Health-promoting behaviors among middle-aged breast cancer survivors compared with matched non-cancer controls: A KNHANES VI-VII (2013-2018) study.

This study aimed to compare health-promoting behaviors between middle-aged breast cancer survivors and matched non-cancer controls. We conducted a retrospective, cross-sectional, matched case-control study using data from Korean National Health and Nutrition Examination Surveys (KNHANES) VI-VII (2013-2018) to compare health-promoting behaviors. We selected breast cancer survivors aged 40 to 65 who completed the surveys, and each case was matched with 5 non-cancer controls (1:5) based on propensity scores. With multivariable logistic regression, middle-aged breast cancer survivors were compared with controls in terms of their last screening for a second primary cancer (SPC), current smoking status, alcohol consumption, aerobic physical activity (PA), sedentary time, and self-reported diet control. The final study sample consisted of 117 middle-aged breast cancer survivors and 585 non-cancer controls after propensity score matching (PSM). In the multivariable analysis, middle-aged breast cancer survivors were less likely to consume alcohol (odds ratio [OR] 0.58, 95% confidence interval [CI], 0.35-0.95), more likely to engage in aerobic PA (OR, 1.60; 95% CI, 1.01-2.54), and more likely to self-report diet control (OR, 2.12; 95% CI, 1.27-3.53). There were no significant intergroup differences in SPC screening uptake within 2 years, smoking status, or sedentary times. There is a need to educate middle-aged breast cancer survivors about SPC screening, smoking cessation, and minimizing sedentariness to reduce the risks of associated with breast cancer recurrence, SPCs, and comorbid chronic diseases.

Effective Timing of Introducing an Inpatient Smoking Cessation Program to Cancer Patients.

PURPOSE: We aimed to identify factors influencing smoking cessation success among cancer patients registered in an inpatient smoking cessation program at a single cancer center. MATERIALS AND METHODS: The electronic medical records of enrolled patients with solid cancer were retrospectively reviewed. We evaluated factors associated with 6-month smoking cessation. RESULTS: A total of 458 patients with cancer were included in this study. Their mean age was 62.9±10.3 years, and 56.3% of the participants had lung cancer. 193 (42.1%) had not yet begun their main treatment. The mean number of counseling sessions for the participants was 8.4±3.5, and 46 (10.0%) patients were prescribed smoking cessation medications. The 6-month smoking cessation success rate was 48.0%. Multivariate analysis showed that younger age (<65 years), cohabited status, early stage, and the number of counseling sessions were statistically significant factors affecting 6-month smoking cessation success (p<0.05). Initiation of a cessation program before cancer treatment was significantly associated with cessation success (odds ratio, 1.66; 95% confidence interval, 1.02-2.70; p=0.040). CONCLUSION: Smoking cessation intervention must be considered when establishing a treatment plan immediately after a cancer diagnosis among smokers.

Smoking cessation rates in elderly and nonelderly smokers after participating in an intensive care smoking cessation camp.

Since it is a widely known fact that smoking cessation is beneficial physically and cognitively, efforts should be made to enable smokers to quit smoking through policy. Intensive care smoking cessation camps generally show a high smoking cessation success rate, but research is needed to determine which smokers should be admitted due to costeffectiveness. Although many studies have been conducted to find factors related to smoking cessation success, there is still controversy about the will and success rate of smoking cessation of elderly smokers. We performed this study to determine behavior characteristics and smoking cessation success rates in nonelderly and elderly smokers who participated in an intensive care smoking cessation camp. Heavy smokers participating in an intensive care smoking cessation camp at Chonnam National University Hospital between the August 2015 and December 2017 were classified into elderly (age ≥65 years old) or nonelderly (age <65 years old) groups after excluding missing data. Smokers were followed up at 4 weeks, 6 weeks, 12 weeks, and 6 months from the start of abstinence by self-report, measurement of carbon monoxide expiration levels or cotinine testing. A total of 351 smokers were enrolled in the study. At the 6-month follow-up, 56 of 107 (52.3%) elderly smokers and 109 of 244 (44.7%) nonelderly smokers continued to abstain from smoking. Elderly smokers showed a higher smoking cessation rate than that of nonelderly smokers, but it was not statistically significant (OR = 1.36, 95%CI: 0.862, 2.145). The most common causes of cessation failure in both groups were stress and temptation, followed by withdrawal symptoms. Smoking cessation rates in the elderly are comparable to that in the nonelderly after an intensive care smoking cessation camp. Intensive care smoking cessation camps can help both elderly and nonelderly smokers who intend to quit smoking by providing motivation, education and medication. Smoking cessation should be strongly recommended regardless of age.

Relationship between frailty and mortality after gastrectomy in older patients with gastric cancer.

OBJECTIVES: Frail older adults with gastric cancer are at an increased risk of poor postoperative outcomes. We assessed whether geriatric frailty assessed using the Study of Osteoporotic Fractures (SOF) index could predict post-gastrectomy mortality. MATERIALS AND METHODS: We retrospectively assessed older adults (age ≥ 65 years) who underwent gastrectomy for gastric cancer between April 2012 and September 2015. Frailty status was assessed using the SOF index (range, 0-3) and categorized as robust (0), pre-frail (1), and frail (2-3). The Kaplan-Meier method and log-rank tests were used to compare survival between frailty groups. Univariate and multivariate analyses were used to identify mortality-associated risk factors. RESULTS: Among 231 patients (the median age 72.04 years and 140 (60.6%) men), 138 (59.7%) were robust, 58 (25.1%) were pre-frail, and 35 (15.2%) were frail. The mortality rate was 14.5% among robust patients, 20.7% among pre-frail patients, and 20.0% among frail patients (log-rank test, P = 0.032). Frail patients had more than a 3-fold increased risk of mortality compared with robust patients (adjusted HR = 3.331; 95% CI, 1.161-9.559). Multivariate analysis revealed that the SOF index and TNM stage were associated with increased mortality. CONCLUSIONS: SOF index predicted post-gastrectomy mortality among older patients independently of age, sex, TNM stage, type of approach, gastrectomy type, and extent of lymph node dissection. SOF index may be used with ease to assess frailty status among older patients with gastric cancer in busy clinics and subgroups that may benefit from targeted frailty interventions before cancer treatments.

Efficacy of an inpatient smoking cessation program at a single regional cancer center: A prospective observational study.

ABSTRACT: Smoking is the leading cause of preventable death and a risk factor for cancer, but smoking cessation is difficult even in patients who need hospitalization. This study aimed to investigate the usefulness of an inpatient smoking cessation consultation program and to analyze the clinical factors associated with abstinence. In this observational study, patients received regular counseling for 6 months, and abstinence was objectively assessed via urine and exhaled carbon monoxide testing. Cessation rates were assessed at 4 weeks and 6 months, and clinical characteristics associated with cessation success were investigated. Of the 571 patients referred to participate in the program, 170 (29.8%) were enrolled, and only 2 (1.2%) used smoking cessation drugs in addition to counseling. The smoking cessation rate was 77.6% after 4 weeks and 59.1% after 6 months. The cessation rates were significantly higher in patients with cancer than in those without cancer at both timepoints (63.8% vs 21.9%, P < .001, 53.6% vs 12.5%, P < .001), and they were also higher in the first admission group than in the re-admission group (87.4% vs 74.7%, P = .033, 88.5% vs 76.1%, P = .037). In patients with lung cancer, progression-free survival and overall survival tended to be better in those enrolled in the program (P = .158, P = .183). In conclusion, the inpatient smoking cessation program was associated with a high abstinence rate. Most patients maintained cessation without medication, suggesting that initial admission, along with a cancer diagnosis, can provide enough motivation to abstain from smoking. In addition, the smoking cessation effort showed potential to improve survival during lung cancer treatment.

Grip strength mediates the relationship between muscle mass and frailty.

BACKGROUND: Although sarcopenia and frailty are important diseases in geriatrics, few studies have investigated the association between the two diseases. Thus, this study aimed to examine the relationship between two components of sarcopenia (muscle mass and muscle function) and frailty. METHODS: In total, 997 Korean older adults (456 men and 541 women) were included in this cross-sectional observational study. We used a polynomial linear regression analysis to obtain standardized sex, age, and height-adjusted appendicular skeletal muscle mass (zASM), as well as to standardized sex, age, and height-adjusted grip strength (zGS). We then performed a causal mediation analysis to confirm the relationship between zASM and frailty. RESULTS: In both men and women, zGS mediated the relationship between zASM and frailty (average causal mediation effect in men: -0.096 {-0.159 to -0.050}; in women: -0.053 {-0.098 to -0.010}). For every one-point increase in zGS score, the relative risk of a one-point increase in frailty was reduced by 21% in men (e-0.238  = 0.788) and by 11% in women (e-0.113  = 0.893). CONCLUSIONS: In this study on Korean older adults, muscle mass did not have a direct effect on frailty but had an indirect effect through altered muscle function.

Frailty index associated with all-cause mortality, long-term institutionalization, and hip fracture.

PURPOSE: To assess the association between frailty, measured using a frailty diagnosis tool, and adverse outcomes using regular health checkup data and National Health Insurance claim data of 66-year-old Koreans. METHODS: We evaluated all Koreans born between 1942 and 1946 who received a 66-year lifetime transition period health examination and regular biennial general and cancer screenings between 2008 and 2012. These patients were observed until December 31, 2015. The Lifetime Transition Period Health Examination version of the Korean Frailty Index (THE frailty index) was used to examine adverse geriatric outcomes based on levels of frailty. THE frailty index scores were used to classify participants as "robust" (0-2), "pre-frail" (3-4), or "frail" (more than 5). The main outcomes included the risks of all-cause mortality, long-term care facility institutionalization, and hip fracture. RESULTS: Among 725,759 Korean men and women, the prevalence of frail and pre-frail conditions was 3.4% and 26.6%, respectively. After an average of 4.4 years of follow-up, frail older persons had significantly higher mortality rates [men: hazard ratio (HR) 2.031 (95% confidence interval [CI], 1.894-2.178); women: HR 2.092 (95% CI 1.920-2.279)], long-term care facility institutionalization [men: HR 2.997 (95% CI 2.750-3.268); women: HR 3.057 (95% CI 2.866-3.261)], and hip fracture [men: HR 2.230 (95% CI 1.854-2.681); women: HR 2.356 (95% CI 2.086-2.660)] than those of robust older persons. CONCLUSIONS: Aged frail persons diagnosed using the THE frailty index had higher all-cause mortality, more frequent entry into long-term care facilities, and greater risk of hip fracture.

Interaction between frailty and nutritional status on mortality and long-term hospitalization in older Koreans: A retrospective analysis of data from the 2008 Survey on Health and Welfare Status of the Elderly in Korea.

OBJECTIVES: Although it is well known that nutritional deficiency influences frailty, and both nutritional status and frailty are closely related to mortality and morbidity in older people, there are no studies concerning this interaction. In this study, we evaluated whether the interaction of frailty and nutritional deficiency is additive and/or multiplicative. METHODS: We analyzed data from 8907 individuals (≥65 years old) who took part in the 2008 Survey on Health and Welfare Status of the Elderly in Korea. We used the Cardiovascular Health Study (CHS) frailty index and the DETERMINE checklist for assessment of frailty and nutritional status, respectively. We conducted Cox regression analysis for the outcomes 'mortality' and 'mortality and long-term hospitalization risk.' RESULTS: In the multivariate analysis for main effect model on 'mortality', the hazard ratios (HRs) of frail, high nutritional risk were 2.63 (95% CI 1.76-3.93), 1.04 (95% CI 0.78-1.38), respectively, and on 'mortality and long-term hospitalization risk' those values were 2.56 (95% CI 1.72-3.80), 1.18 (95% CI 0.88-1.58), respectively. In interaction effect model, multiplicative interaction existed between frailty and nutritional status (p < 0.001). Participants with frail X high nutritional risk had much higher HRs for 'mortality' (4.14, 95% CI 2.43-7.07) and 'mortality and long-term hospitalization risk' (4.60, 95% CI 2.74-7.72). CONCLUSION: We found that frailty and nutritional status have a multiplicative effect on adverse outcomes in community-dwelling older adults. Nutritional status assessment in older people is important because nutritional supplementation can potentially improve both nutritional status and frailty.

Clinically Relevant Cut-off Points for the Diagnosis of Sarcopenia in Older Korean People.

BACKGROUND: The optimal criteria applied to older Korean people have not been defined. We aimed to define clinically relevant cut-off points for older Korean people and to compare the predictive validity with other definitions of sarcopenia. METHODS: Nine hundred and sixteen older Koreans (≥65 years) were included in this cross-sectional observational study. We used conditional inference tree analysis to determine cut-off points for height-adjusted grip strength (GS) and appendicular skeletal muscle mass (ASM), for use in the diagnosis of sarcopenia. We then compared the Korean sarcopenia criteria with the Foundation for the National Institutes of Health and Asian Working Group for Sarcopenia criteria, using frailty, assessed with the Korean Frailty Index, as an outcome variable. RESULTS: For men, a residual GS (GSre) of ≤ 0.25 was defined as weak, and a residual ASM (ASMre) of ≤ 1.29 was defined as low. Corresponding cut-off points for women were a GSre of ≤ 0.17 and an ASMre of ≤ 0.69. GSre and ASMre values were adjusted for height. In logistic regression analysis with new cut-off points, the adjusted odds ratios for pre-frail or frail status in the sarcopenia group were 3.23 (95% confidence interval [CI] 1.33-7.83) for the men and 1.74 (95% CI 0.91-3.35) for the women. In receiver operating characteristic curve analysis, the unadjusted area under the curve for Korean sarcopenia criteria in men and women were 0.653 and 0.608, respectively (p < .001). CONCLUSIONS: Our proposed cut-off points for low GS and low ASM should be useful in the diagnosis of sarcopenia in older Korean people.

Association between frailty and readmission within one year after gastrectomy in older patients with gastric cancer.

OBJECTIVE: The incidence of gastric cancer in older people is increasing. Because older patients are at increased risk of postoperative complications and mortality, preoperative risk assessment in this population is important. This study explored whether preoperative assessment of frailty could be useful for predicting the postoperative outcome in patients with gastric cancer. MATERIALS AND METHODS: We investigated 223 patients (136 men and 87 women) over 65years of age who underwent gastric cancer surgery from April 2012 to March 2015 at a single institution in Korea. Frailty was assessed using the Study of Osteoporotic Fractures (SOF) frailty index. Logistic regression was used to identify factors predicting readmission within one year of discharge following gastrectomy. RESULTS: Twenty six (11.7%) patients were readmitted within one year after gastrectomy. Patients in the "robust" and "pre-frail and frail" group had a readmission rate of 6.7% and 19.1%, respectively. After adjusting age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS) (score≥1), histological type and stage (III, IV), frailty (pre-frail and frail) was a predictive factor for readmission within one year of discharge after gastrectomy (Odds Ratio, 5.74, 95%; Confidence Interval, 1.78-18.48; p=0.003). CONCLUSIONS: Preoperative risk assessment including frailty evaluation can predict the readmission within one year of discharge after gastrectomy. Frailty assessment can help physicians to identify the risk and inform patients and their families of the risk, which should improve decision making in gastric cancer treatment.

Relationship Between Post-exercise Heart Rate Recovery and Changing Ratio of Cardiopulmonary Exercise Capacity.

OBJECTIVE: To determine whether heart rate recovery (HRR) following an exercise tolerance test (ETT) is correlated with a changing ratio of peak oxygen consumption (VO2) and maximal metabolic equivalents (METmax). METHODS: A total of 60 acute myocardial infarction (AMI) patients who underwent ETT at both assessment points - 3 weeks (T0) after the AMI attack and 3 months after T0 (T1) were included. After achieving a peak workload, the treadmill was stopped with a 5-minute cooldown period, and the patients recovered in a comfortable and relaxed seated position. HRR was defined as the difference between the maximal heart rate (HRmax) and the HR measured at specific time intervals - immediately after the cool down period (HRR-0) and 3 minutes after the completion of the ETT (HRR-3). RESULTS: HRR-0 and HRR-3 increased over time, whereas VO2max and METmax did not show significant changes. There was a positive correlation between HRR at T0 and the exercise capacity at T0. HRR at T0 also showed a positive correlation with the exercise capacity at T1. There was no significant correlation between HRR measured at T0 and the change in the ratio of VO2max and METmax, as calculated by subtracting VO2max and METmax obtained at T0 from those obtained at T1, divided by VO2max at T0 and multiplied by 100. CONCLUSION: Post-exercise HRR measured at 3 weeks after the AMI onset can reflect the exercise capacity 3 months after the first ETT. However, it may be difficult to correlate post-exercise HRR at T0 with the degree of increase in cardiopulmonary exercise capacity in patients with AMI.

Comparison of the Effects of Cardiac Rehabilitation Between Obese and Non-obese Patients After Acute Myocardial Infarction.

OBJECTIVE: To evaluate the effects of cardiac rehabilitation (CR) on functional capacity in obese and non-obese patients who have suffered acute myocardial infarction (AMI). METHODS: Overall, 359 patients who have suffered AMI, and were referred for CR after percutaneous coronary intervention from 2010 to 2015 and underwent an exercise tolerance test before and after phase II CR were included in this study. The patients were divided into two groups: obese group with body mass index (BMI) ≥25 kg/m2 (n=170; age, 54.32±9.98 years; BMI, 27.52±2.92 kg/m2) and non-obese group with BMI <25 kg/m2 (n=189; age, 59.12±11.50 years; BMI 22.86±2.01 kg/m2). The demographic characteristics and cardiopulmonary exercise capacity of all patients were analyzed before and after CR. RESULTS: There were significant changes in resting heart rate (HRrest) before and after CR between the obese and non-obese groups (before CR, p=0.028; after CR, p=0.046), but other cardiopulmonary exercise capacity before and after CR was not different between the groups. HRrest (p<0.001), maximal metabolic equivalents (METs, p<0.001), total exercise duration (TED, p<0.001), and maximal oxygen consumption (VO2max, p<0.001) improved significantly in the obese and non-obese groups after CR. No difference in the change in the cardiopulmonary exercise capacity rate was detected between the groups. CONCLUSION: CR may improve functional capacity in patients who suffered AMI regardless of their obesity.

Successful Treatment of Phantom Limb Pain by 1 Hz Repetitive Transcranial Magnetic Stimulation Over Affected Supplementary Motor Complex: A Case Report.

A 37-year-old man with a right transfemoral amputation suffered from severe phantom limb pain (PLP). After targeting the affected supplementary motor complex (SMC) or primary motor cortex (PMC) using a neuro-navigation system with 800 stimuli of 1 Hz repetitive transcranial magnetic stimulation (rTMS) at 85% of resting motor threshold, the 1 Hz rTMS over SMC dramatically reduced his visual analog scale (VAS) of PLP from 7 to 0. However, the 1 Hz rTMS over PMC failed to reduce pain. To our knowledge, this is the first case report of a successfully treated severe PLP with a low frequency rTMS over SMC in affected hemisphere.

Comparison of growth hormone treatment in patients with idiopathic short stature and idiopathic growth hormone deficiency.

After recombinant human growth hormone (rhGH) was introduced in the treatment of patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS), many studies have addressed the effect of GH treatment and changes in the height standard deviation score (SDS) after GH treatment. However, few studies comparing the effect of GH in Korean patients with idiopathic GHD and ISS have been designed. Therefore, this study focused on the difference in effect of GH treatment between the two groups. We retrospectively reviewed the height SDS of 34 patients with idiopathic GHD and 12 patients with ISS. The mean ages of the patients with idiopathic GHD and ISS were 9.84±2.09 and 10.72±1.48 years, respectively. All patients were treated with GH for 1 year and body parameters were recorded before and after the GH treatment. Change in height SDS in patients with idiopathic GHD was significantly higher than that in patients with ISS (0.62±0.33 vs. 0.40±0.27, p=0.03). However, body mass index, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 were not significantly different between the two groups after GH treatment. These results suggest that GH treatment has a more powerful effect on increasing height SDS in patients with idiopathic GHD than in patients with ISS.