Yuen-Liang Lai

Mackay Medical College, T’ai-pei, Taipei, Taiwan

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Publications (24)97.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The causative relationship between autoimmune thyroiditis and thyroid cancer remains a controversial issue. The aim of this population-based study was to investigate the risk of thyroid cancer in patients with thyroiditis. From the Longitudinal Health Insurance Database 2005 (LHID2005) of Taiwan, we identified adult patients newly diagnosed with thyroiditis between 2004 and 2009 (n = 1,654). The comparison cohort (n = 8,270) included five randomly selected age- and sex-matched controls for each patient in the study cohort. All patients were followed up from the date of cohort entry until they developed thyroid cancer or to the end of 2010. Multivariate Cox regression was used to assess the risk of developing thyroid cancer. A total of 1,000 bootstrap replicates were created for internal validation. A total of 35 patients developed thyroid cancer during the study period, of whom 24 were from the thyroiditis cohort and 11 were from the comparison cohort (incidence 353 and 22 per 100,000 person-years, respectively). After adjusting for potential confounding factors, the hazard ratio (HR) for thyroid cancer in patients with thyroiditis was 13.24 (95 % CI 6.40-27.39). Excluding cancers occurring within 1 year of follow-up, the HR remained significantly increased (6.64; 95 % CI 2.35-18.75). Hypothyroidism was not an independent factor associated with the occurrence of thyroid cancer. We found an increased risk for the development of thyroid cancer after a diagnosis of thyroiditis, independent of comorbidities.
    Annals of Surgical Oncology 11/2013; · 4.12 Impact Factor
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    ABSTRACT: BACKGROUND:: Lung cancer is the leading cause of cancer deaths in the world. Physical activity could help lung cancer patients improve their health. OBJECTIVE:: The purpose of our study was to investigate lung cancer patients' physical activity preferences and relevant contributing factors, so that we could develop individualized intervention strategies to fit their needs. METHODS:: This study used a descriptive and correlational design. Instruments included a physical activity preference survey form, the Physical Activity Social Support Scale, and Physical Activity Self-efficacy Scale. RESULTS:: From 81 lung cancer patients' physical activity preferences, our results showed that during the course of their illness, 85.2% of patients wanted to have a physical activity consultation and preferred to obtain advice from their physicians (28.4%) through face-to-face counseling (48.1%). Moreover, patients (70.4%) showed an interest in physical activity programs, and many (69.1%) revealed that they were able to participate. About 88.9% of patients showed a preference for walking, and 54.3% patients preferred moderate physical activity. CONCLUSIONS:: This study also revealed that social support and self-efficacy for physical activity effectively predicted moderate physical activity preferences. IMPLICATIONS FOR PRACTICE:: The adherence to regular physical activity is improved by understanding the lung cancer patients' unique preferences for physical activity.
    Cancer nursing 06/2012; · 1.88 Impact Factor
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    ABSTRACT: Background Demands for long-term care facilities for the elderly increased rapidly due to longevity of the current population and a trend toward nuclear families with fewer offspring1. A study showed that the prevalence of depression is 8–15% and 30% among the community-dwelling and the institutionalized elderly2, respectively, in the USA compared with 29.5% and 39.2% in Taiwan3. The major goal of this study was to investigate the prevalence of depression in the elderly residing at long-term care facilities in Taiwan, to explore the relationship between demographic characteristics, health status, social support, and the participation in leisure activities with the development of depression in the elderly, and finally to propose possible interventional items for clinical use and further interventional study design. Methods A cross-sectional survey of the elderly was conducted through interview using questionnaire. A total of 309 subjects, aged 65 and above, in six long-term care facilities were enrolled in this study. The questionnaire collected information on their characteristics, health condition, the level of social support and daily activity, and depression status. Results Thee prevalence of depression among the elderly residing at long-term care facilities was 37% in Taiwan, and self-funded elderly had a higher depression rate than those in government-sponsored facilities. Participants with advanced ages, religious practices, literacy, longer facility stay, better instrumental activities of daily living (IADLs), more leisure activities, and strong social support had lower association with depression. Factors strongly associated with depression included better self-assessed health status, ability to perform IADLs, level of social support (especially social companionship), and leisure-activity involvement. Conclusion We summarized the perceptions for preventing the elderly residing at facilities from developing depression, including increased interactions provided by caregivers, more family visits and social companionship, and more frequent leisure activities. Further interventional studies with a larger group of participants and longitudinal design should be conducted to confirm our recommendations.
    International Journal of Gerontology 03/2012; 6(1):5–10. · 0.24 Impact Factor
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    ABSTRACT: This study investigated the efficacy of the botanical-derived drug, PG2, a partially purified extract of Astragalus membranaceus, as a complementary and palliative medicine for managing cancer-related fatigue (CRF). Patients with advanced cancer and moderate to severe CRF were randomized to receive either PG2 or a placebo (normal saline, NS) in the first treatment cycle (four weeks) in a double-blind manner; thereafter, on the next cycle (four weeks), all patients received open-label treatment with PG2. PG2 significantly improved CRF in the NS-primed group. In the first four week cycle, PG2 administration resulted in a greater fatigue-improvement response rate than seen with NS alone. In addition, approximately 82% of patients who reported an improvement of fatigue symptoms following the first cycle of PG2 experienced sustained benefits after administration of the second treatment cycle. Among patients treated with PG2 who did not report an improvement in symptoms throughout the first treatment cycle, approximately 71% showed significant improvement after the second treatment cycle. No major or irreversible toxicities were observed with PG2 treatment. PG2 might be an effective and safe treatment for relieving CRF among advanced cancer patients.
    Clinical and investigative medicine. Medecine clinique et experimentale 01/2012; 35(1):E1-11. · 1.15 Impact Factor
  • The Lancet Oncology 12/2011; 12(13):1184-5. · 25.12 Impact Factor
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    ABSTRACT: Breakthrough pain (BTP) has been defined as a transient exacerbation of pain that occurs to patients with otherwise stable baseline persistent pain. It is one of the most prevalent and formidable symptoms cancer patients have to face which can be classified into 4 types: predictable incident pain, unpredictable incident pain, idiopathic pain, and end-of-dose pain. Because of the characteristics of BTP, its management should be based on a consistent definition and thorough assessment including the determination of intensity, quality, duration, and other factors related to current treatment and so on. Medical treatment aims at reducing the frequency and intensity of BTP. Medication effectiveness should be sufficient for patients’ daily living activities, and devoid of side effects, dependence or drug–drug interactions. BTP should be clearly distinguished from chronic pain. Clinicians should be capable of using assessment tools for further identification and individual management. It is worth probing into these issues further in Taiwan from the aspects of different races, cancer types, and disease stages to evaluate the quality of patients’ pain control during and after cancer therapy and to develop appropriate local management and guidelines.
    Journal of Experimental & Clinical Medicine. 12/2011;
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    ABSTRACT: Fatigue among cancer patients has often been reported in the literature; however, great variations have been documented, ranging from 15% to 90%, probably due to the lack of a widely accepted definition and established diagnostic criteria for cancer-related fatigue. The objective of this study was to evaluate the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria in a sample of cancer patients from a medical center and a regional teaching hospital in northern Taiwan. More accurate prevalence estimates of CRF may result in improved diagnoses and management of one of the most common symptoms associated with cancer and its treatment. Since self-reporting from patients is the most effective and efficient method to measure fatigue, the ICD-10 criteria for fatigue were used. The ICD-10 criteria questionnaire was translated into Chinese and was approved by experts. Patients were recruited from outpatient palliative and oncology clinics and from palliative and oncology inpatient units. Of the 265 cancer patients that were interviewed between 21 October 2008 and 28 October 2009, 228 (86%) reported having at least 2 weeks of fatigue in the past month, and further evaluation with the ICD-10 criteria showed that 132 (49.8%) had cancer-related fatigue. Internal consistency was very good, which was indicated by a Cronbach alpha of 0.843. The prevalence of diagnosable CRF in the patients in this sample, of whom most were under palliative treatment, was 49.8%, which was probably somewhat lower than in some of the previous reports that have used less-strict criteria. In addition, among the various criteria of the proposed diagnostic criteria, the most frequently reported symptoms in our sample populations were regarding sleep disturbance and physical factors. Although they will require further replication in other samples, these formal diagnostic criteria can serve as a step toward a common language and a better understanding of the severity range of CRF.
    BMC Cancer 09/2011; 11:387. · 3.33 Impact Factor
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    ABSTRACT: Ovarian cancer is commonly fatal and incidence has persistently risen in Taiwan over the past 20 years. Prevention strategies, however, are limited. Pelvic inflammatory disease (PID) has been suggested to increase the risk of developing ovarian cancer, but the results of studies have been inconsistent. Therefore, we investigated whether PID increases the risk of developing ovarian cancer in a large, nationwide cohort. From the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan, we obtained data for women aged 13-65 years for whom a diagnosis of PID, confirmed by multiple episodes, had been recorded between Jan 1, 2004, and Dec 31, 2005. We also obtained data for two controls per patient, matched for age and the year of first entry into the LHID2005. All patients were followed up from the date of entry in the LHID2005 until they developed ovarian cancer or to the end of 2006, whichever was earlier. We used Cox's regression models to assess the risk of developing ovarian cancer, with adjustment for age, comorbid disorders, and socioeconomic characteristics. We identified 67,936 women with PID and 135,872 controls. Among these 90 had developed ovarian cancer during the 3-year follow-up period (42 patients with PID and 48 controls, incidence 2·78 and 1·44 per 10,000 person-years, respectively). The adjusted hazard ratio for ovarian cancer in patients with PID was 1·92 (95% CI 1·27-2·92) compared with controls, which rose to 2·46 (1·48-4·09) in women who had had at least five episodes of PID. The adjusted hazard ratio was slightly higher for women aged 35 years or younger with PID than in older women with PID (2·23, 1·02-4·79 vs 1·82, 1·10-3·04). We found an association between PID and ovarian cancer. PID might, therefore, be a useful marker for ovarian cancer, and early treatment could help to improve prognosis. Whether pelvic inflammation itself accelerates the growth of ovarian cancers or affects cancer-cell differentiation in ways that adversely alter prognosis needs to be investigated. None.
    The Lancet Oncology 08/2011; 12(9):900-4. · 25.12 Impact Factor
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    ABSTRACT: Background Fatigue among older patients and cancer patients is often reported in the literatures. However, relatively few studies can conclude whether fatigue happens more frequently in older patients with advanced cancer. We designed our study to examine the prevalence and features of fatigue among older advanced cancer patients in Taiwan. Methods Because self-reporting from patients is the most effective method to measure fatigue, the instrument of International Classification of Diseases-10 criteria for fatigue was applied. The questionnaire was translated to Chinese and approved by experts. Patients were collected from a palliative clinic or ward. Results Two hundred patients were interviewed between October 21, 2008, and October 28, 2009. There were 187 patients (93.5%) complaining of fatigue, and 130 of them (65%) met the criteria of cancer-related fatigue (CRF). Among the patients who were older than 65 years, 69 (92%) felt fatigue subjectively and 53 (71%) met the criteria of CRF. Feeling weak or heavy, having difficulty finishing something that had been started, and losing the interest or desire to the things that were usually done were more frequently seen among older cancer patients who experienced fatigue. Older cancer patients with CRF had a significantly higher incidence of feeling weak or heavy all over. Conclusion High incidence of fatigue among older patients with advanced cancer was noted. Fatigue in this population was related to physical and psychosocial factors. Physical factor plays an important role in older cancer patients with CRF.
    International Journal of Gerontology - INT J GERONTOL. 01/2011; 5(2):84-88.
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    ABSTRACT: Background Strong opioids have been recommended as the mainstay of therapy for moderate-to-severe pain, which is highly prevalent in terminally ill cancer patients. Purposes The aims of this study were to collect valuable data on the clinical use of strong opioid analgesics in the management of pain in terminally ill cancer patients receiving palliative care in Taiwan and disseminate the knowledge gleaned from these data to guide practical opioid treatment and improve pain control in end-of-life care. Methods This study retrospectively reviewed 150 cancer patients who received palliative care in a Taiwanese medical center between July 2005 and August 2008. Information regarding medications for pain control (opioid type, daily dosage, frequency, and route), adverse events, and pain assessments in the last 2 weeks before death was analyzed. Results In the second-last week of life, 97 (64.6%) patients were prescribed morphine only and 43 (28.7%) of them received two or more different opioids. In the last week, patients tended to prefer morphine to other opioids. The mean (standard deviation) daily morphine dosage was significantly higher in the last week [96.79 mg (110.55 mg)] than in the second-last week [88.08 mg (100.87 mg)]. The mean daily dose differed significantly between the gender and the three age groups (≤50, 51–70, and ≥71 years) in the last week of life but did not show difference in the second-last week of life. Subcutaneous injection (114 of 150, 76%) was the most frequent route of opioid administration. In the second-last week before death, patients with an improvement in their usual breakthrough pain level had taken a significantly higher dose of opioids than those who showed no improvement. Conclusion Overall, through appropriate dose adjustments, strong opioid regimens, and appropriate routes, strong opioids can be administered as extremely effective analgesics in the palliative care of patients with intractable cancer pain.
    Journal of Experimental & Clinical Medicine. 01/2010; 2(6):292-296.
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    ABSTRACT: Although immunodeficiency is usually considered a prerequisite of oncogenesis, a detailed immune pro- file in cancer has not yet been described. Without such profiling, it is not surprising that there is a vast discrepancy in the responses of cancer patients to immunotherapy. Our results show that the integrity of the immune system deteriorates with cancer progression by displaying a trend toward decreasing levels of functional T cells, including CD4, naïve, and central memory T cells, and an expansion of hyporesponsive populations such as CD28⁻ and CMV-specific T cells. One hundred and one patients constitute the study group for the observational study reported in this paper. Forty-eight patients with newly diagnosed stages III and IV and 53 patients with extensively treated stage IV disease. The costimulatory molecules CD27 and CD28 were downregulated in all patients. Among the proinflammatory cytokines (IL-6, TNF-α, IFN-γ), only IL-6 differed significantly among the groups, increasing as the cancer stage progressed. Plasma IL-7 did not diVer among the participants. The relative deficits of naïve T cells in cancer patients may be associated with the downregulation of IL-7Rα expression rather than changes in the circulating levels of IL-7. The downregulation of IL-7Rα expression was shown to be associated with increased levels of intracellular CMV. The present study suggests that the immune impairment in patients with cancer is associated with multiple factors, such as the stage of cancer, consequence of CMV infection and impact of treatment.
    Cancer Immunology and Immunotherapy 09/2009; 59(2):323-34. · 3.64 Impact Factor
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    ABSTRACT: End-stage cancer patients frequently suffer from idiopathic sweating of unknown cause. This study was to evaluate the effect (primary endpoint) of modified Yu Ping Feng San on idiopathic sweating and adverse reactions (secondary endpoint). Thirty two end-stage cancer patients receiving hospice care, with exclusion criteria including sweating due to known causes and taking drugs which may affect the sweating threshold were enrolled. Patients received modified Yu Ping Feng San for 10 consecutive days. The quantitative measurement of sweating showed 26 patients (81.3%) had complete remission of sweating, and the average time required to reach 50% reduction was 4.6 days. The visual analog scale (VAS) sweating score estimated by patients and care-givers showed that the mean reductions were 8.4 and 9.1 points, respectively. An increase in appetite was experienced by 65.6% of patients, after administration of modified Yu Ping Feng San. The most prevalent treatment-related complications were nausea (15.6%), diarrhea (9.3%) and allergy (3.1%) without severity greater than grade 2, and these were reversible after cessation of treatment. These results suggest that modified Yu Ping Feng San is a safe and effective treatment for idiopathic sweating of unknown cause in end-stage cancer patients.
    Phytotherapy Research 10/2008; 23(3):363-6. · 2.07 Impact Factor
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    ABSTRACT: Delirium is a common syndrome in terminal cancer patients. However, its detection and treatment by palliative care teams are not well documented. This survey aimed to determine the prevalence, detection and treatment of delirium in terminal cancer inpatients. The survey was conducted in Mackay Hospice and Palliative Care Center, Taiwan, from August 2006 to January 2007. All terminal cancer inpatients were invited to participate. The Delirium Rating Scale-Chinese Version was used by a research assistant as the screening instrument. Patients detected by screening were reviewed by psychiatrists to verify the diagnosis and determine the sub-type of delirium. The palliative care team members were asked to evaluate all the participants weekly. The medications used for delirium were obtained by a medical chart review. Result Two hundred and twenty eight participants (49.9%) among 457 inpatients were screened. The prevalence of delirium was 46.9% (n = 107). Of these, the most common subtype was hypoactive (68.2%, 95% confidence interval (CI): 59.4-77.0%). The mortality rate of inpatients with delirium (77.6%, 95% CI: 69.7-85.5%) was higher (P < 0.0001) than those without delirium (50.9%, 95% CI: 44.4-57.4%). The overall detection rate by any member of the palliative team was 44.9% (n = 48) (95% CI: 35.5-54.3%). The detection rate of the hypoactive subtype was only 20.5% (95% CI: 11.2-29.8%), which was significantly lower than that of the hyperactive/mixed subtypes (P < 0.0001). Therapy for delirium was prescribed in 42.1% (n = 45) (95% CI: 32.7-51.5%) with haloperidol being the most common medication. The prevalence of delirium was high, but the rates of detection and treatment were low. Interventions are recommended to improve the diagnosis and treatment of delirium in palliative care units.
    Japanese Journal of Clinical Oncology 02/2008; 38(1):56-63. · 1.90 Impact Factor
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    ABSTRACT: Most patients with advanced cancer experience pain. However, many cancer patients do not find satisfaction with conventional treatment of pain relief. This study examined the effect of electromyography (EMG) biofeedback-assisted relaxation on cancer-related pain in advanced cancer patients. We hypothesized that changes in EMG activity in frontal muscles underlie the efficacy of EMG biofeedback-assisted relaxation. This was a randomized control study. The experimental group (n = 12) received 6 EMG biofeedback-assisted relaxation sessions over a 4-week period, whereas the control group (n = 12) received conventional care. The primary efficacy measure was the level of pain, measured by the Brief Pain Inventory. Findings from this study show that relaxation training supplemented with visual and auditory EMG biofeedback signals is effective in reducing cancer-related pain in advanced cancer patients, possibly through a mechanism of attenuation of physiological arousal. Electromyography biofeedback-assisted relaxation training may be used along with medications for effective pain management in patients with advanced cancer.
    Cancer nursing 01/2007; 30(5):347-53. · 1.88 Impact Factor
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    ABSTRACT: Minocycline is a second-generation tetracycline with multiple biological effects, including inhibition of microglial activation. Recently, microglial activation has been implicated in the development of nerve injury-induced neuropathic pain. In this study, the authors examined the effects of continuous intrathecal minocycline on the development of neuropathic pain and microglial activation induced by L5/6 spinal-nerve ligation in rats. Under isoflurane anesthesia, male Sprague-Dawley rats (200-250 g) received right L5/6 spinal-nerve ligation and intrathecal catheters connected to an infusion pump. Intrathecal saline or minocycline (2 and 6 microg/h) was given continuously after surgery for 7 days (n = 8 per group). The rat right hind paw withdrawal threshold to von Frey filament stimuli and withdrawal latency to radiant heat were determined before surgery and on days 1 to 7 after surgery. Spinal microglial activation was evaluated with OX-42 immunoreactivity on day 7 after surgery. Spinal-nerve ligation induced mechanical allodynia and thermal hyperalgesia on the affected hind paw of saline-treated rats. Intrathecal minocycline (2 and 6 microg/h) prevented the development of mechanical allodynia and thermal hyperalgesia induced by nerve ligation. It also inhibited nerve ligation-induced microglial activation, as evidenced by decreased OX-42 staining. No obvious histopathologic change was noted after intrathecal minocycline (6 microg/h) infusion. In this study, the authors demonstrate the preventive effect of continuous intrathecal minocycline on the development of nociceptive behaviors induced by L5/6 spinal-nerve ligation in rats. Further studies are required to examine if continuous intrathecal minocycline could be used safely in the clinical setting.
    Regional Anesthesia and Pain Medicine 01/2007; 32(3):209-16. · 3.46 Impact Factor
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    ABSTRACT: Home death has a special cultural meaning for Taiwanese patients who are dying and their family members. However, very limited evidence has been presented on the impact of home death on caregiver bereavement outcomes. The purpose of this study was to explore the preference for place of death by Taiwanese patients dying of cancer and the actual place of death and to investigate the relationship between place of death of a patient and grief reactions of the family caregivers. This study consisted of 46 dying patients and 46 matched family caregivers (N = 92). The grief reaction was measured using the Texas Revised Inventory of Grief. Statistical analyses included descriptive statistics, t tests, logistic regression, and multiple regression. Most of the patients (74%) preferred to die at home; however, only 33% of family caregivers preferred the patient to die at home, and only 17% of patients actually died at home. Of these patients, 43% of their preferences were congruent with the actual place of death, whereas 79% of the family caregivers' preferences were congruent with the patients' actual place of death. Finally, the place of death was not a significant predictor of caregivers' grief reactions immediately after the loss of a loved one or at 1 month after the death occurred. This study provides important implications for future studies and clinical practice.
    Cancer nursing 01/2007; 30(4):278-84. · 1.88 Impact Factor
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    ABSTRACT: The purpose of this research was to investigate the effectiveness of a patient and family pain education program on reducing cancer patients' and their families' barriers to (i.e., concerns or misconceptions about) cancer pain management, on increasing patients' adherence to a prescribed analgesic regimen, and on decreasing pain intensity and pain interference with daily life. An experimental and longitudinal design was used. The experimental group consisted of 31 pairs of cancer outpatients and their family carers, while the control group consisted of 30 patient-family pairs (N=122). Patients and their family carers in the experimental group simultaneously received a pain management education program. Both groups had pretest data collection and after-test follow-ups on the second and fourth weeks at the outpatient clinics. Comparisons between those two groups were made using the Generalized Estimating Equations (GEE) method. Results revealed that at both the second and fourth weeks, patients and family carers in the experimental group showed a significantly greater reduction in barrier scores than did patients and family carers in the control group. At the second and fourth weeks, patients in the experimental group reported significantly better adherence to a scheduled analgesic regimen than did patients in the control group. In the fourth week, patients in the experimental group reported significantly lower levels of worst pain intensity and pain interference than did patients in the control group. This research provides evidence of the effectiveness of a patient and family pain education program.
    Pain 07/2006; 122(3):271-81. · 5.64 Impact Factor
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    ABSTRACT: This prospective, nonrandomized study was conducted to compare the efficacy and toxicity of post-operative concurrent chemoradiation therapy (CCRT) using daily oral uracil-tegafur plus leucovorin (UFUR/LV) vs. weekly intravenous fluorouracil plus leucovorin (5-FU/LV) in patients with locally advanced rectal cancer. From November 1996 through December 2004, 30 patients with stage II or III rectal cancer were enrolled. Either 5-FU (400 to 450 mg/m2) plus LV (80 to 100 mg/m2) weekly or oral UFUR (250 to 300 mg/m2/d) plus oral LV (30 to 45 mg/m2/d) were given during radiotherapy. Radiation (50.4 to 60.4 Gy) was delivered to the tumor bed in 28-33 fractions. The mean survival, 2-year overall survival and disease-free survival were 36 months vs. 30 months, 68% vs. 66% and 55% vs. 50%, (p > 0.05), in the UFUR/LV and 5-FU/LV groups, respectively. There were no treatment-related deaths or grade 4 toxicity in either group. Grade 3 dermatitis, gastrointestinal and hematologic toxicity were noted in the 5-FU/LV group. Because of a similar survival rate and lower toxicity, oral UFUR/LV is suggested as an alternative regimen to intravenous 5-FU/LV in post-operative CCRT of locally advanced rectal cancer.
    Anticancer research 01/2006; 26(5B):3709-15. · 1.71 Impact Factor
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    ABSTRACT: Our aim was to study the correlation between plasma transforming growth factor (TGF)-beta1 level and radiation-induced mucositis and dermatitis in nasopharyngeal carcinoma (NPC) patients. Blood samples obtained from patients treated with concurrent chemo-radiotherapy (CCRT) were divided into two groups according to the pre-treatment plasma TGF-beta1 level (> or =7.5 ng/ml as group 1 and < 7.5 ng/ml as group 2). Enzyme-linked immunosorbent assay (ELISA) was used for the measurement of the TGF-beta1 level. Radiation toxicity was evaluated according to Radiation Treatment Oncology Group criteria. Data were analyzed by the generalized estimation equation method. TGF-beta1 levels of group 1 patients were decreased significantly (P = 0.002) at the end of the treatment. The rate of decrease was 0.12 ng/ml per fraction (P = 0.02). The average TGF-beta1 level in patients who suffered acute radiation morbidity (grade > or =2) was significantly higher (P = 0.0057) than that of those who suffered less (grade < 2). A lower pre-treatment plasma TGF-beta1 level and the grade of radiation toxicity both appeared to contribute to the elevated plasma TGF-beta1 after CCRT.
    Japanese Journal of Clinical Oncology 09/2005; 35(8):427-32. · 1.90 Impact Factor
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    ABSTRACT: The aim of this study was to investigate a nursing staff's knowledge of the Natural Death Act before and after an educational intervention. This was a quasi-experimental designed study. Questionnaires were sent to 135 nurses in a medical center who volunteered to participate in the educational program. Demographic data and knowledge of the Natural Death Act were collected. The return rate was 85.37% (n=105). The educational program lasted for 6 h and included five subjects: hospice-palliative care, Natural Death Act, how to face suffering patients, nursing for agonized patients, and communicating with families. The program was a combination of lectures, case discussions, evaluation of individuals' values, and attitudes toward patient death. At baseline, the average total score in the 18-item questionnaire on the Natural Death Act was 12.96, with a range of 5-18. After the educational intervention, the average total score increased from 12.9 correct answers to 17.04 (of 18). The average increase was 4.08 points, a statistically significant difference. A provision of appropriate training for medical professionals appears to be a useful educational strategy, and this result shows that the Natural Death Act should be included in nursing school educational program. In the future, more effort should be made to fulfill patients' expectations and to follow medical ethics guidelines.
    Supportive Care Cancer 05/2005; 13(4):232-8. · 2.65 Impact Factor

Publication Stats

305 Citations
97.03 Total Impact Points

Institutions

  • 2013
    • Mackay Medical College
      T’ai-pei, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College
      T’ai-pei, Taipei, Taiwan
  • 2006–2012
    • Taipei Medical University
      • • School of Medicine
      • • Graduate Institute of Humanities in Medicine
      • • Graduate Institute of Nursing
      T’ai-pei, Taipei, Taiwan
  • 2003–2012
    • Mackay Memorial Hospital
      T’ai-pei, Taipei, Taiwan
  • 2011
    • Soochow University, Taiwan
      • Department of Mathematics
      Taipei, Taipei, Taiwan
    • Cardinal Tien Hospital
      T’ai-pei, Taipei, Taiwan
  • 2008
    • National Yang Ming University
      • Center for General Education
      T’ai-pei, Taipei, Taiwan
  • 2007
    • Wan Fang Hospital
      T’ai-pei, Taipei, Taiwan