Browsing by Author "Chen, Jen-Shi"

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The Prognostic Value of Circulating Tumor Cells in Asian Neuroendocrine Tumors
(2019-12-27)
Hsieh, Jason Chia-Hsun
;
Chen, Guan-Yu
;
Jhou, David Da-Wei
;
Chou, Wen-Chi
;
Yeh, Chun-Nan
Circulating tumor cells (CTC) play important roles in various cancers; however, few studies have assessed their clinical utility in neuroendocrine tumors. This study aimed to prospectively evaluate the prognostic value of CTC counts in Asian patients with neuroendocrine tumors before and during anti-cancer therapy. Patients who were diagnosed with unresectable histological neuroendocrine tumors between September 2011 and September 2017 were enrolled. CTC testing was performed before and during anti-cancer therapy using a negative selection protocol. Chromogranin A levels were also assessed. Univariate and multivariate Cox's proportional hazard model with forward LR model was performed to investigate the impact of independent factors on overall survival and progression-free survival. Kaplan-Meier method with log-rank tests were used to determine the difference among different clinicopathological signatures and CTC cutoff. The baseline CTC detection rate was 94.3% (33/35). CTC counts were associated with cancer stages (I-III vs. IV, P = 0.015), liver metastasis (P = 0.026), and neuroendocrine tumor grading (P = 0.03). The median progression-free survival and overall survivals were 12.3 and 30.4 months, respectively. In multivariate Cox regression model, neuroendocrine tumors grading and baseline CTC counts were both independent prognostic factors for progression-free survival (PFS, P = 0.005 and 0.015, respectively) and overall survival (OS, P = 0.018 and 0.023, respectively). In Kaplan-Meier analysis, lower baseline chromogranin A levels were associated with longer PFS (P = 0.024). Baseline CTC counts are associated with the clinicopathologic features of neuroendocrine tumors and are an independent prognostic factor for this malignancy.
Trajectories of caregiver depressive symptoms while providing end-of-life care
(2013-12-01)
Tang, Siew Tzuh
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Huang, Guan-Hua
;
Wei, Yu-Chung
;
Chang, Wen-Cheng
;
Chen, Jen-Shi
ObjectiveThe course of caregivers' depressive symptoms may not be homogenous. This study identified trajectories of depressive symptoms among caregivers providing end-of-life care to cancer patients and profiled the unique characteristics of caregivers within each trajectory. MethodsTrajectories of depressive symptoms were explored in 447 caregivers who completed the Center for Epidemiological Studies Depression Scale over four periods close to the patient's death (1-30, 31-90, 91-180, and >180days). Distinct trajectories were identified by latent class analysis. ResultsFour trajectories were identified as endurance, resilience, moderately symptomatic, and chronically distressed and contained 32.0%, 11.4%, 36.9%, and 19.7% of the sample, respectively. Caregivers in the endurance trajectory were relatively well-adjusted individuals with less education, adequate financial support, and ample psychological resources but provided care to older patients with greater symptom distress. They perceived less subjective caregiving burden than caregivers with moderate or chronic depressive symptoms. Caregivers in the resilience trajectory were in a more vulnerable position than those in other trajectories when they first transitioned into the caregiving role because they were more likely to be the patient's spouse, have greater educational attainment and insufficient finances, provide higher intensity assistance to a younger relative, and have weaker psychological resources. However, they were older, reported greater confidence in caregiving, and perceived less caregiving burden than caregivers in other trajectories. The moderately symptomatic and chronically distressed trajectories were differentiated only by the strength of psychological resources. ConclusionsCaregivers of terminally ill cancer patients follow distinct depressive-symptom trajectories while providing end-of-life care. Copyright (c) 2013 John Wiley & Sons, Ltd.