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C.Y. Kim



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    P1.08 - Poster Session 1 - Radiotherapy (ID 195)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P1.08-002 - Relation of tumor response to radiation dose distribution in locally advanced non-small cell lung cancer undergoing concurrent chemoradiotherapy (ID 201)

      09:30 - 09:30  |  Author(s): C.Y. Kim

      • Abstract

      Background
      To determine whether the quality of radiation dose distribution is associated with the tumor response of advanced non-small cell lung cancer (NSCLC) undergoing concurrent chemoradiotherapy (CCRT).

      Methods
      Thirty one patients with stage IIIA/IIIB NSCLC underwent CCRT with a median dose of 63 Gy (range 40-66 Gy). The chemotherapy combined taxene and alkylating agents. On our actual plans, we drew the planning target volume (PTV) including the electric nodes and tried to make a plan to cover the PTV with at least 95% of prescribed dose. The following CT simulation was done when a cumulative dose was about 36 Gy and the cone-down was undergone at about 40 Gy only including the primary tumor and the bulky nodes. For this retrospective study, each PTV of primary tumor (n=30) and lymph nodes (n=36) was separately re-defined with even margins from gross target volume (GTV) to reduce the variation of target delineation, and the actual plan overlaid the re-defined PTV. For the measurement of tumor response rate during CCRT (RR(mid)) and after CCRT (RR(end)), the GTV on initial simulation was compared with the GTV on following CT simulation and following CT scan after 2 months from end of CCRT, respectively. The relations between the RR(mid), RR(end), dose distribution parameters (D~95~, V~95~, mean tumor dose (MTD) and homogeneity index (HI)), total dose and tumor volume were evaluated by bivariate correlation analysis.

      Results
      Median overall survival was 15.5 months and 2-year survival 42.3%. For primary tumors and lymph nodes, the dose distribution parameters were favorable (Table). For primary tumors, the relation between dose distribution parameters and tumor response was not significant. The RR(end) was correlated with the GTV on following CT simulation (γ=0.627, p<0.001) and the RR(mid) (γ=0.541, p=0.003). For lymph nodes, the RR(mid) was correlated with the mean tumor dose (γ=0.356, p=0.033).

      Mean/SD (%) D~95~ V~95~ MTD HI
      Tumor Node 97.4/2.5 96.6/6.7 99.7/5.4 100.0/23.5 100.3/1.0 98.6/3.1 2.9/1.4 2.2/1.7

      Conclusion
      The quality of radiation dose distribution minimally affected the tumor response. Based on the marked association between the RR(mid) and RR(end), further studies of tumor intrinsic factors related to radiation sensitivity will be rewarding.

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-023 - Envoy Service, a form of dignity therapy, designed to assist communication and palliative care decision for patients with advanced cancer: a preliminary report. (ID 1765)

      09:30 - 09:30  |  Author(s): C.Y. Kim

      • Abstract

      Background
      Patients with advanced cancer experience various difficulties to communicate and express regarding their wishes, personal values and end-of-life care options. These difficulties could be serious obstacles to initiate early palliative care decision and consequently lead to unwanted and/or futile invasive end-of- life care. There is an urgent need to develop innovative approach to address suffering and distress and improve communication between patients and family members, care givers’ and medical providers.

      Methods
      “Envoy Service” was designed to assist patients' own words delivered to family members, friends, care givers in processed and edited form. The assigned patients were interviewed by trained dialogist (2 nurses and 3 clinical psychologists), in individualized and narrative style for 30 to 60 minutes per session up to 3 sessions. During the interview, pre-structured questioned regarding palliative care and end-of-life care options. Additionally, patients are offered to speak what matters most to them, things they would most want remembered. The whole interview process could be videotaped, or voice recorded, or writes down by the dialogist, or in combination upon the patients’ own choices. Once interview sessions completed, the dialogues were reshaped into narrative form and carefully edited in the form of video-audio clip recorded in CDs, or letters. The final products were returned to patients to bequeath to a friend or family member. The responses of patients and family members and caregivers’ and medical provider’s opinions were collected and examined.

      Results
      Twelve patients with advanced cancer (age 40-68, median 57, 5 female, 7 male, 4 lung cancer, 2 head and neck cancer, 5 GI cancer, 1 Gy cancer) received “Envoy service”. It was offered in two hospitals; five patients in Korea University Medical Centre (university Hospital) and seven patients in Seoul Medical Centre (General Hospital) respectively. Interview with dialogist took usually 30-60 minutes (median 40 min) in each session and 1-3 (median 1) sessions. All twelve patients expressed their emotional feeling regarding their illness, fear of death and dying, briefly reviewed their own lives and personal appreciation to their family members and medical providers. Regarding the end-of-life care options, 6 patients choose non-invasive care and 3 patients wished to be chosen by their care giver and physician’s discretion, 3 patients did not evidently spoke about. The edited products, 1 CD, 11 letters were returned to patients to bequeathed to family members. Seven patients reported feeling satisfied. Five patients indicated that the service heightened their physical and psychological well-being. One dialogist reported that completion of services, patients were looked “ready” for dignified end-of-life. Four patients died, 3 without any invasive care, but 1 in ICU.

      Conclusion
      "Envoy service” a form of dignity therapy, is feasible and could be a novel approach to address distress and suffering of patients with advanced cancer. It might help patients to communicate with family members and caregivers and leads to initiate early palliative care and avoid unnecessary invasive procedure near end-of-life.