 1.882 and 3.423 times higher than minimal group, respectively. Conclusions : Of the patients with terminal cancer who were admitted to the palliative care unit, the survival time was shorter in the depressed group than in the non-depressed group. Further research is needed to determine if treatment of depression increase the survival in terminal cancer patients.

Clinical Change of Terminally Ill Cancer Patients at the End-of-life Time (임종 전 말기 암 환자의 임상 증상 및 징후의 변화)

  • Koh, Su-Jin;Lee, Kyung-Shik;Hong, Yeong-Seon;Yoo, Yang-Sook;Park, Hyea-Ja
    • Journal of Hospice and Palliative Care
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    • v.11 no.2
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    • pp.99-105
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    • 2008
  • Purpose: In terminally ill cancer patients, accurate prediction of survival is necessary for clinical and ethical reasons, especially in helping to avoid harm, discomfort and inappropriate therapies and in planning specific care strategies. The aim of the study was to investigate prognostic factor of dying patients. Methods: We enrolled the terminal cancer patients from Kangnam St. Mary's Hospital from 2004 until their death. We observed symptoms shown in dying patients and assess 17 common symptoms shown in terminally ill cancer patients, performance status, pain and analgesic use. Results: Average period from hospitalization to death was 11.7 days. The most important prognostic factor is performance status (KPS), average KPS at enrollment is 48% and at last 48 hours is 25%. Physical symptoms that have significant prognostic importance are poor oral intake, weakness, constipation, decreased Karnofsky performance status, bed sore, edema, jaundice, dry mouth, dyspnea. Dying patients showed markedly decreased systolic blood pressure, cyanosis, drowsiness, abnormal respiration, death rattle frequently at 48 hours before death. Conclusion: If we assess the symptoms more carefully, we can predict the more accurate prognosis. The communication about the prognostic information will influence the personal therapeutic decision and specific care planning.

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