Earticle

다발성 골수종은 형질세포가 비정상적으로 증식하는 혈액암으로, 고령 인구의 증가로 국내 발생률이 점차 늘 어나는 추세이다. 재발과 불응이 반복되는 난치성 질환이지만 최근 여러 신약이 개발되면서 생존기간이 향상되고 있 다. 2019년 다발성 골수종 환자의 4차 치료에 보험 급여가 승인된 daratumumab은 새로운 기전의 치료제로, daratumumab의 사용 여부에 따른 환자들의 특성은 차이를 보일 것으로 예상된다. 따라서 본 연구에서는 현재 국내에 서 요양급여가 인정되는 약제들을 검토하고, 건강보험심사평가원 청구자료를 활용하여 4차 치료를 경험한 환자들의 인구학적 임상적 특성을 탐색하였다. 연구대상자들은 4차 이상의 치료에서의 daratumumab 사용 여부에 따라 두 군 으로 나누었다. 601명의 daratumumab 치료군(Dara)과 1,141명의 daratumumab 비치료군(Non-dara)이 최종 연구대상 자로 선정되었다. 분석 결과, 양 군은 4차 치료 당시의 평균 연령, 동반 질환, 이전 차수에서 사용된 약제 등에서 통 계적으로 유의한 차이를 보였다. 연구 대상자들에게 1~3차 치료로 가장 많이 사용된 약제는 bortezomib(Dara: 94.34%; Non-dara: 96.49%)이었고, daratumumab 치료군에서 심혈관 질환(Dara: 24.46%; Non-dara: 19.54%)과 간질환(Dara: 34.78; Non-dara: 29.80%)을 동반한 환자가 유의하게 더 많았다. 국내 실제 임상에서의 다발성 골수종 치료는 요양급 여 적용 기준과 밀접한 관계가 있는 것으로 보인다. 의약품의 전 주기를 다루는 규제과학 분야에서 실사용 자료를 활 용한 임상 현실의 파악은 매우 중요하다. 이에 본 연구는 국내 유병률이 증가하고 있는 다발성 골수종 치료의 의사 결정에 기여할 수 있는 기초 자료로 활용될 수 있을 것이라 생각된다.

Multiple myeloma (MM) is a blood cancer characterized by the abnormal proliferation of plasma cells, and its prevalence is increasing in Korea due to an aging population. Although MM shows challenges with frequent relapses, developments in innovative medications have significantly improved survival rates. In 2019, daratumumab was approved for reimbursement as a fourth-line treatment by the Korean National Health Insurance (NHI). This study aimed to examine the current MM drugs covered by NHI benefits and explore the demographic and clinical characteristics of patients receiving fourth-line treatment. We divided the subjects into two groups based on whether they used daratumumab in the fourth line or later using Health Insurance Review and Assessment Service claims data. The final study cohort comprised 601 patients in the daratumumab treatment group (Dara) and 1,141 patients in the non-daratumumab treatment group (Non-dara). There were significant differences between the two groups, including average age at the time of the fourth treatment, comorbidities, and prior treatment drugs. For both groups, bortezomib was the most frequently used drug during the first to third lines of treatment (Dara: 94.34%; Non-dara: 96.49%). Additionally, higher rates of liver disease (Dara: 34.78%; Non-dara: 29.80%) and cardiovascular disease (Dara: 24.46%; Non-dara: 19.54%) were seen in the daratumumab treatment group. The results implied a close relationship between MM treatment in actual settings and reimbursement criteria in Korea. Recognizing the pivotal role of real-world data in regulatory science across pharmaceutical life cycles, our findings contribute valuable insights. This study will serve as foundational data for decision-making about MM, which is becoming more prevalent in Korea.

이 연구의 목적은 폐기물처리시설의 입지 특성과 분포, 그리고 산업요인과의 공간적 연관성을 파악하는 것이다. Moran’s I와 LISA를 적용하여 전국 229개 시군구의 공간적 분포를 분석한 결과, 특정 지역에 폐기물 처리시설이 집중되어 있는 것으로 나타났다. 산업요인의 11개 지표에 대한 요인분석을 통해 세 가지 유형으로 분류하고 폐기물처리시설과 이변량 Moran’s I 및 LISA 분석을 실시하였다. 그 결과, 폐기물처리시설은 산업군과 유의미한 공간적 상관성을 가지는 것으로 나타났다. 제조업 및 기초생산·에 너지 산업군과는 정(+)의 상관관계를 가졌으며 지식·기술 산업군과는 부(-)의 상관관계를 보였다. 본 연구는 폐기물처리시설의 불균형 문제를 조명하고 생태산업개념 적용을 통해 산업 요인과의 산업공생 네트워크 중요성을 강조하였다. 또한 환경정의 실현과 순환경제로의 전환 촉진을 위한 정책적 함의도 제시하였다.

The purpose of this study is to identify the locational characteristics and spatial distribution of waste treatment facilities and their associations with industrial factors. Using Moran’s I and LISA, we analyzed 229 administrative districts and found that waste treatment facilities are concentrated in specific regions. Factor analysis of 11 industrial indicators classified them into three types, and bivariate Moran’s I and LISA analyses were conducted to explore their relationships with waste treatment facilities. As a result, waste treatment facilities were found to have a significant spatial correlation with industrial sectors. Waste treatment facilities exhibited a weak positive correlation with the manufacturing and basic production/energy sectors, while showing a negative correlation with the knowledge and technology sector. This study emphasizes the issue of the uneven distribution of waste treatment facilities and underscores the importance of Industrial Symbiosis Networks through the concept of Eco-Industrial Development. It also presents policy implications to promote environmental justice and the transition to a Circular Economy.

비선호시설의 건설에 있어서 과거에는 사업기관이 효율성을 중시하는 관점에서 독단적으로 사업을 추진하기도 했다. 최근 공공갈등이 증가하면서 비선호시설의 건설에 있어 지역주민들의 참여가 바람직하다는 관점이 힘을 얻고 있는 바, 본 연구에서는 비선호시설과 관련된 공공갈등에 있어서 지역주민들이 어떤 방식으로 행동하는지에 대해 20개의 사례를 대상으로 체계적으로 분석하였다. 연구결과 지역 주민들이 비선호시설과 관련된 갈등에서 사업기관에 대해 문제를 제기하는 역할에 머문 경우가 가장 많았으나, 적지 않은 사례에서 협상, 조정, 공모, 시민배심원제 등 다양한 대안적 분쟁해결방법의 과정 속에서 당사자로서 참여한 경우도 발견되었다. 주민참여는 사업기관에게 긍정적인 결과를 가져왔을 뿐 아니라, 지역주민의 입장에서도 도 아니면 모 식의 극단적인 결과 대신 환경적 우려에 대한 해소, 지역 사회를 위한 인센티브 확보 등 긍정적인 결과를 가져온 것이 확인되었다.

This study examines 20 environmental conflict cases that are related to waste treatment facilities. Nowadays it is highly recommended for local government officials to engage local residents in the process of siting and constructing NIMBY facilities in order to prevent and manage conflicts. The results of this study show that local residents protested against the decision of local governments in many cases. However, there were also many cases where local residents participated in communication with the officials in negotiation, mediation, Dutch reverse auction, and citizens’ jury. On one hand, the participation of local residents helped the officials design a better policy in implementing the facilities. On the other hand, their participation in the communication were also favorable to themselves since it helped diminish their concerns on toxic gases and provide appropriate incentives for the local communities.

Objective: To analyze osteoporosis treatment patterns and teriparatide prescription-associated factors in Korea by using a national health insurance claims database. Methods: We utilized the Health Insurance Review & Assessment Service National Patients Sample claims database to identify patients (aged ≥50 years) with at least one osteoporosis claim (International Classification of Disease 10th revision code: M80, M81, M82) and at least one prescription for osteoporosis medication (antiresorptive agents: bisphosphonates, selective estrogen receptor modulators, denosumab, and calcitonin; bone-forming agent: teriparatide) in 2018. Demographic characteristics and healthcare utilization patterns were analyzed. Factors associated with teriparatide prescriptions were assessed using a multivariate logistic regression model. Results: Records showed that 44,815 patients were prescribed osteoporosis medications in 2018; the percentage of patients prescribed each treatment was as follows: 86.6% bisphosphonates, 13.9% selective estrogen receptor modulators, 3.1% calcitonin, 2.1% denosumab, and 0.7% teriparatide. A greater proportion of patients prescribed teriparatide were ≥75 years (53.4% vs. 33.8%) and had fractures (63.9% vs. 12.8%) compared to the same for antiresorptives (p<0.001). Patients prescribed teriparatide had higher Charlson comorbidity index values (1.2±1.3 vs. 0.9±1.2) and were more frequently hospitalized (0.8±1.3 vs. 0.1±0.5) than those prescribed antiresorptives (p<0.001). Elderly patients (≥75 years old; adjusted OR=1.66; 95% CI 1.16-2.38) and those with fractures (adjusted OR=6.23; 95% CI 4.76-8.14) were more likely to be prescribed teriparatide than antiresorptives. Conclusion: Patients prescribed teriparatide were older and more likely to have severe osteoporosis than those prescribed antiresorptives.

본 연구에서는 DSM-IV에 근거한 사회 공포증의 하위 유형 구분인 일반화 유형과 비일반화 유형이 증상 심각도의 양적 차이만을 반영할 수 있다고 보아, 사회 공포증 내담자에게서 나타나는 질적 차이를 대인관계 유형을 통해 살펴보고자 하였다. 이를 위하여 사회 공포증 내담자들의 이질적인 대인관계 특성에 근거하여 질적으로 구분되는 하위 유형을 분류한 후, 이러한 분류가 DSM-IV의 하위 유형과 구별되는 부가적 정보를 제공하는지 알아보았다. 구조화된 면접을 통해 사회 공포증으로 진단받고 8주간의 사회 공포증 인지 행동 치료를 받은 74명을 대상으로 한국판 대인관계 문제 검사(KIIP) 자료를 수집하였다. Leary(1957)가 제안한 대인관계 원형 모델에 입각하여 KIIP의 편차 점수를 군집 분석한 후 내담자 집단을 ‘지배형-통제/ 자기중심성 유형(n=14)’, ‘굴종형-비주장/ 사회적 억제 유형(n=60)’으로 구분하였으며, 두 집단의 임상적 특성과 치료 반응성을 비교하였다. 이를 위해 자기 보고식 척도로는 사회적 회피 및 불편감 척도(SADS), 부정적 평가에 대한 두려움 척도(B-FNE), 사회적 상호 작용 불안 척도(SIAS), 사회 공포증 척도(SPS)를 이용하였으며, 보다 객관적인 평가를 위해서 치료 전후의 즉흥 연설 시간과 주관적 불편감 점수, 임상가의 전반적 인상 평가(CGI)를 측정하였다. DSM-IV 진단적 정의에 근거해서 사회 공포증 하위 유형을 분류했을 때, 일반형 집단(GSP)의 대인관계 문제나 증상 심각도가 더욱 심각한 것으로 나타났다. 대인관계 문제를 근거로 사회 공포증의 하위 유형을 군집 분석했을 때, 지배형과 굴종형 집단의 전반적인 임상적인 특성에서는 뚜렷한 차이가 관찰되지 않았으며, 8회기 동안의 인지 행동 치료에도 대부분 동등한 수준의 효과를 거두는 것으로 나타났다. 그러나 굴종형 집단에 비해 지배형 집단의 경우 사회적 상황에 대한 회피 수준이 인지 치료를 통해 더 유의하게 감소하는 것으로 나타났다. 대인관계 문제 유형에 근거한 하위 유형 구분의 의의와 한계에 대해서 논의하였다.

This study aimed to determine whether individuals with social phobia (SP) could be classified into subtypes according to their interpersonal problem patterns and to discover whether such different subtypes would respond differently to cognitive -behavioral therapy. We used the Korean Inventory of Interpersonal Problems (KIIP-C), Anxiety Disorder Interview Schedule-IV (ADIS-IV), and Self-Reported Test Battery (Korean version of Social Avoidance and Distress Scale; SADS, Brief-Fear of negative Evaluation Scale; B-FNE, Social Interaction Anxiety Scale; SIAS, Social Phobia Scale; SPS) to assess 74 SP patients who participated in eight-weeks of cognitive-behavioral therapy and we examined the participants' behavior patterns as recorded before -and -after the therapy for the treatment's effects. According to our cluster analysis of T-scores of KIIP-C variations, Participants fell into two different classifications: dominant type (n = 14), and submissive type (n = 60). Comparing their different characteristics and responses to treatment, we found the generalized social phobia group reported greater symptom severity and suffered more interpersonal problems than did the non-generalized social phobia group. When examined via interpersonal subtype classification, the two subgroups shared similar symptom severity and treatment responses patterns. With regard to social avoidance, dominant-type SP patients improved significantly more than did submissive type patients. We discussed the implications and potential clinical relevance of social phobia classification based on interpersonal problem patterns.

Purpose: The aim of this study was to investigate drug prescription patterns for the treatment of asthma and chronicobstructive pulmonary disease (COPD) patients in Korea. Methods: Ambulatory adult patients who were diagnosed andreceived treatment for the asthma (ICD-10 code J45) or COPD (ICD-10 code J44) from January 2009 to September2011 in two independent secondary hospitals in Korea were enrolled in this study. Prescribed drug lists were generatedbased on the evidence-based guidelines and prescribed drug dosage forms were identified from the patient medicalrecords and computerized drug prescription databases of the study centers. Results: Total numbers of asthma andCOPD patient enrolled in this study were 2,432 and 2,615, respectively. Individual prescription-based accumulated numbersof patient were 12,021 for asthma and 16,584 for COPD. The most commonly prescribed three drugs were oralpredisolone, oral formoterol and oral montelukast for asthma and oral formoterol, oral doxofylline and inhaled tiotropiumfor COPD. Frequencies of oral drugs were 83.4% and 63.3% while inhalers were 16.4% and 30.2%, for asthmaand COPD, respectively. Conclusion: The oral treatment was prescribed more in asthma and COPD patients than inhalers. To enhance the compliance of evidence-based guidelines for these chronic airway diseases, more realistic and specificstrategies to increase the use of inhalers recommended as primary treatment options for asthma and COPD wouldbe required.

Objectives: This study examines the spatial and temporal patterns of hypertension prevalence and treatment, while also suggesting a public health intervention strategy for hypertension management. Methods: We utilized the hypertension prevalence and treatment rate from the Community Health Survey data collected between 2011 and 2020. To analyze the spatio-temporal patterns of hypertension prevalence and treatment, spatial autocorrelation and hotspot analyses were performed. Results: The spatial autocorrelation analysis revealed regional hypertension prevalence clusters between adjacent regions. For the previous five years, the hotspots with a high prevalence of hypertension were 28 si-gun-gu, which were adjacent to each other, including 16 regions in Gangwon, four in Gyeonggi, two in Incheon, and six in Chungnam. The treatment rate of hypertension showed a random pattern, irrespective of regional and spatial proximity. Conclusions: The results highlight the cooperative approach from adjacent regions by reflecting regional and spatial effects for effective hypertension management. In addition, it is necessary to implement customized interventions for regions with a low treatment rate.

Background: Alzheimer's dementia is the most common dementia. However, recently, choline alfoscerate is prescribed for treating Alzheimer's dementia, although it is not a treatment for this disease. Purpose: To analyze the prescription patterns of choline alfoscerate as a dementia treatment for patients with Alzheimer's disease and to analyze, as well as the factors affecting choline alfoscerate prescription. Method: The 2016 HIRA-NPS data was used in this study. The code of Alzheimer's dementia is F00 in the ICD-10 disease classification code. We analyzed the demographic, clinical, and regional characteristics associated with donepezil, rivastigmine, galantamine, memantine, and choline alfoscerate prescriptions. All statistical and data analyse were conducted by SAS 9.4 and Excel. Results: For patients with Alzheimer's disease, choline alfoscerate was the second most prescribed after donepezil. Analysis results showed that choline alfoscerate was more likely to be prescribed to men than to women, and more likely to be prescribed by local health centers than by medical institutions. Moreover, choline alfoscerate was highly likely to be prescribed at neurosurgical departments, among medical departments. Conclusions: This study confirmed that choline alfoscerate was prescribed considerably for patients with Alzheimer's dementia. Further studies valuating its clinical validity should be performed to clarify whether choline alfoscerate prescription is appropriate for treating Alzheimer's dementia.

학교폭력은 가정과 학교, 지역사회와 정부가 역량을 총 결집하여 해결해야 할 국가적 과제가 된지 오래다. 2004년 학교폭력예방 및 대책에 관한 법률이 제정되고 십수차례의 개정을 거쳐 2012년에 가해학생에 대한 처벌을 강화하고 교원과 학부모의책무성을 강화하며 피해학생의 보호에 방점을 둔 학교폭력예방법이 시행되었다. 이는교육과 선도보다는 학교폭력대책자치위원회의 심의를 통한 처벌위주의 처방으로서 당연히 심의건수와 이에 대한 불복재심 건수가 꾸준하게 증가하여 왔다. 본 연구는 2012년도와 2017년도 각각의 학교폭력의 양상의 변화와 재심관련 실태를 비교분석하였고 전담기구와 학교폭력대책자치위원회의 전문성과 공정성의 실태등을 분석하였고 학교폭력의 가·피해자별로 상이한 재심절차의 문제점 등을 분석하여 이에 대한 개선방안을 제시하고자 하였다. 학교폭력을 처리하는 단위학교의 학교폭력대책자치위원회는 전문성과 공정성을 확보하여야 한다. 이를 위해 자치위원회의 구성을 학부모 위주에서 전문가 위주로 개선하여야 하고, 나아가 단위학교에서의 자치위원회의 비전문성을 탈피하기 위하여 상급교육 지원청에서 법조인, 의료인, 수사전문가, 청소년전문가 등으로 구성된 지역별 통합 자치위원회를 구성하여 운영할 필요성이 있다. 가해자와 피해자별로 달리 규정된재심절차를 일원화하여 권리규제의 형평성을 도모해야 한다. 학생간의 사소한 갈등은일응 학교폭력사안으로 의심되더라도, 신체·정신·재산상의 피해가 없고, 양 당사자간에 즉시 화해하고 처벌의사가 없는 등, 일정한 요건이 구비되면 담임이 학교장에게보고한 후 학교장 재량으로 자체 종결하는 방안을 과감히 허용하여야 한다.

School violence has long been a national problem for families, schools, communities and governments to work together to solve. A pan-governmental measure was established and implemented to solve school violence that led to the social illumination in the wake of the high school student's 1995 high school student. However, school violence is on a quantitative and quantitative increase as it shows no signs of decreasing and is becoming more organized, scarred and aged. The Act on the Prevention of Violence in Schools and Countermeasures was enacted in 2004 and the Act on the Prevention of Violence in Schools was enacted in 2012 after a dozen revisions, which strengthened the punishment of perpetrators, strengthened the accountability of teachers and parents, and focused on the protection of victims. This is a punishment-oriented remedy through deliberation by the school violence prevention committee rather than education and initiative, and the number of review cases and the number of non-recurring players have steadily increased. It is a negative fall effect that schools have moved toward punishment and exclusion-oriented policies rather than embracing the misdemeanor of school violence. The school violence prevention committee of each school dealing with school violence should ensure professionalism and fairness. To this end, the composition of the autonomous council should be improved from parents to experts, and furthermore, it is necessary to operate an integrated regional autonomous committee consisting of legal professionals, medical professionals, investigation experts and youth experts in the higher education support office in order to escape the amateurism of the autonomous council in the unit school. Different perpetrators and victims should unify the prescribed redeliberations to promote the equity of the rights regulations. Even if a minor conflict between students is suspected of a single school violence case, the two parties should boldly allow the teacher to report it to the school head and to close it himself at the discretion of the school principal if certain requirements are met, including no physical, mental, or property damage, and no intention of punishment.

Purpose: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. Materials and Methods: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) ${\geq}65$ years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemotherapy agent. Results: In total, 2,583 patients met the inclusion criteria. The mean age at index was $74.8{\pm}6.0years$. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) $70,808{\pm}56,620$. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). Conclusions: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

Purpose: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. Materials and Methods: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) ${\geq}65$ years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemotherapy agent. Results: In total, 2,583 patients met the inclusion criteria. The mean age at index was $74.8{\pm}6.0years$. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) $70,808{\pm}56,620$. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). Conclusions: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

Background and Purpose Migraine is one of the most common chronic neurological diseases worldwide. Although diverse treatment regimens have been recommended, there is insufficient evidence for which treatment patterns to apply in routine clinical settings. Methods We used nationwide claims data from South Korea for 2015?2021 to identify incident migraine patients with at least one prescription for migraine. Patients were categorized according to their initial treatment classes and followed up from the date of treatment initiation. Treatment regimens included prophylactic treatments (antidepressants, anticonvulsants, beta blockers, calcium-channel blockers, and renin-angiotensin-aldosterone system [RAAS] inhibitors) and acute treatments (acetaminophen, antiemetics, aspirin, ergotamine, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, and triptans). The treatment patterns of migraine were evaluated until the end of the study period, including the secular trends, prevalence, persistence, and changes in migraine treatment. Results Among the 761,350 included patients who received migraine treatment, the most frequently prescribed acute treatment was an NSAID (69.9%), followed by acetaminophen (50.0%). The most-prescribed prophylactic treatment was flunarizine (36.9%), followed by propranolol (24.4%). Among the patients, 54.8% received acute treatment, 13.5% received prophylactic treatment, and 31.6% received both treatment types. However, 65.7% of the patients discontinued their treatment within 3 months. The 3-month persistence rate was highest for triptans (25.2%) among the acute treatments and for RAAS inhibitors (62.0%) among the prophylactic treatments. Conclusions While the prevalence rates of medication use were found to align with current migraine guidelines, frequent switching and rapid discontinuation of drugs were observed in routine clinical settings.

Background/Aims: To evaluate the treatment patterns of knee osteoarthritis (OA) patients in South Korea. Methods: Using the Korean nationwide claims database, all knee OA patients in Korea during 2014 were identified by the knee OA diagnostic code (M17) or any OA diagnostic code (M15 to M19) in combination with a procedure for a knee X-ray. Patterns of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CSs), analgesics, and symptomatic slow acting drugs for OA (SYSADOA) were analyzed. Prevalence and characteristics of knee OA patients who received a CS intra-articular injection (IAI) were also evaluated. Results: We identified 2,016,516 knee OA patients whose age (mean ± standard deviation) was 63.2 ± 10.8 years. The number of patients with at least one use of NSAIDs, analgesics, CS, and SYSADOA were 82.5%, 32.2%, 8.6%, and 43.4%, respectively. The use of herbal SYSADOAs was 29.7%. For regular users (medication possession ratios ≥ 50%), the use of NSAIDs was substantially decreased (48.8%), while the use of SYSADOA (37.3%) and CS (6.7%) were not significantly changed. The number of CS IAI users among knee OA patients was 0.18%; they were slightly older (64.4 ± 10.9 vs. 63.2 ± 10.8, p < 0.01) and more skewed towards females (75.7% vs. 71.5%, p < 0.01) than patients who had not received CS IAI. Conclusions: In Korea, the use of SYSADOA or CS in knee OA patients was relatively high. Further studies on the effectiveness and the safety of these treatment options for knee OA are needed.

Purpose The purpose of this study was to evaluate chemotherapy patterns and changes in quality of life (QOL) during first-line palliative chemotherapy for Korean patients with unresectable or metastatic/recurrent gastric cancer (GC). Materials and Methods This was a non-interventional, multi-center, prospective, observational study of 527 patients in Korea. QOL assessments were conducted using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-STO22 every 3 months over a 12-month period during first-line palliative chemotherapy. The specific chemotherapy regimens were selected by individual clinicians. Results Most patients (93.2%) received combination chemotherapy (mainly fluoropyrimidine plus platinum) as their first-line palliative chemotherapy. The median progression-free survival and overall survival were 8.2 and 14.8 months, respectively. Overall, “a little” changes (differences of 5-10 points from baseline) were observed in some of the functioning or symptom scales; none of the QOL scales showed either “moderate” or “very much” change (i.e., ? 11 point difference from baseline). When examining the best change in each QOL domain from baseline, scales related to some aspects of functioning, global health status/QOL, and most symptoms revealed significant improvements (p < 0.05). Throughout the course of first-line palliative chemotherapy, most patients’ QOL was maintained to a similar degree, regardless of their actual response to chemotherapy. Conclusion This observational study provides important information on the chemotherapy patterns and QOL changes in Korean patients with advanced GC. Overall, first-line palliative chemotherapy was found to maintain QOL, and most parameters showed an improvement compared with the baseline at some point during the course.

Purpose We conducted a nationwide, multicenter, prospective registry study for newly diagnosed patients with peripheral T-cell lymphoma (PTCL) to better define the clinical characteristics, treatment patterns, survival outcomes, and the role of upfront autologous stem cell transplantation (ASCT) in these patients. Materials and Methods Patients with PTCL receiving chemotherapy with curative intent were registered and prospectively monitored. All patients were pathologically diagnosed with PTCL. Results A total of 191 patients with PTCL were enrolled in this prospective registry study. PTCL, not otherwise specified (PTCL-NOS) was the most common pathologic subtype (n=80, 41.9%), followed by angioimmunoblastic T-cell lymphoma (AITL) (n=60, 31.4%). With a median follow-up duration of 3.9 years, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 39.5% and 60.4%, respectively. The role of upfront ASCT was evaluated in patients who were considered transplant-eligible (n=59). ASCT was performed as an upfront consolidative treatment in 32 (54.2%) of these patients. There were no significant differences in PFS and OS between the ASCT and non-ASCT groups for all patients (n=59) and for patients with PTCL-NOS (n=26). However, in patients with AITL, the ASCT group was associated with significantly better PFS than the non-ASCT group, although there was no significant difference in OS. Conclusion The current study demonstrated that the survival outcomes with the current treatment options remain poor for patients with PTCL-NOS. Upfront ASCT may provide a survival benefit for patients with AITL, but not PTCL-NOS.

Purpose The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) has increased, and staging and optimal therapeutic approaches are challenging. A questionnaire survey was conducted to investigate the controversial treatment policy of stage T2 OPC according to the N category and determine the opinions of multidisciplinary experts in Korea. Materials and Methods Five OPC scenarios were developed by the Subcommittee on Oropharyngeal Treatment Guidelines of the Korean Society for Head and Neck Oncology and distributed to experts of multidisciplinary treatment hospitals. Results Sixty-five experts from 45 institutions responded. For the HPV-positive T2N0M0 scenario, 67.7% of respondents selected surgery followed by definitive concurrent chemoradiotherapy (CCRT) or radiotherapy alone. For the T2N1M0 HPV-positive scenario, there was a notable difference in the selection of primary treatment by expert specialty; 53.9% of respondents selected surgery and 39.8% selected definitive CCRT as the primary treatment. For the T2N3M0 advanced HPV-positive scenario, 50.0% of respondents selected CCRT and 33.3% considered induction chemotherapy (IC) as the primary treatment. CCRT and IC were significantly more frequently selected for the HPV-related OPC cases (p=0.010). The interdepartmental variability showed that the head and neck surgeons and medical oncologists favored surgery, whereas the radiation oncologists preferably selected definitive CCRT (p < 0.001). Conclusion In this study, surgery was preferred for lymph node-negative OPC, and as lymph node metastasis progressed, CCRT tended to be preferred, and IC was administered. Clinical practice patterns by stage and HPV status showed differences according to expert specialty. Multidisciplinary consensus guidelines will be essential in the future.

Background/Aims: Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. Methods: Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III?IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. Results: Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. Conclusions: Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.

Purpose A soft tissue sarcoma (STS) is a rare type of cancer, accounting for 1% of adult solid cancers. The aim of the present study is to determine the incidence of localized and advanced STS in Korean patients, their treatment patterns, and the survival of patients by disease status. Materials and Methods The STS patient cohort was defined using National Health Insurance Service medical data from 2002 to 2015. Incidence, distribution, anatomical location of tumors, survival rates (Kaplan-Meyer survival function) and treatment patterns were analyzed by applying different algorithms to the STS cohort containing localized and advanced STS cases. Results A total of 7,813 patients were diagnosed with STS from 2007 to 2014, 4,307 were localized STS and 3,506 advanced STS cases. The total incidence of STS was 2.49 per 100,000 person- years: 1.37 per 100,000 person-years for localized STS and 1.12 per 100,000 personyears for advanced STS. The 5-year survival rate after diagnosis was 56.4% for all STS, 82.4% for localized, and 27.2% for advanced STS. Half of the advanced STS patients (49.98%) received anthracycline-containing chemotherapy as initial treatment after diagnosis. Conclusion This study provides insights into localized and advanced STS epidemiology, treatment patterns and outcomes in Korea, which could be used as fundamental data in improving clinical outcomes of STS patients in the future.

Purpose The purpose of this study was to understand patient treatment patterns, outcomes, and healthcare resource use in cases of metastatic and/or locally recurrent, unresectable gastric cancer (MGC) in South Korea. Materials and Methods Thirty physicians reviewed charts of eligible patients to collect de-identified data. Patients must have received platinum/fluoropyrimidine first-line therapy followed by second-line therapy or best supportive care, had no other primary cancer, and not participated in a clinical trial following MGC diagnosis. Data were summarized using descriptive statistics. Kaplan- Meier analysis was used to describe survival. Results Of 198 patients, 73.7% were male, 78.3% were diagnosed with MGC after age 55 (mean, 61.3 years), and 47.0% were current or former smokers. The majority of tumors were located in the antrum/pylorus (51.5%). Metastatic sites most often occurred in the peritoneum (53.5%), lymph nodes (47.5%), and liver (38.9%). At diagnosis, the mean Charlson comorbidity index was 0.4 (standard deviation, 0.6). The most common comorbidities were chronic gastritis (22.7%) and cardiovascular disease (18.7%). Most patients (80.3%) received second- line treatment. Single-agent fluoropyrimidine was reported for 22.0% of patients, while 19.5% were treated with irinotecan and a fluoropyrimidine or platinum agent. The most common physician-reported symptoms during second-line treatment were nausea/vomiting (44.7%) and pain (11.3%), with antiemetics (44.7%), analgesics (36.5%), and nutritional support (11.3%) most often used as supportive care. Two-thirds of inpatient hospitalizations were for chemotherapy infusion. Outpatient hospitalization (31.6%) and visits to the oncologist (58.8%) were common among second-line patients. Conclusion Most patients received second-line treatment, although regimens varied. Understanding MGC patient characteristics and treatment patterns in South Korea will help address unmet needs.