Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

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

Article information

J Korean Med. 2024;45(2):74-82
Publication date (electronic) : 2024 June 01
doi : https://doi.org/10.13048/jkm.24025
Keon-Jun Lee1,2,§orcid_icon, Dong Hyeon Kim1,§orcid_icon, Jong-Hee Kim2orcid_icon, Han-Eum Joo2orcid_icon, Young-Min Cho2orcid_icon, Jung-Hyo Cho2orcid_icon, Ji-Hye Park2orcid_icon, So-Jung Park1,3,orcid_icon
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 2024 April 19; Revised 2024 May 2; Accepted 2024 May 7.

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

Patient Characteristics

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

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

Comparison of the CBC Test in Inpatients with Clinical Pathway Application

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

References

1. 2020 Cancer Registry Statistics and 2014–2018 Regional Cancer Incidence Statistics press release National Cancer Center; 2022. 출처: URL: https://ncc.re.kr.
2. Yang Lei, et al. 2020;Gastric cancer: Epidemiology, risk factors and prevention strategies. Chinese Journal of Cancer Research 32(6):695. https://doi.org/10.21147/j.issn.1000-9604.2020.06.03.
3. Joo Kang Mee, et al. 2023;“Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2020.” Cancer Research and Treatment. Official Journal of Korean Cancer Association 55(2):385. https://doi.org/10.4143/crt.2023.447.
4. Park SH, Lee SI. 2012;Recent Advances in Chemotherapy of Gastric Cancer. The Korean Journal of Medicine 82(4):417–26. DOI: https://doi.org/10.3904/kjm.2012.82.4.417.
5. 설은미 . 2021. 위암 수술 환자의 건강관련 삶의 질 구조모형. Doctoral dissertation 서울대학교. 대학원:
6. Zhao P, Lei XM. 2013;Progress in causes of cancer-related fatigue[J]. Journal of Modern Oncology 21(4):894–898. https://doi.org/10.3969/j.issn.1672-4992.2013.04.77.
7. Oh IO, Chang TI, Kim HJ. 2022;Status of the Development and Utilization of Critical Pathways. Quality Improvement in Health Care 28(1):2–13. DOI: https://doi.org/10.14371/QIH.2022.28.1.2.
8. Chang SB, Lee TW, Kim S. 2006;A study of complementary and alternative medicine used by cancer patients in Korea. J Korean Acad Adult Nurs :92–101.
9. Hwang CY. 1997;Bibliographic Study on the Therapy of Gastric Cancer by Intergrated Oriental and Western Medicine. The Journal of Wonkwang Oriental Medicine 7(1):10–8.
10. Jung JH, Seo JC, Kwak MA, Sohn KC. 2014;Literature Review on Traditional Chinese Medicine Treatment of Gastric Cancer. J Int Korean Med 35(3):332–42.
11. Konishi T, Noye T, Furujima K, Harihara Y. 2001;Significance of critical path for gastric cancer: Gastrointestinal diseases and social medicine. Nippon Shokakibyo Gakkai Zasshi; 98(12):1341–8.
12. Hong MN, Shim SH, Yoon SH. 2017;Development and Validity Test on Preliminary Critical Pathway of Integrative Medicine for Lung Cancer Patients Treated with Chemotherapy. J Int Korean Med 38(6):917–29. https://doi.org/10.22246/jikm.2017.38.6.917.
13. 김기연 . 1996;관상동맥 우회술 환자를 위한 Critical pathway 개발. 연세대학교 대학원 간호 학과 석사논문 28(1):117–131.
14. 김효린 , et al. 2016;위암 치료에 대한 한의 임 상 가이드라인. 대한한방내과학회지 제 37(1)
15. Park SJ, Yoo HS, Cho CK, et al. 2023. The Korean Association of Traditional Oncology. Clinical Practice Guideline of Korean Medicine for Gastric Cancer Panmuneducation National Institute for Korean Medicine Development. p. 1–177.
16. Kwon HK, Kim JS, Yu HS. 2009;Review for the Status of Cancer Complementary and Alternative Medicine in the World. J Korean Tradit Oncol 14(1):1–11.
17. Kim MH, Kang PS, Lee KS. 2007;Utilization of Complementary and Alternative Medicine of Cancer Patient in Korea. J Agr Med Community Health 32(3):155–67.
18. Yoo SH, Yoo HS, Cho CK, Lee YW. 2007;A Case Report for Recurred Squeamous Cell Lung Carcinoma Treated with Hang-An-Dan: 7-year follow-up. Korean J Int Korean Med 28(2):385–90.
19. Choi JY, Lee JY, Kim ES, et al. 2008;Clinical data analysis of 106 breast cancer patients who received oriental medical treatment. The Journal of Korean Obstetrics and Gynecology 21(4):228–236.
20. 고금영 박소정, et al. 2023;‘표준치료를 받은 폐암 환자의 한방병원 입원 임상경로’개발 및 적 용. J Physiol & Pathol Korean Med 37(6):178–184. http://dx.doi.org/10.15188/kjopp.2023.12.37.6.178.
21. 송교영 김승남 박조현. 2005;위암수술 환 자에서의 critical pathway 의 개발과 적용. 대한 위암학회지 5(2):95–100.

Article information Continued

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