324

86

325

TEE ISVISZIGATIOE OF TKLLISG TEE TRUTH TO LUSG CASCSR PATISSTS. K. Kobayashi~23, I. Gotohl, K. Itohl, S. Saksil, S. Yonedal, Y. Noguchil, 8. Ogasawaralz, F. Takedel, K. Yoahidal. 1Saitma Cancer Center, Saitama, 2Nippon Medical School, Tokyo, 3International Medical Center of Japan, Tokyo, Japan The investigation of the telling the truth to lung cancer patients under medical treatment was performed in Saitama Cancer Center in 1992. Ninety-four patients (SCLC;22, NSCLC ;72) answered Questionnaire about Notice for Patient (QNP) and Japanese version of EORTC Core Quality of Life Questionnaire (QLQJ) every 2 weeks and their doctors noted Questionnaire about Notice for Dc-ztor (QND). Results 1) The test-retest reliability of QNP (~0.48-0.87, X0.01), the concurrent validity between QNP and QND, and the construct validity of QNP were probed. 2) The rate of telling the truth about diagnosis was 62%. but that about prognosis was only 7%. There was the difference between doctor's explanation about diagnosis and patient's acceptance (accordance rate; 53.1%). Patients thought better diseases than the true diagnosis. significantly (Stuart-Xaxwell's test, PCO.001). 3) The question, "If the telling the truth about diagnosis gives bad effect to patients, it may not be performed generally.", was agreed by 57% patients, especially by them told malignancy (r= -0.36, PCO.01) and with progressive stage (x-=0.29, P~0.05). 4) Most patients wanted to be told the truth about diagnosis (74%). But it was not wanted by 26% patients, especially by them with poor performance status (r=0.50, &X0.01). From QNP and QLQJ, when the truth about diagnosis was told to the patients who didn't want it, their QOL was found to be get worse in psychological concentration (P< 0.045), social interaction (p<O.O05), and financial economic impact (P<O.OOl), significantly. Conclusion From these results it is now thought in Japan that the reserch of patient's wiJ_l to know the truth is necessary.

326

STUDY ON THR REASONS FOR THE DIFFICULTIES IN BEING TRUTHFUL WITH CANCER PATIENTS ABOUT THEIR DISEASE R.Saito’, S.Tsuchiya’, H.Nakano’ , S.Watanabe’ Y.Takei’ T.Makimoto’ ,T.Nomoto’ , S.Ishihaca’ , A.Takisc’, K.Minat~, K.Ezawa2, N.Fu&, H.Hoshino*, I.Naruse*, M.Mori*. ‘w of Intemal Medicine, National Nishigunma Hospital, and ‘First Bt of Internal Medicine, Gunma University, Gunma, Japan.

About two-thirds of the Japanese population wants to lamw the truth about dii in the case of cancer. Thus, a big difference exists between the de&es of patients aad the practices of physicians. Themforep our hospital, we put into practice the policy of actively giving inoperable patients with advanced lung caucef the true i&mu&ion about their disease aad &hewing outpatients and their familii with regard to telling the truth in the case of cancerThe conclusions were as follows:

1)The analysis performed before this study revealed that the rate of beiig truthful with cancer patknts about their disease was 17.4%,aod that 96.5% of the mason patients were not t~thfully informed was because of judgments made by their dodors and families. 2)While interview results showed that 97% of patients wanted to be informed ofthetruthinthecaseof~,~ylOaDoftheirfamilieswere truthful. Fmthennom,most peopk,as potential patients&d not went to be treated accord@ m the criteria developed only between their doctors and families without theii knowledge. 3)The results of this study indicate that we should be tmthfid with cancer patients about theii disease irrespective of the patients’ age and extent of disease. 4)Thc cancer patients who were told the truth became more considerate of others because of their experience of thinking about life. and death.

LUNG CANCER MANAGEMENT, CAN PATIENTS BE SELECTED FOR COST-EFFECTIVE TREATMENT USING APPROPRIATE PROGNOSTIC FACTORS?

J. Lim, P. Coy, J. Schaafsma’, J. Schofield’, KS. Wilson, and I. Yong, British Columbia Cancer Agency (BCCA), Victoria Clinic, and University of Victoria’, Department of Economics, Victoria, B.C., Canada

To optimise future lung cancer treatment resource utilisation, a prospective analysis of treatment outcomes, including quality of life assessment (QOLA) and cost has been undertaken. From l/1/90 to l/1/92 one hundred and sixty-two consecutive, consenting, geographically available lung cancer [I7 small cell &CC), 145 non- small cell ] patients referred to the BCCA Victoria Clinic were treated initially by curative surgery [CS] (8). palliative surgery (a), radical radiotherapy [RRI] (30), palliative radiotherapy (82). chemotherapy [CT] (17) or supportive care (19). and reviewed until death with monthly EORTC QOLA. Standard BCCA Lung Tumour Group treatment policies were followed. Sixteen initial CT patients had SCC. Patients receiving CS or RRT had higher performance status, smaller tumoun, and less weight loss. Median survivals were 33, 12,21,6, 5, 5 months and 3 year survival proportions were 75%, 17%. 40%, 10%. 6% and 10% respectively.

Using Cox Proportional Haaard analysis, models were developed to examine the relative impact of treatments and other prognostic factors on survival, and relative costs. Significant factors were treatment, stage, weight loss, Feinstain index, symptom duration and performance status. Median survival of treated patients was 4 months longer than untreated patients at an average cost of Cs 8935 per year of life gained. QOLA data will ba prasanted in relation to treatments received. Identification of cost-effective treatments is possible using several prognostic indicators.

327

EFFECT OF OK-432 IN COMBINATION WITH rhG-CSF ON THROMBOCYTOPENIA DURING CHEMOTHERAPY FOR LUNG CANCER. J. Shindoh, K. Machida, A. Takekoshi, M. Horiba, M. Hara, Y. Itoh*, M. Andoh*. Ohgaki Municipal Hospital, Ohgaki, Gifu, and *University of Nagoya, Nagoya, Japan.

The degree and period of leukopenia during cancer chemo- therapy can be reduced by using recombinant human gran- ulocyte colony stimulating factor (rhG-CSF) (G). Thrombo- cytopenia. however. has not yet been controled. A strepto- coccal preparation. OK-432(0K), treated with G. has been re- potted to have protective effect on radiation induced bone marrow suppression in mice. The effects of OK therapy in combination with G on thrombocytopenia during chemotherapy for lung cancer was evaluated.

Carboplatin (300 mglm2. dayl) plus ifosfamide (1.5 g/m2. dayl-3) plus etoposide (SO mg/body, dayl-21. per OS) plus G (daylo-) were used for the regimen (CIE). Patients were assigned to 3 groups. OK-432 was injected subcutaneously (1KEdKE). ;

CIE 1st comae CIE 2nd course day 1 3 5 7 10 14 17 21 24 28 1 3 5 7 10 14 17 21 24 28 A) - - B) 1235 5 S 5 5 S 5 C)1235-& 5 5 S 5 S S 555555

So far. 20 patients have been evaluated. Nadir of platelet counts were similar in the 3 groups. Recovery Time A(n=6) B(n=7) C(n=7)

1st course 6.5 f 6.1 6.4 + 8.4 7.9 f 5.2 (mean f SD) 2nd Course 7.3 f 6.5 7.6 Y 5.6 4.7 f 4.3 (days)

Recovery time of 2nd course in the C group was accelerated. These results suggest that OK-432 in combination with G-CSF may have preventional effect on thrombocytopenia during chemotherapy for lung cancer.