Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients' Returning to Work (START): A Multi-center, Randomized Controlled Trial

강단비,배가령,안여진,김나연,남석진,이정언,이세경,심영목,신동현,오승엽,전미선,허재성,조주희 대한암학회 2023 Cancer Research and Treatment Vol.55 No.2

Purpose We developed a comprehensive return to work (RTW) intervention covering physical, psycho-social and practical issues for patients newly diagnosed and evaluated its efficacy in terms of RTW. Materials and Methods A multi-center randomized controlled trial was done to evaluate the efficacy of the intervention conducted at two university-based cancer centers in Korea. The intervention program comprised educational material at diagnosis, a face-to-face educational session at completion of active treatment, and three individualized telephone counseling sessions. The control group received other education at enrollment. Results At 1-month post-intervention (T2), the intervention group was more likely to be working compared to the control group after controlling working status at diagnosis (65.4% vs. 55.9%, p=0.037). Among patients who did not work at baseline, the intervention group was 1.99-times more likely to be working at T2. The mean of knowledge score was higher in the intervention group compared to the control group (7.4 vs. 6.8, p=0.029). At the 1-year follow-up, the intervention group was 65% (95% confidence interval, 0.78 to 3.48) more likely to have higher odds for having work. Conclusion The intervention improved work-related knowledge and was effective in facilitating cancer patients’ RTW.

Health-Related Quality of Life in Non-Hodgkin Lymphoma Survivors: A Prospective Cohort Study

강단비,조주희,김임령,김미경,김원석,김석진 대한암학회 2018 Cancer Research and Treatment Vol.50 No.4

Purpose We evaluated health-related quality of life (HRQOL) in long-term survivors of indolent and aggressive non-Hodgkin lymphoma (NHL). Materials and Methods The HRQOL was assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30) at diagnosis in NHL patients between 2008 and 2011, and follow-up evaluation was conducted from June 2014 to February 2015 using EORTC QLQ-C30 and the quality of life in cancer survivors (QOL-CS) questionnaire. We used linear mixed models to compare changes in HRQOL between indolent and aggressive NHL over time. Results The HRQOL of long-term survivors with aggressive NHL improved to the similar level of indolent NHL during the follow-up survey. However, survivors of NHL were found to fear the probability of relapse and second malignancy, and the degree of fear was not different between survivors with aggressive stage I/II or III/IV NHL (p > 0.05). Furthermore, a half of survivors reported impaired sense of psychosocial well-being regardless of aggressiveness and stage during follow-up survey. More than 65% of survivors thought they did not receive sufficient support from others, and patients who had financial difficulties at diagnosis were more frequently associated with suffering from insufficient support. Impaired physical and cognitive functioning at diagnosis was significantly associated with lack of life purpose in long-term survivors. Conclusion The HRQOL of aggressive NHL survivors improved to a similar level to that of indolent NHL. However, the majority of survivors still had fear of relapse, and psychosocial well-being remained unmet needs.

Validation of the Korean Version of the Patient-Reported Outcomes Measurement Information System 29 Profile V2.1 among Cancer Survivors

강단비,김영하,임지현,윤정희,김수연,강은지,남희수,심성근,이만경,복혜숙,이상원,신수용,안진석,오동렬,조주희 대한암학회 2022 Cancer Research and Treatment Vol.54 No.1

Purpose The purpose of the study was to validate the Korean version of Patient-Reported Outcomes Measurement Information System 29 Profile v2.1 (K-PROMIS-29 V2.1) among cancer survivors. Materials and Methods Participants were recruited from outpatient clinics of the Comprehensive Cancer Center at the Samsung Medical Center in Seoul, South Korea, from September to October 2018. Participants completed a survey questionnaire that included the K-PROMIS-29 V2.1 and the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). Principal component analysis and confirmatory factor analysis (CFA) and Pearson’s correlations were used to evaluate the reliability and validity of the K-PROMIS-29 V2.1. Results The mean age of the study participants was 54.4 years, the mean time since diagnosis was 1.2 (±2.4) years, and 349 (87.3%) completed the entire questionnaire. The Cronbach’s alpha coefficients of the seven domains in the K-PROMIS-29 V2.1 ranged from 0.81 to 0.96, indicating satisfactory internal consistency. In the CFA, the goodness-of-fit indices for the K-PROMIS-29 V2.1 were high (comparative fit index, 0.91 and standardized root-mean-squared residual, 0.06). High to moderate correlations were found between comparable subscales of the K-PROMIS-29 V2.1 and subscales of the EORTC QLQ-C30 (r=0.52-0.73). Conclusion The K-PROMIS-29 V2.1 is a reliable and valid measure for assessing the health-related quality of life domains in a cancer population, thus supporting their use in studies and oncology trials.

Impact of Social Support during Diagnosis and Treatment on Disease Progression in Young Patients with Breast Cancer: A Prospective Cohort Study

강단비,박세리,김효정,김석원,이정언,유종한,이세경,김지연,남석진,조주희,박연희 대한암학회 2024 Cancer Research and Treatment Vol.56 No.1

Purpose We evaluated the association between changes in social support after cancer treatment and recurrence-free survival (RFS) in such patients using a prospective cohort study. Materials and Methods Data were obtained from a prospective cohort study (NCT03131089) conducted at Samsung Medical Center (2013-2021). The primary outcome measure was RFS. Social support was measured using the social and family well-being (SFWB) domain of the Functional Assessment of Cancer Therapy-General. We calculated the changes in SFWB scores before and during treatment and the hazard ratio for RFS by comparing such changes. Results The mean±standard deviation (SD) age of the patients was 35±3.9 years, and 71.5% and 64.8% of the patients were married and had children, respectively. The mean±SD SFWB score at baseline was 20.5±5.0 out of 26. After cancer treatment, 35.9%, 10.3%, and 53.8% of the participants had increasing, unchanged, and decreasing SFWB scores, respectively. The decreasing SFWB score group had a higher risk of mortality or recurrence than the increasing group. Risk factors for the decreasing score were the presence of children during diagnosis. Conclusion In this cohort, changes in social support after treatment were associated with RFS in young patients with breast cancer. Health professionals should develop family interventions to help them receive proper social support.

Psychometric Validation of the Korean Version of the Cancer Survivors’ Unmet Needs (CaSUN) Scale among Korean Non–Small Cell Lung Cancer Survivors

강단비,이진희,김수연,남희수,공성아,심성근,이재경,정원영,신수민,김홍관,조재일,심영목,신동욱,조주희 대한암학회 2023 Cancer Research and Treatment Vol.55 No.1

Purpose The purpose of the study was to validate the Korean version of Cancer Survivors’ Unmet Needs (CaSUN) scale among non–small cell lung cancer survivors.Materials and Methods Participants were recruited from outpatient clinics at the Samsung Medical Center in Seoul, South Korea, from January to October 2020. Participants completed a survey questionnaire that included the CaSUN. Exploratory and confirmatory factor analysis and Pearson’s correlations were used to evaluate the reliability and validity of the Korean version of the CaSUN (CaSUN-K). We also tested known-group validity using an independent t test or ANOVA.Results In total, 949 provided informed consent and all of which completed the questionnaire. Among the 949 patients, 529 (55.7%) were male; the mean age and median time since the end of active treatment (standard deviation) was 63.4±8.8 years and the median was 18 months. Although the factor loadings were different from those for the original scale, the Cronbach’s alpha coefficients of the six domains in the CaSUN-K ranged from 0.68 to 0.95, indicating satisfactory internal consistency. In the CFA, the goodness-of-fit indices for the CaSUN-K were high. Moderate correlations demonstrated the convergent validity of CaSUN-K with the relevant questionnaire. More than 60% of the participants reported information-related unmet needs, and the CaSUN-K discriminated between the needs reported by the different subgroups that we analyzed.Conclusion The CaSUN-K is a reliable and valid measure for assessing the unmet needs in a cancer population, thus this tool help population to receive timely, targeted, and relevant care.

Validation of Korean Version of the COmprehensive Score for financial Toxicity (COST) Among Breast Cancer Survivors

심성근,강단비,김나연,한가연,임지현,김현수,박정현,이만경,이정언,김석원,유종한,채병주,유재민,남석진,이세경,조주희 대한암학회 2022 Cancer Research and Treatment Vol.54 No.3

Purpose Little is known about the impact of financial toxicity in disease-free breast cancer survivors. We aim to validate the COmprehensive Score for financial Toxicity in Korean (COST-K) and evaluate financial toxicity among disease-free breast cancer survivors.Materials and Methods We conducted linguistic validation following a standardized methodology recommended by Functional Assessment of Chronic Illness Therapy multilingual translation (FACITtrans). For psychometric validation, we conducted a cross-sectional survey with 4,297 disease-free breast cancer survivors at a tertiary hospital in Seoul, Korea between November 2018 and April 2019. Survivors were asked to complete the COST-K and European Organization for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30) questionnaires. The test-retest reliability, internal consistency, and validity of the COST-K were assessed using standard scale construction techniques.Results The COST-K demonstrated good internal consistency, with a Cronbach’s α of 0.81. The test-retest analysis revealed an intraclass correlation coefficient of 0.78. The COST-K had moderate correlation (r=–0.60) with the financial difficulty item of the EORTC QLQ-C30 and week correlation with the items on acute and chronic symptom burdens (nausea/vomiting, –0.18; constipation, –0.14; diarrhea, –0.14), showing good convergent and divergent validity. The median COST-K was 27 (range, 0 to 44; mean±standard deivation [SD], 27.1±7.5) and about 30% and 5% of cancer survivors experienced mild and severe financial toxicity, respectively. Younger age, lower education, lower household income was associated with higher financial toxicity.Conclusion The COST-K is a valid and reliable instrument for measuring financial toxicity in disease-free breast cancer survivors. Considering its impact on the health-related quality of life, more studies need to be conducted to evaluate financial toxicity in cancer survivors and design interventions.

Impact of Breast Reconstruction on Biophysical Parameters of Mammary Skin in Patients Receiving Postmastectomy Radiotherapy for Breast Cancer

김해영,강단비,박원,조주희,박혁곤,김은주,최두호,조원경,전병준,이경태 한국유방암학회 2021 Journal of breast cancer Vol.24 No.2

Purpose: In this study, we examined the impact of reconstruction using tissue expander insertion (TEI) on the risk of radiation dermatitis in patients undergoing postmastectomy radiotherapy (PMRT). Methods: Between August 2015 and March 2019, patients with breast cancer who had received systemic chemotherapy and PMRT were prospectively included. Skin parameters, including melanin, erythema, hydration, sebum, and elasticity, were measured using a multiprobe instrument at 6 time points: before the initiation of radiotherapy (pre-RT), at weeks 1, 3, and 5 during radiotherapy (weeks 1–5), and 1 and 3-month after radiotherapy (post-RT1m and post-RT-3m). Patient-reported outcomes (PROs) were assessed at each time point. Changes in biophysical parameters and PRO were compared between patients with and without TEI (TEI+ vs. TEI−). Results: Thirty-eight patients, including 18 with TEI+ and 20 with TEI-, were analyzed. The pattern of time-course changes in biophysical parameters and PRO did not differ between TEI+ and TEI− patients. The melanin index was highest at post-RT-1m, while the erythema index was highest at week 5. At post-RT-3m, TEI+ patients presented higher melanin values than TEI- patients, with no statistical significance (coefficient, 47.9 vs. 14.2%; p = 0.07). In all patients, water content decreased throughout the measurement period. At post-RT-3m, TEI+ patients demonstrated a further decrease in water content, while the TEI- group nearly recovered the water content to pre-RT status (coefficient, −17.1, −2.5; p = 0.11). The sebum and elasticity levels were not altered by TEI. Conclusion: In patients undergoing PMRT, TEI did not significantly affect the changing patterns of skin biophysical parameters and PRO during radiotherapy.

간호중재기반 암환자 맞춤형 직장복귀 지원 프로그램 개발 및 효과 평가: 다기관 무작위대조군 실험설계

배가령,강단비,안여진,김임령,이아영,조주희 한국간호과학회 2020 한국간호과학회 학술대회 Vol.2020 No.10

대한민국 상급 종합병원 임상현장에서 환자자기평가결과(Patient-Reported Outcome)의 일상적인 사용 현황

방가람,강단비,조주희 한국임상약학회 2022 한국임상약학회지 Vol.32 No.2

Objective: There is a growing movement to introduce Patient-Reported Outcome (PRO) to clinical settings. This study aimed toinvestigate the routine use of PRO in tertiary hospital clinical settings. Methods: From January 2016 to December 2018, the usagestatus of Patient-Reported Outcome Measures (PROMs) submitted to the electronic medical record of a tertiary hospital clinicalsetting was investigated. Descriptive analysis was conducted to investigate the usage status of PROMs by 42 departments. Also, themost frequently used PROMs by departments, the purpose of measurement, the use rate of verified PROMs were investigated. Results: The PROMs accounted for 66% (98) of the 148 Instruments. Of the 98 PROMs, 64% (63) were using a validation Koreanversion of PROMs. Only about 1% of total outpatient visits applied PROMs, and among them, it was frequently used in urology(13%), orthopedics (8%), and otolaryngology (5%). The use rate of the validated PROMs was found to be 64%. Conclusions: Theuse of PROMs in domestic clinical settings was found to be very limited and frequently used only in specific departments. It isessential to use a PROMs that has been validated according to guidelines, as the use of validated PROMs will provide beneficialinformation to health professionals and also for the patient health improvement by objectively measuring the patient's health status.

Prognostic Impact of Elevation of Cancer Antigen 15-3 (CA15-3) in Patients With Early Breast Cancer With Normal Serum CA15-3 Level

유재민,강단비,조주희,이정언,김석원,남석진,이세경,김연진,임영혁,안진석,박연희,김지연,이현종,강미라,유종한 한국유방암학회 2023 Journal of breast cancer Vol.26 No.2

Purpose: Cancer antigen 15-3 (CA15-3) is a serum tumor marker for breast cancer (BC) extensively used in clinical practice. CA15-3 is non-invasive, easily available, and a cost-effective tumor marker for immediate diagnosis, monitoring and prediction of BC recurrence. We hypothesized that an elevation of CA15-3 may have prognostic impact in patients with early BC with normal serum CA15-3 level. Methods: This was a retrospective cohort study, which included patients with BC who received curative surgery at a comprehensive single institution between 2000 and 2016. CA15-3 levels from 0 to 30 U/mL were considered normal, and patients who had CA15-3 > 30 U/mL, were excluded from the study. Results: The mean age of study participants (n = 11,452) was 49.3 years. The proportion of participants with elevated CA15-3 ≥ 1 standard deviation (SD) compared with the previous examination during follow-up was 23.3% (n = 2,666). During the follow-up (median follow-up 5.8 years), 790 patients experienced recurrence. The fully-adjusted hazard ratio (HR) for recurrence comparing participants with stable CA15-3 level to subjects with elevated CA15-3 level was 1.76 (95% confidence interval [CI], 1.52–2.03). In addition, if the CA15-3 was elevated ≥ 1 SD, the risk was much higher (HR, 6.87; 95% CI, 5.81–8.11) than in patients without elevated CA15-3 ≥ 1 SD. In sensitivity analysis, the recurrence risk was consistently higher in participants with elevated CA15-3 levels than in participants without elevated CA15-3 levels. The association between elevated CA15-3 levels and incidence of recurrence was observed in all subtypes and the association was stronger in patients with N+ than in patients with N0 stage (p-value for interaction < 0.01). Conclusion: The results of the present study demonstrated that elevation of CA15-3 in patients with early BC and initial normal serum CA15-3 levels has a prognostic impact.