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￭ S-465 ￭
경장영양이 불가능한 진행성 암환자에서 수액치료 또는 총정맥영양을 비교한 무작위배정 2상연구
서울특별시 서울의료원 내과
*Sung Jae Park, In Ki Park, Ga Jin Lim, So Yeon Oh
Background: Experts advise not to use parenteral nutrition (PN) for advanced cancer patient at the end of life. But in real practice in Korea, many patients and families fear starving to death. Thus many physicians administer PN to the terminal cancer patients. We designed this study to investigate the effect of PN in the end of life. Methods: This study was conducted in the Seoul Medical Center in 2011.6-2011.12. Institutional review board approved this study. We prospectively enrolled consecutive patients with life-expectancy of less than 3 months due to progressive cancer. Patients with functioning bowel were excluded. Patients were randomized to receive either fluid or PN. Statistical analysis was done by PASW Statistics v18. Results: Study was closed early because many patients and families were repulsed this study because of concern for starv- ing to death. Total 31 patients were enrolled (M:F=19:12). Median age is 59 years (40-83) and median survival was 9 (95% CI: 3.7-14.3) days.
16 patients were assigned to PN group. Baseline characteristics were not significantly different between 2 groups including nutritional parameters.
Mean administered calorie was 374.7 (± 71.7) Kcal/day for fluid group and 1286.8 (± 108.3) Kcal/day for PN group (p<0.001 by t-test). Median survival was 8 (95% CI: 5.7-10.3) days in fluid group and 13 (95% CI: 3.1-22.9) days in PN group and this difference was not statistically sig- nificant (p=0.982 by Log-rank test). Conclusions: This study is not conclusive to determine the role of PN for advanced cancer patients. But PN failed prolonging survival significantly. Further study is warranted to give us more information.
￭ S-466 ￭
Palliative cares for symptom clusters and clinical outcomes in hospice cancer patients
1Hemato-oncology, Department of Internal Medicine, Cheong Ju St. Mary’s Hospital, 2Department of Internal Medicine,
3Department of Radiation Oncology, 4Hospice Team, St. Vincent’s Hospital, The Catholic University of Korea
*Der Sheng Sun1, Eun Sil Ko2, June Seop Lee2, Chi Hong Kim2, Byoung Young Shim2, Seung Hwan Kim3, Ok Kyoung Lee4, Hoon Kyo Kim2
Background: Effective symptomatic care is important to improve quality of life for cancer patients in hospice ward. Despite the progression in palliative treatments, terminal cancer patients are still suffering from multiple discomfort symptoms. We tried to indentify the clusters of cancer symptoms and describe how the managements impact on the clinical course. Methods: Patients were evaluated from August to December 2010.
The symptoms from the patients were measured by the M.D. Anderson symptom inventory (MDASI), palliative procedures were recorded pro- spectively and the clinical outcomes were analyzed. Results: Of the 86 patients, 51 were male (59%), 35 were female (41%) with a median age of 65 years (range 36-86). The most common diagnosis were lung cancer (31patients, 36%), stomach cancer (13patients, 15%), colo-rectal cancer (11patients, 13%). Five clusters were identified: 1. Pain (edema, metastasis), 2. Respiratory (dyspnea, tachypnea, sputum, hoarseness, pleural and pericardial effusion), 3. Fatigue (weakness, anorexia), 4. Digestive (dysphagia, ascites, constipation, ileus, weight loss), 5. Neuropsychological (confusion, anxiety, insomnia). The median severity score according to MDASI of the clusters were 8.6 in Pain, 7.4 in Respiratory, 6.7 in Fatigue, 7.5 in Digestive, 8.2 in Neuropsychological. The major palliative procedures in Pain cluster were opioids(40, 46.5%), radiations(7, 8.2%), in Respiratory cluster were oxygen supply (14, 16.3%), pleural effusion drainage (4, 4.6%), in Fatigue was hydration(5, 5.8%), in Digestive cluster were tube feeding (3, 3.5%), ascites tap (3, 3.5%), Levin-tube (4, 4.6%), and 6 (7.0%) with palliative sedation in neuropsychological cluster. 52 of the 86 patients had survival data. The clusters associated with poor prognosis with survivals (days) were Neuropsychological (2-17, median: 5), Respiratory (5-61, median: 14), Fatigue (8-21, median: 15) followed by Digestive (4-58, median: 18), Pain (2-present, median: 22). Conclusion:
Pain cluster with active symptomatic procedures may improve clinical result on survival in hospice ward. To assess symptoms and proper pallia- tive procedure is important to relief distress and quality of life in advanced cancer patients.
