The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 371
Poster Session
PS 1450 Hemato-Oncology (Oncology) Docetaxel-Induced Nail Toxicity and Its Prevention with Ice-Water Finger Dipping
Jae Young Cho1, Ho Jung An1, Gyong Moon Kim2, Hoon-Kyo Kim1
Department of Internal Medicine, The Catholic University of Korea, St. Vincent’s Hospital, Korea1, De- partment of Dermatology, The Catholic University of Korea, St. Vincent’s Hospital, Korea2
Background: Docetaxel-induced nail toxicity is reported in 10–50%. Risk factors in- clude cumulative dose and weakly administration. Severe nail toxicity impairs patient’s quality of life which leads to treatment discontinuation. Ice-mitten is used to decrease peripheral circulation to nail, but hard to get. We observed serial changes of nail in patients receiving docetaxel for lung cancer and tried to prevent nail toxicity with ice-water fi nger dipping.
Methods: Patients received weekly docetaxel at a dose of 20mg/m2, 1 hour intrave- nous infusion, on days 1,8 and 15, every 4 weeks. In two patients, natural nail changes were observed, and later another two patients did ice-water fi nger dipping while in- travenous infusion of docetaxel.
Results: In two patients without intervention, painful subungal hemorrhage and nail ridge (cumulative dose: 140-160mg/m2) followed by hemopurulent subungal hemato- mas, longitudinal ridges, onycholysis and paronychias developed. The whole fi nger nail became hyperpigmented and onycholysis resulted in nail extraction. After then, regen- erationfrom proximal nail areas (dose over 300 mg/m2) happened with onychodys- trophy, subungal hyperkeratosis, trachyonychia at the distal areas. Nail change of toes was somewhat delayed and less severe than hands. In two patients who did ice-water fi nger dipping, any of nail changes developed but in toes and patients were tolerable to ice-water. Four patients showed more than stable disease with chemotherapy.
Conclusions: Finger nail changes in patients receiving weakly docetaxel were subungal hemorrhage, purulent change, onycholysis, and then regeneration. Ice-water finger dipping was effective to prevent nail toxicity.
PS 1451 Hemato-Oncology (Oncology) Trends in Chemotherapy for Advanced Cancer Patients at the End of Life
Hee Seung Lee1, SooHyeon Lee1
Department of Internal Medicine, Yonsei University College of Medicine, Korea1
Background: As new, high effi cacy anticancer therapeutic agents have been devel- oped, the use of chemotherapy in advanced cancer patients has increased. We analyz- ed 10-year trends in patients receiving chemotherapy at the end of life.
Methods: We retrospectively reviewed mortality data from a single institution for ad- vanced cancer patients who died in 2000, 2005, and 2010. Logistic regression analysis was performed to determine factors that associated with receiving chemotherapy.
Results: Patients with less responsive tumors were less likely to receive chemotherapy than patients with responsive tumors at the time of death. Patients who were 65 years or older were less likely to receive chemotherapy compared to patients who were younger than 65 years at the end of life. However, the proportion of older pa- tients receiving chemotherapy in the last 1 month of life increased in 2010 (44.2%) compared to 2005 (32.7%) and 2000 (25.7%). Compared to 2000, the likelihood of receiving chemotherapy in the last 1 month of life increased in 2005 (odds ratio, 2.05;
95%CI, 1.60-2.62) and 2010 (odds ratio, 4.42; 95%CI, 3.51-5.57).
Conclusions: We assume that the availability of new treatment regimens including oral agents lengthened the treatment timeline. It is necessary to concern more about whether to continue chemotherapy at the end of life.
PS 1452 Hemato-Oncology (Oncology) Research about the Effi cacy and Safety of the Use of High-Dose Opioid
Hwa Sik Jung1
Ulsan University Hospital, Korea1
Background: Although opioid usually has been used to control cancer pain, patients and doctors hesitate to use medication due to adverse effects, especially high dose opioid. In this research, we conducted observation study to evaluate efficacy and safety of high dose opioid, represented by fentanyl patch in cancer patients.
Methods: This trial was multicenter, non-intervention, observation study. 636 Pa- tients not enough to control cancer pain, that need to use high dose opioid, defi ned more than 75ug/hr were screened between December 2008 and July 2012 from fi fty hospitals. Primary outcome was effi cacy comparing that 10-day interval change of satisfaction before and after using high dose opioid. Secondary outcome was 10- day interval change of numerical pain score and sleep disturbance. Also we evaluated safety through adverse events during research period.
Results: Total 634 patients were included in the Full data analysis and 533 patients were included in the Per protocol analysis. 403 patients(75.6%) were more satisfi ed with controlling cancer pain at Day 10 than Day 1. (10.0%, p<0.0001). interestingly, nine-tenth of them was usual, dissatisfactory, highly dissatisfactory with controlling their pain at Day 1. Secondary outcome, 10-day interval change of pain intensity was improved. (Day 1 was 5.4±2.1 and Day 10 was 2.5±2.0, difference was 2.9±2.4, p<0.0001). And 10-day interval change of sleep disturbance was also improved.(Day 1 was 4.2±2.8 and Day 10 was 1.7±2.1, difference was 2.5±2.8, p<0.0001). Adverse drug reaction was 41 patients, 52 cases. Nervous system disorders were most common events followed gastrointestinal disorders.
Conclusions: In our research, the use of high dose opioids was certifi ed improving quality of life and decreasing cancer pain. And in term of safety, it made no difference with previous study. In conclusion, cancer patients can be recommended to use high dose opioids.
