Publications (30)102.29 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Patients with terminal cancer frequently suffer from sleep sweats, which occur while sleeping and cease after waking; the cause of these sweats is unknown. The aim of this study was to evaluate the efficacy of a modified Dang Gui Liu Huang Tang in managing sleep sweats, as well as to identify any associated adverse effects.
- [Show abstract] [Hide abstract] ABSTRACT: Background The present study aimed to explore the attitude and knowledge toward hospice palliative care among medical caregivers in Taiwan. Methods A cross-sectional questionnaire survey was conducted among medical staff attending a hospice palliative care conference. Results Overall, 163 of 232 questionnaires were valid. Based on the results, 54.9% of opinions on who has the right to sign a Hospice Palliative Care Declaration for an autonomous patient was consistent with the Taiwan Hospice Palliative Care Article; 91.4% of opinions on whether a life-sustaining therapy has been authorized to withhold was consistent with the article, compared with only 28.3% of opinions on whether a life-sustaining therapy has been authorized to withdraw. The capability of medical staff to provide these three procedures was varied (Cochran's Q = 121.150, p < 0.001). The medical staff who were aged > 32.5 years (odds ratio = 0.41; 95% confidence interval, 0.22-0.90; p < 0.01), and whose work experience was >9 years (odds ratio = 0.52; 95% confidence interval, 0.27-0.97; p < 0.05) tended to approach patients' informed consent of Hospice Palliative Care Declaration precisely. Conclusion Life and work experience improve the accuracy of medical staff in providing hospice palliative care. A culture-based, case-oriented continuing education program and a timely revision of the Hospice Palliative Care Article are recommended to increase the consistency between the principle and the practice of hospice palliative care. © 2015, Taiwan Society of Geriatric Emergency and Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.
- [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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] ABSTRACT: The primary objective of this study was to explore gender and age differences in the use of medical services during the year preceding suicide. Data were obtained from the mortality dataset of Department of Health and National Health Insurance Database. Included in the sample were 862 persons aged 12-24 years who committed suicide in Taiwan between 2001 and 2004. We compared the records of medical service utilization of adolescents (ages 12-18 years) with young adults (ages 19-24 years). Persons in both age groups contacted general practitioners more often than other types of medical providers in the year preceding suicide, with the exception of the month before suicide. Females made greater use of medical services than males in both age groups. Suicide prevention strategies should increase the emphasis in training non-psychiatric medical practitioners to identify and treat young persons at suicide risk.
- [Show abstract] [Hide abstract] ABSTRACT: Archidenron lucidum is an indigenous medicinal plant in Taiwan used for treatment of inflammatory diseases and cancer. This study was aimed to investigate its anti-cancer effect against gastrointestinal and hepatic malignancy. We found that the 50% effective concentrations of its methanol extract (MEAL) against human esophageal cancer CE81T/VGH, hepatoma HA22T/VGH and murine colorectal cancer CT26 cells were less than 5.0 μg/mL in vitro whereas those of water extract were greater than 30 μg/mL. Cell cycle arrest at G2/M phase was observed in all three cell lines treated with MEAL. Development of hypodiploidy cells suggests that apoptosis might be one of the cell death pathways of CE81T/VGH cells. Intraperitoneal injection with 1.25 mg/kg MEAL significantly inhibited syngeneic CT26 tumor growth in BALB/c mice without obvious toxicity in terms of changes in body weight, leukocyte count and plasma creatinine and alanine aminotransferase (ALT) levels. Higher dose (2.5 mg/kg) MEAL did not further increase the anti-tumor effect, but resulted in elevation of plasma ALT level. Our results indicate that optimal dose of MEAL might possess the anti-tumor effects against esophageal, hepatocellular and colorectal cancers with a relative safety profile. Accordingly, we are purifying effective and less toxic compounds from MEAL.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] ABSTRACT: One of the major challenges for intensivists is resolving the conflicting interests in end-of-life care. We reviewed patients' characteristics in an intensive care unit to determine the major barriers of practicing good end-of-life care and the medical ethics involved for the care team to resolve these conflicts.
- [Show abstract] [Hide abstract] 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.
- [Show abstract] [Hide abstract] 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.
Taipei Medical University
T’ai-pei, Taipei, Taiwan
- School of Medicine
Mackay Medical CollegeT’ai-pei, Taipei, Taiwan
National Yang Ming University
T’ai-pei, Taipei, Taiwan
- Education Center for Humanities and Social Sciences