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Purpose:Treatment of non-small cell lung cancer(NSCLC)have made modest prolongation of survial and improvement in quality of life. Although many studies have tried to treat the non-small cell lung cancer with combination chemotherapy based on cisplatin and etoposide, it remains to be certain what kind of assitional drugs and schedules can be applied. Thus, we conducted this study to assess the therapeutic effects of three different chemotheraeputic regimens, all containing cisplatin and etoposide, in patients with advanced NSCLC. Materias and Methoods: Eighty patients were enrolled who had histologically confirmed NSCLC with advanced stage, normal renal and bone marrow function. Sixteen patients were treated with FVP(cisplatin 20 mg/㎟ i.v. days 1∼5, etoposide 60mg/㎡ i.v. days 1∼5, 5-fluorouracil 800mg/㎟ i.v. days 1∼5), 36 patients with CVP(cisplatin 60mg/㎡ i.v. day 1, etoposide 80g/㎡ i.v. days 1∼5, cyclophosphamide 1000mg/㎡ i.v. day 1), and 28 patients with VIP(cisplatin 20mg/㎟ i.v. days 1∼5, etoposide 60mg/㎡ i.v. days 1∼5, ifosfamide1000mg/㎡ i.v. day 1∼5). Each cycle was repected every 3 or 4 weeks. We evaluated response rates, duration of remission, survival time, treatment-related toxicity and prognostic factors for survival. Results: One patient treated with VIP showed complete respose. Response rate of FVP(37.5%) and VIP(39.3%) were significantly higher than that of CVP(16.7%)(p=0.04). Median duration of remission was not significantly different among three groups(FVP14.9, CVP5.8, VIP7.3 months). No significant difference was found in overall median survival time among three groups(16.0 momths in FVP,14.3in CVP,17.3 in VIPgroup). In respoders to each therapeutic regimen, median survival times of FVP(21.5 months),VIP(undefined were significantly prolonged than 9.3 months of CVP group(p=0.016). We found that divided administration of cisplatin had relieved severe nausea and vomiting. Finally, as a result of prognostic factor analysis with Coxs proportional hazard model, chemotherapy was found to be significant prognostic factor for survival benefit in advanced NSCLC. Conciusion: Higher response rate and significant prolongation of survival time had been acquired as results of addition of ifosfamide or 5-fluorouracil to cisplatin and etoposide-based chemotherapy. In accordance with these data,it is warranted to conduct further prospective randomized study with combination of cisplatin, etoposide, ifosfamide and 5-fluorouracil.
본고에서는 사회공포증의 발병과 유지를 설명하는 여러 이론들을 고찰하고, 이러한 인지적 개념화가 치료에 어떤 함의를 가지는지 살펴보았다. 그리고 사회공포증에 대한 인지행동치료의 주요 치료요소인 인지재구성 작업과 노출훈련의 기본원리를 기술하였으며, 사회공포증의 치료에 이들 기법이 어떻게 효과적으로 적용될 수 있는지 논의하였다. 다음으로 사회공포증에 대한 인지행동치료의 효과를 검증한 국내외 연구들을 살펴보고, 최근의 동향을 고찰하였다. 문헌 고찰에 따르면, 여러 편의 메타분석이 사회공포증에 인지행동치료의 효과를 지지하였으나, 인지재구성기법과 노출훈련이 결합된 인지행동치료가 노출치료에 비해 더 월등한 효과를 나타나는지에 대해서는 일관된 결과가 나타나지 않은 것으로 밝혀졌다. 국내에서도 여러 편의 연구에서 인지행동치료의 효과가 입증된 것으로 보고되었다. 마지막으로 사회공포증에 대한 인지행동치료의 최근 동향을 살펴보고, 앞으로 나아가야 할 방향에 대해 논의하였다. Social phobia is a common and underdiagnosed disorder that is associated with considerable social and occupational handicap. This article provided an overview of cognitive models of social phobia and described two major techniques, cognitive restructuring and exposure training. It also summarized the current literature on treatment outcomes of cognitive behavioral therapy(CBT) for social phobia. Numerous studies have demonstrated the efficacy of CBT and meta-analyses have indicated that both CBT and exposure therapy produce very similar effect sizes in the moderate range. Although CBT appears well-established in regard to their effects on social phobia, a number of questions remain to be answered, including the search for predictors of who will benefit from which treatment and clarification of the mechanism of treatment changes. New trends and future directions were also discussed.
Purpose A cross-sectional survey was conducted to explore the current awareness and use of complementary and alternative medicine (CAM), as well as attitudes toward CAM, in patients with cancer and their family members in South Korea. Materials and Methods Between September 21 and October 31, 2017, a 25-item questionnaire regarding CAM experiences among cancer patients and their family members was conducted in 10 oncology clinics in South Korea after institutional review board approval at each institution. Results In total, 283/310 patients were analyzed. The median age was 60 years, and 60% were male. Most of the patients were actively receiving anticancer treatment at the time of the survey. A total of 106 patients (37%) had experienced a median of two types (interquartile range, 1 to 3) of CAM. Belief in CAM (odds ratio [OR], 3.015; 95% confidence interval [CI], 1.611 to 5.640) and duration of disease (OR, 1.012; 95% CI, 1.004 to 1.020) were independent factors for using CAM in multivariable analysis. Belief in CAM was significantly associated with current use of CAM (OR, 3.633; 95% CI, 1.567 to 8.424). Lay referral was the most common reason for deciding to use CAM, and only 25% of patients (72/283) discussed CAM with their physicians. Conclusion Patient attitudes toward and confidence in CAM modalities were strongly associated with their CAM experiences, and only a small number of patients had an open discussion about CAM with their physicians. A patient education program for CAM is needed.
Background/Aims: Despite increased demand for cancer patient’s to make their own decisions based on an adequate understanding of what is involved in chemotherapy, the primary signing agent and the reasons for surrogate signing have not been appropriately evaluated. Methods: The ethics committee of the palliative medicine subgroup of the Korean Cancer Study Group designed this study and solid cancer patients to whom chemotherapy was offered, from seven institutions, were evaluated. The details relating to surrogate’s signing of chemotherapy consent were evaluated. Then, we analyzed the factors associated with surrogate’s signing according to patient’s demographics and characteristics related to chemotherapy consent. Results: Surrogate’s signing was noted for 20.7% (84/405) of patient and over half of surrogate signings were performed by the patients’ son or daughter (60.7%). Two main reasons for surrogate signing were patient’s incapacity (34.5%) and taking over authorization from patients (33.3%). The factors associated with more frequent surrogate’s signing were absence of spouse, lower education level, outpatient, and when residents played a role as a principle provider of chemotherapy consent. Conclusions: This study suggests the lack of patients’ own decision making for chemotherapy in some situations. This ethical dilemma must be considered for adequately informed decision making for chemotherapy while ensuring the patients’ autonomy is maintained.
Purpose This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. Materials and Methods The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS). Results Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach’s α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and –0.130 (p=0.493) for the social domain. Conclusion This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.