Background/aim Validated measures in palliative cancer patients are very important in the evaluation and management of the disease. The Karnofsky Performance Scale (KPS) has been used for many years to assess the performance status of cancer patients. The aim of this study is to determine the validity and reliability of the KPS in cancer patients receiving palliative care in Turkey. Materials and methods Eighty patients with a cancer diagnosis who were admitted to Gaziosmanpasa University Medical Faculty Hospital Palliative Care Unit between 01.03.2016 and 01.03.2017 were included in the study. KPS, measurements from the Katz Activi-ties of Daily Living (ADL) scale, and Basic Activities of Daily Living (BADL) scale were recorded. The alpha coefficient (Cronbach) was calculated by using SPSS version 20.0. The P-value was accepted as P < 0.05 in the analysis of the data. Results There was a positive and strong correlation between Katz ADL scale total score and KPS score (r = 0.895; P < 0.001). In ad-dition, there was a strong negative correlation between the total score of BADL scale and KPS score (r = –0.894; P < 0.001). As for the reliability of the scale scores, Cronbach’s alpha coefficient found to be 0.720. Conclusion KPS is a reliable scale for Turkish cancer patients in palliative care settings.

https://journals.tubitak.gov.tr/medical/issues/sag-19-49-3/sag-49-3-28-1810-44.pdf

Karnofsky Performance Scale validity and reliability of Turkish palliative cancer patients

Introduction-heterogeneity in clinical outcomes and survival was observed in patients with papillary thyroid cancer (PTC) and distant metastases. Here, we investigated the effect of distant metastases sites on survival in PTC patients. Methods-patients with a diagnosis of PTC and known metastases were identified using the Surveillance, Epidemiology, and End Results database (1975-2016). Univariate and multivariate Cox regression analyses were performed to analyze the effect of distant metastases sites on thyroid cancer-specific survival (TCSS) and overall survival (OS). Results-from 89,694 PTC patients, 1819 (2%) developed distant metastasis at the initial diagnosis, of whom 26.3% presented with the multiple-organ disease. The most common metastatic sites were lung (53.4%), followed by bone (28.1%), liver (8.3%), and brain (4.7%). In metastatic patients, thyroid cancer-specific death accounted for 73.2%. Kaplan-Meier curves showed decreased OS in patients with metastases to the brain (median OS = 5 months) and liver (median OS = 6 months) compared to lung (median OS = 10 months) and bone (median OS = 23 months). Moreover, multiple organ metastasis had a higher mortality rate (67.4%) compared to single organ metastasis (51.2%, p < 0.001). Using multivariate analysis, risk factors that significantly influence TCSS and OS were male gender (HR = 1.86, 95% CI = 1.17-2.94, p < 0.001, and HR = 1.90, 95% CI = 1.40-2.57, p = 0.009), higher tumor grade (HR = 7.31, 95% CI = 2.13-25.0, p < 0.001 and HR = 4.76, 95% CI = 3.93-5.76, p < 0.001), multiple organ involvement (HR = 6.52, 95% CI = 1.50-28.39, p = 0.026 and HR = 5.08, 95% CI = 1.21-21.30, p = 0.013), and brain metastasis (HR = 1.82, 95% CI = 1.15-2.89, p < 0.001 and HR = 4.21, 95% CI = 2.20-8.07, p = 0.010). Conclusion-the pattern of distant metastatic organ involvement was associated with variability in OS in PTC. Multi-organ metastasis and brain involvement are associated with lower survival rates in PTC. Knowledge of the patterns of distant metastasis is crucial to personalize the treatment and follow-up strategies.

Site-Specific Metastasis and Survival in Papillary Thyroid Cancer: The Importance of Brain and Multi-Organ Disease.

Biofeedback therapy for chronic pelvic pain syndrome

Symptoms Experienced and Information Needs of Women Receiving Chemotherapy.

This study aims to identify the knowledge level of students receiving health education about the human papilloma virus, screening tests, and human papilloma virus vaccination. The present study was designed as a descriptive study. It was conducted in the Nursing department and First and Emergency Aid programs in a city in the Eastern part of Turkey between November and December 2019. The sample of the study included 312 students who volunteered to participate in the study. The data collection tools used were the Socio-demographic Form and the Human Papilloma Virus Knowledge Scale. The students’ Human Papilloma Virus Knowledge Scale total mean score was 5.86 ± 6.40. The HPV knowledge Scale total score, the General HPV Knowledge sub-scale, and the General HPV Vaccination Knowledge subs-scale mean scores were found to be significantly higher in women, in those who were enrolled in 3rd year, and in those who were knowledgeable about sexually transmitted diseases and cervical cancer. The HPV screening Test Knowledge sub-scale mean score was found to be significantly higher in those who were enrolled in 3rd year and who were knowledgeable about cervical cancer (p < 0.05). The results showed that students’ knowledge levels about HPV were not sufficient, and variables such as gender, class level, and knowledge about sexually transmitted diseases and cervical cancer were found to affect the knowledge level about HPV, screening tests, and vaccination. It is recommended that similar studies should be conducted in larger groups, and initiations to increase the knowledge levels of students should be planned.

Identification of the Knowledge Level of Students Receiving Health Education About the Human Papilloma Virus, Screening Tests, and Human Papilloma Virus Vaccination.

Objectives Palliative care has been developing rapidly throughout the world. A substantial number of palliative care patients are advanced cancer patients. Terminal cancer patients suffer from groups of symptoms called symptom clusters, rather than from individual independent symptoms. The aim of this study is to evaluate the symptoms of terminal cancer patients retrospectively and to present the symptom clusters of these patients. Methods After ethical approval was obtained, a total of 113 (74 female, 39 male) patients with the diagnosis of the terminal stage cancer were retrospectively evaluated in Gaziosmanpasa University, Department of Anesthesiology and Reanimation between January 2011 and January 2013. Patient records were used to obtain medical history, physical examination findings, patient complaints, accompanying persons, primary cancer site, and metastasis sites. Symptoms such as fatigue, pain, vomiting, loss of appetite,insomnia, constipation, cough and dyspnea were assessed with the Edmonton Symptom Assessment System scale (0: None, 10: Worst possible). The symptom clusters were constructed using hierarchical symptom cluster analysis. Results The mean age was 64.51 ± 11.38 years. Patients were referred to our outpatient clinic from Departments of General Surgery, Emergency Medicine, Urology, Oncology, Ear-Nose-Throat, Thoracic Surgery, Internal Medicine and Neurosurgery. Fatigue was the most-detected symptom (98.2%). Three symptom clusters were identified: nausea-vomiting-loss of appetite-constipation, dyspnea-cough, and fatigue-pain-insomnia. Conclusion Although palliative cancer patients were referred mainly with the symptom of pain, at least three symptom clusters were detected. The management of terminal stage cancer patients should focus on symptom clusters rather than individual symptoms.

The evaluation of the symptom clusters in patients with the diagnosis of terminal stage cancer

Amac: Serviks kanseri gelismekte olan ulkelerde, hala en olumcul kanserlerden biridir. Bugun human papilloma virus (HPV)’unun serviks kanserine neden oldugu bilinmektedir. Diger risk faktorleri de viral persistansi artirip karsinojenik sureci hizlandirir. Bu calismanin amaci; saglik yuksek okulu ogrencileri arasinda HPV enfeksiyonu ve asi bilgi duzeyinin belirlenmesi ve elde edilen veriler isiginda hem ogrencilere verilecek egitim programlarinin hem de toplum bilgilendirilmesine yonelik yapilacaklarin gozden gecirilmesidir.  Gerec ve Yontem: Gaziosmanpasa Universitesi Saglik Yuksek Okulu’ndaki birinci ve dorduncu sinif toplam 245 ogrenciye 20 soruluk anket formu verilmis ve cevaplamalari istenmistir.  Bulgular: HPV asisi uygulamasi oldugunu bilme orani birinci siniflarda %25, dorduncu siniflarda %90.3 olup, 99 birinci sinif ogrencisinin ve 11 dorduncu sinif ogrencisinin asi konusunda herhangi bir bilgisi olmadigi tespit edildi. Asinin serviks kanserine karsi koruyucu oldugunu bilme orani birinci siniflarda % 9.8 iken dorduncu siniflarda %63.7 idi. HPV asisi ve enfeksiyonu hakkindaki bilgi duzeyleri siniflar arasinda karsilastirildiginda istatistiksel olarak anlamli bir fark saptandi (p<0.001).  Sonuc: Saglik yuksek okulu ogrencileri, gelecegin saglik personeli olmalari ve HPV enfeksiyonu ve iliskili komplikasyonlar acisindan risk grubu olusturmalari nedeniyle, HPV enfeksiyonu ve asilari konusunda yeterli bilgiye sahip olmasi gereken onemli bir topluluktur. Ayrica toplum sagligi acisindan HPV asisi ve serviks kanser tarama programlarinin tanitilmasi ulke genelinde surdurulmeye calisilsa da yeterli duzeye ulasilamamistir. Medya organlarinin daha aktif katilimiyla bu konuya yonelik onlemlerin suratle alinmasi gerektigi ve ogrencilere verilecek egitim programlarinin planlanmasinda da; bu sonuclarin katki saglayacagi dusunulmektedir.

/pdf/saglik-yuksek-okulu-ogrencilerinin-hpv-asisi-bilgi-duzeyinin-260e7ramrc.pdf

Sağlık Yüksek Okulu Öğrencilerinin HPV Aşısı Bilgi Düzeyinin Değerlendirilmesi

Palyatif bakimda ayrintili ve iyi yapilmis bir degerlendirme kanser hastalarinin genel iyilik halinin degerlendirilmesi icin cok onemlidir. Degerlendirmede detayli bilgi toplayip hastaya verilecek palyatif bakimi yonlendirmek temel amactir. Bu amacla hastalarin mevcut durumlarinin ortaya konmasi, ihtiyaclarinin belirlenmesi ve buna gore bir oncelik sirasi olusturularak multidisipliner bir yaklasim izlenmesi gerekmektedir. Hastanin ilk degerlendirmesi hastayi takip eden hekim tarafindan yapilmali ve palyatif bakim ihtiyaci olup olmadigini anlamak amaciyla tarama seklinde olmalidir. Tarama kriterlerini karsilayan hastalara ayrintili bir palyatif bakim degerlendirmesi yapilmalidir. Bu hastalarin belirti ve klinik bulgulari cok kisa surede degisebileceginden hastalarin her muayenesinde palyatif bakim ihtiyaci icin tarama yapilmalidir. Yapilan degerlendirmeler not edilmeli, ekibin diger uyeleri tarafindan anlasilabilir ve kolay erisilebilir olmalidir. Hastaligin iyi yonetilebilmesi icin hastanin semptomlarinin, karsilastigi yan etkilerin, fonksiyonelliginin, yasam kalitesi ve tedaviye uyumunun cok dikkatli degerlendirilmesi gerekir. Palyatif bakim hastalarinin degerlendirilmesinde pek cok olcek kullanilmaktadir. En sik kullanilan olcekler ornegin Edmonton Semptom Tanilama Olcegi, Karnofsky Performans Skalasi, Katz’in Gunluk Yasam Aktiviteleri Indeksi makalede tartisilacaktir.

/pdf/palyatif-bakimda-hasta-degerlendirmesi-ve-skalalar-2tlx1cwcsb.pdf

Palyatif Bakımda Hasta Değerlendirmesi ve Skalalar

Background: Palliative care practice, aimed at improving psychosocial and physical quality of life without the aim of providing medical cure, is under development in our country. We aimed to reveal the implementation strategy and success of a short palliative care education program organised for health workers in our institution. Method: This descriptive and cross-sectional study was conducted at the Palliative Care Research and Application Centre of Gaziosmanpasa University in Tokat. As part of implementation strategy, an educational program for all nurses, technicians and other hospital staff (bureau personnel and etc.) was organised. A test about palliative care was conducted before and after the education program. 4 weeks later, the same test was delivered to hospital staff who can’t attend education program. The pre- and post-test results of attending staff and the test results of non-attending staff were compared and analysed via SPSS Statistic 20 program. Findings: There were 120 women (63,2%), 70 men (36,8%) participants in attending group and 42 women (45,2%), 51 men (54,8 %) participants in non-attending group. Rate of correct response to ‘Which of the following is not suitable for the definition of palliative care?’ question, increased 14,7 % and reached 55,8 % in attending group. The non-attending group expressed that they have learned palliative care from attending group with 73,7 % . Conclusions: This study showed that there is a high level of lack of knowledge about palliative care among healthcare workers and that a statistically significant level of awareness can be achieved via a brief education program.

/pdf/a-short-educational-program-for-the-working-staff-of-a-1hlu7qoc4y.pdf

Nagihan Yildiz Çeltek

Papers

Karnofsky Performance Scale validity and reliability of Turkish palliative cancer patients

The evaluation of the symptom clusters in patients with the diagnosis of terminal stage cancer

Sağlık Yüksek Okulu Öğrencilerinin HPV Aşısı Bilgi Düzeyinin Değerlendirilmesi

Palyatif Bakımda Hasta Değerlendirmesi ve Skalalar

A Short Educational program for the working staff of a university hospital: An intriguing implementation strategy for palliative care.