• 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.

• Journal of Korean Public Health Nursing
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• v.4 no.1
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• pp.37-55
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• 1990

Every country in the world has been trying to expand the basic health right for the peoples as W.H.O has established the goal 'health for AU' by the year of 2000. Related to this goal, our government authority has establish the policy 'the insurance of health for all' into effect from July 198\). Recently hospitalshave been making a ceaseless effort for the plan for the rationalization of its management the academic World is making it a subject of discussion by doing the secure of manpower at a resonable level and the increase of productivity by the manpower. As a result of the efforts the study was established to secure the numbers of nursing manpower at a resonable level and use the unskilled persons at the utilizing field and seek the possible area of their activity for more efficient service through the investigation of ablity of simple nursing activities of regiestered nurses and nurse aides for rational function according to the educational levels and talents. The method of study was established by the registered nurses and nurse and nurse aides(R.N 229, N.A 226) who are working in 15 hospitals with over 200 beds. This surrey was conducted from Mar 29, 1989 to April 8, 1989. The method to test the degree of importance, difficulties, and the abillity of performance of a simple nursing activities was classified into 35 activities on the basis of references on this field. The degree of importance was composed from point l(Not so important) to 5(Very important). the degree of difficulties. was composed as follows; very easy - Point 1 very difficult and complicated - Point 5. and the ability of performance was composed from point 1 to 5. The materials gathered through the survey were analyzed with frequency, mean standard deviation, percentage. t-test, Anova, pearson's coefficient of correlation, stepwise multiple regression. factor analysis, discriminant analysis. The obtained results are summarized as follows: 1. The recognition values of the simple nursing activities of each group of registered nurse and nurse aides show; The degree of importance; 4.04 and 4.26 The degree of difficulties; 2.72 and 2.94 The ability of performance; 2.07 and 2.38 The brief summary shows there are little differences between who two groups the simple nursing activities turned out to be easy and simple work. 2. Regardless of the degree of importance, and difficulties, the ability of performance the important in fluencing of the degree of the simple nursing activities between the registered nurses and nurse aides was the order of educational level, hospital career, working career in wards and ages of the registered nurses and ages and hospital creer of nurse aides. The result was that the simple nursing activities could easily be familiar through the training of their working environment and period of experience. 3. Among the 35 simple nursing activities the items capable of resonable entrusting to the nurse aides are 5 that is helping bed-bathing, 8itz Bath, using bed pan, care while delivering patient, accompaying patient when visitor's check. There wasn't and differences between RN and nurse aides in performing the above 5 items. In anywhere. so we can say obviosuly that this nursing activities should be performed under the nursing system of which chief of nurse are supposed to supervise nurse aides as a possible function to be entrusted. In view of the above mentioned results, therefore, this partial functional job of the simple nursing activities can able be entrusted to the nurse aides through the regular training course. In case of these functional activities could be entrusted under, the responsibility of registered nurse, we can able suggest to for that there are the following advantages: 1.. In the nursing activities-affairs, the qualified guarantee of the nursing services can be kept and increased or promotoed with accommodation of the required nursing service and roles being expanded presently. 2. In the productivity of the hospital manpower, therefore, we have comt to view and consider in favourly that when an automational administration times would be come in the near future time to hospital affairs as a reality, to utilize the existing nures aides is better rather than investing so as to develop the other source manpowers or seek its for the efficient business management in the operational strategy or its policy.

• Radiation Oncology Journal
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• v.22 no.3
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• pp.192-199
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• 2004

Purpose: To determine the patterns on evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was peformed. Materials and Methods: A web-based database system for korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998$\~$1999 from 15 hospitals were reviewed. Results: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9$\%$) followed by medullary carcinoma (4.2$\%$) and infiltrating lobular carcinoma (1.5$\%$). Pathologic T stage by AJCC was T1 in 59.7$\%$ of the casses, T2 in 29.5$\%$ of the cases, Tis in 8.8$\%$ of the cases. Axillary lymph node dissection was peformed I\in 91.2$\%$ of the cases and 69.7$\%$ were node negative. AJCC stage was 0 in 8.8$\%$ of the cases, stage I in 44.9$\%$ of the cases, stage IIa in 33.3$\%$ of the cases, and stage IIb in 8.4$\%$ of the cases. Estrogen and progesteron receptors were evaluated in 71.6$\%$, and 70.9$\%$ of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2$\%$, wide excision in 11.5$\%$, quadrantectomy in 23$\%$ and partial mastectomy in 27.5$\%$ of the cases. A pathologically confirmed negative margin was obtained in 90.8$\%$ of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90$\%$ of the planned radiotherapy dose. Radiotherapy volume was breast only In 88$\%$ of the cases, breast+supraclavicular fossa (SCL) in 5$\%$ of the cases, and breast+ SCL+ posterior axillary boost in 4.2%$\%$of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45$\~$59.4 Gy (median 50.4) and boost dose was 8$\~$20 Gy (median 10 Gy). The total radiation dose delivered was 50.4$\~$70.4 Gy (median 60.4 Gy). Conclusion: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.