Screening for hepatocellular carcinoma (HCC) is clinically important given that its early detection has remarkable survival benefits. We investigated the possible role of FIB-4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers 40 years of age or older who visited Seoul National University Hospital for a health checkup. National medical service claims data were used to determine HCC incidence. Median follow-up time was 5.4 years (interquartile range: 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and antiviral medication for hepatitis B, compared to subjects with FIB-4 <1.25, subjects with 1.7 £ FIB-4 <2.4 showed an adjusted hazard ratio (aHR) of 4.57 (95% confidence interval [CI]: 1.50-13.92) and subjects with FIB-4 2.4 showed an aHR of 21.34 (95% CI: 7.73-58.92) for HCC incidence. FIB-4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C-index: 0.701 vs. 0.831; P 5 0.001). FIB-4 was also better predictive of HCC incidence, compared to that of ultrasonographic liver cirrhosis (C-index: 0.775 vs. 0.701; P 5 0.040). Conclusion: High FIB-4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB-4 is a promising, easily applicable, and cost-effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests that FIB-4 may play a valuable role in HCC screening among HBsAg carriers. (HEPATOLOGY 2015;61:1261-1268 L iver cancer is the fifth-most frequently diagnosed cancer worldwide in men, also the secondleading cause of cancer mortality in the world. 1 For females, it is the seventh-most common cancer and sixth-leading cause of cancer mortality. 1 Liver cancer incidence is increasing in many parts of the world, including in the United States and Europe. 2,3 In Korea, liver cancer represents the second-highest cause of cancer mortality and is the fifth-most frequently diagnosed cancer. 4 Despite such high incidence and mortality, major risk factors for liver cancer are well established as chronic hepatitis and cirrhosis, 5 similarly in Korea where liver cancer has been attributed to chronic hepatitis B (CHB), C, or cirrhosis in 95% of

This study examined how patients with cancer estimate caregiver burden (CB) and the association between their underestimation of CB and their caregivers' self-ratings of their quality of life (CQOLC-K; Korean version of the Caregiver Quality of Life Index-Cancer), depression and anxiety (Korean version of the Hospital Anxiety and Depression Scale). Participants consisted of 990 patient-caregiver dyads recruited from a nationwide cross-sectional survey conducted in South Korea. Medical baseline data were retrieved from the hospital information systems of the participating centres. The patients with cancer who underestimated CB ranged from 18.62% (for physical CB) to 23.33% (for social CB). They had less advanced cancer, a lower income, were the caregiver's spouse, reported higher levels of family avoidance of communication about cancer, and had female caregivers. The patients' underestimation of CB was significantly related to lower CQoL and higher levels of caregiver depression and anxiety. The current study provides empirical evidence for the link between the underestimation of CB by patients with cancer and compromised caregiving experiences of cancer caregivers. Open family communication about cancer was discussed as one of several practical strategies for decreasing patients' underestimation of CB.

Objective: With the increased survival rate of cancer patients, positive changes in health behaviors, including smoking cessation, are becoming progressively more important. While studies in the general population have demonstrated the beneficial effects of high perceived support of smoking cessation and continuing abstinence, few studies have addressed such issues in cancer survivors. We examined the factors related to continued smoking among cancer survivors with specific attention given to the role of perceived social support. Methods: A nationwide, multicenter survey was conducted with 1956 cancer patients. Smoking status at the time of diagnosis and at the time of survey, and perceived social support, as measured by the Duke-UNC Functional Social Support Questionnaire, were collected by self-reported questionnaire. Results: Among 493 participants who were smoking at the time of cancer diagnosis, 131 (26.6%) were continued smokers at the time of survey. In a multivariate logistic regression analysis, current alcohol consumption (odds ratio, 3.29; 95% confidence interval, 1.91 -5.65), early cancer stage (P for trend , 0.01), lung cancer diagnosis (odds ratio, 0.41; 95% confidence interval, 0.19 -0.88), and high perceived social support (odds ratio, 0.59; 95% confidence interval, 0.37 -0.96) showed significant associations with continued smoking. Conclusions: Cancer survivors with low perceived social support were more likely to continue smoking. Our study suggests that perceived social support may be an important factor for smoking cessation and maintenance of smoking cessation in this population.

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Please cite this paper as: Shin et al. (2012) Practices and predictors of 2009 H1N1 vaccination in cancer patients: a nationwide survey in Korea. Influenza and Other Respiratory Viruses 6(601), e120–e128. Background  Because patients with cancer are considered to be at high‐risk for influenza infection and related complications, annual vaccination is recommended. The emergence of the novel H1N1 influenza virus in 2009 complicated the medical care of patients with cancer. The present study examined H1N1 vaccination practices among patients with cancer during the pandemic season and investigated factors related to the vaccination. Methods  A national multicenter cross‐sectional survey of patient–doctor dyads was performed; A total of 97 oncologists (response rates of invited participants, 87·4%) and 495 patients (response rates of recruited participants, 86·5%) were included. Patients with cancer provided information concerning vaccination practices and reasons for/against it. Oncologists answered questions about their recommendations and knowledge of H1N1 vaccination. Mixed logistic regression was used to identify patient‐level and physician‐level predictors of H1N1 vaccination. Results  Only 34·1% of the patients had received H1N1 vaccination, and 53·5% had not considered the need for vaccination. The H1N1 vaccine was proactively recommended by physicians in only a small fraction of patients (8·3%). Increasing age, higher educational status, longer time since the cancer diagnosis, comorbidities, and greater knowledge of H1N1 vaccination among oncologists were significant predictors of patients being vaccinated. Conclusions  The present results showed low levels of utilization and poor interaction between patients and physicians with regard to the need for vaccination. In addition, the oncologist’s level of knowledge affected the adoption of preventive services. Intervention strategies are needed to maximize the rapid adoption of preventive methods to confront future pandemic threats in the cancer patient population.