• 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.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.188-193
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• 2017

Purpose: There has been very little study on the associations between patient's symptoms themselves and family caregiver (FC)'s depression in the palliative phase. This cross-sectional study was to investigate the relationship between symptom features of terminally ill cancer patients and their FC's depression. Methods: We performed a multicenter survey using the MD Anderson symptom inventory and the Hospital Anxiety and Depression Scale. A total of 293 patient-FC pairs were recruited from seven tertiary medical centers. A multivariate regression analysis was applied for identifying the relevant factors associated with FC depression and for estimating adjusted depression score of FCs. Results: Among various psychosocial factors, low FC quality of life, low social support, spouse, and more caregiving time were significantly associated with FCs' depression. According to the presence of FCs' depression, there were significant differences in some symptom characteristics of patients. Even after adjusting for the relevant confounders, depression scores were lower in FCs caring for patients who had negative symptoms (loss of appetite, P=0.005; drowsiness, P=0.024; and dry mouth, P=0.043) than in FCs caring for patients who had not. FCs caring for patients with severe appetite loss had lower depression scores than those with not severe one (P=0.039). Conclusion: Our result suggests that patient's symptom characteristics might be helpful when evaluating a FC's depression.

• Journal of Hospice and Palliative Care
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• v.10 no.4
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• pp.190-194
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• 2007

Purpose: Individual cancer patients often experience many symptoms that impair their quality of life at the end of life. Identifying symptoms at the terminal stage of cancer patients and possible imminent death prediction by using that assessment can assist physicians and patients in preparing the 'peaceful death'. This study examines symptom experience during the last 48 hours of life of terminal cancer patients, and determines whether symptom experience change with proximal to death. Methods: The medical records of 89 patients who died with terminal cancer at a hospital between July 1, 2003 and March 31, 2006 were reviewed. Symptom prevalence at the last 48 hours was analyzed along with the change of symptom experience at the admission, $48{\sim}24$ hours, and $24{\sim}0$ hours before death. Results: Median age of all patients was 62 years old (range $16{\sim}97$). During the last 48 hours, symptom prevalence was described as follows; unclear consciousness (57%), pain (30%), fever (22%), and dyspnea (19%). According to the primary site, unclear consciousness was notified the most frequent symptom, but fever was relatively high prevalence in patients of biliary origin cancer rather than other site cancer (P=0.012). As death was Impending, the prevalence of poor appetite and general weakness were decreased, while that of unclear consciousness was increased, which were all statistically significant (P < 0.05). Conclusion: The presence of unclear consciousness could be regarded as the symptom indicator as imminent death of terminal canter patients.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.179-188
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• 2004

Purpose: The purpose of this study was to investigate the degree of fatigue and its related factors in cancer patients during chemotherapy. Methods: The subjects of this study consisted of 90 patients over 20 years old who were receiving chemotherapy at the injection room of the o.p.d. and ward admission care unit in a University hospital located in Gwang-ju city and data were collected from August 8th to October 2nd, 2002. Collected data were analysed using SPSS v 10.0. to obtain summary statistics for the descriptive analysis, t-test, ANOVA, pearson correlation, and multiple regression. Results: 1. Fatigue of the subjects was significantly correlated with physical distress score. and 6 items of subscale those were nausea, vomiting, anorexia, pain, and immobility, showed statistically significant correlation. 2. Fatigue of the subjects showed statistically significant differences according to a nap satisfaction. Fatigue of the subjects was significantly correlated with mood state, Also, all 5 items of subscale, which are those were anxiety, confusion, depression, energy, and anger showed statistically significant correlations. 3. Fatigue of the subjects showed statistically significant differences according to metastasis, chemotherapy cycle, post operation existence, post radiation therapy existence. There were significant negative correlation between fatigue and hematocrit and fatigue and weight change. There was no significant correlation between fatigue and spiritual well-being state. With the result to multiple regression, Immobility, Anorexia, Anger explained fatigue by, pain, and immobility showed statistically significant correlation.

• Journal of Hospice and Palliative Care
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• v.21 no.4
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• pp.158-162
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• 2018

Breast cancer related lymphedema (BCRL) is one of the most intractable complications after surgery. Patients suffer from physical impairment, as well as psychological depression. Moreover, a recent study revealed that cellulitis significantly increased the risk of BCRL, and cellulitis has been suggested as a risk factor of BCRL development. We describe a patient treated with stellate ganglion blocks (SGBs) without steroid for relief of symptoms and reduction of the arm circumference of breast cancer-related infectious lymphedema in a month. We measured the arm circumference at four locations; 10 cm and 5 cm above and below the elbow crease, numeric rating scale (NRS) score, lymphedema and breast cancer questionnaire (LBCQ) score on every visit to the pain clinic. A serial decrease of the arm circumference and pain score were observed after second injection. In the middle of the process, cellulitis recurred, we performed successive SGBs to treat infectious lymphedema. The patient was satisfied with the relieved pain and swelling, especially with improved shoulder range of motion as it contributes to better quality of life. This case describes the effects of SGB for infectious BCRL patients. SGB could be an alternative or ancillary treatment for infectious BCRL patients.

• Journal of Hospice and Palliative Care
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• v.17 no.4
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• pp.207-215
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• 2014

Multiple bone metastases are common manifestation of many malignant tumors such as lung cancer, breast cancer, prostate cancer and renal cell carcinoma. Bone metastasis is secondary cancer in the bone, and it can lead to bone pain, fracture, and instability of the weight bearing bones, all of which may profoundly reduce physical activity and life quality. Treatment for bone metastasis is determined by multiple factors including pathology, performance status, involved site, and neurologic status. Treatment strategies for bone metastasis are analgesics, surgery, chemotherapy and radiotherapy. External beam radiotherapy has traditionally been an effective palliative treatment for localized painful bone metastasis. However, in some cases such as multiple bone metastases, especially osteoblastic bone metastasis originated from breast or prostate cancer, the radiopharmaceutical therapy using $^{89}Sr$, $^{186}Re$, $^{188}Re$, $^{153}Sm$ and $^{117m}Sn$ are also useful treatment option because of administrative simplicity (injection), few side effects, low risk of radiation exposure and high response rate. This article offers a concise explanation of the radiopharmaceutical therapy for multiple bone metastases.

• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.56-60
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• 2009

More than 80% of cancer-related pain is pharmacologically controllable, whereas $10{\sim}20%$ of patients require interventional treatments. Neurolytic nerve block can play a major role in cancer pain treatment, and it has been proposed to prevent the development of pain and improve the quality of life of patients with cancer. If the pain is well localized and restricted to certain peripheral parts of the body, spinal peripheral or sympathetic nerve blocks may result in excellent therapeutic effects. Neurolytic sympathetic block, especially Celiac plexsus block (CPB) performed in earlier stages, is effective with successful long term results. However, selection of patients is critical for succeful outcomes. Neurolytic plexus block significantly improves the quality of life of patients and reduces abdominal and pelvic cancer pain, analgesic consumption and adverse opioids-related side effects. Interventional pain management should be considered at earlier stages to provide patients with the best quality of life possible.

• Journal of Hospice and Palliative Care
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• v.16 no.3
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• pp.145-154
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• 2013

This study was performed to evaluate the existing pain assessment methods including the tools developed for use with nonverbal older adults with dementia, and to suggest recommendations to clinicians based on the evaluations. Computerized literature searches published after year 2000 using databases - Google scholar, RISS, KoreaMed, Medline, ScienceDirect, CINAHL - were done. Searching keywords were 'pain', 'pain assessment', and 'cognitive impairment/dementia'. The pain assessments for non-communicative dementia patients who are unable to self-report their pains are often made using the assessment tools relying on the observation of behavioral indicators or alternatively the strategy of surrogate reporting. While several tools in English version and only one in Korean are suggested for the pain assessments based on the observation of behavioral indicators, none are commonly used. In this review, we selectively evaluated those tools known to show relatively higher degree of validity and reliability for nonverbal older adults with dementia, namely, CNPI, DOLOPLUS 2, PACSLAC, PAINAD, and DS-DAT. It is hoped that the present review of selected tools for assessing pain in those vulnerable population and the general recommendations given be useful for clinicians in their palliative care practice. And future studies should focus on enriching the validation of the useful tools used to observe the nonverbal patient's behavioral indicators for pain in Korean.

• 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.

• Journal of Hospice and Palliative Care
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• v.8 no.2
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• pp.156-162
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• 2005

Purpose: Lymphedema is edema developing mainly in the arms and legs due to an abnormal lymphatic system, over one hundred millions of patient worldwide suffer from it. At present, prevention is the best treatment. Thus, It is important to know which patient are more pone to develop it in order to prevent it. By evaluating the risk factor for lymphedema, we intended to find the effective prevention. Methods: We have investigated that outpatients who chiefly complained of lymphedema visited the lymphedema clinic at one university hospital from September 1 in 2003 to August 31 in 2005. We evaluated the risk factor for lymphedema by questionnaires. Questionnaire consists of demographic data, disease factor, treatment factor, posttreatment factor. We evaluated the correlation between lymphedema with each factor. Results: The total number of patients was 50, 19 patients with breast cancer and 31 patients with cervical cancer. In terms of stages of edema, 12 patients were below stage 1 and 38 patients were above stage 2. The incidence of lymphangitis was more frequent, more obese and the impairment of the site of edema site more severe, the stage of cancer was higher in the patients higher than stage 2 than in the patients below stage 1 (P>0.05). Conclusion: Lymphedema is more severe when the cancer stage in higher, accompanying more frequent infections, more obesity and more impairment at the site of edema site. Above all, cancer stage and the impairment of edema site are impossible to correct but obesity and infection may be corrected. Therefore we speculate that we are able to protect the aggravation of edema by weight reduction and infection control.