• Asian Pacific Journal of Cancer Prevention
• /
• 제15권14호
• /
• pp.5787-5791
• /
• 2014

Background: With increasing survival periods and diversification of treatment methods, treatment of critically ill cancer patients has become an important factor influencing patient prognosis. Patients with cancer are at high risk of infections and subsequent complications. This study investigated the incidence and factors contributing to the development of ventilator-associated pneumonia (VAP). Materials and Methods: This retrospective study investigated the incidence of VAP and factors leading to infection in patients admitted to the intensive care unit (ICU) of a cancer center from January 1, 2012 to December 31, 2013. Results: The incidence of VAP was 2.13 cases per 1,000 days of intubation, and 13 of 288 patients (4.5%) developed VAP. Lung cancer was the most common cancer associated with VAP (N=7, 53.9%), and longer hospital stays and intubation were associated with increased VAP incidence. In the group using a "ventilator bundle," the incidence was 1.14 cases per 1,000 days compared to 2.89 cases per 1,000 days without its use; however, this difference was not statistically significant (p=0.158). Age (${\geq}65$, OR=5.56, 95% confidence interval [CI]=1.29-23.95), surgery (OR=3.78, 95%CI=1.05-13.78), and tracheotomy (OR=4.46, 95%CI=1.00-19.85) were significant VAP risk factors. The most common causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (N=4, 30.8% each), followed by Acinetobacter baumannii and Candida albicans (N=2, 15.4% each). Conclusions: The incidence of pneumonia among critically ill cancer patients is highest in those with lung cancer, but lower than among non-cancer patients. The length of hospital stay and time on mechanical ventilation are important risk factors for development of VAP. Although not statistically significant, "ventilator bundle" care is an effective intervention that delays or reduces incidence of VAP. Major risk factors for VAP include age (${\geq}65$ years), surgery, and tracheostomy, while fungi, gram-negative bacteria, and multidrug-resistant organisms were identified as the major causative pathogens of VAP in this study.

• Journal of Hospice and Palliative Care
• /
• 제15권4호
• /
• pp.205-211
• /
• 2012

목적: 본 연구는 암병동 간호사의 임종간호에 따른 스트레스와 인지정도 및 교육요구도를 파악하고자 수행되었다. 방법: 본 연구는 서울과 경기도에 소재한 4개 종합병원 암병동에 근무하는 간호사 151명이었으며, 자가보고식 설문지로 자료를 수집하였다. 스트레스 측정도구는 40문항, 인지정도와 교육요구도 측정도구는 각각 27문항으로 구성되었으며, 수집된 자료는 서술적 통계방법으로 분석하였다. 결과: 암병동 간호사의 임종간호에 따른 스트레스 정도는 5점 만점에 평균 3.96점으로 높았으며, 영역별 스트레스는 업무량 과중이 가장 높았고, 임종환자에게 시간할애의 어려움, 임종환자와의 인간적 갈등의 순이었다. 임종간호에 대한 인지정도는 5점 만점에 평균 2.64점이었으며, 인지정도가 가장 낮은 문항은 죽음에 대한 아동의 이해였으며, 법적 측면, 진실통고에 대한 윤리적 근거의 순이었다. 임종간호에 대한 교육요구도는 5점 만점에 평균 3.25점으로 높았으며, 스트레스와 소진관리, 임종 전 관리, 의사소통 방법, 임종준비에 대한 의사소통, 마약성 진통제 관리에 대한 교육요구도가 높았다. 간호사의 일반적 특성에 따른 임종간호에 대한 스트레스는 유의한 차이가 없었으며, 임상경력이 길수록, 호스피스 교육기간이 길수록, 임종간호 횟수가 많을수록 임종간호에 대한 인지정도가 높았고, 암병동 근무기간이 길수록 임종간호에 대한 교육요구도가 높음을 알 수 있었다. 결론: 본 연구의 결과에서 임종간호에 대한 스트레스가 높고, 인지정도는 낮으며, 교육요구도가 높았던 내용을 토대로 하여 교육 프로그램을 개발, 적용하는 것이 필요하다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권19호
• /
• pp.8127-8134
• /
• 2014

Background: Qigong is highly favoured among Asian breast cancer survivors for enhancing health. This study examined the hypothesis that quality of life (QoL) in the Qigong group is better than the placebo (aerobic) or usual care group. Materials and Methods: A total of 197 participants were randomly assigned to either the 8-week Kuala Lumpur Qigong Trial or control groups in 2010-2011. Measurement taken at baseline and post-intervention included QoL, distress and fatigue. Analysis of covariance (ANCOVA) and Kruskal Wallis were used to examine for differences between groups in the measurements. Results: There were 95 consenting participants in this 8week trial. The adherence rates were 63% for Qigong and 65% for the placebo group. The Qigong group showed significant marginal improvement in Quality of life scores compared to placebo (mean difference=7.3 unit; p=0.036), compared to usual care (mean difference=6.7 unit; p=0.048) on Functional Assessment Cancer Therapy-Breast measure. There were no significant changes between the placebo and usual care groups in fatigue or distress at post intervention (8-week). Conclusions: Cancer survivors who participated in the Qigong intervention showed slightly better QOL. Follow up studies are greatly needed to evaluate which subgroups may best benefit from Qigong. With a steep rise of cancer survivors, there is an urgent need to explore and engage more cultural means of physical activity to fight side effects of treatment and for cancer control in developing countries.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권12호
• /
• pp.4903-4907
• /
• 2014

Background: This study aimed to identify factors associated with women's decisions to attend cervical cancer screening and to explore those linked with intention to attend in the coming year and to continue regular screening. Materials and Methods: A community based case-control study was conducted among woman 30-60 years of age in catchment area of Chatapadung Contracting Medical Unit (CCMU), networking of Khon Kaen Center Hospital, Thailand. Self-administered questionnaires were used to collect data, and in-depth interviews were then performed to explore in greater detail. Results: There were 195 participants. Only one third (32.3 %) had been screened for cervical cancer within the past 5 years. Some 67.7% reported that they had not been screened because they had no abnormal symptoms, single marital status, and no children. Only 10.6% of those never had screening intent to be screened within the next 12 months. High family income (adjusted OR=2.16, 95%CI=1.13-4.14), good attitude towards a Pap test (OR=1.87, 95%CI=1.09-4.23), and having received a recommendation from health care providers were important factors associated with decisions to attend cervical cancer screening (OR=1.73, 95%CI=1.01-4.63). From in-depth interviews, there were five reasons of their decisions to attend cervical cancer screening including yearly check-up, postpartum check-up, having abnormal symptom, encouragement by health care providers, and request from workplace. Conclusions: High family income, good attitude towards a Pap test, and receiving proper recommendation by health care providers, were important factors associated with decision to have cervical cancer screening among women 30-60 years old. Trying to enhance these factors and reduce barriers regarding screening, may increase the coverage rate for cervical cancer screening in Thailand.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권8호
• /
• pp.3429-3434
• /
• 2014

Aims: To identify the psychosocial adjustment of Turkish patients with breast cancer and the effects of perceived social support on their adjustment. Materials and Methods: The sample comprised 100 volunteering patients diagnosed with breast cancer in the last six months reporting to the Outpatient Chemotherapy Unit at the Medical Faculty Hospital in northern Turkey. The data for the study were collected through the Descriptive Information Form, the Psychosocial Adjustment to Illness Scale-Self-reflection (PAIS-SR) and the Cancer-Specific Social Support Scale and analyzed via SPSS 16.0 for Windows. Descriptive statistics, Chi square test, ANOVA and correlation were used to evaluate data. Results: There was a negative significant correlation between mean scores in the sub-scales of the social support scale and the ones in the sub-scales of the psychosocial adjustment to illness scale (p<0.05). Similarly, there was a negative significant correlation between confidence support and health care orientation as well as adjustment to social environment. Likewise, emotional support was in a negative significant correlation with health care orientation, adjustment to domestic environment, extended family relationships and adjustment to social environment. Conclusions: It was concluded that social support for patients with breast cancer had an influence on their psychosocial adjustment to illness. Holistic care should be given to breast cancer patients by oncology nurses especially in the first six months of treatment. It could be concluded that patients should be accompanied by their family/relatives in treatment and care following their diagnosis with breast cancer, that their family should be made more aware of the fact that the patient should be physically and psychologically supported, that patients with breast cancer should be provided with domiciliary care, and that they should be encouraged to participate in social support groups.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권2호
• /
• pp.739-742
• /
• 2013

Background: This study was to evaluate the survival of patients with pleural and intraperitoneal malignant mesothelioma and to investigate the efficacy of chemotherapy (CT) as well as radiotherapy (RTH) and surgery compared to best supportive care (BSC). Materials and Methods: Forty patients with malignant mesothelioma (38 with pleural and 2 with intraperitoneal) were enrolled. Twenty seven patients underwent (CT) chemotherapy of which 2 also received (RTH) and surgery was only for biopsy in 15/40. Combination chemotherapy included cisplatin-gemcitabine, cisplatin-navelbine and cisplatin (or carboplatin) with premetrexed. Thirteen patients received only best supportive care. Results: A total of 12 (30%) patients were male, and 28 (70%) female. Median age was 54.0 years and the male/female ratio was 1/2.33 (P=0.210). Residential exposure played a major role in two regions, Helwan and Shoubra, in 20% and 15%, respectively. Overall mean survival time was $13.9{\pm}2.29$ months. That for patients who had received best supportive care was $7.57{\pm}1.85$ months, for chemotherapy was $16.5{\pm}3.20$ months, and multimodality treatment regimen $27{\pm}21.0$ months (P=0.028). Kaplan-Meier survival did not significantly vary for sex, residence and the pathological types epithelial, mixed and sarcomatous. The median survival for performance status and treatment modalities was significant (P=0.001 and 0.028). Best supportive care using opioids with a mean dose of 147.1 mg (range 0-1680) of morphine sulphate produced good subjective response and reasonable quality of life but did not affect survival. Conclusions: We conclude that CT prolongs survival compared to BSC in patients with malignant mesothelioma. Moreover, using escalating doses of opioids provides good pain relief and subjective responses.

• Journal of Hospice and Palliative Care
• /
• 제18권4호
• /
• pp.322-328
• /
• 2015

목적: 의학의 발달로 인구가 고령화됨에 따라, 사망의 원인이 되는 질환 및 동반질환의 유병기간은 함께 증가하고 있으며, 고령환자의 임종기 관리에 대한 연구의 필요성도 더욱 증가하고 있다. 그러나 임종기 치료 강도에 대한 국내연구는 암환자에 국한되어 있으며, 비-암환자의 임종기 치료 강도에 대한 국내 연구는 없었다. 그래서 본 연구는 암환자와 비-암환자의 임종기 치료 강도에 대해 연구하였다. 방법: 경희대학교병원에서 2014년 12월 1일부터 2015년 3월 31일까지 4개월간 사망자의 의무기록을 조사하여 암환자와 비-암환자의 기본 인구학적 정보, 임종기 치료 강도, 심폐소생술 금지 요청서 경향 등에 대해 비교 연구하였다. 결과: 비-암환자가 암환자에 비해 나이가 많았음에도 불구하고(73.7 vs. 67.4, P=0.001), 중환자실 치료(87.4% vs. 36.0%, P<0.001), 기도 삽관 및 기계 호흡(63.2% vs. 24%, P<0.001), 응급 투석(28.7% vs. 8.0%, P=0.001)을 더 많이 받은 것으로 나타났으며, 나이(P=0.038), 암의 유병 여부(P<0.001)가 임종기 침습적 치료에 영향을 미치는 인자로 나타났다. 결론: 임종기 치료 강도는 비-암환자에서 더 높은 것으로 나타났으며, 나이와 암의 유병여부가 임종기 치료 강도를 결정하는 중요한 인자였다.

• Journal of Hospice and Palliative Care
• /
• 제24권4호
• /
• pp.254-260
• /
• 2021

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

• Journal of Hospice and Palliative Care
• /
• 제8권1호
• /
• pp.30-36
• /
• 2005

목적: 치료에 관계없이 뇌전이는 예후가 불량하다. 본 연구는 뇌 전이로 호스피스 완화의료를 받았던 환자를 대상으로 적절한 돌봄을 받았는지를 알아보고 임상적인 특성을 알아보고자 하였다. 방법: 2003년 3월부터 2005년 3월까지 본원의 호스피스 병동에서 뇌전이로 호스피스 완화의료를 받았던 40명의 말기 암환자를 대상으로 후향적으로 의무기록을 조사하였다. 결과: 대상자 중 남자 20명(50%), 여자 20명(50%)이며 연령의 중간값은 64세 였다. 가장 많은 암은 폐암으로 22명(55%)이고 다음으로 위암 5명(13%), 유방암 3명(8%) 순서였다. 원발암에 대한 전치료는 전혀 치료를 하지 않은 환자가 16명(40%)이고 항암치료는 20명(50%)를 받았다. 뇌전이 때의 증상은 두통 12명(30%), 의식변화 10명(25%), 국소 약화 9명(23%), 경련 4명(10%) 순서였다. 호스피스 병동의 입원 이유는 의식변화가 13명(33%)으로 가장 많았고 통증이 9명(23%)였다. 호스피스 완화의료를 받게 된 이유로 환자와 가족이 원한 경우가 14명(35%), 의사가 의뢰한 경우가 1명, 그 나머지 25명(62%)은 본원에서 보존적인 요법을 받던 중 호스피스 완화의료를 받게 된 경우이다. 호스피스 병동에서 입원기간의 중간값은 19일이었으며 호스피스 완화의료로 전원 후 생존기간의 중간값은 41일이었다. 뇌전이 진단 후 중간 생존기간은 87일이었다. 결론: 전이성 뇌암 환자의 호스피스 완화의료의 기간은 환자를 돌보기에는 충분하지 못하였다. 효과적인 호스피스 완화의료를 위해서는 의사와 환자, 가족에 대한 지속적인 호스피스 완화의료 교육과 홍보가 필요하리라고 생각된다.

• Journal of Hospice and Palliative Care
• /
• 제21권4호
• /
• pp.137-143
• /
• 2018

목적: 가족구성의 특성이 건강에 미치는 영향에 관한 다양한 실증 연구들이 꾸준히 보고되어 왔다. 우리나라에 말기암환자의 가족구성의 특성에 대한 연구가 부족하여 이에 본 연구에서는 호스피스 병동에 입원하고, 사망한 말기암환자의 가족구성의 특징을 파악하고 호스피스 완화의료 이용과의 연관성에 대해 알아보고자 하였다. 방법: 2009년 1월부터 2014년 3월까지 일개 호스피스 병동에 입원 후 48시간 후 사망한 말기암환자의 134명의 의무기록을 후향적으로 분석하였다. 환자들의 인구사회학적 및 임상적인 특성을 확인하여 동거배우자 유무에 따른 차이를 살펴보았으며, 암 진단 후 호스피스 입원까지 기간(개월) 및 입원 후 사망까지의 생존기간(일)을 산출하여 가족구성과의 연관성을 알아보았다. 결과: 암 진단 후 호스피스 입원까지 기간의 중앙값 13개월을 기준으로 나눈 Group B(13개월 이후)에서 배우자 동거군의 비율이 통계적으로 유의하게 높았다(P<0.01). 주의사결정권자는 Group A에서는 자녀인 경우가 59.0%, B에서는 배우자가 52.9%로 많았다(P=0.04). 호스피스 입원 후 사망까지 기간의 중앙값 20일을 기준으로 Group 1(20일 미만)과 Group 2(20일 이상)로 나누어 살펴보았을 때 두 군 간의 가족구성의 특징은 통계적으로 유의한 차이가 없었다. 결론: 가족구성의 특성 중 배우자의 유무가 말기암환자의 호스피스 완화의료 이용 시기에 영향을 미치는 요인으로 나타났으며, 말기암 환자와 가족의 보다 더 효율적이고 적절한 호스피스 완화의료 이용을 위해 가족 구성의 특성을 파악하는 것이 도움이 될 수 있다.