Development of a Standardized Clinical Pathway in Korean Patients with Gastric Cancer Clinical Application Observational Study

Keon-Jun Lee; Dong Hyeon Kim; Jong-Hee Kim; Han-Eum Joo; Young-Min Cho; Jung-Hyo Cho; Ji-Hye Park; So-Jung Park; Lee, Keon-Jun; Kim, Dong Hyeon; Kim, Jong-Hee; Joo, Han-Eum; Cho, Young-Min; Cho, Jung-Hyo; Park, Ji-Hye; Park, So-Jung

doi:10.13048/jkm.24025

JKM > Volume 45(2); 2024 > Article

Lee, Kim, Kim, Joo, Cho, Cho, Park, and Park: Development of a Standardized Clinical Pathway in Korean Patients with Gastric Cancer Clinical Application Observational Study

Original Article

The Journal of Korean Medicine 2024; 45(2): 74-82.

Published online: June 01, 2024

DOI: https://doi.org/10.13048/jkm.24025

Development of a Standardized Clinical Pathway in Korean Patients with Gastric Cancer Clinical Application Observational Study

Keon-Jun Lee¹^{, 2}^{, §}

, Dong Hyeon Kim¹^{, §}

, Jong-Hee Kim²

, Han-Eum Joo²

, Young-Min Cho²

, Jung-Hyo Cho²

, Ji-Hye Park²

, So-Jung Park¹^{, 3}^{, *}

¹Department of Oriental Internal Medicine, Pusan National University Korean Medicine Hospital

²Department of Korean Medicine, School of Korean Medicine, Daejeon National University

³Department of Korean Medicine, School of Korean Medicine, Pusan National University

Correspondence to: So-Jung Park, Geumoro 20, Mulgeum-eup, Yangsan-si, Gyeongnam, 50612, Republic of Korea., Email: vivies@hanmail.net

§ These authors contributed equally to this work.

Received April 19, 2024 Revised May 2, 2024 Accepted May 7, 2024

Abstract

Objectives

The objective of this study was to explore the integration of Traditional Korean Medicine (TKM) into existing clinical pathways for the treatment of gastric cancer. focusing on enhancing treatment outcomes and improving patient quality of life.

Methods

Employing a prospective observational design, the study targeted adults aged 20–75 diagnosed with gastric cancer. It assessed the TKM pathway's impact on quality of life, tumor markers, complete blood count test values, and patient satisfaction, and monitored adverse reactions to evaluate effectiveness and safety.

Results

The study demonstrated improved quality of life(QOL), as indicated by increased Karnofsky Performance Scale(KPS) scores Mean Difference(MD)=20.37, and better quality of life (MD=19.79) assessments. Blood test results showed notable enhancements in immune function markers such as Neutrophil (MD=−7.34%) and Lymphocyte (6.80%), and Erythrocyte Sedimentation Rate (ESR)(MD=−11.05mm/hr). Both patient and medical staff satisfaction (MD=0.33) improved, although changes in tumor markers were not statistically significant.

Conclusions

The integration of TKM into the treatment of gastric cancer can significantly improve patient quality of life and satisfaction. To further substantiate these results, developing and implementing more critical pathways across varied clinical settings, along with larger-scaled studies, are essential.

Keywords: Traditional Korean Medicine(TKM), Gastric Cancer, Clinical Pathway, Integrative Cancer Care, Quality of Life, Treatment Efficacy

Table 1

Patient Characteristics

	N(8)	Percentage(%)
Sex
Male	1	12.5
Female	7	87.5

Age	59.13±8.32(46–75)

Stages of gastric cancer
Early Gastric Cancer (EGC)	4	50
Advanced Gastric Cancer (AGC)	4	50

Surgical Methods
Endoscopic resection	1	12.5
Total gastrectomy	3	37.5
Partial gastrectomy	4	50

Table 2

Comparison of the KPS, EORTC QLQ-C30, EORTC QLQ-STO22 Scores in Inpatients with Clinical Pathway Application

	Admission average	Discharge average	MD	T-test	P-value
KPS score	64.63±15.85	85.00±5.35	20.37	−4.18	0.002**

QLQ-C30
Physical Functioning	70.83±22.24	82.50±10.65	11.67	−2.08	0.03*
Role functioning	68.75±24.30	70.83±21.36	2.08	−0.19	0.42
Emotional functioning	59.37±25.76	78.12±33.02	18.75	−4.58	0.001***
Cognitive functioning	64.58±31.42	75±33.33	10.42	−1.66	0.06
Social functioning	70.83±31.81	81.25±18.77	10.42	−1.48	0.09
Quality of Life	46.87±31.16	66.66±21.82	19.79	−2.18	0.03*
Fatigue	51.38±22.17	36.11±11.50	−15.27	3.27	0.006**
Nausea and Vomiting	6.25±12.40	8.33±12.60	2.08	−0.55	0.329
Pain	31.25±30.13	22.91±21.71	−8.34	1.87	0.05
Dyspnea	16.66±17.82	16.66±17.82	0.00	0.00	-
Sleep	54.16±39.59	41.66±34.50	−12.50	2.04	0.03*
Appetite loss	37.50±37.53	8.33±15.43	−29.17	2.19	0.03*
Constipation	37.50±±41.55	37.50±33.03	0.00	1.62	1.89
Diarrhea	25.00±38.83	12.50±17.25	−12.50	1.15	0.14
Financial difficulties	29.16±37.53	12.50±35.36	−16.66	1.87	0.05*

QLQ-STO22
Dysphagia	30.55±26.39	15.27±11.79	−15.28	1.94	0.04*
Pain	36.45±17.78	32.29±14.39	−4.16	1.32	0.11
Reflux symptoms	16.66±14.55	20.83±14.55	4.17	−0.81	0.22
Eating restrictions	37.50±27.82	29.16±25.59	−8.34	1.76	0.06
Anxiety	52.77±17.57	43.05±29.95	−9.72	1.31	0.11
Dry mouth	50.00±47.14	45.83±35.36	−4.17	0.42	0.34
Taste	20.83±35.36	16.66±35.63	−4.17	0.55	0.29
Body image	41.66±34.50	33.33±30.86	−8.33	1.00	0.17
Hair loss	60.00±27.22	26.66±14.91	−33.34	1.82	0.07

MD, Mean Difference; KPS, Karnofsky Performance Scale.

* p<0.05,

** p<0.01,

*** p<0.001

Table 3

Comparison of the CEA, CA19-9 in Inpatients with Clinical Pathway Application

	Admission average	Discharge average	MD	T-test	P-value
CEA (ng/ml)	1.51±0.91	1.89±1.60	0.38	−1.39	0.10
CA19-9 (U/ml)	9.06±9.24	12.20±18.30	3.14	−0.94	0.18

Table 4

Comparison of the CBC Test in Inpatients with Clinical Pathway Application

CBC test	Admission average	Discharge average	MD	T-test	P-value
RBC (106/ul)	3.99±0.32	3.92±0.35	−0.07	0.65	0.27
WBC (103/ul)	4.36±0.98	4.24±0.68	−0.12	0.38	0.36
Hemoglobin (g/dl)	11.30±1.54	10.95±1.58	−0.35	1.06	0.16
Hematocrit (%)	34.03±18.08	33.08±10.45	−0.95	0.92	0.20
ESR (mm/hr)	28.43±14.95	17.38±9.49	−11.05	2.10	0.04*
Platelet (104/ul)	25.71±8.88	26.20±7.5	0.49	−0.34	0.37
Neutrophil (%)	60.09±13.35	52.75±7.85	−7.34	2.05	0.04*
Lymphocyte (%)	29.23±13.34	36.03±7.70	6.80	−1.88	0.057*
Monocyte (%)	7.93±1.67	7.55±2.14	−0.38	0.53	0.30
Eosinophil (%)	2.44±1.24	3.33±2.22	0.89	−1.42	0.10

* p<0.05

Table 5

Comparison of the Patients, Medical Employees's Satisfaction in Inpatients with Clinical Pathway Application

Satisfaction	Admission average	Discharge average	MD	T-test	P-value
Patients (n=8)	4.28±0.43	4.39±0.52	0.11	−1.02	0.17
Medical Employees (n=11)	3.45±0.47	3.78±0.46	0.33	−2.54	0.01**

** p<0.01

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