S-455 : Palliative sedation: Experience in a Tertiary Center in Korea

( Haa Na Song ),( An Na Lee ),( Un Suk Lee ),( Se Il Go ),( Myung Hee Kang ),( Hoon Gu Kim ),( Gyeong Won Lee ),( Jung Hun Kang ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background/Aims: Palliative sedation (PS) such as deep sedation is a practice using sedative agents to relieve refractory suffering of dying patients and widely used in clinical practice in western country. However, there is no report in Korea about the frequency and clinical characteristics of palliative sedation. Methods: The data was retrospectively collected by medical charts of patients who died at Gyeongnam regional cancer center from January 2009 to December 2012. Of eligible 2,062 cohort patients, 41 (2.0%) patients received PS before death. We collected information about demographic characteristics, indication, sedative drugs. The dose of used opioids by converting morphine equivalent daily dose (MEDD) in each group was also compared under hypothesis that high dose opioids may induce delirium, which is the most common cause of PS. Results: We categorized 2,062 patients into two groups, patients with PS (N=41) and patients without PS (n=2,021). There were no differences in age, sex, primary site between two groups. Pain (n=19, 46.3%) is the most frequent indication of PS followed by delirium (n=11, 26.8%) and dyspnea (n=10, 24.4%), seizure (n=1, 2.4%) All the patients used midazolam as sedative drug with the median total dose of 108 mg/day. The median survival after PS was 3 days (confidence interval 95%, 1-35 days). MEDD was significantly higher in the patients with PS than patients without PS (2,112 mg vs 178 mg, p<0.001) Conclusions: Although PS has established role in dying patients, PS is not commonly used in clinical practice in Korea. Further research and education are warranted on this field in Korea.

S-585 Nonsteroid Anti-inflammatory Agents for the Management of Cold Sweating in Advanced Cancer Patients

( Hee Cheul Jung ),( Haa-na Song ),( Gyeong-won Lee ),( Jung Hun Kang ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Purpose: Advanced cancer may develop cold sweating as paraneoplastic symptom. Few research was performed on the efficacy of non-steroid anti-inflammatory drug (NSAID) in advanced cancer patients suffering from sweating without fever. Methods: Patients were selected who met following criteria and medical records were retrospectively reviewed. 1) incurable, advanced solid cancer 2) Suffering from cold sweating more than numeric rating scale(NRS) 4 3) No evidence of infection 4) No newly started opioid or antihormonal agents within 1 month 4) NSAID prescription for the management of cold sweating 5) Documented NRS information before and after NSAID Results: A total of 17 patients were selected and four patients were excluded for the lack of NRS information or fever. Nine patients(69%) were male and mean age was 59(range:50-71). Bile duct cancer was most common primary tumor followed by pancreatic cancer, gastric cancer and prostate caner. Mean Baseline NRS of cold sweating was 6.5(min-max;4-10) was reduced to NRS 1.9 at the next follow-up assessment(min-max;0-5).The difference of severity between baseline and follow-up evaluation was significant(95% confidence interval;3.3-6,0, p<0.001). Mean period from initiation of NSAID and the next follw-up time was 9.1 days (range:2 days-30 days). Conclusions: NSAID was effective medication for the management of advanced cancer patients who had significant sweating without fever.

식은 땀을 호소하는 진행성 암 환자에서 비스테로이드성 항염증 제제를 이용한 치료

최혜정,송하나,강정훈,Choi, Hye Jung,Song, Haa-Na,Kang, Jung Hun 한국호스피스완화의료학회 2016 한국호스피스.완화의료학회지 Vol.19 No.4

목적: 진행성 암 환자에서 발열이 동반되지 않은, 암성 발한에서 NSAID (non-steroid anti-inflammatory drug) 치료 효과를 알아보고자 함이 목적이다. 방법: 다음과 같은 조건을 만족하는 환자를 대상으로 후향적으로 의무 기록을 조사하였다. 1) 수술적 절제나 항암방사선 치료로 완치가 불가능한 진행성 암 환자 2) 숫자평가등급 4점 이상의 식은 땀을 호소하며 발열이 동반되지 않은 환자 3) 식은 땀의 원인이 될 만한 감염이 없고, 마약성 진통 및 호르몬 차단제를 현재 최근 1개월 이내 새롭게 사용하지 않는 환자 4) 식은 땀 치료를 위해 NSAID를 사용하고, NRS 평가가 치료 전 후 시행한 환자. 결과: 총 13명의 환자가 등록되었다. 남자가 9명(69%)이었고, 평균 59세(범위: 50~71)였다. 암종별 빈도는 담도암, 췌장암, 위암, 전립선암 순이었다. 치료 전 환자들의 식은 땀은 평균 NRS 6.5 (최소값: 4, 최대값: 10) 이었고, 치료 후에는 NRS 1.9 (최소값: 0, 최대값: 5)이었다. 평균 추적 관찰 기간은 9.1일이었다. 결론: 진행성 암 환자에서 열이 동반되지 않은 중등도 이상의 식은 땀 환자에서 NSAID는 효과적인 치료방법이다. Purpose: Advanced cancer may accompany cold sweat as paraneoplastic symptom. Few studies have been performed on the efficacy of non-steroid anti-inflammatory drug (NSAID) in advanced cancer patients who sweated without fever. Methods: To select study participants, medical records were retrospectively reviewed for patients who satisfied the following criteria: 1) incurable, advanced solid cancer; 2) Cold sweating of 4 or higher on the numeric rating scale (NRS) 4; 3) No evidence of infection or hypoglycemia; 4) No newly started opioid or anti-hormonal agents within one month; 5) NSAID prescription for the management of cold sweating and 6) Documented NRS information before and after NSAID administration. Results: A total of 13 patients were selected after excluding four patients due to lack of NRS information or fever. The mean age was 59 years old (range: 50~71), and nine patients (69%) were male. Bile duct cancer was the most common primary tumor followed by pancreatic cancer, gastric cancer and prostate cancer. The mean NRS of cold sweating dropped from baseline 6.5 (min-max: 4~10) to 1.9 at the follow-up assessment (min-max: 0~5). The mean follow-up period was 9.1 days (range: 2~30 days) from NSAID treatment to assessment. Conclusion: NSAID was effective medication for management of sweating without fever in patients with advanced cancer.

Prognostic implications of cancer cachexia in patients with small cell lung cancer

( Hye Jung Choi ),( Se-il Go ),( Mi Jung Park ),( Haa-na Song ),( Myoung Hee Kang ),( Hee Jung Park ),( Kyung Nyeo Jeon ),( Seok-hyun Kim ),( Moon Jin Kim ),( Jung-hun Kang ),( Gyeong-won Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Purpose: Sarcopenia, a criterion for cancer cachexia, is suggested to be associated with cancer-related inflammation. We assessed the clinical outcome of small cell lung cancer (SCLC) patients according to sarcopenia and the neutrophil-to-lymphocyte ratio (NLR). Methods: A total of 117 male SCLC patients treated with first-line chemo- or chemoradiotherapywere reviewed. The mass of the pectoralis muscle was measured by computed tomography and normalized to height. Patients with the lowest quartile of muscle mass were considered to have sarcopenia. Patients were grouped according to their sarcopenia and NLRstatuses: sarcopenia/high NLR, sarcopenia/low NLR, nonsarcopenia/ high NLR, non-sarcopenia/low NLR. Results: Sarcopenic patients had lower progression-free survival (PFS) than did nonsarcopenic patients (median 6.0 vs. 7.5 months, p=0.009), but the difference in overall survival (OS) was not statistically significant (median 10.5 vs. 13.5 months, p=0.052). However, the OS of sarcopenic patients with high NLR was significantly lower than that in all other groups (median 3.2 vs. 16.0 vs. 12.5 vs. 13.7 months, respectively, p<0.001), as was PFS (median 3.2 vs. 7.7 vs. 7.6 vs. 7.1 months, respectively, p<0.001). On multivariate analysis, sarcopenia with high NLR was an independent prognostic factor for shorter PFS and OS. Early discontinuation of treatment (20.0% vs. 10.3%) and treatment-related mortality (50.0% vs. 8.4%) occurred more frequently in these patients than in the other groups (p<0.001). Conclusions: In SCLC, sarcopenic patients with a high NLR have a poor prognosis and do not tolerate standard treatment. Intensive supportive care is needed in these patients. Keywords: Sarcopenia; Cachexia; Neutrophil to lymphocyte ratio; Small cell lung carcinoma; Toxicity; Prognosis

경남 지역 암센터와 보건소 재가암환자 관리 서비스와의 연계 사업

송하나,강명희,이경원,김훈구,이원섭,강정훈,강윤식,은영,Song, Haa-Na,Kang, Myoung Hee,Lee, Gyeong Won,Kim, Hoon Gu,Lee, Won Sup,Kang, Jung Hun,Kang, Yoon Sik,Eun, Young 한국호스피스완화의료학회 2013 한국호스피스.완화의료학회지 Vol.16 No.1

목적: 경남지역 암센터와 경남지역 각 보건소와의 말기암환자를 대상으로 시행한 연계 사업을 담당자를 대상으로 한 설문조사를 통해서 평가하고자 하였다. 방법: 2008년 1월 1일부터 2011년 12월 31일까지 경남지역 암센터와 연계 사업 협약을 체결하고, 환자를 등록해서 진행한 보건소 실무자를 대상으로 진행하였다. 총 9개 지역 보건소의 실제 사업에 참여한 경험이 있는 재가암 담당자 20명을 대상으로 설문지를 개발하여 조사를 하였다. 각 문항의 평가는 Likert 5단계 척도를 변형하여 단계마다 -2에서 +2까지 점수를 부여하였고, 각 문항의 총점은 40점이었다. 결과: 2008년 1월부터 2011년 12월까지 73예(72예는 경남지역 암센터, 1예는 보건소에서 등록)가 연계되었다. 서비스에 대한 평가로 환자나 가족들의 심리적 안정에 도움이 된다라는 항목이 23점으로 가장 높았고, 전반적으로 재가암 사업에 도움이 된다는 점이 11점으로 가장 낮게 나왔다. 연계 서비스에 대한 개선 문항으로는 입원 절차의 간소화가 35점, 환자 병원 방문 시 실질적 혜택 제공이 34점으로 높게 나온 반면, 보건소의 인력 강화가 4점으로 가장 낮게 나타났다. 결론: 말기암환자를 대상으로 한 경남 지역 암센터-보건소 재가암 쌍방향 서비스는 몇 가지 한계점을 드러내었다. 보다 나은 연계 서비스를 위해서는 이번 연구를 통해 나타난 여러 점들을 개선하고, 또 지역 실정에 맞는 모델을 개발하는 등의 노력이 필요한 것으로 생각된다. Purpose: Home-based care providers were surveyed to assess the effect of collaborative service between Gyeongnam Regional Cancer Center (GRCC) and public health centers (PHCs) in Gyeongnam province. Methods: Twenty home-based care providers who had previously participated in the GRCC-PHC care project were recruited from nine PHCs and were surveyed using a questionnaire developed by specialists. Questions were rated using the 5-point Likert scale ranging from "strongly disagree (-2)" to "strongly agree (+2)" and each score was multiplied by the corresponding number of respondents (n=20) with the maximum score of 40. Results: Between January 2008 and December 2011, 73 patients were registered to the collaborative service: 72 by GRCC and one by PHC. Home-based care providers marked the highest score (23 points) to "The collaborative service contributed to patients and their family's psychological stability" and the lowest score (11 points) to "The collaborative service was generally helpful for home-based cancer management." For possible suggestions to improve the service, the highest score (35 points) was given to "Simplification of the hospitalization process" followed by "Substantial benefits for patients at their visit to the hospital" (34 points). Conclusion: The results revealed several limitations of the GRCC-PHC collaborative care service for terminal cancer patients. The service could be further improved by developing measures to address the limitations and a service model tailored to region-specific needs.