Factors Associated With Depression in Disease-Free Stomach Cancer Survivors

Han, K.H.,Hwang, I.C.,Kim, S.,Bae, J.M.,Kim, Y.W.,Ryu, K.W.,Lee, J.H.,Noh, J.H.,Sohn, T.S.,Shin, D.W.,Yun, Y.H. Dept. of Anesthesiology, University of Wisconsin-- 2013 Journal of pain and symptom management Vol.46 No.4

Context: Depression in cancer survivors affects the rest of their lives in many ways. Objectives: To estimate the prevalence of depression and identify associated factors in disease-free stomach cancer survivors. Methods: We enrolled 391 stomach cancer survivors who had been disease-free for at least one year after surgery from the cancer registries of two hospitals in Korea. Stomach cancer survivors were mailed a survey that included the Beck Depression Inventory, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and the associated stomach module, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach Cancer Module 22. Results: Forty-four percent of survivors suffered from depression, and more women (49%) than men (42%) had high depression scores (Beck Depression Inventory >13). In multiple logistic regression analysis, lower income (odds ratio [OR] 2.49; 95% CI 1.64-3.78), problems with care before treatment (OR 1.92; 95% CI 1.23-2.98), body image change (OR 2.23; 95% CI 1.41-3.53), and symptoms of fatigue (OR 3.11; 95% CI 1.49-6.52), dyspnea (OR 2.57; 95% CI 1.48-4.45), or insomnia (OR 4.51; 95% CI 1.88-10.83) were associated with depression. Conclusion: The prevalence of depression was high in stomach cancer survivors even after the completion of treatment, especially among those with problems amenable to treatment, and we identified the associated factors. We suggest that stomach cancer survivors should be screened for depression after the end of treatment.

Measuring Comprehensive Outcomes in Palliative Care: Validation of the Korean Version of the Good Death Inventory

Shin, D.W.,Choi, J.,Miyashita, M.,Choi, J.Y.,Kang, J.,Baik, Y.J.,Mo, H.N.,Choi, J.S.,Son, Y.S.,Lee, H.S. Dept. of Anesthesiology, University of Wisconsin-- 2011 Journal of pain and symptom management Vol.42 No.4

Context: No systematic or comprehensive attempts have yet been made to assess quality of death as an indicator of palliative care outcomes in Korea, and no validated instruments exist for the assessment of a good death in Koreans. Objectives: This study examined the validity and reliability of the Korean version of the Good Death Inventory (GDI), which was developed in Japan to evaluate the quality of death from the perspective of bereaved family members. Methods: Forward and backward translations and a pilot test were conducted. In a multicenter cross-sectional survey, a questionnaire packet, including the GDI, overall quality of life during the last week, and overall satisfaction with care, was mailed to bereaved family members (n=501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed, including response rate, mean, median, skewness, and kurtosis for each item. The reliability of the GDI was tested by Cronbach's alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent validity was tested by correlation with the overall quality of life and overall satisfaction with care. Results: Participants were able to complete the GDI, and the compliance rates were satisfactory. Cronbach's alpha coefficient for internal consistency was 0.93 overall and ranged from 0.69 to 0.94 for subdomains. The hypothesized 18-factor model of a good death appeared to fit the data (goodness of fit index [GFI]=0.964; adjusted GFI index=0.960; normal fit index=0.952). The overall scores on the GDI correlated with patients' quality of life (0.56; P<0.001) and overall satisfaction with care (0.44; P<0.001). Conclusion: The Korean version of the GDI is a reliable and valid measure of the comprehensive outcomes of palliative care from the perspective of bereaved Korean family members.

Validation Study of the Korean Version of the Brief Fatigue Inventory

Yun, Young Ho,Wang, Xin Shelley,Lee, Jung Suk,Roh, Ju Won,Lee, Chang Geol,Lee, Won Sup,Lee, Keun Seok,Bang, Soo-Mee,Mendoza, Tito R.,Cleeland, Charles S. Dept. of Anesthesiology, University of Wisconsin-- 2005 Journal of Pain and Symptom Management Vol.29 No.2

<P><B>Abstract</B></P><P>The goal of this study was to evaluate the reliability and validity of the Korean version of the Brief Fatigue Inventory (BFI-K). One hundred seventy-eight cancer patients and the same number of age- and sex-matched control subjects completed the BFI-K, the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30), the Beck Depression Inventory (BDI), and a Brief Pain Inventory (BPI). The Cronbach's alpha coefficient for the BFI-K was 0.956 in the cancer patient group and 0.955 in the control group. The global score and nine of the single item scores for the BFI-K were significantly correlated with the fatigue and global health status/QoL subscale of the EORTC QLQ-C30, BDI, and BPI (coefficient range 0.38–0.66). Discriminant validity showed that BFI-K could distinguish significant differences of performance status between subgroups of patients, and between the cancer patient group and the control group, as expected. Our study has shown that the BFI-K is a reliable, valid self-rating instrument in terms of its psychometric properties.</P>

Do the Phenotypes of Symptom Fluctuation Differ Among Motor Subtypes in Patients With Delirium?

Kim, Seon-Young,Kim, Jae-Min,Kim, Sung-Wan,Kim, Eun-Song,Kang, Hee-Ju,Lee, Ju-Yeon,Bae, Kyung-Yeol,Shin, Il-Seon,Yoon, Jin-Sang Dept. of Anesthesiology, University of Wisconsin-- 2018 Journal of pain and symptom management Vol.56 No.5

<P><B>Abstract</B></P> <P><B>Context</B></P> <P>Fluctuation in symptoms is a core feature of delirium. However, it is not well known whether the fluctuating nature would differ or not among the delirium subtype groups.</P> <P><B>Objective</B></P> <P>This study compared phenotypes of diurnal fluctuation among different delirium subtypes using a prospective design.</P> <P><B>Methods</B></P> <P>The motor subtypes of delirium patients were determined using the Delirium Motor Subtype Scale, fluctuations in consciousness levels were monitored with the Richmond Agitation-Sedation Scale (RASS), and symptom severity was assessed with the Nursing Delirium Screening Scale (Nu-DESC). All scales were administered at three time points over 24 hours; fluctuations in and phenotypes of symptoms were compared according to subtype of delirium using repeated-measures analysis of variance after adjustment for covariates.</P> <P><B>Results</B></P> <P>This study included 224 delirium patients. Of this patients, 144 (64.3%) were classified as hyperactive, 25 (11.2%) as hypoactive, 33 (14.7%) as mixed, and 22 (9.9%) as no subtype. Scores on the RASS and Nu-DESC significantly changed during the evening and/or night and there were significant subtype group × time interaction for the RASS and Nu-DESC (<I>F</I> = 9.66, <I>P</I> < 0.001 and <I>F</I> = 5.11, <I>P</I> < 0.001, respectively). Post hoc analyses revealed that the hyperactive and mixed subtype groups had higher mean RASS scores and greater ranges of fluctuation than the other groups. The mixed subtype group was differentiated from hyperactive and hypoactive subtype groups by the range of fluctuation in psychomotor activity.</P> <P><B>Conclusions</B></P> <P>The phenotypes of symptom fluctuation differed among the motor subtypes. These findings further support the rationale that fluctuations are a core feature of delirium and could differentiate delirium subtypes.</P>

Reliability and Validity of the Hospice Quality of Life Scale for Korean Cancer Patients

Kim, S.H.,Choi, Y.S.,Lee, J.,Oh, S.C.,Yeom, C.H.,Lee, M.A.,Kim, D.G.,Moon, D.H.,Kim, D.Y.,Koh, S.J. Dept. of Anesthesiology, University of Wisconsin-- 2009 Journal of Pain and Symptom Management Vol.37 No.2

The Hospice Quality of Life Scale (HQLS) for Korean cancer patients was developed as follows: 1) item generation by semi-structured interviews and review of existing scales, 2) item reduction by the Delphi method, and 3) reliability and validity test. The final HQLS consisted of 40 questions within 13 domains and the internal consistency was 0.41-0.93. The domain ''Family and Economy'' was uniquely separated from the general social issues, which reflects the family-oriented Asian culture. For construct validity, the HQLS scores differed significantly according to their Eastern Cooperative Oncology Group Performance Status (known-group validity). Convergent and discriminant success rates were optimal in nine and four subscales, respectively. Total and subscale scores were significantly correlated with the related subscales in the European Organization for Research and Treatment of Cancer QLQ-C30 and the McMaster Quality of Life Scale, which supported the concurrent validity. HQLS was approved as an efficient tool for assessing the quality of life of Korean cancer patients who were receiving hospice and palliative care.

Fatigue in the General Korean Population: Application and Normative Data of the Brief Fatigue Inventory

Yun, Y.H.,Lee, M.K.,Chun, H.N.,Lee, Y.M.,Park, S.M.,Mendoza, T.R.,Wang, X.S.,Cleeland, C.S. Dept. of Anesthesiology, University of Wisconsin-- 2008 Journal of pain and symptom management Vol.36 No.3

The purpose of this study was to provide normative data for the Brief Fatigue Inventory (BFI) in the general Korean population so that the results for the general population could be compared with those for patients. We constructed a questionnaire that included the BFI and items on demographic characteristics and conducted a population-based, cross-sectional survey in 1,000 individuals. We used multivariate logistic analysis to investigate factors associated with ''usual'' and ''worst'' fatigue. The internal consistency was very high (Cronbach's alpha=0.96) and construct validity was confirmed by factor analysis. All patients had a mean+/-SD BFI score of 4.33+/-2.48 for ''worst'' fatigue and of 4.07+/-2.27 for ''usual'' fatigue, and the global BFI score was 3.44+/-2.05. The prevalence of each moderate-to-severe fatigue type was similar in severity of fatigue, with 55.2% in ''usual'' fatigue, and 57.3% in ''worst'' fatigue. Among the types of fatigue, the prevalence of severe fatigue was lowest for ''usual'' fatigue (16.5%). In multivariate analyses, the group aged 40-59 years had greater levels of ''usual'' and ''worst'' fatigue compared with the group aged 20-29 years. Poor general health and the presence of comorbidities were also associated with increased ''usual'' and ''worst'' fatigue. Regular physical activity was associated with reduced levels of ''worst'' fatigue. The normal values of BFI with proper psychometric properties may help us to better understand the correlates of fatigue in the general population and patients. Our findings indicate that comorbidities should be considered when comparing fatigue data from the general population with data from patients.

Late Referral to Palliative Care Services in Korea

Baek, Y.J.,Shin, D.W.,Choi, J.Y.,Kang, J.,Mo, H.N.,Kim, Y.H.,Kim, S.,Jung, K.W.,Joo, J.,Park, E.C. Dept. of Anesthesiology, University of Wisconsin-- 2011 Journal of pain and symptom management Vol.41 No.4

Context: Although timely referral to palliative care services can help improve quality of life by minimizing patient and family suffering during a life-threatening illness, it remains unclear whether patients in Korea who suffer from advanced cancer are referred to palliative care services in a timely manner. Objectives: We aimed to investigate the timeliness of patient referral to palliative care services in Korea by examining the duration of survival after enrollment and identify the factors contributing to earlier or later referral. Methods: Patient- and episode-level data were collected from 3867 terminal cancer patients, who were registered in 34 inpatient palliative care services designated by the Ministry of Health, Welfare, and Family Affairs. Cox proportional hazard models were used to determine factors associated with the duration of survival after enrollment in palliative care services. Results: The median duration of survival after enrollment in palliative care services was 18 days. Male sex, liver cancer diagnosis, poor performance status, being covered by National Health Insurance, and being married were significantly associated with shorter duration of survival after enrollment, whereas a prostate cancer diagnosis was associated with longer survival. Conclusion: Korean terminal cancer patients are referred to palliative care very late, and the timing appears to be influenced by some socioeconomic and medical factors. Interventions, such as physician education and establishing palliative care teams, are required to promote earlier referrals in Korea.

Cross-Cultural Application of the Korean Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care

Shin, D.W.,Choi, J.E.,Miyashita, M.,Choi, J.Y.,Kang, J.,Baik, Y.J.,Mo, H.N.,Park, J.,Kim, H.J.,Park, E.C. Dept. of Anesthesiology, University of Wisconsin-- 2011 Journal of pain and symptom management Vol.41 No.2

Context: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL) is a shortened version of the EORTC QLQ-C30, developed for use in advanced cancer patients. Objectives: We evaluated the psychometric properties of the Korean version of the EORTC QLQ-C15-PAL to determine if this tool can be used to evaluate Korean patients with cancer who receive palliative care. Methods: A multicenter, cross-sectional survey was performed in palliative care units and hospices in Korea from September to October 2009. A total of 102 patients with cancer completed the questionnaires that included the EORTC QLQ-C15-PAL. Results: The compliance rate was high, with the missing rate for each item ranging from 0% to 7.8% (mean 3.1%). A multitrait scaling analysis revealed good convergent and discriminant validity, with only three scaling errors. The Cronbach's alpha coefficients ranged from 0.65 to 0.89. The questionnaire discriminated among patient subgroups with different clinical profiles (e.g., performance status and degree of oral intake), thereby demonstrating the clinical validity of this tool. Conclusion: Our findings indicate that the Korean version of the EORTC QLQ-C15-PAL is a reliable and valid instrument with regard to its psychometric properties. This tool is suitable for measuring quality of life, particularly with regard to physical aspects, in Korean cancer patients who receive palliative care.

Subgroups of Cancer Patients With Unique Pain and Fatigue Experiences During Chemotherapy

Kim, H.J.,Malone, P.S.,Barsevick, A.M. Dept. of Anesthesiology, University of Wisconsin-- 2014 Journal of pain and symptom management Vol.48 No.4

Context: Some cancer patients experience pain and fatigue, whereas others experience only one of the two symptoms. Yet, it is not clear who experiences these unique patterns and why. Objectives: This study aimed to identify subgroups of cancer patients with unique pain and fatigue experiences in two different chemotherapy cycles to examine how selected factors influenced subgroup membership and identify how subgroups differed in concurrently measured functional limitation outcome. Methods: The sample included 276 patients with diverse cancer types from four U.S. sites. To investigate subgroups, latent profile analyses were performed. Multinomial logistic regression and one-way analysis of variance-type analyses were conducted to examine the influencing variables of subgroup membership and to examine differences among subgroups in patient outcome. Results: The high-pain/high-fatigue (HPHF) and low-pain/low-fatigue subgroups were found at both time points. The low-pain/high-fatigue subgroup was present only in the first chemotherapy cycle. Pain and fatigue levels significantly differentiated subgroups at each time point (all P<0.05). Across the two time points, experiencing higher depressed mood increased the risk to be in the HPHF subgroup (all P<0.01). The HPHF subgroup had the most serious limitations in activities (all P<0.01). Conclusion: This study confirmed the existence of a unique symptom experience of pain and fatigue. This pattern should be acknowledged for symptom assessment and management.

Fatigue and Depression in Disease-Free Breast Cancer Survivors: Prevalence, Correlates, and Association with Quality of Life

Kim, S.H.,Son, B.H.,Hwang, S.Y.,Han, W.,Yang, J.H.,Lee, S.,Yun, Y.H. Dept. of Anesthesiology, University of Wisconsin-- 2008 Journal of pain and symptom management Vol.35 No.6

We performed this study to examine the prevalence and correlates of fatigue and depression, and their relevance to health-related quality of life in disease-free breast cancer survivors. A total of 1,933 breast cancer survivors recruited from five large hospitals in Korea completed a mailed survey, which included the Brief Fatigue Inventory, Beck Depression Inventory, European Organization for Research and Treatment of Cancer QLQ-C30, and QLQ-BR23. With a framework that included sociodemographic, clinical, and symptom characteristics, multivariate logistic regression models were used to identify factors associated with fatigue and depression. Among breast cancer survivors, 66.1% reported moderate to severe fatigue and 24.9% reported moderate to severe depression. Risk factors common to both fatigue and depression were lower income, dyspnea, insomnia, appetite loss, constipation, and arm symptoms. Risk factors for fatigue only included younger age, employment, presence of gastrointestinal disease, and pain. Having a musculoskeletal disease was identified as a risk factor for depression only. Both fatigue and depression were influenced by sociodemographic factors, comorbidity and symptom characteristics rather than cancer or treatment-related factors. Both fatigue and depression were negatively associated with survivors' health-related quality of life. However, the patterns of differences in health-related quality of life according to severity of fatigue or depression were similar. This concurrent examination of risk factors for fatigue and depression may be helpful in the development of clinical management strategies in disease-free breast cancer survivors.