Patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure: A study with patient-caregiver-physician triad.

OBJECTIVE: Accurate understanding of the extent of disease, treatment goal, and prognosis is a prerequisite for patients with cancer and their caregivers to make informed decision. We sought to evaluate patients' and family caregivers' understanding of the cancer stage, treatment goal, and chance of cure taking their own physician's evaluation as reference. METHODS: A national survey was performed with 750 patient-caregiver dyads (75.5% participation rate) recruited by 134 oncologists in 13 cancer centers (93% participation rate) in South Korea. Both patients and caregivers were asked to report their knowledge of patient's cancer stage, treatment goal, and chance of cure. Concordance was evaluated with percentage agreement and weighted κ, and predictors of discordance of patient and caregiver's response with that of physician's were explored by multivariate regression analyses with mixed effect model. RESULTS: The agreement rates between patient-physician and caregiver-physician were 63.0% and 65.9% for disease stage, 69.0% and 70.0% for treatment goal, and 41.4% and 45.1% for chance of cure. When discordance occurs, patients and caregivers often had an optimistic view. Distant stage, older age, female sex, and absence of depression were associated with optimistic view of patients, and there was significant between-physician variance for all 3 outcomes. CONCLUSION: The discordance revealed that our study suggests the need for better communication between physician and patients, as well as the caregivers. Research is needed to develop a comprehensive strategy to improve the understanding of the patients and family so that treatment decisions are made based on realistic estimation.

Association between cancer stigma and depression among cancer survivors: a nationwide survey in Korea.

OBJECTIVE: Cancer patients are more likely to experience depression than the general population. This study aims to evaluate the possible association between cancer stigma and depression among cancer patients. METHODS: As a part of the Korean government's program to develop comprehensive supportive care, we conducted a nationwide survey in 2010 at the National Cancer Center and in nine regional cancer centers across Korea. Cancer stigma was assessed by using a set of 12 questions grouped in three domains-impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination. Depression was measured by using the Hospital Anxiety and Depression Scale. RESULTS: A total of 466 cancer patients were included in the study. Over 30% of the cancer survivors had negative attitudes toward cancer and held stereotypical views of themselves: about 10% of the participants experienced social discrimination due to cancer, and 24.5% reported clinically significant depressive symptoms. Patients who had or experienced cancer stigma were 2.5 times more likely to have depression than patients with positive attitudes. CONCLUSIONS: Regardless of highly developed medical science and increased survivorship, cancer survivors had cancer stigmas, and it was significantly associated with depression. IMPACT: Our findings emphasize the need for medical societies and health professionals to pay more attention to cancer stigma that patients are likely to experience during treatment.

A simple prediction score for kidney disease in the Korean population.

AIM: Screening algorithms for chronic kidney disease have been developed and validated in American populations. Given the worldwide burden of kidney disease, developing algorithms for populations outside the USA is needed. METHODS: Using simple, non-invasive questions, we developed a prediction model for chronic kidney disease from national population samples in Korea. The Korean National Health and Nutrition Examination Survey (n = 6565) was used for model development while validation was performed in two independent population samples, internal (n = 2921) and external datasets (n = 8166). Chronic kidney disease was defined as glomerular filtration rate < 60 mL/min per 1.73 m(2). RESULTS: Seven factors - age, female gender, anaemia, hypertension, diabetes mellitus, cardiovascular disease and proteinuria - were significantly associated with prevalent chronic kidney disease. Integer scores were assigned to variables based on the magnitude of associations: 2 for age 50-59 years, 3 for age 60-69 years and 4 for age 70 years or older, and 1 for female gender, anaemia, hypertension, diabetes, proteinuria and cardiovascular dis ase. Based on the Youden index, a value of 4 or greater defined a high risk population with sensitivity 89%, specificity 71%, and positive predictive value 19%, and negative predictive value 99%. The area under the curve was 0.83 for the development set, and 0.87 and 0.78 in the two validation datasets. CONCLUSION: This prediction algorithm, weighted towards common non-invasive variables, had good performance characteristics in an Asian population, and provides new evidence of the similarity of the algorithms for Western and Eastern populations.

Facial wrinkles as a predictor of decreased renal function.

AIMS: Oxidative stress generated either by exogenous or endogenous sources can lead to progressive organ damage and skin ageing over a long period of time. Moreover, some dermatological signs are independent of chronological ageing, and may reflect the long-term redox state of internal organs. Therefore, we hypothesized that there might be an association between facial wrinkles and decreased renal function, an oxidative stress-related disease. METHODS: A cross-sectional study was carried out in a Korean population of 264 adults aged 30 years and older. Facial wrinkle scores in the crow's-foot area were estimated using a standardized form of visual assessment. As an index of renal function, we determined estimated glomerular filtration rate (eGFR). Lipid hydroperoxide (LPO) assay was performed to measure the levels of oxidative stress. RESULTS: After adjusting for possible confounders, lower eGFRs and higher LPO levels were found in those with severe facial wrinkles. CONCLUSION: We conclude that severe facial wrinkles might be used as a predictive marker of decreased renal function, independently of age, gender and other established risk factors.

Depression and suicide ideas of cancer patients and influencing factors in South Korea.

BACKGROUND: This study compared risk factors for depression and suicidal ideas among cancer patients for comparison with the general population, and identified influencing factors. MATERIALS AND METHODS: We analyzed data from 2,472 cancer patients in the National Cancer Center and nine Regional Cancer Centers and frequency-matched data for age and sex from 2,349 members of the general population who completed the National Health and Nutrition Examination Survey in 2008. Logistic regression analysis was used to identify factors affecting depression and suicidal ideas. RESULTS: Cancer patients were not likely to have more depression (OR=0.96, 95%CI=0.79-1.18) and were less likely to have suicidal ideas (OR=0.64, 95%CI=0.53-0.79) compared to the general population. Female sex, more stress, and lower quality of life were influencing factors. The additional risk factors for suicidal ideas among cancer patients included income (OR=0.62, 95%CI=0.43-0.91), smoking (OR=1.63, 95% CI=1.06-2.50), recurrence (OR=1.50, 95%CI=1.15-1.95), and chemotherapy (OR=1.66, 95%CI=1.26-2.19). CONCLUSIONS: No differences appeared in depression rates between cancer patients and the general population, and cancer patients were less likely to have suicidal ideas. However, cancer patients were likely to have more risk factors than the general population, and those classified as being at high risk of suicide should receive distress management and social economic support, from early in the treatment process.

Expression of DBC1 and SIRT1 is associated with poor prognosis for breast carcinoma.

Recently, it has been reported that SIRT1 and DBC1 may be involved in the development of tumors and predict poor survival in some cancers. However, their exact role is not clear. Therefore, we investigated the expression status and clinical significance of DBC1 and SIRT1 expression in breast carcinomas. We evaluated the immunohistochemical expression of DBC1, SIRT1, and p53 using a 3-mm core from 122 patients with breast cancer for tissue microarray. Positive expression of DBC1 and SIRT1 were seen in 71% and 67% of patients, respectively. In the patients with breast cancer, overall, expression of DBC1 and SIRT1 was significantly associated with distant metastatic relapse and shorter relapse-free survival and overall survival by univariate analysis. Tumor stage and DBC1 and SIRT1 expression were also independent prognostic factors by multivariate analysis. Among the patients who had received chemotherapy, DBC1 and SIRT1 expression was significantly associated with distant metastatic relapse and shorter survival by univariate analysis. DBC1 expression was also associated with distant metastatic relapse and shorter survival in patients who had received endocrine therapy, according to univariate and multivariate analysis. In conclusion, this study shows that expression of DBC1 and SIRT1 is a significant prognostic indicator for breast carcinoma patients.

Declining hepatitis A antibody seroprevalence in the Korean military personnel.

We retrospectively analyzed serological test results for anti-hepatitis A virus immunoglobulin G (anti-HAV IgG) of sera collected from 779 military personnel during January 2001 to May 2008. The overall seroprevalence of anti-HAV IgG of the subjects was 17.5% (95% confidence interval [CI], 14.8-20.1%). When adjusted to the age-specific distribution of the army population, the age-adjusted seroprevalence was 14.6% (95% CI, 13.0-16.3%). All subjects who were 40 years and over had anti-HAV IgG. Meanwhile, the seroprevalence of anti-HAV IgG for those 24 years and younger was 4.7%. This low prevalence rate among young military personnel calls for stricter adherence to vaccination policies and stronger requirements for military HAV vaccination programs.

[Serum gamma-glutamyltransferase levels and the risks of impaired fasting glucose in healthy men: a 2-year follow-up].

OBJECTIVES: An increase in the serum gamma-glutamyltransferase (GGT) concentration has been regarded as a marker of alcohol drinking or liver disease. Some reports, however, have suggested that the serum GGT may be a sensitive and early biomarker for the development of prediabetes and diabetes. In this study we investigated whether serum GGT is a reliable predictor of the incident impaired fasting glucose (IFG), including diabetes. METHODS: We performed a prospective study for two years (2002-2004). We analyzed the periodic health examination data from a total of 4,711 men. The examinations were done in the years 2002 and 2004. The analyzed data included a self-questionnaire, a physical examination and the laboratory results. Both IFG and diabetes were defined as a serum fasting glucose concentration of more than 100 mg/dL and 126 mg/dL, respectively. RESULTS: A total of 738 cases (15.7%) of incident IFG and 13 cases (0.3%) of diabetes occurred. The mean serum GGT concentrations were quite different between the normal (38.0 IU) and incident IFG groups (50.3 IU), and the incident diabetes group (66.0 IU) (p <0.001). After multivariable adjustment, the relative risks for incident IFG or diabetes across the baseline GGT categories (<10th, 10th-20th, 30th-40th, 50th-60th, 70th-80th and >90th percentile) were 1.0, 1.172 (0.769-1.785), 1.107 (0.725-1.689), 1.444 (0.934-2.232), 2.061 (1.401-3.031) and 2.545 (1.784-3.631) (p-value for trend: <0.001). The risks significantly increased with increasing levels of GGT for 2 years; when comparing the increased groups (<10%, .10-20%, >20%) versus the decreased over 20% group of GGT, the risks for IFG or diabetes were 1.334 (1.002-1.776), 1.613 (1.183-2.199) and 1.399 (1.092-1.794). CONCLUSIONS: Our findings suggest that serum GGT concentrations within its normal range may be an early predictor of the development of IFG and diabetes. As serum GGT is a relatively inexpensive test and a reliable marker, it might have important implications in public health promotion.

[Alibi verification and the PCR method to estimate the source of epidemic for a few notified cases of S. sonnei].

OBJECTIVES: A few culture-confirmed cases of S. sonnei have been notified from Korean hospitals. The source of epidemic can't be firmly determined in such cases because of the rarity of this illness in the local communities and the timing of the outbreaks. The objective of this study is to estimate the source of epidemic by investigating the patients' lifestyles. METHODS: Alibi verification was used to access the presumed source of the epidemic. PCR (Polymerase Chain Reaction) was used to rapidly detect the genes of Shigella in water specimens. RESULTS: The common lifestyle trait among the Shigella-infected patients was connected with Mt. Martyr in J city, Korea. The first patient's son had gone on a pilgrimage to Mt. Martyr with 41 friends and he had only eaten rice cakes on April 5th; the second patients had visited Mt. Martyr with their mother for a picnic on April 12th; the third patient had visited Mt. Martyr with 22 friends for a pilgrimage and the patient had only drunk holy water on April 13th. Therefore, the holy water of Mt. Martyr was reckoned to be the source of the epidemic. PCR detected the genes of Shigella two days before the S. sonnei was confirmed. CONCLUSION: The patients' lifestyles for 7 days before the onset of symptoms should be determined in terms of time, place and contacted people to find the source of infection when cases with food poisoning are seen in the hospital setting.

p38 MAP kinase regulates benzo(a)pyrene-induced apoptosis through the regulation of p53 activation.

Polycyclic aromatic hydrocarbons, such as benzo(a)pyrene (BaP), are widespread in the environment and cause untoward effects, including carcinogenesis, in mammalian cells. However, the molecular mechanism of apoptosis by BaP is remained to be elusive. Pharmacological inhibition of p38 kinase markedly inhibited the BaP-induced cytotoxicity, which was proven as apoptosis characterized by an increase in sub-G(0)/G(1) fraction of DNA content, ladder-pattern fragmentation of genomic DNA, and catalytic activation of caspase-3 with PARP cleavage. Our data also demonstrated that activation of caspase-3 was accompanied with activation of caspase-9 and mitochondrial dysfunction, which was also apparently suppressed by pretreatment with p38 kinase inhibitors. Also, pharmacological inhibition of p38 markedly inhibited the phosphorylation, accumulated expression, and transactivation activity of p53 in BaP-treated cells. Adenoviral overexpression of human p53 (wild-type) further augmented in increase of PARP cleavage and the sub-G(0)/G(1) fraction of DNA content. Furthermore, p53 mediated apoptotic activity in BaP-treated cells was inhibited by p38 kinase inhibitor. The current data collectively indicate that BaP induces apoptosis of Hepa1c1c7 cells via activation of p53-related signaling, which was, in part, regulated by p38 kinase.