Epidemiology of Cancer Pain and Symptoms among Underserved Ethnic Chinese Patients Treated in a Community Oncology Setting

Objectives.This study aims to report our experience in the management of HNBCC in ethnic Chinese over a 10-year period.Methods.A retrospective review of all ethnic Chinese patients with HNBCC treated in a tertiary centre from 1999 to 2009.Results.From 1999 to 2009, 225 patients underwent surgical excision for HNBCC. Majority were elderly female patients. Commonest presentation was a pigmented (76.2%) ulcer (64.8%) over the nose (31.6%). Median skin margin taken on tumour excision was 2.0 mm; primary skin closure was achieved in 51.8%. Postresection skin margin was clear in 75.4%. Of those with inadequate skin margins, 56.7% opted for further treatment, 43.4% for observation. Recurrence rates were 2.6% and 13.8%, respectively (). Overall recurrence rate was 5.5%.Conclusions.HNBCC commonly presented as pigmented ulcers over the nose of elderly female patients in our locality. Adequate tumour excision ± reconstruction offered the best chance of cure. Reexcision of those with inadequate skin margins improved local tumour control.

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Dealing With Death Taboo: Discussion of Do-Not-Resuscitate Directives With Chinese Patients With Noncancer Life-Limiting Illnesses

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119828116 ◽

2019 ◽

Vol 36 (9) ◽

pp. 760-766 ◽

Cited By ~ 9

Author(s):

Hon-Wai Benjamin Cheng ◽

Pui-Shan Karen Shek ◽

Ching-Wah Man ◽

Oi-Man Chan ◽

Chun-Hung Chan ◽

...

Keyword(s):

Decision Making ◽

Chinese Culture ◽

Ethnic Disparities ◽

Retrospective Chart Review ◽

Female Gender ◽

Tertiary Hospital ◽

Chinese Patients ◽

Team Approach ◽

Do Not Resuscitate ◽

Ethnic Chinese

Background: Noncancer patients with life-limiting diseases often receive more intensive level of care in their final days of life, with more cardiopulmonary resuscitation performed and less do-not-resuscitate (DNR) orders in place. Nevertheless, death is still often a taboo across Chinese culture, and ethnic disparities could negatively affect DNR directives completion rates. Objectives: We aim to explore whether Chinese noncancer patients are willing to sign their own DNR directives in a palliative specialist clinic, under a multidisciplinary team approach Design: Retrospective chart review of all noncancer patients with life-limiting diseases referred to palliative specialist clinic at a tertiary hospital in Hong Kong over a 4-year period. Results: Over the study period, a total of 566 noncancer patients were seen, 119 of them completed their own DNR directives. Patients had a mean age of 74.9. Top 3 diagnoses were chronic renal failure (37%), congestive heart failure (16%), and motor neuron disease (11%). Forty-two percent of patients signed their DNR directives at first clinic attendance. Most Chinese patients (76.5%) invited family caregivers at DNR decision-making, especially for female gender (84.4% vs 69.1%; P = .047) and older (age >75) age group (86.2% vs 66.7%; P = .012). Of the 40 deceased patients, median time from signed directives to death was 5 months. Vast majority (95%) had their DNR directives being honored. Conclusion: Health-care workers should be sensitive toward the cultural influence during advance care planning. Role of family for ethnic Chinese remains crucial and professionals should respect this family oriented decision-making.

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Standardizing Opioid Prescribing Practices for Cancer-Related Pain Via a Novel Interactive Documentation Template at a Public Hospital

Journal of Oncology Practice ◽

10.1200/jop.18.00789 ◽

2019 ◽

Vol 15 (11) ◽

pp. e989-e996 ◽

Cited By ~ 1

Author(s):

Maliha Nusrat ◽

Amanda Parkes ◽

Ryan Kieser ◽

Bei Hu ◽

Dalia Farhat ◽

...

Keyword(s):

At Risk ◽

Pain Management ◽

Cancer Pain ◽

Systematic Approach ◽

Opioid Misuse ◽

Prescribing Practices ◽

Cancer Pain Management ◽

Opioid Prescribing ◽

Community Oncology ◽

Ensure Patient Safety

PURPOSE: Opioid misuse during cancer pain management places patients at risk for harm and physicians for legal liability. Identifying and monitoring patients who are at risk is challenging given the lack of validated clinical tools and evidence-based guidelines. In the current study, we aimed to standardize opioid prescribing practices at a community oncology clinic to help ensure patient safety and physician compliance with Texas state regulations. METHODS: We used the Plan-Do-Study-Act methodology. In the planning phase, current practices of assessing opioid efficacy, toxicity, and misuse were determined by surveying clinic physicians and reviewing patients’ charts. We developed a new standardized process that incorporated published literature, the Texas Administrative Code, and expert opinion. Two interactive documentation templates (SmartPhrases) were designed to implement the standardized process. The intervention was studied using repeat physician surveys and chart reviews, which prompted action for refinement and sustainability. RESULTS: At baseline, 9% of providers followed a systematic approach to prescribing opioids and 86% expressed an interest in process standardization. We noted high interprovider variability in the opioid risk stratification and refill process. At 2 months and 6 months postimplementation, provider satisfaction with the intervention was 83% and 75%, whereas compliance with SmartPhrase use was 70% and 54%, respectively. The frequency of state database check improved from 36% to 94% at 6 months. Improvement was also noted in assessment and documentation of baseline risk, chemical coping, and toxicity. CONCLUSION: We implemented a systematic approach for assessing opioid misuse, toxicity, and efficacy during cancer pain management at a community oncology clinic. The approach resulted in notable improvement in provider practices and documentation compliance.

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Pharmacokinetics of Indinavir at 800, 600, and 400 Milligrams Administered with Ritonavir at 100 Milligrams and Efavirenz in Ethnic Chinese Patients Infected with Human Immunodeficiency Virus

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.48.11.4476-4478.2004 ◽

2004 ◽

Vol 48 (11) ◽

pp. 4476-4478 ◽

Cited By ~ 1

Author(s):

Lawrence S. Lee ◽

Anushia Panchalingam ◽

Marline C. Yap ◽

Nicholas I. Paton

Keyword(s):

Human Immunodeficiency Virus ◽

Chinese Patients ◽

Ethnic Chinese ◽

Immunodeficiency Virus ◽

Trough Concentrations ◽

Different Doses

ABSTRACT We assessed the pharmacokinetics of three different doses of indinavir in five patients. All doses achieved trough concentrations above efficacy thresholds. Toxic trough concentrations were observed in all patients receiving 800 mg, in two patients receiving 600 mg, and in none receiving 400 mg. Indinavir at 400 mg may be efficacious and less toxic in patients taking ritonavir and efavirenz.

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Phase II randomized study of gefitinib alone or plus vinorelbine every 2 weeks’ treatment in patients with adenocarcinoma of the lung who failed at least two regimens

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17095 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17095-17095

Author(s):

Y. Chen ◽

R. Perng ◽

C. Tsai ◽

J. Whang-Peng

Keyword(s):

Disease Progression ◽

Low Dose ◽

Randomized Study ◽

Objective Response ◽

Progression Free Survival ◽

Chinese Patients ◽

Lung Cancer Patients ◽

Ethnic Chinese ◽

Adenocarcinoma Of The Lung ◽

Treatment Objective

17095 Background: To assess the feasibility and the efficacy of adding chronic intermittent low-dose vinorelbine to gefitinib (Iressa) treatment for lung cancer patients with adenocarcinoma who failed 2 previous regimens of chemotherapy. Methods: Patients who had adenocarcinoma and failed at least 2 regimens, including taxanes and platinum, were enrolled and randomized into 2 arms: oral Iressa 250 mg daily (I) or vinorelbine 15 mg/m2 intravenous infusion day 1 and oral Iressa 250 mg daily from day 2 to 14, every 2 weeks (IV). From August 2004 to October 2005, 48 patients were enrolled. Results: Twenty-four patients were randomized into Iressa plus vinorelbine treatment. However, 3 patients refused vinorelbine treatment and received Iressa treatment only. Thus, 27 patients received I treatment and 21 patients received IV treatment. Objective response rates were 55.6% in I and 57.1% in IV. Any grade of leukopenia, neutropenia, and fatigue sensation was significantly higher in the IV arm (p=0.035, 0.001, 0.012, respectively). All the toxicities in both arms were generally mild and no toxic death occurred. However, many patients in the IV arm stopped V treatment before disease progression, including port-A occlusion in 4 patients (after 2, 5, 20, and 23 injections, respectively), mucositis in 1 (after 4 injections), and fatigue sensation in 1 (after 7 injections). After a median follow-up of 8 months, median time to disease progression was higher in IV than I (longer than 12 months vs. 7.1 months, p = 0.0271), more than half of the patients in each arm were still alive (p = 0.2269), and more than 9 patients in each arm survived longer than 1 year. Conclusions: Iressa is highly effective in ethnic Chinese patients with adenocarcinoma of the lung who have failed previous platinum and taxane treatment. The addition of low-dose V every 2 weeks produced a signiificantly better progression-free survival. Replacement of intravenous V with oral V should be considered to prevent the early termination of V treatment. No significant financial relationships to disclose.

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