• Journal of Hospice and Palliative Care
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• 제19권1호
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• pp.70-75
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• 2016

완치가 불가능한 진행성 암환자에게 시행되는 완화적 항암치료의 목표는 생명연장과 삶의 질 향상이다. 그러나 완화적 항암치료는 상당한 독성을 가질 수도 있기 때문에 의사는 항암제 투여의 중단시점에 대해, 특히 생의 마지막 몇 달 내 기간에는, 항상 지속적으로 평가해야 한다. 완화적 항암치료를 중단하는 분명한 권고안은 없지만 진행성 암환자 돌봄의 질 향상을 위해 해결해야 할 쟁점이다. 저자는 완화적 항암치료를 투여 받았던 진행성 대장암, 비소세포 폐암 환자 두 증례를 기술하였다. 두 증례 모두 완화적 항암치료의 중단에 대한 공동 결정 하에 현재까지 최대한의 증상 치료를 시행하고 있다. 두 증례와 최근까지의 문헌고찰을 통해 국내 호스피스 완화의료가 확립 되어가는 시점에서, 항암치료의 중단 시점과 결정에 대해 부각시키는 바이다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.695-701
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• 2014

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the quality of life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliative treatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliative treatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlations with patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form) tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment, recruited into the study after informed consent using convenient sampling. Results showed that highest satisfaction were observed in Communication Aspect ($50.6{\pm}9.07$) and the least in General Satisfaction ($26.4{\pm}5.90$). The Mental Component Summary ($44.9{\pm}6.84$) scored higher when compared with the Physical Component Summary ($42.2{\pm}7.91$). In this study, we found that patient satisfaction was strongly associated with good quality of life among cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation was found in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poor negative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feeling at peace and having a sense of meaning in life were more important to patients than being active or achieving good physical comfort. More studyis needed to investigate patients who score poorly on physical and mental component aspects to understand their needs in order to achieve better cancer care.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1039-1049
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• 2018

The populations of Asian countries are expected to age rapidly in the near future, with a dramatic increase in the number of heart failure (HF) patients also anticipated. The need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized in aging societies. However, palliative care and active treatment for HF are not mutually exclusive, and palliative care should be provided to reduce suffering occurring at any stage of symptomatic HF after the point of diagnosis. HF patients are at high risk of sudden cardiac death from the early stages of the disease onwards. The decision of whether to perform cardiopulmonary resuscitation in the event of an emergency is challenging, especially in elderly HF patients, because of the difficulty in accurately predicting the prognosis of the condition. Furthermore, advanced HF patients are often fitted with a device, and device deactivation at the end of life is a complicated process. Treatment strategies should thus be discussed by multi-disciplinary teams, including palliative experts, and should consider patient directives to address the problems discussed above. Open communication with the HF patient regarding the expected prognosis, course, and treatment options will serve to support the patient and aid in future planning.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.6919-6922
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• 2015

Background: The treatment selection for the oral squamous cell carcinoma remains controversial. Radiation therapy or surgical excision of the lesion can be applied as the sole treatment or it can be used in combination with other treatment modalities. Radiotherapy is considered to be the safest of all the treatment modalities and can be used in several situations for oral and oropharyngeal cancers. The aim of this study was to evaluate the survival outcome differences in patients treated with radical and palliative radiotherapy as the primary treatment modality. Materials and Methods: The study included a total of 47 patients with oral cancer reporting to our hospital between years 2009 to 2010. The age group for the selected patients was more than 65 years, treated with radical and palliative radiotherapy with no prior surgical interventions. Patients were evaluated till Dec 2013 for overall survival time. Results: Twenty nine patients were treated with radical radiotherapy as main stay of treatment, out of which 21 died during the follow up time with median survival of $352{\pm}281.7$ days with 8 patients alive. All the 16 patients were dead who received palliative radiotherapy with a median survival time of $112{\pm}144.0$ days. Conclusions: This retrospective study showed improved overall survival time, loco regional control rates and reduced morbidity in patients treated with radical radiotherapy when compared to patients treated with palliative radiotherapy.

• Journal of Hospice and Palliative Care
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• 제3권1호
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• pp.1-3
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• 2000

• Journal of Hospice and Palliative Care
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• 제4권1호
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• pp.1-3
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• 2001

• Journal of Hospice and Palliative Care
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• 제21권3호
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• pp.92-103
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• 2018

목적: 본 연구는 병원 근무자의 연명치료 중단에 영향을 미치는 장기기증, 장기이식, 죽음, 호스피스 완화의료의 지식, 태도 및 인식을 알아본 서술적 조사연구이다. 방법: K도 J시에 위치한 일개 상급종합병원에 근무하는 228명의 대학병원 근무자를 대상으로 자가 보고식 설문지를 이용하여 자료를 수집하였다. 자료는 SPSS WIN 21.0 프로그램으로 t-test, ANOVA, and Pearson's correlation coefficient를 이용하여 분석하였다. 결과: 대상자의 생명의료윤리 의식관련 지식은 연령, 학력, 직종, 근무부서, 생명의료윤리 교육유무에 따라 차이를 보였다. 뇌사 장기기증 장기이식에 대한 지식은 인체조직기증 및 이식에 대한 태도, 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식에서 유의한 양의 상관관계가 있었다. 인체조직기증 및 이식에 관한 태도는 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식, 연명치료 중단에서 유의한 상관관계가 있었고, 죽음에 대한 인식은 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식, 연명치료 중단에서 유의한 상관관계가 있었다. 호스피스 완화의료의 인식은 연명치료 중단에서 유의한 상관관계가 있었다. 연명치료 중단 태도에 영향을 주는 요인은 호스피스 병동 근무와 인체조직기증 및 이식에 관한 태도, 호스피스 완화의료의 인식으로 연명치료 중단 태도를 32.5% 설명하였다. 결론: 연명치료 중단 태도에 호스피스 병동 근무와 인체조직기증 및 이식에 관한 태도, 호스피스 완화의료 인식이 관련이 있었으며, 생명의료윤리에 기반을 둔 다양한 교육과정의 개발 및 적용에 대한 연구가 필요함을 제언한다.

• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.1-11
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• 2022

The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for end-of-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified "terminal stage." The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients' wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient's judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients' right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.

• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.42-49
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• 2022

As population aging increases the burden of cancer, the quality of death of patients with cancer is emerging as an important issue alongside their quality of life. To improve the quality of death, it is necessary to prepare for death, allowing patients to die comfortably and with dignity at the end. Considering these issues, I aim to discuss the practical aspects of notifying the patient of the terminal phase of cancer and planning for end-of-life care (i.e., advance care planning). When cancer treatment that can extend the patent's lifespan becomes difficult, the patient enters a treatment transition period. Treatment is shifted from life-prolonging care to life-enhancing care, and end-of-life care must be well planned. Medical providers often worry too much about whether the patient will be disappointed or psychologically traumatized when notified of the terminal phase of their cancer, thus delaying plans for end-of-life care. In fact, patients can accept their condition and prepare for end-of-life care better than we expect. During the treatment transition period, notification of terminal status should be given, and a well-prepared advance care plan should be established early when the patient has decision-making ability. In addition to conveying information, it is always necessary to be sensitive to whether the patient and caregiver understand the information and respond to their emotions.

• Asian Pacific Journal of Cancer Prevention
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• 제16권3호
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• pp.1255-1258
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• 2015

Background: Locally advanced head and neck cancer is generally incurable and has a short survival rate. This study aimed to evaluate symptom relief, disease response, and acute toxicity after palliative hypo-fractionated radiotherapy and long-term survival in affected patients. Materials and Methods: Between January 2011 to December 2011, 80 patients who were histopathologically diagnosed as having stage III or stage IV head and neck squamous cell carcinoma based on Eastern Cooperative Oncology Group (ECOG) performance status 1-3, were offered palliative radiotherapy (20 Gy/5Fr/5 Days). Later these patients were evaluated on 30th day after completion of treatment for disease response based on World Health Organisation (WHO) criteria and palliation of symptoms using symptomatic response grading and acute toxicities by the Radiation Therapy Oncology Group (RTOG). Many patients were given post radiation therapy (RT) palliative chemotherapy for appropriate palliative care and a few patients were selected for further curative RT. The overall survival was also evaluated among this group of patients with last follow up date of 1st May, 2014. Results: The most common presenting complaint was pain followed by dysphagia. Most patients (60-70%) had appreciable relief in their presenting symptoms. A good response was observed in the majority following palliative RT; a few patients had progressive disease and some had stable and regressed disease. None of the patients experienced radiation toxicity that required hospital admission. Almost all showed grade one and two acute skin and mucosal toxicity one month after completion of treatment. The mean survival days for patients given only hypofractionated palliative RT was 307 days, those with post palliative RT and palliative chemotherapy was 390 days and patients who went on to receive further palliative RT and curative RT dose had significantly overall survival of 582 days. Conclusions: Advanced head and neck cancer should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptable symptom relief in a great proportion of patients and should be followed by palliative chemotherapy or curative RT in suitable cases for long-term symptom-free survival.