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Lin CP, Peng JK, Hsieh WT, Martina D, Mori M, Takenouchi S, Chan HYL, Suh SY, Kim SH, Yuen KK, Kizawa Y, Cheng SY. Letter to the Editor: Improving Access to Advance Care Planning in Current and Future Public Health Emergencies: International Challenges and Recommendations. J Palliat Med 2023; 26:462-463. [PMID: 37011291 DOI: 10.1089/jpm.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wan-Ting Hsieh
- Department of Palliative Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Diah Martina
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University-Seoul, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary's Hospital, Catholic Kwandong University, College of Medicine, Incheon, South Korea
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Lo KL, Leung D, Lai Z, Li C, Ma SF, Wong J, Yuen KK, Li J, Chiu P, Mak SK, Wong J, Ng CF. Picture-in-picture video demonstration of systematic transperineal prostate biopsy. Hong Kong Med J 2021; 27:304-305. [PMID: 34413262 DOI: 10.12809/hkmj208864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- K L Lo
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - D Leung
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Z Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - C Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - S F Ma
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Wong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - K K Yuen
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Li
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - P Chiu
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - S K Mak
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - J Wong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - C F Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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Chan WL, Choi HCW, Ho PPY, Lau JKS, Tse RPY, Au J, Lam V, Liu R, Ho I, Wong C, Cheung B, Lam E, Chow D, Lam KO, Yuen KK, Kwong DLW. Immune-Related Endocrine Dysfunctions in Combined Modalities of Treatment: Real-World Data. Cancers (Basel) 2021; 13:cancers13153797. [PMID: 34359698 PMCID: PMC8345182 DOI: 10.3390/cancers13153797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Immune-checkpoint inhibitors (ICI) have been increasingly used in the management of various types of cancers. More studies and guidelines also recommended the combination of ICI with other anti-cancer agents to improve the efficacy and treatment outcome. This retrospective study showed that the combination of ICI and targeted agents increased the risk of immune-related endocrine dysfunction and hypothyroidism. Moreover, older patients on ICI had a higher risk of immune-related diabetes mellitus. ICI is safe and well-tolerated regardless of age, but close monitoring of fasting glucose is essential in older populations. Abstract The number of immune-related endocrine dysfunctions (irEDs) has concurrently increased with the widespread use of immunotherapy in clinical practice and further expansion of the approved indications for immune checkpoint inhibitor (ICI) in cancer management. A retrospective analysis was conducted on consecutive patients ≥18 years of age with advanced solid malignancies who had received at least one dose of anti-programmed cell death protein 1 (anti-PD-1) and/or anti-CTLA4 antibodies between January 2014 and December 2019 at a university hospital in Hong Kong. Patients were reviewed up to two months after the last administration of an ICI. The types, onset times and grades of irEDs, including hypothyroidism, hyperthyroidism, adrenal insufficiency and immune-related diabetes mellitus, were recorded. Factors associated with irEDs were identified using multivariate analysis. A total of 953 patients (male: 603, 64.0%; median age: 62.0 years) were included. Of these, 580 patients (60.9%) used ICI-alone, 132 (13.9%) used dual-ICI, 187 (19.6%) used an ICI combined with chemotherapy (chemo + ICI), and 54 (5.70%) used immunotherapy with a targeted agent (targeted + ICI). A significantly higher proportion of patients using targeted + ICI had irEDs and hypothyroidism; in contrast, a higher proportion of patients using dual-ICI had adrenal insufficiency. There was no significant difference in the incidence of irED between the younger (<65 years) and older (≥65 years) patients. Using logistic regression, only treatment type was significantly associated with irEDs. Notably, older patients had a higher risk of having immune-related diabetes mellitus. This large, real-world cohort demonstrates that targeted + ICI has a higher risk of overall irED and hypothyroidism. Immunotherapy is safe and well-tolerated regardless of age, but close monitoring of fasting glucose is essential in older populations.
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Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; (H.C.-W.C.); (K.-O.L.); (D.L.-W.K.)
- Correspondence:
| | - Horace Cheuk-Wai Choi
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; (H.C.-W.C.); (K.-O.L.); (D.L.-W.K.)
| | - Patty Pui-Ying Ho
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Johnny Kin-San Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Rosa Pui-Ying Tse
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Joyce Au
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Vivian Lam
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Ronald Liu
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Isaac Ho
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Charlotte Wong
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Ben Cheung
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Eric Lam
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Daryn Chow
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Ka-On Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; (H.C.-W.C.); (K.-O.L.); (D.L.-W.K.)
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (P.P.-Y.H.); (J.K.-S.L.); (R.P.-Y.T.); (J.A.); (V.L.); (R.L.); (I.H.); (C.W.); (B.C.); (E.L.); (D.C.); (K.-K.Y.)
| | - Dora Lai-Wan Kwong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; (H.C.-W.C.); (K.-O.L.); (D.L.-W.K.)
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Chan WL, Ho YHT, Wong CKH, Choi HCW, Lam KO, Yuen KK, Kwong D, Hung I. Acceptance of COVID-19 Vaccination in Cancer Patients in Hong Kong: Approaches to Improve the Vaccination Rate. Vaccines (Basel) 2021; 9:vaccines9070792. [PMID: 34358208 PMCID: PMC8310340 DOI: 10.3390/vaccines9070792] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Emerging efficacy and safety data have led to the authorization of COVID-19 vaccines worldwide, but most trials excluded patients with active malignancies. This study evaluates the intended acceptance of COVID-19 vaccination in cancer patients in Hong Kong. Methods: 660 adult cancer patients received a survey, in paper or electronic format, between 31 January 2021 and 15 February 2021. The survey included patient’s clinical characteristics, perceptions of COVID-19 and vaccination, vaccine knowledge, cancer health literacy, and Hospital Anxiety and Depression scale (HADS). The primary outcome was the intended acceptance of COVID-19 vaccine in cancer patients. Multivariable analysis was performed to identify factors associated with intended acceptance. Results: The intended acceptance of COVID-19 vaccination was 17.9%. A total of 487 (73.8%) believed that vaccination could prevent them from infection. Over 70% worried about vaccine negative effects on cancer and its side effects. Factors associated with intended acceptance included higher level of “belief in vaccine on preventing them from getting COVID-19”, less worry about long-term side effects of vaccine, lower level of cancer health literacy, and normal HADS (Depression scale). Conclusions: To improve vaccine acceptance rate, public education campaigns specific to cancer patients to gain their trust in efficacy and relieve their worries are needed.
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Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (Y.-H.T.H.); (K.-O.L.); (D.K.)
- Correspondence:
| | - Yuen-Hung Tricia Ho
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (Y.-H.T.H.); (K.-O.L.); (D.K.)
| | - Carlos King-Ho Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
- Department of Family Medicine and Primary Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Horace Cheuk-Wai Choi
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (H.C.-W.C.); (K.-K.Y.)
| | - Ka-On Lam
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (Y.-H.T.H.); (K.-O.L.); (D.K.)
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; (H.C.-W.C.); (K.-K.Y.)
| | - Dora Kwong
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (Y.-H.T.H.); (K.-O.L.); (D.K.)
| | - Ivan Hung
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
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Chan SK, Lam TC, Choi HCW, Tsang KC, Yuen KK, Soong I, Wong KH, Lui L, Lo SH, Tong M, Lo R, Lam PT, Lam WM, Li B. Integrated palliative medicine in public oncology: a 10-year review. BMJ Support Palliat Care 2021:bmjspcare-2021-002922. [PMID: 34193435 DOI: 10.1136/bmjspcare-2021-002922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/04/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The rapid ageing population of Hong Kong has a high demand on oncology and palliative care (PC) service. This study was the first territory-wide assessment in Hong Kong to assess the palliative service coverage in patients with advanced cancer in the past decade. METHODS Cancer deaths of all 43 public hospitals of Hong Kong were screened. Randomly selected 2800 cancer deaths formed a representative cohort in all seven service clusters of Hospital Authority at 4 time points (2006, 2009, 2012, 2015). Individual patient records were thoroughly reviewed. Predictors of PC coverage was evaluated in univariable and multivariable analyses. RESULTS From 2006 to 2015, PC coverage improved steadily from 55.4% to 68.9% (p<0.001). Median time of referral to PC service to death was 25 days (IQR: 53). For duration of inpatient PC, the median time was 22 days (IQR: 44) and it was stable over the past 10 years. Median time of referral to outpatient service to death was 74 days (IQR: 144) and there was an improvement observed (p<0.05). The current system was highly heterogeneous that PC varied between 9.8% and 84.8% in different hospitals depending on the PC service infrastructure. Multivariable Cox model identified patients associated with lower PC coverage: male, <50, rapid disease deterioration and staying in hospitals without multidisciplinary team clinic and designated palliative bed support (all p<0.01). CONCLUSION There was concrete achievement in palliative service development in the past decade. Heterogeneity and late service provision should be addressed in future.
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Affiliation(s)
- Sik Kwan Chan
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | - Tai Chung Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ka Chun Tsang
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Inda Soong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Kam Hung Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Louisa Lui
- Department of Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Sing Hung Lo
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Macy Tong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Raymond Lo
- Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Palliative Medicine, The Bradbury Hospice, Hong Kong, Hong Kong
| | - Po Tin Lam
- United Christian Hospital, Hong Kong, Hong Kong
| | | | - Bryan Li
- Palliative Medicine, Grantham Hospital, Hong Kong, Hong Kong
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Chan WL, Choi HCW, Lang B, Wong KP, Yuen KK, Lam KO, Lee VHF, Kwong D. Health-Related Quality of Life in Asian Differentiated Thyroid Cancer Survivors. Cancer Control 2021; 28:10732748211029726. [PMID: 34189945 PMCID: PMC8252343 DOI: 10.1177/10732748211029726] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Health-related quality of life (HRQoL) is important for differentiated thyroid cancer survivors, but data for Asian survivors is lacking. This study aimed to have an overview of, and identify any disease-or treatment-related factors associated with, HRQoL in Asian differentiated thyroid cancer survivors. Patients and Methods: Thyroid cancer survivors were recruited from the thyroid clinics at Queen Mary Hospital, Hong Kong from February 2016 to December 2016. All adult differentiated thyroid cancer patients with stable disease more than or equal to 1 year received a survey on HRQoL using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid cancer specific quality of life (THYCA-QoL) questionnaire. Clinical information was collected retrospectively from the computerized clinical management system. To identify factors associated with poor HRQoL, univariable and stepwise multivariable regression analysis were performed. Results: A total of 613 survivors completed the questionnaires (response rate: 82.1%; female: 80.1%; median survivorship: 7.4 years (range: 1.0-48.2 years)). The QLQ-C30 summary score mean was 84.4 (standard deviation (SD): 12.7) while the THYCA-QoL summary score mean was 39.9 (SD: 9.7). The 2 highest symptom subscales were fatigue (mean: 26.4, SD: 20.6) and insomnia (mean: 26.2, SD: 27.6). Factors associated with worse HRQoL included serum thyrotropin (TSH) greater than 1.0 mIU/L, unemployment, and concomitant psychiatric disorders. Concomitant psychiatric illness (n = 40/613, 6.5%) also showed significant association with most of the symptom and functional subscales. Conclusions: Fatigue and insomnia were the 2 most common symptoms experienced by our differentiated thyroid cancer survivors. Long-term survivorship care with monitoring serum TSH level, supporting return-to-work and screening for concomitant psychiatric disorders should be offered.
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Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Horace Cheuk-Wai Choi
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Brian Lang
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kai-Pun Wong
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Ka-On Lam
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Dora Kwong
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Lam TC, Chan SK, Choi CW, Tsang KC, Yuen KK, Soong I, Wong KH, Lui L, Lo SH, Tong M, Lo RSK, Lam PT, Lam WM, Li B. Integrative Palliative Care Service Model Improved End-of-Life Care and Overall Survival of Advanced Cancer Patients in Hong Kong: A Review of Ten-Year Territory-Wide Cohort. J Palliat Med 2021; 24:1314-1320. [PMID: 33507834 DOI: 10.1089/jpm.2020.0640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Integrated palliative care in oncology service has been widely implemented in Hong Kong since 2006. Aim: The study aimed to review its impact on end-of-life outcomes and overall survival (OS) of cancer patients, as well as its utilization of health care resources in the past 10 years. Design: Cancer deaths of all 43 public hospitals of Hong Kong were screened. Setting/Participants: Randomly selected 2800 cancer deaths formed a representative cohort in all seven service clusters of Hospital Authority at four time points (2006, 2009, 2012, and 2015). Individual patient records were thoroughly reviewed. Propensity score-matched (PSM) analysis was employed to compare the survival of patients. Results: Palliative care provision was associated with improved palliative care outcome, including more prescription of strong opioid, fewer cardiopulmonary resuscitations and intensive care unit admissions, and less futile chemotherapy usage in the end-of-life period (all p < 0.001). In the PSM analysis, the median OS in patients with palliative service (5.10 months, 95% confidence interval [CI] 4.52-5.68 months) was significantly better than those without palliative service (1.96 months, 95% CI 1.66-2.27 months). Patients in the palliative care group had more specialist clinic visits (p < 0.001) and longer hospital stay (p < 0.001) in the last six months of life, although the duration of last admission stay at acute general ward was shortened (p < 0.001). Conclusion: Our results suggested palliative care has played a role in the remarkable improvement in end-of-life outcomes and OS. However, current palliative care model relied heavily on hospital resources. Future work is needed to strengthen community care and to build up quality monitoring systems.
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Affiliation(s)
- Tai-Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sik-Kwan Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheuk-Wai Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka-Chun Tsang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Inda Soong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Kam-Hung Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Louisa Lui
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Sing-Hung Lo
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Macy Tong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China
| | - Raymond S K Lo
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China.,Bradbury Hospice, Hong Kong, China
| | - Po-Tin Lam
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
| | - Wai-Man Lam
- Pulmonary and Palliative Care Unit, Haven of Hope Hospital, Hong Kong, China
| | - Bryan Li
- Palliative Medicine Unit, Grantham Hospital, Hong Kong, China
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Chan HYL, Kwok AOL, Yuen KK, Au DKS, Yuen JKY. Association between training experience and readiness for advance care planning among healthcare professionals: a cross-sectional study. BMC Med Educ 2020; 20:451. [PMID: 33228655 PMCID: PMC7684716 DOI: 10.1186/s12909-020-02347-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/30/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Training has been found effective in improving healthcare professionals' knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences. METHODS An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. RESULTS Of 250 respondents, approximately half (52.0%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001-0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience. CONCLUSIONS This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.
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Affiliation(s)
- Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 7/F. Esther Lee Building, Hong Kong SAR, China.
| | - Annie Oi-Ling Kwok
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Derrick Kit-Sing Au
- CUHK Centre for Bioethics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Kwan-Yuk Yuen
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Chan WL, Ma T, Cheung KL, Choi H, Wong J, Lam KO, Yuen KK, Luk MY, Kwong D. The predictive value of G8 and the Cancer and aging research group chemotherapy toxicity tool in treatment-related toxicity in older Chinese patients with cancer. J Geriatr Oncol 2020; 12:557-562. [PMID: 33127385 DOI: 10.1016/j.jgo.2020.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Older patients experience a higher risk of treatment-related toxicity (TRT). The G8 screening tool was developed to separate cancer older patients fit to receive standard treatment from those who are frail and experiencing functional decline due to reduced organ function and multiple comorbidities. The Cancer and Aging Research Group chemotherapy toxicity tool (CARG-tt) questionnaire was developed to predict chemotherapy toxicity in geriatric patients. This prospective observational study evaluated the performance of G8 and CARG-tt in predicting severe TRT in older Chinese cancer patients. METHODS Chinese patients aged ≥65 with a diagnosis of solid malignancy and scheduled to receive anti-cancer treatment (chemotherapy or targeted therapy) were enrolled from March 2016 to July 2017 at the Department of Clinical Oncology at Queen Mary Hospital in Hong Kong. All patients completed the G8 and CARG-tt screening and pre-treatment assessments before starting treatment. Patients were monitored for any severe TRT, which was defined by grades 3-5 using the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03, treatment discontinuation, or unexpected hospitalization from starting to 30 days after treatment. RESULTS A total of 259 patients (male: 154, 59.5%; median age: 73.4, age range: 65-93) were enrolled in the study. Two hundred and ten (81.1%) patients received chemotherapy while the rest (n = 49, 18.9%) received targeted therapy. Overall, 146 patients (56.8%) experienced severe TRT. The mean G8 score was 12.4 (SD: 2.8). The G8 score had a significant association with unexpected admission (cutoff: 14, 41.3% vs. 26.5%, p = 0.03) but not significant in other types of TRTs. The mean CARG-tt score was 7.67 (SD: 3.7); it was not associated with severe TRTs. CONCLUSIONS The G8 and CARG-tt demonstrated a weak prediction of severe TRT in older Chinese cancer patients. Future studies need to develop predictive tools for TRT in patients receiving novel antineoplastic therapies, with a focus on subgroup analysis for different populations.
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Affiliation(s)
- Wing-Lok Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong.
| | - Tiffany Ma
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | | | - Horace Choi
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - Josiah Wong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - Ka-On Lam
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Mai-Yee Luk
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
| | - Dora Kwong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
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Chan WL, Ho PYP, Yuen KK. Social distancing and cancer care during the COVID-19 pandemic. BMJ Support Palliat Care 2020:bmjspcare-2020-002489. [PMID: 32887730 DOI: 10.1136/bmjspcare-2020-002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Wing Lok Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pui-Ying Patty Ho
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
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11
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Siu BWM, So JWL, Yuen KK, Chan AWL, Chan C, Lai ESK, Leung HW, Lam M. A retrospective study on risk assessment and management of forensic psychiatric inpatients in Hong Kong. Behav Sci Law 2020; 38:493-505. [PMID: 32672391 DOI: 10.1002/bsl.2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
The Department of Forensic Psychiatry of Castle Peak Hospital is the only facility in Hong Kong that provides territory-wide forensic psychiatric services for patients with criminal involvement. This retrospective study aimed to explore whether the rehabilitation programs provided by the department could significantly reduce the risks of forensic psychiatric inpatients as measured by the Short-Term Assessment of Risk and Treatability (START). START ratings of inpatients who were hospitalized in the department for more than 3 months and were discharged to the community during the period from 11 April 2015 to 31 March 2019 were analyzed. A total of 79 patients were assessed, of whom 61 (77.2%) were males. Fifty-four (68.4%) patients suffered from schizophrenia. START scores upon admission (strength score = 5.67; vulnerability score = 17.43) and upon discharge (strength score = 6.87, vulnerability score = 11.18) indicated significant reduction of risks among inpatients (p < 0.05).
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Affiliation(s)
- Bonnie W M Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, SAR, China
| | - Jane W L So
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, SAR, China
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, SAR, China
| | - Anita W L Chan
- Occupational Therapy Department, Castle Peak Hospital, Hong Kong, SAR, China
| | - Clement Chan
- Occupational Therapy Department, Castle Peak Hospital, Hong Kong, SAR, China
| | - Eric S K Lai
- Occupational Therapy Department, Castle Peak Hospital, Hong Kong, SAR, China
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, SAR, China
| | - M Lam
- Castle Peak Hospital, Hong Kong, SAR, China
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12
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Ho MK, Hsue CCY, Lai CHN, Chan KT, Cheng CN, Chow CF, Lui KH, Rashed S, Wong E, Yu WY, Cheung VHM, Siu SWK, Ho ML, Yuen KK, Chang ATY. A cross-sectional study on the attitudes and perceptions of outpatients towards palliative care at the Hong Kong Queen Mary Hospital Hospice Centre. Ann Palliat Med 2020; 9:4522-4533. [PMID: 32008335 DOI: 10.21037/apm.2019.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/26/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Palliative care aims to improve the quality of life for patients and their families, by helping them to cope with problems associated with illness. It targets four aspects of health: physical, psychological, social, and spiritual. Most of the current literature on palliative care is limited to the perspectives of health professionals. This study aims to investigate the views of outpatients receiving palliative care at the Hong Kong Queen Mary Hospital Hospice Centre (HKQMHHC), which offers palliative care services to cancer patients. METHODS This observational cross-sectional study was performed with the completion of a single paper- based original questionnaire over 18 afternoon clinic sessions on Thursdays and Fridays from December 2017 to February 2018 at the HKQMHHC. The questionnaire was designed to examine patients' perspectives; in particular, the Edmonton Symptom Assessment Scale (ESAS) was used to assess their symptoms. Descriptive and univariate analyses were performed. RESULTS One hundred patients attending HKQMHHC were included in the study. The study revealed that all the mean scores for aspects of care offered at the centre were above 8, on a scale of 0-10 with 0 being extremely inadequate and 10 being extremely adequate. Each respondent was able to identify an average of 1.82 of the 4 aspects of palliative care. Eighty-seven percent of respondents perceived the physical aspect of this care to be of the highest priority. A negative correlation (P<0.05) was found between the extent of symptoms experienced by the patient and their satisfaction towards the services offered. CONCLUSIONS Patients generally held very positive attitudes, reflecting that the services sufficiently met their needs. However, owing to their rather limited knowledge, this may have restricted their perspectives to a largely superficial level, as many discerned palliative care to be simply targeting physical health with medical consultations. Considering the implications of the results, the addition of accessibility and education components to Hong Kong's current system of palliative care is crucial in the betterment of such services for patients. There should also be increased local coverage of palliative care services to facilitate convenience of access. With reference to the World Health Organisation (WHO) palliative care model, the inclusion of a continued spectrum of services, such as physical and mental health activities and psychosocial counselling, should be reinforced throughout the progression of disease so as to better help patients to cope with illness. The discovery of the relationship between extent of symptoms experienced and patients' satisfaction towards services provided is a new direction for further study.
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Affiliation(s)
- Margaret Kay Ho
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | | | | | - Kwun Ting Chan
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Cheuk Nam Cheng
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Chun Fung Chow
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ka Ho Lui
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Shireen Rashed
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Elaine Wong
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wai Yan Yu
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Vanessa H M Cheung
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Steven W K Siu
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Mei-Ling Ho
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Amy Tien Yee Chang
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China; Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China; Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Shenzhen 518009, China.
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13
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Chiang CL, Choi HC, Lam KO, Chan BY, Lee SF, Yeung SY, Lau KS, Chan SY, Choy TS, Yuen KK. Real-world treatment patterns and outcomes in refractory metastatic colorectal cancer. Asia Pac J Clin Oncol 2019; 15 Suppl 2:5-13. [PMID: 30887726 DOI: 10.1111/ajco.13114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To investigate treatment patterns and outcomes of metastatic colorectal cancer (mCRC) patients beyond second progression (PD2) since regorafenib and TAS-102 became available in Hong Kong. METHODS The clinical records of consecutive mCRC patients who were treated beyond PD2 at Department of Clinical Oncology, Queen Mary Hospital between June 2013 and February 2018, were retrospectively reviewed. RESULTS Of 176 PD2 patients (76.7% Eastern Cooperative Oncology Group performance status 0/1 and a median follow-up time of 6.6 [range, 0.4-37.2] months), 104 (59%) underwent palliative care only and 72 (41%) received active third-line (3L) treatment: regorafenib (n = 22), TAS-102 (n = 6), chemotherapy + antiepidermal growth factor receptor (n = 12), chemotherapy + antivascular endothelial growth factor (n = 28) or clinical trials (n = 4). Patients on active 3L treatment had significantly longer OS than those on palliative care only: 11.7 versus 5.5 months (adjusted hazard ratio = 0.41, 95% confidence interval: 0.28-0.61, P < 0.001). For those on active treatment, OS was significantly associated with the time from diagnosis of metastasis to PD2 (P < 0.001) and post-3L treatments (P = 0.009). When analyzing treatment eligibility according to trial criteria, half of the eligible patients (54/109) did not receive active treatment, but both eligible and ineligible patients achieved better OS when receiving active 3L treatment versus palliative care only (P < 0.001 and P = 0.002). No unexpected toxicity was reported. CONCLUSION Active 3L and beyond treatment significantly prolonged OS versus palliative care, even in selected "trial ineligible" patients. Given a high rate of palliation only care in eligible patients, improved patient access to medicine and counseling may be needed to maximize outcomes.
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Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - H C Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - B Y Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - K S Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - S Y Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - T S Choy
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - K K Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
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Siu BW, Fistein EC, Leung HW, Chan LS, Yan CK, Lai AC, Yuen KK, Ng KK. Compulsory Admission in Hong Kong: Balance between Paternalism and Patient Liberty. East Asian Arch Psychiatry 2018; 28:122-128. [PMID: 30563948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Hong Kong, compulsory admission is governed by the Mental Health Ordinance Section 31 (detention of a patient under observation), Section 32 (extension of period of detention for such a patient), Section 36 (detention of certified patients), and the sections in Part IV for hospital order, transfer order, and removal order. Mental health professionals adopt both legal criteria and practice criteria for compulsory admission. The present study discusses the harm principle, the patient's decision-making capacity, the multi-axial framework for compulsory admission, and the balance between paternalism and patient liberty.
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Affiliation(s)
- B Wm Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - E C Fistein
- School of Clinical Medicine, University of Cambridge, United Kingdom
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - L Sy Chan
- Department of Forensic Psychiatry and Old Age Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - C K Yan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - A Ch Lai
- Head of the Socioanthropology Department, School of Medical Sciences, National University of Asunción (Santa Rosa Campus), Santa Rosa del Aguaray, Paraguay
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - K K Ng
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
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15
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Lam PL, Lam TC, Choi CW, Lee AWM, Yuen KK, Leung TW. The impact of palliative care training for oncologists and integrative palliative service in a public-funded hospital cluster-a retrospective cohort study. Support Care Cancer 2017; 26:1393-1399. [PMID: 29138955 DOI: 10.1007/s00520-017-3963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Oncological care of advanced cancer patients was provided by multiple departments in Hong Kong. One of these departments, the clinical oncology department (COD), introduced systematic palliative care training for its oncologists since 2002. The COD was recognized as a European Society for Medical Oncology (ESMO) Designated Centre of Integrated Oncology and Palliative Care since 2009. This retrospective cohort study aims to review the impact of integrative training and service on palliative care coverage and outcome. METHODS Clinical information, palliative service provision, and end-of-life outcomes of patients who passed away from lung, colorectal, liver, stomach, or breast cancer in the Hong Kong West public hospital network during July 2015 to December 2015 were collected. RESULTS A total of 307 patients were analyzed. Around half (49.2%) were attended primarily by COD, and 68.9% received palliative service. There are significantly fewer patients referred to palliative care from other departments (p < 0.001), with only 19.9% of this patient group receiving palliative referral. COD patients had longer palliative coverage before death (median 65 days versus 24 days, p < 0.001), higher chance of receiving end-of-life care at hospice units (36.4 versus 21.2%, p = 0.003), lower ICU admission (0.66 versus 5.1%, p = 0.02), and higher percentage of receiving strong opioid in the last 30 days of life (51.0 versus 28.9%, p < 0.001) compared to other departments. In multivariable analysis, COD being the primary care team (odds ratio 12.2, p < 0.001) was associated with higher palliative care coverage. CONCLUSION The study results suggested that systematic palliative care training of oncologists and integrative palliative service model was associated with higher palliative service coverage and improved palliative care outcomes.
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Affiliation(s)
- Pak-Lun Lam
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Tai-Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 1/F, Professorial Block, Pokfulam, Hong Kong.
| | - Cheuk-Wai Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 1/F, Professorial Block, Pokfulam, Hong Kong
| | - Anne Wing-Mui Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, 1/F, Professorial Block, Pokfulam, Hong Kong
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, 1/F, Professorial Block, Pokfulam, Hong Kong
| | - To-Wai Leung
- Department of Clinical Oncology, Queen Mary Hospital, 1/F, Professorial Block, Pokfulam, Hong Kong
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16
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Siu BWM, Au-Yeung CCY, Chan AWL, Chan LSY, Yuen KK, Leung HW, Yan CK, Ng KK, Lai ACH, Davies S, Collins M. Validation of the "Security Needs Assessment Profile" for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. Int J Law Psychiatry 2017; 54:61-66. [PMID: 28528124 DOI: 10.1016/j.ijlp.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/13/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
Mapping forensic psychiatric services with the security needs of patients is a salient step in service planning, audit and review. A valid and reliable instrument for measuring the security needs of Chinese forensic psychiatric inpatients was not yet available. This study aimed to develop and validate the Chinese version of the Security Needs Assessment Profile for measuring the profiles of security needs of Chinese forensic psychiatric inpatients. The Security Needs Assessment Profile by Davis was translated into Chinese. Its face validity, content validity, construct validity and internal consistency reliability were assessed by measuring the security needs of 98 Chinese forensic psychiatric inpatients. Principal factor analysis for construct validity provided a six-factor security needs model explaining 68.7% of the variance. Based on the Cronbach's alpha coefficient, the internal consistency reliability was rated as acceptable for procedural security (0.73), and fair for both physical security (0.62) and relational security (0.58). A significant sex difference (p=0.002) in total security score was found. The Chinese version of the Security Needs Assessment Profile is a valid and reliable instrument for assessing the security needs of Chinese forensic psychiatric inpatients.
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Affiliation(s)
- B W M Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - C C Y Au-Yeung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - A W L Chan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - L S Y Chan
- Department of Forensic Psychiatry & Old Age Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - K K Yuen
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - H W Leung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - C K Yan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - K K Ng
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - A C H Lai
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong, China.
| | - S Davies
- Nottinghamshire Healthcare NHS Trust, UK.
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Yeung R, Wong KH, Yuen KK, Wong KY, Yau Y, Lo SH, Liu R. Clinical oncology and palliative medicine as a combined specialty--a unique model in Hong Kong. Ann Palliat Med 2015; 4:132-4. [PMID: 26231809 DOI: 10.3978/j.issn.2224-5820.2015.04.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 11/14/2022]
Abstract
The importance of early integration of palliative care (PC) into oncology treatment is increasingly being recognized. However, there is no consensus on what is the optimal way of integration. This article describes a unique model in Hong Kong where clinical oncology and palliative medicine (PM) is integrated through the development of PM as a subspecialty under clinical oncology.
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Affiliation(s)
- Rebecca Yeung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China.
| | - Kam-Hung Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Ka-Yan Wong
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
| | - Yvonne Yau
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Sing-Hung Lo
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Rico Liu
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong SAR, China
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Ho RMY, Cheung HHK, Lai TTS, Tam VFL, Yan CK, Chan WL, Yuen KK. Use of the Historical, Clinical, Risk Management-20 to assess the risk of violence by discharged psychiatric patients. Hong Kong Med J 2015; 21 Suppl 2:45-47. [PMID: 25852103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Lee EKC, Yuen KK, Mui WH, Law GML, Lui CMM, Chan MKH, Wong FCS, Tung SY. Salvage Radiotherapy to the Prostatic Fossa Using Volumetric-modulated Arc Therapy: Early Results. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1313173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Ma BBY, Hui EP, Wong SCC, Tung SY, Yuen KK, King A, Chan SL, Leung SF, Kam MK, Yu BKH, Zee B, Chan ATC. Multicenter phase II study of gemcitabine and oxaliplatin in advanced nasopharyngeal carcinoma--correlation with excision repair cross-complementing-1 polymorphisms. Ann Oncol 2009; 20:1854-9. [PMID: 19549713 DOI: 10.1093/annonc/mdp065] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a platinum-sensitive cancer and excision repair cross-complementing group 1 (ERCC1) polymorphisms have been shown to predict survival in several cancers following platinum therapy. PATIENTS AND METHODS This multicenter study evaluated the activity of oxaliplatin and prolonged infusion of gemcitabine ('GEMOX' regimen) in recurrent NPC. Baseline blood samples were genotyped for the presence of ERCC1-118 gene polymorphisms. RESULTS Forty-two patients were recruited, of whom most (61%) had metastatic disease. Of the 40 patients evaluated for response, the respective overall response and disease control rates were 56.1% and 90.2%. At a median follow-up of 14.8 months, the respective median overall survival and time to progression were 19.6 months [95% confidence interval (CI) = 12.8-22 months] and 9 months (95% CI = 7.3-10 months). Grade 3-4 toxic effects were uncommon. The distribution of ERCC1-118 genotypes from 29 patients was C/C (n = 17, 40.5%), C/T (n = 10, 23.8%) and T/T (n = 2, 4.8%). No differences in survival or response rates were found between genotypes. CONCLUSIONS GEMOX is active in the treatment of recurrent NPC. Detection of single-nucleotide gene polymorphisms from genomic DNA in peripheral blood is feasible in NPC and further studies are warranted.
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Affiliation(s)
- B B Y Ma
- Department of Clinical Oncology at the Sir Y K Pao Center for Cancer, Hong Kong Cancer Institute, Chinese University of Hong Kong, Hong Kong SAR
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Wong FCS, Lee TW, Yuen KK, Lo SH, Sze WK, Tung SY. Intercostal nerve blockade for cancer pain: effectiveness and selection of patients. Hong Kong Med J 2007; 13:266-70. [PMID: 17664531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES To review treatment results of intercostal nerve blockade at our centre and those reported in the literature, and to determine which patients benefit most from this procedure. DESIGN Retrospective study. SETTING Regional palliative care centre in a regional hospital in Hong Kong. PATIENTS Oncology patients who had intercostal nerve blockade at Tuen Mun Hospital from 1995 to 2005 were divided into three groups: (1) those who appeared not to tolerate opioids; (2) those deemed to have inadequate pain control, despite high doses of analgesics; and (3) those referred to avoid early use of high-dose opioids and tolerance. MAIN OUTCOME MEASURES The effectiveness and complications of intercostal nerve blockade, and the extent of benefit derived from intercostal nerve blockade in different patient groups. RESULTS This study found that 80% of the 25 patients noted optimal local pain control and 56% experienced reduction in analgesic use after intercostal nerve blockade. About 32% did not notice recurrence of the targeted pain till the end of their lives. None of the patients developed pneumothorax. Most benefit from intercostal nerve blocks were derived by group 2 patients, 90% of whom obtained optimal local pain control (P=0.23) and enjoyed a significant reduction in analgesics use (P=0.019), and in 40% their target pain was controlled till the end of life. Only about one third of group 3 patients had subsequent reduction in use of analgesics, mainly because they had co-existing pain other than at the target selected for treatment. Half (50%) of group 1 patients achieved optimal pain control. CONCLUSION Our treatment results from intercostal nerve blockade are comparable to those reported in the literature. The procedure is safe if closely monitored. Good selection of cases is important for optimising the therapeutic gain. The largest benefit is obtained in patients who have inadequate pain control after high-dose morphine.
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Affiliation(s)
- Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong.
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Abstract
BACKGROUND Prostate cancer is the most common cancer in men in many western countries. It is characterized by its propensity for bone metastases which occur in more than 80% of patients with advanced disease. Patients are at risk of complications including pain, hypercalcaemia, bone fracture and spinal cord compression. Hormonal treatment is the mainstay of treatment for these patients but most of them will then become hormone refractory. Bisphosphonates act by inhibiting osteoclast activities and are a potential therapeutic option for metastatic prostate cancer. In addition, they have been shown to reduce pain in patients with bone metastases as a consequence of multiple myeloma. Early uncontrolled studies of bisphosphonates in metastatic prostate cancer patients have shown encouraging results. OBJECTIVES The objective of this review was to determine the effectiveness of bisphosphonates in relieving pain in patients with bone metastases from prostate cancer. SEARCH STRATEGY Studies were identified by electronic search of bibliographic databases including MEDLINE, EMBASE, CancerLit and the Cochrane Controlled Trials Register. Handsearching included Proceedings of American Society of Clinical Oncology and reference lists of all eligible trials identified. SELECTION CRITERIA Randomised controlled studies comparing the effectiveness of bisphosphonates with placebo or open control for pain relief in patients with bone metastases from prostate cancer. DATA COLLECTION AND ANALYSIS Data were extracted from eligible studies and included study design, participants, interventions and outcomes. Comparable data were pooled together for meta-analysis with intention-to-treat principle. Outcomes included pain response, analgesic consumption, skeletal events (including pathological fractures, spinal cord compression, bone radiotherapy, bone surgery), prostate cancer death, disease progression, radiological response, PSA response, adverse events, performance status, quality of life and comparisons between different routes, doses and types of bisphosphonates. MAIN RESULTS One thousand nine hundred and fifty-five patients from ten studies were included in this review. The pain response rates were 27.9% and 21.1% for the treatment group and the control group, respectively, with an absolute risk difference of 6.8%. The OR for pain response was 1.54 (95% CI 0.97 to 2.44, P = 0.07), showing a trend of improved pain relief in the bisphosphonate group, although this was not statistically significant. The rates for skeletal events were 37.8% and 43.0% for the treatment group and the control group, respectively, with an absolute risk difference of 5.2%. The OR for skeletal events was 0.79 (95% CI 0.62 to 1.00, P = 0.05). A significant increase in nausea was observed in patients who received bisphosphonates compared to placebo. No increase in other adverse events was observed. There was no statistically significant difference between the bisphosphonate group and the control group in terms of prostate cancer death, disease progression, radiological response and PSA response. There are insufficient data to guide the choice of bisphosphonates or the dose and the route of administration . AUTHORS' CONCLUSIONS Bisphosphonates should be considered for patients with metastatic prostate cancer for the treatment of refractory bone pain and prevention of skeletal events. More research is needed to guide the choice of bisphosphonates, optimal treatment schedule as well as cost-benefit comparisons. Combining results from different studies is difficult because different tools were used to assess pain, and also, bisphosphonates vary considerably in potency. This review highlights the need for standardisation and co-ordination among researchers in cancer pain studies.
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Affiliation(s)
- K K Yuen
- University of Hong Kong, Centre of Infection, Hong Kong, China.
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Leung TW, Tung SY, Sze WK, Wong FCS, Yuen KK, Lui CMM, Lo SH, Ng TY, O SK. Treatment results of 1070 patients with nasopharyngeal carcinoma: an analysis of survival and failure patterns. Head Neck 2005; 27:555-65. [PMID: 15880410 DOI: 10.1002/hed.20189] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this analysis was to evaluate the outcomes of patients with nasopharyngeal carcinoma (NPC) treated primarily by external beam irradiation (ERT) and to explore for possible ways to improve the treatment results. METHODS One thousand seventy patients with nonmetastatic NPC treated from 1990 to 1998 were retrospectively analyzed. The distribution according to the Union Internationale Contre le Cancer (UICC) (1997 edition) staging system at initial diagnosis was as follows: stage I, n = 113; stage IIA, n = 38; stage IIB, n = 360; stage III, n = 306; stage IVA, n = 136; stage IVB, n = 117; T1, n = 284; T2a, n = 88; T2b, n = 398; T3, n = 149; T4, n = 151; N0, n = 321; N1, n = 393; N2, n = 238; N3a, n = 29; N3b, n = 89. Two hundred eight patients were given neoadjuvant chemotherapy. Ninety-seven patients were diagnosed with locally persistent disease and were salvaged with high dose rate intracavitary brachytherapy. Multivariate analysis was performed with the Cox regression proportional hazards model. RESULTS The 5-year actuarial local failure-free survival, regional failure-free survival, distant metastasis-free survival, progression-free survival, cancer-specific survival, and overall survival rates were 80.9%, 93.3%, 77.2%, 62.7%, 71.4%, and 66.5%, respectively. Isolated distant metastasis occurred in 191 patients (18%). The distributions were as follow: stage I, 2.1% (two of 95); stage IIA, 5.7% (two of 35); stage IIB, 14.9% (45 of 302); stage III, 26.4% (62 of 235); stage IVA, 40% (40 of 100); stage IVB, 47.1% (40 of 85). Results of the multivariate analysis of various clinical endpoints were discussed. By studying these failure patterns, it is hoped that we could refine future treatments according to the failure patterns of patients with different risks of locoregional and distant failure. CONCLUSIONS The 18% incidence of isolated distant metastasis is too high to be ignored. Maximizing the local control and minimizing the risk of distant metastasis and late complications should be the key objectives in designing future clinical trials.
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Affiliation(s)
- To-Wai Leung
- Department of Clinical Oncology, Tuen Mun Hospital, Tsing Chung Koon Road, Hong Kong, People's Republic of China.
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Abstract
BACKGROUND Alveolar rhabdomyosarcoma (RMS) has a high risk for local and distal failure. Multimodal management of a patient with alveolar RMS of the cervix uteri is outlined. CASE A 39-year-old woman suffered from alveolar RMS of the cervix without involvement of uterus and parametrium. She was treated with total hysterectomy and left salpingo-oophorectomy. Systemic chemotherapy and pelvic irradiation were also offered. She remains in clinical remission 3 years after presentation. CONCLUSION Postoperative chemotherapy and irradiation could be effective treatments for alveolar rhabdomyosarcoma of the cervix in adult patients.
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Affiliation(s)
- T Y Ng
- Tuen Mun Hospital, Hong Kong.
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25
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Wong FCS, Tung SY, Leung TW, Sze WK, Wong VYW, Lui CMM, Yuen KK, O SK. Treatment results of high-dose-rate remote afterloading brachytherapy for cervical cancer and retrospective comparison of two regimens. Int J Radiat Oncol Biol Phys 2003; 55:1254-64. [PMID: 12654435 DOI: 10.1016/s0360-3016(02)04525-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To review the treatment results and complications of high-dose-rate (HDR) intracavitary brachytherapy for patients with carcinoma of the cervix in a single institute and to compare them with those of low-dose-rate (LDR) brachytherapy reported in the literature. METHODS AND MATERIALS Two hundred twenty patients with carcinoma of the cervix were treated by primary radiotherapy between 1991 and 1998. The median age was 63 (range 24-84). The distribution according to Federation of Gynecology and Obstetrics (FIGO) staging system was as follows: Stage IB, 11.4%; IIA, 9.1%; IIB, 50.9%; IIIA, 3.6%; IIIB, 23.2%; and IVA, 1.8%. They were treated with whole pelvic irradiation giving 40 Gy to the midplane in 20 fractions over 4 weeks. This was followed by parametrial irradiation, giving 16-20 Gy in 8-10 fractions. HDR intracavitary brachytherapy was given weekly, with a dose of 7 Gy to point A for three fractions and, starting from 1996, 6 Gy weekly for four fractions. The median overall treatment time was 50 days (range 42-73 days). The median follow-up time was 4.7 years (range 3 months to 11.1 years). Multivariate analysis was performed using the Cox regression proportional hazards model. RESULTS The complete remission rate after radiotherapy was 93.4% (211/226). The 5-year actuarial failure-free survival (FFS) and cancer-specific survival (CSS) rates for stage IB, IIA, IIB, IIIA, IIIB, and IVA were 87.7% and 86.6%, 85% and 85%, 67.8% and 74%, 46.9% and 54.7%, 44.8% and 50.4%, 0% and 25%, respectively. On multivariate analysis, young age (< 50) (p = 0.0054), adenocarcinoma (p = 0.0384), and stage (p = 0.0005) were found to be independent poor prognostic factors. The 5-year actuarial major complication rates (Grade 3 or above) were as follows: proctitis, 1.0%; cystitis, 0.5%; enteritis, 1.3%; and overall, 2.8%. On multivariate analysis, history of pelvic surgery was a significant prognosticator. The two HDR fractionation schedules were not a significant prognosticator in predicting disease control and complications. CONCLUSION Our experience in treating cervical cancer with HDR intracavitary brachytherapy is encouraging. Our treatment results and complication rates were compatible with those of the LDR series. Further studies are eagerly awaited to better define the optimal fractionation schedule for HDR brachytherapy and the schedule on how chemotherapy may be combined with it.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Brachytherapy/adverse effects
- Brachytherapy/methods
- Carcinoma, Adenosquamous/mortality
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Adenosquamous/radiotherapy
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Combined Modality Therapy
- Cystitis/etiology
- Disease-Free Survival
- Dose Fractionation, Radiation
- Enteritis/etiology
- Female
- Follow-Up Studies
- Humans
- Life Tables
- Lymphatic Irradiation
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Staging
- Particle Accelerators
- Pelvis
- Proctitis/etiology
- Proportional Hazards Models
- Radiation Injuries/etiology
- Radiotherapy, High-Energy/adverse effects
- Remission Induction
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
- Uterine Cervical Neoplasms/radiotherapy
- Uterine Cervical Neoplasms/surgery
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Affiliation(s)
- Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, (Special Administrative Region), Hong Kong, People's Republic of China.
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Wong CS, Luk SH, Leung TW, Yuen KK, Sze WK, Tung SY. Sphenoid sinus mucocoele and cranial nerve palsies in a patient with a history of nasopharyngeal carcinoma: may mimic local recurrence. Clin Oncol (R Coll Radiol) 2002; 13:353-5. [PMID: 11716228 DOI: 10.1053/clon.2001.9288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the case history of a patient with a sphenoid sinus mucocoele detected by computed tomography and medical resonance imaging. The patient had a history of nasopharyngeal carcinoma, which was treated by radiotherapy more than 10 years previously. He presented with bilateral twelfth and sixth cranial nerve palsies. Local tumour recurrence was suspected. Further investigations showed that the cranial nerve palsies were caused by radiation damage and the sphenoid sinus mucocoele was an incidental finding. Sphenoid sinus mucocoele is a possible rare late complication of radiotherapy in patients with nasopharyngeal carcinoma.
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Affiliation(s)
- C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
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Abstract
Using simple linear regression analyses, prediction equations for the combined mesiodistal crown diameters of canines and premolars based on lower incisor size were generated from 97 Hong Kong Chinese (51 males and 46 females, average age 12.31 years) out of a sample of 112. The mesiodistal crown diameters of the permanent teeth were measured using calipers and recorded to the nearest 0.01 mm. Significant sex differences were found for the combined diameters of the canine-premolar segments. The coefficients of correlation between combined diameters of canines and premolars and lower incisors ranged from 0.65 to 0.79. Significant sex differences of the regression equations were found and thus four simple linear regression equations were generated. Coefficients for the slope ranged from 0.58 to 0.66, and coefficients for the intercept ranged from 6.66 to 8.82. The R2 values, standard errors of estimate, and absolute mean errors revealed that prediction models for females were less precise than those for males. Probability tables were constructed from the results of the present study. The prediction equations were found to differ from those of Tanaka and Johnston. Accuracy in the mixed dentition analysis for southern Chinese would be improved by applying the prediction equations or probability tables generated from the present study.
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Affiliation(s)
- K K Yuen
- Department of Health, Government of Hong Kong Special Administrative Region, China
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28
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Abstract
The mesiodistal crown diameters of the primary and permanent teeth were measured on serial casts of 112 Hong Kong Southern Chinese (61 males and 51 females) taken at 5.68 and 12.31 years of age. None of the teeth showed significant sex difference in bilateral asymmetry, and significant bilateral asymmetry was found only for the upper primary second molars. The asymmetries were small and the sizes of the antimeres were averaged. Posterior teeth were generally less variable than anterior teeth in both dentitions in Chinese, which is contrary to other reports, but the anterior tooth of each morphological class was, in general, less variable than the posterior member. Male teeth were larger than those of females except for the lower central and lateral incisors in both dentitions, but the difference was not statistically significant. None of the primary teeth nor three of the permanent teeth were found to have significant sex differences in size. Percentage sexual dimorphism ranged from 0.06 to 1.97 per cent for the primary teeth and from 0.36 to 5.27 per cent for the permanent teeth. In the primary dentition, molars were the most dimorphic teeth in both arches, while upper incisors and lower canine were the least dimorphic teeth in their own arch. Among the permanent teeth, the canines were the most dimorphic and the incisors were among the least dimorphic teeth in both arches. Tooth sizes in both dentitions were, in general, larger than those of the Caucasians, comparable with Northern Chinese, but smaller than those of Australian Aboriginals.
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Affiliation(s)
- K K Yuen
- Department of Children's Dentistry & Orthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong
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29
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Abstract
Relations between these diameters were studied on serial dental casts of 112 Hong Kong Chinese (61 males, 51 females) taken at mean ages of 5.68 and 12.31 yr. Size relations were studied in terms of correlation coefficient, difference, and ratio between corresponding pairs of individual teeth and corresponding groups of teeth in both dentitions. The coefficients of correlation were low to moderate (0.2-0.8), with those between groups of teeth consistently higher. As for size differences, incisors and canines were larger in the permanent dentition in both arches by 1.2-2.0 mm. Premolars were smaller than their primary predecessors except for the upper first premolar. When the absolute values of the differences were ranked, the second premolar-second primary molar differences were the greatest (2.0-2.8 mm) while those between the first premolar-first primary molar were the smallest (0.3-0.7 mm). When tooth groups were assessed, the permanent teeth were larger than their predecessors in the anterior segments but smaller in the posterior segments. The leeway space was larger in the mandibular arch (2.2 mm) than in the maxillary arch (0.3 mm). When diameters of five teeth on one side of the arch were combined, the permanent exceeded the primary by 3.5 mm in the upper arch but only 0.5 mm in the lower. The ratios between the permanent and primary tooth sizes showed the same trend as the differences.
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Affiliation(s)
- K K Yuen
- Department of Childrens Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong
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30
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Abstract
The rates of blindness from diabetic retinopathy with or without other causes for persons in the Model Reporting Area (14 states) were determined in five-year intervals by sex. Diabetic males younger than 45 years of age had a higher rate of diabetic blindness than females under 45 years of age. However, for ages 45 and older, the risks of blindness among diabetics were approximately equal for men and women. These data were consistent with the hypothesis that the presence of female hormones improves the prognosis in diabetic retinopathy.
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