Incidence and Direct Medical Cost of Adjustment Disorder and in Korea Using National Health Insurance Service Claims Data From 2011 to 2017.

OBJECTIVE: We aimed to investigate the annual incidence and direct medical cost of adjustment disorder in general population using the National Health Insurance Service Database (NHID) in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim for adjustment disorder and had not been diagnosed in the previous 365 days, from 2010 to 2017. RESULTS: The number of newly diagnosed cases of adjustment disorder from 2011 to 2017 were total 101,922. Annual incidence of adjustment disorder was ranged from 22.0 to 36.8 per 100,000 persons. The incidence of adjustment disorder was found more in female and highest among 70-79 years of age group and medical aid beneficiaries group. Annual prevalence of adjustment disorder was in the range from 95.4 to 116.4 per 100,000 persons. Estimated annual medical cost per person of adjustment disorder was ranged from 162 to 231.4 US dollars. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of adjustment disorder in Korea were increased. Proper information on adjustment disorder will not only allows us to accumulate more knowledge but also lead to more appropriate therapeutic interventions.

Incidence and Direct Medical Cost of Acute Stress Disorder and Post-traumatic Stress Disorder in Korea: Based on National Health Insurance Service Claims Data from 2011 to 2017.

BACKGROUND: We aimed to investigate the annual incidence of trauma and stress-related mental disorder including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) using the National Health Insurance Service Database. In addition, we estimated direct medical cost of ASD and PTSD in Korea. METHODS: To examine the incidence, we selected patients who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems code for ASD (F43.0) and PTSD (F43.1) and had not been diagnosed in the previous 360 days, from 2010 to 2017. We estimated annual incidence and the number of newly diagnosed patients of ASD and PTSD. Annual prevalence and direct medical cost of ASD and PTSD were also estimated. RESULTS: The number of newly diagnosed cases of ASD and PTSD from 2011 to 2017 totaled 38,298 and 21,402, respectively. The mean annual incidence of ASD ranged from 8.4 to 13.7 per 100,000 population and that of PTSD ranged from 4.2 to 8.3 per 100,000 population, respectively. The incidence of ASD was found more in females and was highest among the 70-79 years of age group and the self-employed individuals group. The incidence of PTSD was also more common in the female group. However, the incidence of PTSD was highest in the 60-69 years of age group and in the medical aid beneficiaries group. The annual estimated medical cost per person of ASD ranged from 104 to 149 US dollars (USD). In addition, that of PTSD ranged from 310 to 426 USD. CONCLUSION: From 2011 to 2017, the annual incidence and direct medical cost of ASD and PTSD in Korea were increased. Proper information on ASD and PTSD will not only allows us to accumulate more knowledge about these disorders themselves but also lead to more appropriate therapeutic interventions by improving the ability to cope with these trauma related psychiatric sequelae.

INTERCOMPARISON ON INTERNAL DOSE ASSESSMENT FOR NUCLEAR POWER PLANTS IN KOREA.

The intercomparison test is a quality assurance activity performed for internal dose assessment. In Korea, the intercomparison test on internal dose assessment was carried out for nuclear facilities in May 2018. The test involved four nuclear facilities in Korea, and seven exposure scenarios were applied. These scenarios cover the intake of 131I, a uranium mixture, 60Co and tritium under various conditions. This paper only reviews the participant results of three scenarios pertinent to the operation of nuclear power plants and adopts the statistical evaluation method, used in international intercomparison tests, to determine the significance values of the results. Although no outliers were established in the test, improvements in the internal dose assessment procedure were derived. These included the selection of intake time, selection of lung absorption type according to the chemical form and consideration of the contribution of previous intake.

Attitudes toward early palliative care in cancer patients and caregivers: a Korean nationwide survey.

Integrated early palliative care (EPC) improves quality of life and reduces psychological distress in adult patients with cancer and caregivers, but attitudes toward EPC have been poorly studied. We aimed to investigate attitudes toward EPC in a nationwide survey of patients with cancer and caregivers. From July to October 2016, we administered nationwide questionnaires examining attitudes toward EPC in patients with cancer (n = 1001) and their families (n = 1006) from 12 Korean hospitals. When an individual considered EPC unnecessary, the reasons were collected and analyzed. Factors associated with perception of EPC were examined. A majority of patients (84.5%) and caregivers (89.5%) had positive attitudes toward EPC. The most common reasons for deeming EPC unnecessary were that EPC may be an obstacle to cancer treatment (patients: 37%; caregivers: 23%; respectively) or that they were not sure if EPC is beneficial (patients: 21%; caregivers: 24%; respectively). Financial burden as a reason was more evident in caregivers (23%) than in patients (17%). Male gender, age <50, early stage, intensive care unit admission, and not believing that dying people should prepare to practice charity were associated with patients' negative attitudes. In caregivers, opposition to EPC was associated with not thinking death should be feared, not thinking people should be remembered, and lower educational level. Our findings showed that significant numbers of patients with advanced cancer and family caregivers showed positive attitudes toward EPC. However, more than 10% of participants did not consider EPC necessary. Physicians' communication with patients and caregivers and financial support could help overcome the barriers of EPC.

Efficacy of a training program for long-term disease- free cancer survivors as health partners: a randomized controlled trial in Korea.

BACKGROUND: To determine whether the Health Partner Program is effective in training long-term cancer survivors to be health coaches. MATERIALS AND METHODS: We randomly assigned cancer survivors who were selected through a rigorous screening process to either the Health Partner Program or the waiting-list control group. The program consisted of 8 weeks of training in health management, leadership, and coaching. At baseline, 8, and 16 weeks, we measured primary outcomes using the Seven Habit Profile (SHP), the Korean Leadership Coaching Competency Inventory (KCCI), Ed Diner's Satisfaction with Life Scale (SWLS), and the Posttraumatic Growth inventory (PTGI) and secondary outcomes using the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale-Revised (IES-R), and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF- 36). RESULTS: We recruited 70 subjects and randomly assigned 34 to the intervention group. The Sharpen the Saw habit of the SHP increased significantly more in intervention group than in the control group (p = 0.049), as did most PTGI factors. The intervention group also showed a significantly greater enhancement of vitality (p = 0.015) and mental health (p = 0.049) SF-36 scores but no improvement in KCCI, SWLS, HADS, or IES-R scores. The intervention group also showed a greater clinically meaningful improvement in the "Think Win-Win" of SHP (p = 0.043) and in the personal strength score (p = 0.025) and total score (p = 0.015) of the PTGI. CONCLUSIONS: Long-term cancer survivors can benefit from the Health Partner Program to become health coaches.

Complementary and alternative medicine use among cancer patients at the end of life: Korean national study.

OBJECTIVES: To investigate in depth the use of complementary and alternative medicines (CAMs) by cancer patients at the end-of-life (EOL) and how they communicate with physicians about them. DESIGN AND LOCATION: In 17 hospitals in Korea between January and December 2004 we identified 4,042 families of cancer patients. RESULTS: The prevalence of CAM use among cancer patients at the EOL was 37.0%, and 93.1% had used pharmacologic types of agents. The most frequent motive for CAM use was the recommendation of friends or a close relative (53.4%) or a physician (1.6%). Only 42.5% discussed CAM use with their physicians. Satisfaction with CAMS was recalled for 37.1% . The most common reason given for that satisfaction was improvement of emotional or physical well-being, while ineffectiveness was the most common reason given for dissatisfaction. The average cost of CAM during the last month of life was $US 900. CAM use was associated with longer disease periods, primary cancers other than liver, biliary, and pancreatic, and need of support from physicians or religion. CONCLUSIONS: CAM use among cancer patients at the EOL was common, not discussed with physicians, and associated with expectation of cure. Expectations were generally unmet while the treatments were a financial burden. Further studies evaluating the effects of CAM at the EOL and factors that enhance communication with the physician are needed.

Patient-reported assessment of quality care at end of life: development and validation of Quality Care Questionnaire-End of Life (QCQ-EOL).

Our goal was to validate an instrument with which terminally ill patients could evaluate the quality of care they receive at the end of life (EOL). Questionnaire development followed a four-phase process: item generation and reduction, construction, pilot testing, and field-testing. Using relevance and priority criteria and pilot testing, we developed a 16-item questionnaire. Factor analyses of data from 235 patients resulted in the Quality Care Questionnaire-End of Life (QCQ-EOL) covering dignity-conserving care, care by health care professionals, individualised care, and family relationships. All subscales and total scores showed high internal consistency (Cronbach alpha range, 0.73-0.89). The ability of total score and selective subscale scores clearly differentiated patients on the basis of clinical situation, sense of dignity, and general rating of care quality. Correlations of scores between patients and caregivers were substantial. The QCQ-EOL can be adopted to assess the quality of care received by terminally ill patients.

Change in patients' satisfaction with pain control after using the Korean cancer pain assessment tool in Korea.

Appropriate pain assessment is very important for managing cancer pain. This study was designed to evaluate the utility of the Korean Cancer Pain Assessment Tool (KCPAT) by assessing changes in the management of cancer pain. The changes in pain intensity, the pattern of drug prescriptions, and the patients' satisfaction with pain control were analyzed after using the KCPAT. The results indicated that pain medicine prescriptions were changed in 194 (51.5%) cases after using the KCPAT, and 69.5% of these changes were affected by the KCPAT. After using the KCPAT, pain intensity as assessed by the Visual Analogue Scale (VAS, 0-10cm) decreased (4.31+/-2.35 vs. 3.60+/-2.45, P<0.0001), and the presence of associated symptoms and psychosocial items was significantly reduced. The patients' satisfaction with pain control was improved. Forty-four physicians (89.8%) thought that the KCPAT was useful. The KCPAT improved patients' satisfaction with pain control and was a useful tool for evaluating and managing cancer pain.

EuroQol and survival prediction in terminal cancer patients: a multicenter prospective study in hospice-palliative care units.

GOALS OF WORK: Although the EuroQol (EQ-5D) is widely used for economic evaluation, it remains unclear whether it can be combined with medical data to predict survival in patients with terminal cancer. PATIENTS AND METHODS: We carried out this prospective study on 142 terminal cancer patients in four hospice-palliative care units. Association was sought between survival time and a range of variables such as cancer site, performance, previous treatment, age, sex, pain, and EuroQol. The EQ-5D was transformed into the corresponding EQ-5D utility. For univariate analysis, we estimated differences in survival with the Gehan generalized Wilcoxon test. For those variables that were significant, we performed multivariate analysis using the Cox proportional hazard model. MAIN RESULTS: Univariate analysis showed that sex, age, performance, previous use of chemotherapy, and the EQ-5D utility provided statistically significant prognostic survival information. The median survival time was 13.0 days for the group with an EQ-5D utility score lower than -0.5 and 21.0 days for the group with an EQ-5D utility score above -0.5. In multivariate analysis with the Cox proportional hazard model, an EQ-5D utility score < or = 0.5 (RR 1.57, 95% confidence interval 1.06-2.33) was an independent negative predictor of survival. CONCLUSIONS: The EQ-5D quality-of-life assessment tool might be useful for predicting survival time for terminal cancer patients.

Economic burdens and quality of life of family caregivers of cancer patients.

OBJECTIVES: We conducted this study to identify factors influencing the burdens cancer brings to a patient's family and to evaluate the association between the burdens and the caregiver's quality of life (QOL). METHODS: Participants were drawn from the primary family caregivers of cancer patients at 6 university hospitals and the National Cancer Center in Korea. Of the 738 eligible caregivers, 704 (95.4%) completed the questionnaire packets (Family Impact Questions and Caregiver's QOL-Cancer). RESULTS: Caregivers, who were poor (OR, 2.11; 95% CI, 1.44-3.10), whose health status was poor (OR, 1.87; 95% CI, 1.29-2.70), who were married (OR, 1.75; 95% CI, 1.12-2.72), who provided care for a long time (OR, 2.29; 95% CI, 1.59-3.28), who cared for patients with poor performance status (OR, 1.35; 95% CI, 1.00-1.82), and who paid high medical expenses (OR, 1.70; 95% CI, 1.21-2.40), were more likely to lose their family savings. In multiple regression analysis, most burden variables--including requiring caregiving assistance, major life change, inability to function normally, loss of savings, loss of income, and altered educational plans--were associated with caregiver QOL. Loss of family income, which was related to economic issues, was most strongly associated with it (16.0%). CONCLUSIONS: Our study suggests that to improve caregiver QOL, we should give priority to decreasing the economic burden that cancer places on patient's family.