Systemic Treatment for Cholangiocarcinoma.

Cholangiocarcinoma (CCA) is a diverse group of epithelial cancers that affect the biliary tree. The incidence of CCA is low in Western countries but significantly higher in endemic regions such as China and Thailand. Various risk factors contribute to the development of CCA. Recent studies have revealed molecular alterations in biliary tract cancers, providing insights into cholangiocarcinogenesis and potential targeted therapies. Surgical resection is the primary curative treatment for CCA. Adjuvant chemotherapy has been extensively studied, and some regimens have proven to be beneficial. Neoadjuvant chemotherapy has shown potential benefits in select cases, but its role remains controversial. In advanced stages, chemotherapy is the standard of care, and molecular profiling has identified potential targets such as FGFR, IDH1, HER2, and other tumor-agnostic therapies. Immunotherapy has demonstrated limited benefit in advanced CCA. This chapter provides an overview of the current evidence and ongoing research evaluating various chemotherapy regimens, targeted therapies, and immunotherapies across different stages of CCA.

Hierarchy, "Kreng Jai" and Feedback: A Grounded Theory Study Exploring Perspectives of Clinical Faculty and Medical Students in Thailand.

Phenomenon: Institutional learning culture influences how feedback is provided, accepted, and acted upon. The Thai societal culture, characterized by strict hierarchy and collectivism, may have a significant impact on the learning culture and, therefore, feedback conversations between teachers and learners. This study explored: common approaches used by faculty to provide feedback to students; and faculty and student perspectives regarding sociocultural factors that impact feedback seeking, provision, and acceptance. Approach: Using a constructivist paradigm, we explored perspectives of clinical faculty and medical students at an academic medical center in Thailand using focus groups (students) and a focus group and individual interviews (faculty). Sessions were audiotaped, transcribed, and de-identified prior to analysis. Constant comparative analysis was performed on transcripts, focusing on perceived cultural factors that impacted feedback conversations. Findings: Thirty faculty participated in the study, four participated in a focus group, and 27 participated in individual interviews. Twenty-two medical students participated in four focus groups. We identified the following key themes, which could be grouped under three categories: (1) Faculty approaches to providing feedback (1.1) Feedback should be initiated by faculty. (1.2) Feedback is initiated primarily for deficit identification and correction. (2) Factors impacting students' feedback seeking and acceptance. (2.1) Students are willing to accept harsh feedback when it provides suggestions for improvement. (2.2) Feedback is most credible when faculty have direct knowledge of the student's effort. (2.3) Feedback seeking is considered a burden on teachers. (3) Cultural factors that influence feedback (3.1) Societal hierarchy perpetuates unidirectional top-down feedback. (3.2) Kreng jai (the balance between consideration for others and self-interests) affects feedback seeking and provision. Insights: Though the value of feedback on learning was emphasized by all participants, the hierarchical culture of Thai society was perceived to have a significant influence on feedback seeking, provision, and acceptance. Identifying and addressing societal as well as institutional cultural factors would be key in designing growth-enhancing feedback initiatives relevant to the local context. One size feedback training does not fit all.

Validation of the Thai version of the family reported outcome measure (FROM-16)© to assess the impact of disease on the partner or family members of patients with cancer.

BACKGROUND: Cancer not only impairs a patient's physical and psychosocial functional behaviour, but also contributes to negative impact on family members' health related quality of life. Currently, there is an absence of a relevant tool in Thai with which to measure such impact. The aim of this study was to translate and validate the Family Reported Outcome Measure (FROM-16) in Thai cancer patients' family members. METHODS: Thai version of FROM-16 was generated by interactive forward-backward translation process following standard guidelines. This was tested for psychometric properties including reliability and validity, namely content validity, concurrent validity, known group validity, internal consistency, exploratory and confirmatory factor analysis. Construct validity was examined by comparing the Thai FROM-16 version with the WHOQOL-BREF-THAI. RESULTS: The internal consistency reliability was strong (Cronbach's alpha = 0.86). A Negative moderate correlation between the Thai FROM-16 and WHOQOL-BREF-THAI was observed (r = - 0.4545, p < 0.00), and known group validity was proved by a statistically significant higher score in family members with high burden of care and insufficient income. The factor analysis supported both 3-factor and 2-factor loading model with slight difference when compared with the original version. CONCLUSIONS: The Thai FROM-16 showed good reliability and validity in Thai family members of patients with cancer. A slight difference in factor analysis results compared to the original version could be due to cross-culture application.

Breast Cancer Incidence Trends and Projections in Northeastern Thailand.

BACKGROUND: The northeast has the lowest incidence of breast cancer of all regions in Thailand, although national rates are increasing. The heterogeneity in subnational trends necessitates a comprehensive evaluation of breast cancer incidence trends and projections to provide evidence for future region-specific strategies that may be employed to attenuate this growing burden. METHODS: Joinpoint regression and age-period-cohort modeling were used to describe trends from 1988-2012. Data was projected from three separate models to provide a range of estimates of incidence to the year 2030 by age group. RESULTS: Age-standardized rates (ASRs) increased significantly for all women from 1995-2012 by 4.5% per year. Rates for women below age 50 increased by 5.1% per year, while women age 50 years and older increased by 6% per year from 1988-2012. Projected rates show that women age 50 years and older have the largest projected increase in ASRs by 2030 compared to younger women and all women combined. CONCLUSIONS: Breast cancer trends in Khon Kaen are presently lower than other regions but are expected to increase and become comparable to other regions by 2030, particularly for women ages 50 years and older.

Radiographic features predictive of recurrence and survival after surgical resection of perihilar cholangiocarcinoma.

Objective: To study which radiographic features were associated with recurrence and adverse outcome in patients undergoing surgical resection of perihilar cholangiocarcinoma (PCCA), as well as to evaluate the imaging patterns that signify recurrence after the resection of PCCA. Materials and methods: This study was conducted in a solitary tertiary center and utilized a retrospective, analytical, case-control design. The study population consisted of patients with pathologically confirmed PCCA who underwent surgical resection and were subsequently followed up from January 2009 to December 2017. A total of 77 patients were enrolled in the study and were categorized into two distinct groups, namely recurrent and non-recurrent. The analysis encompassed the examination of demographic data and recurrence patterns. Additionally, survival and multivariate analyses were employed to assess radiographic imaging data and surgical information. Results: Seventy-seven patients diagnosed with PCCA based on pathological evidence were included in the study. Among the participants, there were 28 females and 49 males, with ages ranging from 41 to 81 years (mean age of 60.65 ±â€¯7.66). A noteworthy finding was the recurrence rate of 65 % observed following surgical resection. The presence of regional lymph node (LN) metastasis, adjacent organ invasion, and surgical margin emerged as the three independent factors that exhibited a significant association with recurrence after post-operative resection (p = 0.023, p = 0.028, and p = 0.010, respectively). The patients with PCCA who experienced regional LN metastasis had a median overall survival (OS) of 22 months, which was significantly lower than the 46 months observed in those without regional LN metastasis (p < 0.018). Furthermore, the individuals with regional LN metastasis had a death rate that was 2.08 times higher than those without (p = 0.040). In addition, those with adjacent organ invasion had an OS duration of 21 months compared with 52 months in those without (p = 0.008), and the rate of death was 2.39 times higher (p = 0.018). Patients with an R1 resection margin had an OS duration of 36 months compared with 51.56 months in those with an R0 resection margin (p = 0.006), as well as a 2.13 times higher rate of recurrence (p = 0.010) and a 2.43 times higher mortality rate (p = 0.013). Conclusion: The presence of regional LN metastasis, invasion of adjacent organs, and R1 resection margin were identified as distinct factors that are linked to both disease recurrence and reduced OS. Local recurrence, as well as the spread of cancer to distant organs such as the lungs and liver, were frequently observed patterns of recurrence. To enhance the precision of staging, prognosis, and treatment, the inclusion of periductal fat or invasion of adjacent organs should be considered in the staging system for PCCA.

Adjuvant chemotherapy in resectable cholangiocarcinoma patients.

BACKGROUND AND AIM: Cholangiocarcinoma patients usually have poor treatment outcome and a high mortality rate. The role of adjuvant chemotherapy (AC) is controversial. Our study aimed to evaluate benefits of AC in resectable cholangiocarcinoma patients. METHODS: A retrospective study included 263 patients who underwent curative resection in Srinakarind University Hospital. These patients had pathological reports showing a clear margin (R0) or microscopic margin (R1) of lesion-free tissue. RESULTS: There were 138 patients who received AC. This group had a significantly lower mean age than patients not receiving adjuvant chemotherapy (NAC) group (57.7 ± 8.5 vs 60.4 ± 9.0 years, P = 0.01). The level of serum albumin above 3 g/dL was more common in AC group than the NAC one (87.7% vs 79.2%, P = 0.04). Patients who received AC had significantly longer overall median survival time (21.6 vs 13.4 months, P = 0.01). Patients with a combination of gemcitabine and capecitabine regimen had the longest survival time (median overall survival time of gemcitabine and capecitabine 31.5, 5-fluorouracil and mitomycin 17.3, 5-fluorouracil alone 22.2, capecitabine alone 21.6, and gemcitabine alone 7.9 months, P = 0.02). Benefits of AC were likely to be found in patients who had high-risk features, that is, high level of carbohydrate antigen 19-9, advanced stage, T4 stage, lymph node involvement, and R1 margin. CONCLUSIONS: AC significantly prolongs survival time in resectable cholangiocarcinoma patients, particularly in the high risk group.

Programmed death­ligand 1 expression in tumor cells and tumor­infiltrating lymphocytes are associated with depth of tumor invasion in penile cancer.

The present study aimed to demonstrate the proportion of the programmed death-ligand 1 (PD-L1) expression in penile cancer patients and the association with clinicopathological parameters. Formalin-fixed paraffin-embedded specimens were obtained from 43 patients with primary penile squamous cell carcinoma treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, between 2008 and 2018. PD-L1 expression was evaluated by the immunohistochemistry using an SP263 monoclonal antibody. PD-L1 positivity was defined as >25% tumor cell staining or >25% tumor-associated immune cell staining. The correlation between PD-L1 expression and clinicopathological parameters was analyzed. A total of eight of 43 patients (18.6%) were identified as positive for PD-L1 expression in tumor cells and tumor-infiltrating lymphocytes. In the PD-L1 positive group, there was a significant association with pathological T stage (P=0.014) with a higher percentage of PD-L1 positive tumors in T1 stage compared with T2-T4 stage. In this cohort, there was a trend towards longer survival in patients with positive PD-L1 expression (5-year OS: 75% vs. 61.2%, P=0.19). Lymph node involvement and the location of tumor at the shaft of penis were two independent prognostic factors for survival. In conclusion, the PD-L1 expression was detected in 18% of penile cancer patients and high expression of PD-L1 was associated with the early T stage.

Lung cancer in hospitalized patients of Thailand.

OBJECTIVE: To identify admission rates, treatments and healthcare cost of lung cancer MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in the fiscal year 2010. The data included 96% of the population and were analyzed by age groups, hospital levels, treatment and insurance schemes in patients with lung cancer. RESULTS: Lung cancer occurred in 27,896 of all admissions, contributing to admission rate of 60 per 100,000 persons. The admission rates were markedly increased in male more than 60 years old. The majority of treatments were palliative care 61.38%, chemotherapy 36.81%. The average length of stay and hospital charges in three insurance schemes groups: government welfare, social welfare and universal coverage were 40,571.29 Baht/9.86 days, 43,342.54 Baht/8.24 days and 17,897.75 Baht/6.08 days, respectively. CONCLUSION: Admission rates showed that lung cancer increased with age. The highest rate was observed in more than 60 years old. The window gap in hospital charges and length of stay in three insurance schemes are interesting. Thus, analysis of treatment protocol should be examined.

Patterns of chemotherapy usage in hospitalized breast cancer patients.

BACKGROUND: Breast cancer is the leading cancer in Thai women. Systemic chemotherapy is one of the main treatment options in both adjuvant and metastatic disease. Patterns of chemotherapy usage and hospital cost data are lacking. OBJECTIVE: To identify overall admission rate, chemotherapy admission and hospital cost data of breast cancer patients. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the three health insurance schemes in the fiscal 2010. The data included 96% of the population. The data were analyzed by age groups, regions, hospital levels and insurance schemes in breast cancer patients. RESULTS: Admissions from breast cancer occurred for 35,490 in the year 2010. Admissions for systemic chemotherapy accounted for 53.1% of all breast cancer admissions and accounted for 17.3% of all admissions for chemotherapy. Most of chemotherapy admissions were in tertiary care hospital level. Mean length of stay for chemotherapy in breast cancer was 2.33 days compared to 5.30 days in other cancers. Mean hospital charge for chemotherapy for breast cancer was 13,904 THB compared to 33,693 THB for other cancers. The mean hospital charge three insurance schemes groups: government welfare, social welfare and universal coverage were 33,096, 19,932 and 9,599 THB, respectively. CONCLUSION: Admission rate for chemotherapy in breast cancer was not high. The cost of chemotherapy in each admission in breast cancer is nearly 50% lesser than chemotherapy for other cancers. Thus, generic drugs usage and outpatient administration of chemotherapy should be encouraged.

Health situation analysis of hospitalized Thai older persons in the year 2010.

BACKGROUND: Thailand has reached an ageing society on account of demographic transitions. Hospitalized elders are susceptible to having detrimental consequences in many aspects. Understanding the situation regarding elders being hospitalized would help allied-healthcare workers to focus and take necessary action on particular issues. OBJECTIVE: To demonstrate the admission rate of elders, common causes of hospitalization and their mortality rates. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospitals withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups and burdensome diseases. RESULTS: Elders posed the highest rate of all hospitalization (24.3/100 older persons) and the proportion increased with age. The top three common causes for hospitalization were diseases of respiratory tract (13%), circulatory (12%) and digestive system (11%). Mortality rates were highest in elders with pneumonia (129.7/100,000 persons). CONCLUSION: Older hospitalization was the highest for all hospitalization ages. Common causes for hospitalization are partly the consequences of modifiable factors. Thus, healthcare providers require extensive effort to enhance education and training to allied-healthcare workers regarding preventive and early diagnosis strategies to those with frequent illnesses.

Cost of colorectal cancer care in hospitalized patients of Thailand.

BACKGROUND: Colorectal cancer incidence rate is high and expected to increase in Thailand. But it is a preventable and curable disease if found in the early stage of development. The overall data regarding admission rates and healthcare cost in Thai patients are lacking. OBJECTIVE: To identify admission rates and healthcare cost of colorectal cancer. MATERIAL AND METHOD: Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population and were analyzed by age groups, hospital level and insurance schemes in patients with colorectal cancer. RESULTS: Colorectal cancer occurred in 45,692 of all admissions, contributing to admission rates of 98.5 per 100,000 persons. These figures increased with age. The highest admission was found in the central region including Bangkok (43%) followed by the northeast region (23%). The average hospital charges per admission in three insurance schemes groups: government welfare, social welfare and universal coverage were 64,241, 49,490 and 28,588 Baht, respectively CONCLUSION: Admission rates showed that colorectal cancer increased with age. The highest rate was observed in sixty years and older The hospital charges were extensive, especially in those on the government welfare scheme. Thus, screening programs, cost-effective analysis of treatment modalities and treatment protocol for the elderly should be examined.

Diffusion-weighted imaging as an imaging biomarker for assessing survival of patients with intrahepatic mass-forming cholangiocarcinoma.

BACKGROUND: Mass-forming cholangiocarcinoma is the most common form of intrahepatic cholangiocarcinoma and is associated with a worse prognosis. This study aimed to assess the role of diffusion-weighted imaging and other imaging features as prognostic markers to predict the survival of patients with intrahepatic mass-forming cholangiocarcinoma (IMCC). MATERIALS AND METHODS: The study included patients with pathologically proven IMCC from January 2011 to January 2018. Two radiologists retrospectively reviewed various imaging findings and manually estimated the area of diffusion restriction. Patients were grouped according to their restriction area into (group 1) restriction ≥ 1/3 of the tumor and (group 2) restriction < 1/3 of the tumor. Statistical analysis was performed to assess the relationship between various imaging features and patients' survival. RESULTS: Seventy-three patients were included in the study. IMCC patients with tumor size ≥ 5 cm had increased intrahepatic- and peritoneal metastases (p = 039 and p = 0.001 for reader 1 and p = 0.048 and p = 0.057 for reader 2). There was no significant relationship between the diffusion restriction area and tumor size, enhancement pattern, vascular involvement, lymph node metastasis, peritoneal- and distant metastasis. The number of deaths was significantly higher in patients with group 2 restriction (63.6% for group 1 vs. 96.6% for group 2; p = 0.001 for reader 1)(68.2% for group 1 vs. 89.7%% for group 2; p = 0.030 for reader 2). Patients with group 2 restriction had shorter 1- and 3-year survival rates and lower median survival time. Multivariable survival analysis showed two independent prognostic factors relating to poor survival outcomes: peritoneal metastasis (p = 0.04 for reader 1 and p = 0.041 for reader 2) and diffusion restriction < 1/3 (p = 0.011 for reader 1 and p = 0.042 for reader 2). Lymph node metastasis and intrahepatic metastasis were associated with shorter survival in the univariate analysis. However, these factors were non-significant in the multivariate analysis. CONCLUSION: Restriction diffusion of less than 1/3 and peritoneal metastasis were associated with shorter overall survival of IMCC patients. Other features that might correlate with the outcome are suspicious lymph nodes and multifocal lesions.

Prognostic Factors for Penile Cancer and Survival in Response to Multimodality Therapy.

PURPOSE: To report treatment outcomes of penile cancer in a single institution in Thailand and to identify prognostic factors for survival, highlighting the crucial role of multi-modality treatment (MMT). PATIENTS AND METHODS: Squamous cell carcinoma of penis patients who were treated at Srinagarind hospital between 2007-2015 were retrospectively analyzed. Clinical and pathological data were retrospectively reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method and data were compared using the Log rank test. Cox regression analysis of factors affecting survival was conducted. RESULTS: A total of 70 patients were identified with a median follow-up of 69.4 months. Twenty-eight patients (40%) presented with early-stage (stage I or II), whereas 42 patients (60%) were stage III or IV disease. The median OS was 29.3 months (Interquartile range 10.5 months - not reached) for the entire cohort. Nodal involvement was the only factor identified from the multivariate model with the adjusted HR or 5.74 (95% CI 2.52-13.04). For patients with stage IIIB/IV, multi-modality treatment (MMT) resulted in longer survival when compared with surgery alone (HR 0.37; 95% CI 0.16-0.90). CONCLUSION: Patients with penile cancer in Thailand presented with younger age and more locally advanced stage. Nodal involvement is the single poor prognostic factor for OS and MMT was associated with longer survival in stage IIIB/IV disease.

Frailty Syndrome in Biliary Tract Cancer Patients: Prevalence and Associated Factors

Background: Frailty, a risk of unfavorable outcomes from disability to adapt to stressors, is common in the elderly but could occur in younger patients with cancer. This study focused on the prevalence of frailty in biliary tract cancer (BTC) and associated factors. Methods: A total of 75 BTC patients receiving chemotherapy from January 2016 to September 2017 were enrolled. Frailty was diagnosed by the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight) scale. Univariate and multivariate regression analyses were used to analyze factors associated with frailty. Results: The prevalence rates of frailty and pre-frailty were 12% (9 cases) and 60% (45 cases). According to multivariate logistic analysis, three factors were associated with frailty, including old age, high body mass index (BMI), and history of liver surgery. The adjusted odds ratios of the factors were 1.12 (95%CI: 1.01, 1.24), 1.28 (95%CI: 1.01, 1.64), and 6.16 (95%CI: 1.11, 34.16), respectively. Conclusion: Frailty is not uncommon in BTC patients. Old age, high BMI, and history of liver surgery are important risk factors for frailty.

The impact of skeletal muscle mass on survival outcome in biliary tract cancer patients.

Low skeletal muscle mass is frequently observed in cancer patients and is known to be a poor prognostic factor for survival outcomes. The purposes of our study were to determine the prevalence of sarcopenia and its relation to mortality in biliary tract cancer. Body composition measurements (skeletal muscle index, total fat mass, bone mineral content) were evaluated by using dual-energy x-ray absorptiometry in 75 biliary tract cancer patients before chemotherapy. Muscle strength was measured by handgrip strength and gait speed. Overall survival and its associated factors were determined. The mean appendicular muscle mass was 17.8±2.7 kg in men and 14.0±2.1 kg in women (p < 0.05). Sarcopenia was diagnosed in 46 patients (61.3%) and higher proportion of men was classified as sarcopenia than women (69.0% vs 35.3%, p < 0.05). Multivariable analysis adjusted for chemotherapy regimen and age revealed that high appendicular muscle mass independently predicted better survival outcomes (HR 0.40; 95% CI, 0.18 to 0.88; p = 0.023). Sarcopenia is common in biliary tract cancer patients and low appendicular muscle mass was associated with poor survival outcome.

Programmed Death-Ligand 1 (PD-L1) Expression Associated with a High Neutrophil/Lymphocyte Ratio in Cholangiocarcinoma

Background: Effective treatments for cholangiocarcinoma (CCA) are still lacking. There are promising results of checkpoint inhibitor programmed cell death ligand-1 (PD-L1) activities in early phase trials. This study aimed to investigate the expression of PD-L1 and its relation to possible treatments for CCA. Methods: Formalin-fixed paraffin-embedded tumor samples from 46 patients with cholangiocarcinoma were retrieved. PD-L1 expression was evaluated by immunohistochemistry using anti-PD-L1 antibody, clone 5H1. A PD-L1 positive response on tumor cells was defined as >1% of tumor cell membranes stained. The association between PD-L1, clinico-pathological characteristics was analyzed using Fisher's exact test, and survival analysis was done with the Cox regression model. Results: Out of 46 samples, 32 (70%) had positive PD-L1 expression in tumor cell membranes. The median level of PD-L1 expression was 1.75% (0-34.7). PD-L1 expression was significantly associated with stage IV disease (OR 3.98, p=0.046) and a high neutrophil/lymphocyte ratio (OR 5.36, p=0.018). PD-L1 positivity was associated with worse overall survival compared with those with a PD-L1 negative tumor but did not reach a level of significance (7.2 vs. 7.9 months, p=0.32). Conclusion: PD-L1 is widely expressed in CCA but was not predictive for overall survival. PD-L1 positivity was (7.2 and 7.9 months, p=0.32). Significantly associated with stage IV disease and a high neutrophil/lymphocyte ratio.

Treatment Outcome and Predictors of Survival in Thai Adult Rhabdomyosarcoma Cases.

BACKGROUND: Adult rhabdomyosarcoma (RMS) is a rare and aggressive disease with limited data compared with pediatric RMS. The goal of this study was to determine the treatment outcome and identify factors related to survival outcome in Thailand. MATERIALS AND METHODS: Adult patients (≥15 years old) with the pathological diagnosis of RMS between 1985 and 2010 were reviewed. The data were retrospectively reviewed from the pathological results and medical records from Srinagarind Hospital, Khon Kaen University. RESULTS: A total of 34 patients were identified in the study. The median age at diagnosis was 35.5 years and the most common primary sites were extremity and the head and neck region. The incidence of pleomorphic RMS increased with age and none was found in those aged younger than 20 years old. The median survival time was 9.33 months (95%CI: 5.6-13.1). The 1- and 5- year survival rates were 38.2% (22.3-54.0) and 20.6% (9.1-35.3). On multivariate analysis, age and size of tumor did not predict better outcome while chemotherapy and surgery were significantly associated with longer survival. CONCLUSIONS: Outcome of adult RMS was poor. Surgery and chemotherapy are s trongly associated with better prognosis and multimodality treatment should be incorporated in the clinic.

Numbers of new cases and trends of cancer 1993-2012: srinagarind hospital based population, Khon Kaen, North- East Thailand.

BACKGROUND: Cancer is the most common cause of death in Thailand, where treatment outcomes and prognosis are poor and mortality rates remain high. This study reports new cancer cases and trends of all cancers registered in Srinagarind Hospital from 1993 to 2012 and also provides a picture of the cancer situation in Northeast Thailand. MATERIALS AND METHODS: All new cases of cancer registered in the hospital-based cancer registry at Faculty of Medicine, Srinagarind Hospital, Khon Kaen University during 1993-2012 were included in the study. RESULTS AND CONCLUSIONS: The number of new cancer cases has gradually increased each year during the last 20 years. The three most common cancers at present in males are liver and bile duct cancer, lung cancer and colorectal cancer, respectively. In females, liver and bile duct, breast and thyroid cancers are now the most frequent. Interestingly, the number of cases of both liver and bile duct cancer and colorectal cancer in males noticeably increased during the second decade of the study. Additionally, breast cancer greatly increased in the same decade and lung cancer in females climbed into the top five most common cancers. Thyroid cancer has also risen steadily in the last decade. Trends of common cancers are similar to those throughout Thailand.

Burdens among caregivers of older adults with advanced cancer and risk factors.

UNLABELLED: Family caregivers of older cancer patients face many challenges in managing illness. The burden impacts physical, emotional, spiritual, and social health. The objective of this study was to identify burden among caregivers of older patients with advanced cancer, and associated factors. MATERIALS AND METHODS: Caregivers of older cancer patients were randomly interviewed from March-September 2012. Information on baseline characteristics and caregiver burden using the Zarit Burden Inventory (ZBI) was collected. Descriptive statistics were used to analyze baseline data, with univariate and multiple linear regression to analyze factors associated with higher burden. RESULTS: One hundred and fifty participants were assessed. The mean ZBI was 19.2 ± 12.9 (95%CI, 17.1, 21.2). Two-thirds of caregivers reported no burden (63%) and the main impact variable on ZBI was guilt. High burdens were associated with single caregiver, relationship with the patient as siblings, presence of migraines, and cancer types of the patients. CONCLUSIONS: Caregiver burden of Thai cancer patients is low. This unexpected small number could be the result of the socio-cultural viewpoint. Assessment of caregivers and focusing on related factors should be incorporated into treatment plans.

Prognostic factors in resectable cholangiocarcinoma patients: Carcinoembryonic antigen, lymph node, surgical margin and chemotherapy.

AIM: To evaluate outcomes in resectable cholangiocarcinoma patients and to determine prognostic factors. METHODS: A retrospective study was conducted among newly-diagnosed cholangiocarcinoma patients from January 2009 to December 2011 who underwent curative resection in Srinakarind Hospital (a 1000-bed university hospital). Two hundred and sixty-three cholangiocarcinoma patients with good performance were enrolled. These patients had pathological reports with clear margins or microscopic margins. Prognostic factors which included clinical factors, serum liver function test as well as serum tumor makers at presentation, tumor data, and receiving adjuvant chemotherapy were determined by uni- and multivariate analysis. RESULTS: The median overall survival time was 17 mo (95%CI: 13.2-20.7); and 1-, 2-, and 3- year survival rates were 65.5%, 45.2% and 35.4%. Serum albumin levels, serum carcinoembryonic antigen (CEA) levels, staging classifications by American Joint Committee on cancer, pathological tumor staging, lymph node metastases, tumor grading, surgical margin status, and if adjuvant chemotherapy was administered, were shown to be significant prognostic factors of resectable cholangiocarcinoma by univariate analysis. Multivariate analysis, however, established that only abnormal serum CEA [hazard ratio (HR) 1.68; P = 0.027] and lymph node metastases (HR 2.27; P = 0.007) were significantly associated with a decrease in overall survival, while adjuvant chemotherapy (HR 0.71; P = 0.067) and surgical margin negative (HR 0.72; P = 0.094) tended to improve survival time. CONCLUSION: Serum CEA and lymph node metastases which were associated with advanced stage tumors become strong negative prognostic factors in cholangiocarcinoma.