OBJECTIVE. To identify potential prognostic factors affecting the survival in patients with advanced cancer in a local palliative care unit.

DESIGN. Prospective cohort study.

SETTING. Palliative Care Unit of a regional hospital in Hong Kong.

PATIENTS. All advanced cancer in-patients and out-patients who were enrolled into the palliative care service of the United Christian Hospital between January and December 2002 were recruited.

MAIN OUTCOME MEASURES. Potential prognostic factors including demographic data, tumour characteristics, blood parameters, functional status, co-morbidities, total symptom score, and psychosocial parameters were recorded upon enrolment.

RESULTS. A total of 170 patients were eligible for analysis; their mean age was 69 (standard deviation, 12) years, of which 106 (62%) were male. Overall median survival was 77 (interquartile range, 31-160) days. The most frequent primary malignancy was lung (n=58, 34%), followed by liver (n= 24, 14%) and lower gastro-intestinal tract (n=24, 14%). By univariate analysis, 11 factors affected survival, including: age (P=0.040), number of metastatic sites involved (P=0.001), peritoneal metastases (P=0.009), skin metastases (P=0.011), tachycardia (P=0.009), serum albumin concentration (P<0.001), white cell count (P=0.002), Karnofsky Performance Status score (P<0.001), Hamilton Depression Scale score (P=0.004), Edmonton Symptom Assessment System score (P=0.003), and McGill Quality of Life (Hong Kong)-single item score (P=0.002). Multivariable Cox regression analysis revealed that only age (hazard ratio=0.84; 95% confidence interval, 0.73-0.96), number of metastatic sites involved (1.33; 1.13-1.56), serum albumin concentration (0.95; 0.92-0.98), Karnofsky Performance Status score (0.86; 0.78-0.96), and Edmonton Symptom Assessment System score (1.22; 1.05-1.41) were independent prognosticators.

CONCLUSION. Age, number of involved metastatic sites, serum albumin, Karnofsky Performance Scale score, and Edmonton Symptom Assessment System score were independent prognosticators. Further studies are needed to provide a prognostic instrument applicable in local clinical settings.

Key words: Life expectancy; Prognosis; Neoplasms; Survival analysis

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OBJECTIVE. To evaluate the benefits of laparoscopic versus open resection of liver tumours.

DESIGN. Case control study.

SETTING. Tertiary teaching hospital, Hong Kong.

PATIENTS. Data from 25 patients who underwent laparoscopic resections for liver tumours from 2003 to 2006 were compared to a retrospective series of 25 patients who underwent open hepatectomy in a pair-matched design.

MAIN OUTCOME MEASURES. Duration of operation, operative morbidity and mortality, blood loss, tumour resection margin, analgesics usage, days to return to an oral diet, duration of postoperative hospital stay, and survival of patients with malignancy.

RESULTS. The demographic data and the tumour characteristics were comparable in the two patient groups, as were mortality (0% in both groups) and morbidity rates (4% in both groups). Two (8%) of the patients having laparoscopic resections were converted to open surgery. There was no statistically significant difference between the two groups in terms of operating time or resection margins. However, the laparoscopically treated patients experienced significantly less blood loss (median, 100 vs 250 mL), had shorter hospital stays (median, 4 vs 7 days), were prescribed less analgesia (median morphine dosage, 0.16 vs 0.83 mg per kg body weight), and resumed oral diet earlier (median, 1 vs 2 days). For patients with malignant tumours, there was no significant difference between the two groups in terms of actuarial and disease-free survival.

CONCLUSION. Compared to open hepatectomy, in selected patients laparoscopic liver resection delivers the benefits of decreased blood loss, shorter hospital stay, lesser requirement for analgesics, and an earlier return to an oral diet, without evidence of compromised oncological clearance.

Key words: Hepatectomy; Laparoscopy; Liver diseases; Liver neoplasms; Treatment outcome

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OBJECTIVE. To study the prescribing pattern of proton pump inhibitors with regard to the time of dosing.

DESIGN. Retrospective study.

SETTING. Private hospital, Hong Kong.

PATIENTS. All patients prescribed three specific proton pump inhibitors from 1 January to 31 July 2006 were included.

MAIN OUTCOME MEASURES. For all three proton pump inhibitors, the prescribed dosing instructions were recorded as well as the specialties of the corresponding prescribers.

RESULTS. The ratio of doctors prescribing proton pump inhibitors before meals versus at other times was 1:105. The ratio of patients receiving proton pump inhibitors before meals versus at other times was 1:341. The number of tablets of proton pump inhibitors prescribed before meals versus at other times was 1:409.

CONCLUSIONS. The overwhelming majority of doctors in this study did not prescribe proton pump inhibitors before meals.

Key words: Anti-ulcer agents; Omeprazole; Prescriptions, drug; Proton pumps

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OBJECTIVES. To assess the prevalence of cardiovascular risk factors in men presenting with lower urinary tract symptoms, and their possible correlation with the severity of such symptoms.

DESIGN. Retrospective cohort study.

SETTING. Specialty clinic, Hong Kong.

PATIENTS. A total of 617 men presenting with lower urinary tract symptoms between April 2005 and October 2006.

MAIN OUTCOME MEASURES. Presence of cardiovascular risk factors inferred from the prior and current medical and social history as well as physical examination and investigative findings, among patients with International Prostatic Symptom Scores of different severity.

RESULTS. Of 617 patients, 268 (43%) had known hypertension and 318 (52%) had a history of smoking. According to the World Health Organization criteria for Asian populations, 396 (64%) patients were considered to be overweight (body mass index > or =23 kg/m(2)). A total of 178 (29%) patients were either known to have or were diagnosed to have dysglycaemia during workup. For dyslipidaemia and hyperuricaemia, the corresponding figures were 331 (54%) and 191 (31%). In total, 264 (43%) patients were newly diagnosed as having dysglycaemia, dyslipidaemia, or hyperuricaemia. Logistic regression indicated that only hyperuricaemia and a smoking history were significant predictors of moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8), with respective adjusted odds ratios of 2.20 (95% confidence interval, 1.12-4.31; P=0.022) and 2.11 (1.24-3.57, P=0.006). Patients with moderate-to-severe International Prostatic Symptom Scores had a statistically higher chance of having at least one cardiovascular risk factor during assessment (P=0.001).

CONCLUSIONS. Cardiovascular risk factors were prevalent in male patients who had lower urinary tract symptoms; a large portion of these cardiovascular risk factors were not recognised until their urological consultations. Patients with moderate-to-severe lower urinary tract symptoms (International Prostatic Symptom Score > or =8) had statistically higher chances of having more cardiovascular risk factors.

Key words: Cardiovascular diseases; Hyperuricemia; Smoking; Urinary tract infections

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OBJECTIVE. To describe experience with a chronic pain management programme in Hong Kong Chinese patients.

DESIGN. Prospective study.

SETTING. Regional hospital, Hong Kong.

PARTICIPANTS. Patients with chronic pain who participated in the first six Comprehensive Out-patient Pain Engagement programmes between 2002 and 2005.

INTERVENTION. Comprehensive Out-patient Pain Engagement is a 14-day structured, multidisciplinary out-patient programme conducted over 6 weeks. It includes pain education, cognitive re-conceptualisation, training in communication skills and coping strategies, graded physical exercises and functional activities training. It aims to improve patient function and quality of life, despite persistent pain.

MAIN OUTCOME MEASURES. Changes in scores from baseline values after joining the programme, with respect to several assessment tools. These included the following: visual analogue pain scale, Pain Catastrophizing Scale, Patient Self-efficacy Questionnaire, Canadian Occupational Performance Measure, Medical Outcome Survey-Short Form 36 Questionnaire, and duration of physical tolerances, medication utilisation, and work status records.

RESULTS. Forty-five patients were available for analysis. After the Comprehensive Out-patient Pain Engagement programme, improvements in Medical Outcome Survey-Short Form 36 Questionnaire (role physical and vitality), Pain Catastrophizing Scale, Patient Self-efficacy Questionnaire, and Canadian Occupational Performance Measure were demonstrated (P<0.05). The duration of standing and sitting tolerances increased (P<0.05). An improvement in employment rate was also evident (P=0.01).

CONCLUSION. The initial results of our management programme in Chinese patients with chronic pain are encouraging. This type of programme should be promoted more widely in this group of patients, as it appears to improve physical function, psychological well-being, and productivity.

Key words: Chronic disease; Cognitive therapy; Combined modality therapy; Pain management; Quality of life

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