Assessment of Palliative Care in Lung Cancer in Turkey

Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the. 2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey. (C) 2016 S. Karger AG, Base

Sleep disturbances in patients with lung cancer in Turkey

Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey.Materials and Methods: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale.Results: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia.Conclusion: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer

Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, BaselC1 [Sonmez, Alper; Haymana, Cem; Demirci, Ibrahim] Univ Hlth Sci, Gulhane Sch Med, Dept Endocrinol & Metab, TR-06018 Ankara, Turkey.[Yumuk, Volkan] Istanbul Univ, Cerrahpasa Med Fac, Dept Endocrinol & Metab, Istanbul, Turkey.[Barcin, Cem] Univ Hlth Sci, Gulhane Sch Med, Dept Cardiol, Ankara, Turkey.[Kiyici, Sinem] Univ Hlth Sci, Bursa Yuksek Ihtisas Training & Res Hosp, Dept Endocrinol & Metab, Bursa, Turkey.[Guldiken, Sibel] Trakya Univ, Med Fac, Dept Endocrinol & Metab, Edirne, Turkey.[Oruk, Gonca] Izmir Katip Celebi Univ, Ataturk Educ & Res Hosp, Dept Endocrinol & Metab, Izmir, Turkey.[Saydam, Basak Ozgen] Dokuz Eylul Univ, Med Fac, Dept Endocrinol & Metab, Izmir, Turkey.[Baldane, Suleyman] Selcuk Univ, Med Fac, Dept Endocrinol & Metab, Konya, Turkey.[Kutluturk, Faruk] Gaziosmanpasa Univ, Med Fac, Dept Endocrinol & Metab, Tokat, Turkey.[Kucukler, Ferit Kerim] Hitit Univ, Med Fac, Dept Endocrinol & Metab, Corum, Turkey.[Deyneli, Oguzhan] Marmara Univ, Med Fac, Dept Endocrinol & Metab, Istanbul, Turkey.[Cetinarslan, Berrin] Kocaeli Univ, Med Fac, Dept Endocrinol & Metab, Kocaeli, Turkey.[Sabuncu, Tevfik] Harran Univ, Med Fac, Dept Endocrinol & Metab, Urfa, Turkey.[Bayram, Fahri] Erciyes Univ, Med Fac, Dept Endocrinol & Metab, Kayseri, Turkey.[Satman, Ilhan] Istanbul Univ, Med Fac, Dept Endocrinol & Metab, Istanbul, Turkey.[Ayturk, Semra] Trakya Univ, Sch Med, Dept Endocrinol & Metab, Edirne, Turkey.[Yilmaz, Murat] Corlu REYAP Private Hosp, Dept Endocrinol & Metab, Corlu, Turkey.[Asik, Mehmet] Canakkale 18 March Univ, Sch Med, Dept Endocrinol & Metab, Canakkale, Turkey.[Dinccag, Nevin; Cakmak, Ramazan; Turker, Fulya; Idiz, Cemile; Hacisahinogullari, Hulya; Bagdemir, Elif; Yildiz, Busra; Haliloglu, Ozlem] Istanbul Univ, Sch Med, Dept Endocrinol & Metab, Cerrahpasa, Turkey.[Sancak, Seda] Univ Hlth Sci, Sch Med, Fatih Sultan Mehmet Training & Res Hosp, Dept Endocrinol & Metab, Istanbul, Turkey.[Ozsari, Levent; Cagiltay, Eylem] Univ Hlth Sci, Sch Med, Sultanabdulhamit Training & Res Hosp, Dept Endocrinol & Metab, Istanbul, Turkey.[Imre, Eren] Marmara Univ, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey.[Sait Gonen; Boysan, S. Nur] Istanbul Sci Univ, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey.[Altuntas, Yuksel; Ozturk, Feyza Yener] Univ Hlth Sci, Sch Med, Sisli Hamidiye Etfal Training & Res Hosp, Dept Endocrinol & Metab, Istanbul, Turkey.[Mert, Meral; Piskinpasa, Hamide] Univ Hlth Sci, Istanbul Bakirkoy Dr Sadi Konuk Training & Res Ho, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey.[Aydin, Hasan] Yeditepe Univ, Sch Med, Dept Endocrinol & Metab, Istanbul, Turkey.[Ersoy, Canan; Oz Gul, Ozen] Uludag Univ, Sch Med, Dept Endocrinol & Metab, Bursa, Turkey.[Selek, Alev] Kocaeli Univ, Sch Med, Dept Endocrinol & Metab, Kocaeli, Turkey.[Dogru, Teoman; Kirik, Ali] Balikesir Univ, Sch Med, Dept Internal Med, Balikesir, Turkey.[Kebapci, Nur; Efe, Belgin] Eskisehir Osmangazi Univ, Sch Med, Dept Endocrinol & Metab, Odunpazari Eskisehir, Turkey.[Kaya, Ahmet; Cordan, Ilker] Necmettin Erbakan Univ, Sch Med, Dept Endocrinol & Metab, Konya, Turkey.[Kirac, Cem Onur] Selcuk Univ, Sch Med, Dept Endocrinol & Metab, Konya, Turkey.[Capa, Zehra] Univ Hlth Sci, Gulhane Sch Med, Ankara, Turkey.[Capa, Zehra] Gulhane Training & Res Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Cesur, Mustafa] Private Guven Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Yetkin, Ilhan] Gazi Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Corapcioglu, Demet; Canlar, Sule] Ankara Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Yildiz, Okan Bulent; Sendur, Suleyman Nahit] Hacettepe Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Cakir, Bekir; Ozdemir, Didem] Yildirim Beyazit Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Corakci, Ahmet] Ufuk Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Kutlu, Mustafa] Private Bayindir Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Bascil Tutuncu, Neslihan; Bozkus, Yusuf] Baskent Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Cakal, Erman] Univ Hlth Sci, Sch Med, Diskapi Yildirim Beyazit Training & Res Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Demirbas, Berrin] TOBB Univ, Sch Med, Dept Endocrinol & Metab, Ankara, Turkey.[Ertek, Sibel] Private Mem Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Altay, Mustafa; Dagdeviren, Murat] Univ Hlth Sci, Sch Med, Kecioren Training & Res Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Abedi, Amir Hassein] Erciyes Univ, Sch Med, Dept Endocrinol & Metab, Kayseri, Turkey.[Cetinkalp, Sevki; Ozisik, Hatice] Ege Univ, Sch Med, Dept Endocrinol & Metab, Izmir, Turkey.[Yener, Serkan] Dokuz Eylul Univ, Sch Med, Dept Endocrinol & Metab, Izmir, Turkey.[Guney, Engin; Unubol, Mustafa] Adnan Menderes Univ, Sch Med, Dept Endocrinol & Metab, Aydin, Turkey.[Yaylali, Guzin Fidan; Topsakal, Senay] Pamukkale Univ, Sch Med, Dept Endocrinol & Metab, Denizli, Turkey.[Hekimsoy, Zeliha] Celal Bayar Univ, Sch Med, Dept Endocrinol & Metab, Manisa, Turkey.[Akbaba, Gulhan] Mugla Univ, Sch Med, Dept Endocrinol & Metab, Mugla, Turkey.[Aslan, Ibrahim] Univ Hlth Sci, Antalya Training & Res Hosp, Sch Med, Dept Endocrinol & Metab, Antalya, Turkey.[Balci, Mustafa Kemal; Dalkiran, Sefika] Akdeniz Univ, Sch Med, Dept Endocrinol & Metab, Antalya, Turkey.[Akbay, Esen] Mersin Univ, Sch Med, Dept Endocrinol & Metab, Mersin, Turkey.[Gul, Kamile] Kahramanmaras Sutcu Imam Univ, Sch Med, Dept Endocrinol & Metab, Kahramanmaras, Turkey.[Agbaht, Kemal] Private Defne Hosp, Dept Endocrinol & Metab, Antalya, Turkey.[Yilmaz, Muge Ozsan] Mustafa Kemal Univ, Sch Med, Dept Endocrinol & Metab, Antakya, Turkey.[Bozkirli, Emre] Baskent Univ, Adana Training Hosp, Dept Endocrinol & Metab, Ankara, Turkey.[Tetiker, B. Tamer; Cetinkaya Altuntas, Seher] Cukurova Univ, Sch Med, Dept Endocrinol & Metab, Adana, Turkey.[Atmaca, Aysegul; Durmus, Elif Tutku] 19 Mayis Univ, Sch Med, Dept Endocrinol & Metab, Samsun, Turkey.[Mete, Turkan] Univ Hlth Sci, Sch Med, Samsun Training & Res Hosp, Dept Endocrinol & Metab, Samsun, Turkey.[Dikbas, Oguz] Giresun Univ, Sch Med, Dept Endocrinol & Metab, Giresun, Turkey.[Akin, Safak] Recep Tayyip Erdogan Univ, Sch Med, Dept Endocrinol & Metab, Rize, Turkey.[Nuhoglu, Irfan; Ersoz, Halil Onder] Karadeniz Tech Univ, Sch Med, Dept Endocrinol & Metab, Trabzon, Turkey.[Bayraktaroglu, Taner] Bulent Ecevit Univ, Sch Med, Dept Endocrinol & Metab, Zonguldak, Turkey.[Sisman, Pinar] Kars Harakani State Hosp, Dept Endocrinol & Metab, Kars, Turkey.[Sahin, Ibrahim; Cetin, Sedat] Inonu Univ, Sch Med, Dept Endocrinol & Metab, Malatya, Turkey.[Capoglu, Ilyas; Akbas, Emin Murat] Erzincan Univ, Sch Med, Dept Endocrinol & Metab, Erzincan, Turkey.[Ucler, Rifki] Yuzuncu Yil Univ, Sch Med, Dept Endocrinol & Metab, Van, Turkey.[Eren, Mehmet Ali] Harran Univ, Sch Med, Dept Endocrinol & Metab, Sanliurfa, Turkey.[Tuzcu, Alpaslan Kemal; Pekkolay, Zafer] Dicle Univ, Sch Med, Dept Endocrinol & Metab, Diyarbakir, Turkey.[Ozkaya, Mesut] Univ Hlth Sci, Sch Med, Gaziantep Ersin Arslan Res & Training Hosp, Gaziantep, Turkey.[Araz, Mustafa] Gaziantep Univ, Sch Med, Dept Endocrinol & Metab, Gaziantep, Turkey.[Salman, Serpil] Liv Hosp Ulus, Dept Endocrinol & Metab, Istanbul, Turkey.[Dizdar, Oguzhan Sitki] Kayseri Educ & Res Hosp, Dept Internal Med, Kayseri, Turkey.[Gurkan, Eren] Mustafa Kemal Univ, Dept Endocrinol & Metab, Antakya, Turkey.[Kargili Carlioglu, Ayse] Erzurum Reg Educ & Res Hosp, Dept Endocrinol & Metab, Erzurum, Turkey