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KMID : 0371319770190100071
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Journal of the Korean Surgical Society
1977 Volume.19 No. 10 p.71 ~ p.74
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Critical Analysis in a Long Term Postoperative Followup of Stomach Cancer, Colon Cancer and Breast Cancer Among Koreans
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이용각
김인철/주상용/고용복/장선택/박영훈
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Abstract
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Stomach cancer, colon cancer and breast cancer accounts for three major malignant tumors in the field of general surgery in Korea. While there have been numerous follow up studies reported in this country, `most of them showed pitfalls of inability to trace those patients confirma-tory way. The reasons are many. To name of these factors lack of family doctor and referral system, still limited number of telephone among population, patient´s trend to hide his disease and thus shying, away follow up inquires, and traditional custom of people not comply with statistical inquires especially when unpleasant subjects.
Western countries and some Asian nations have established their own statistics in cancer follow-up enabling them to assess the influence of many factors of the therapeutic eutic results of cancer diseases. In our country, we are yet to establish the base line of cancer patient follow-up after surgery so that future statistics may be compared with the past ones. It is especially important now when the medical care of total population with national medional insurance system is to be complete within near future. The Korean Traders Scholorship Foundation was generous to as kus to undertake the current study with massive financial support.
1. Cancer diseases subjected to postoperative follow-up were, gastric cancer, colon cancer and breast cancer.
2. Materials patients of the above three categories operated during the period of 1961 to 1976 were included in this series. They were treated at the Catholic Medical Center Hospitals (St. Mary´s Hospital, St. Paul´s Hospital, Holy Family Hospital, St. Vincent´s hospital, Perpetual Mercy Hospital, Bupyung St. Mary´s Hospital and Taejeon St. Mary´s hospital), Sacred Heart Hospital of Joong-ang University and pusan Gospel hospital.
3. Method of our follow-up study.
With help of all staffs and resident doctors of the Surgical Department of the Catholic Medical College, We extracted all charts of stomach cancer, colon cancer and breast cancer and trans-ferred numerous information on format sheet of each patient. Patients were then inquired about their present postoperative status by return mails, three trial mailing on each patient. On those large number of failure by mail inquiry either due to incorrect address or refusal of reply by the patients were then- individually visited to their home scattered throughout the whole country and data were collected and transferred to the format sheet. 40 students of the Catholic Medical College and 7 residents of our surgical department were given about the training how to contact a patient or his diseased household.
During the period from December 1976 to March 1977 these investigators were dispatched to Seoul Area, Pusan Area, Kyunsangnamdo Area, Coongnam, Chunbuk-Chunnam Area, Kangwon-Chungbook-Kyungbook Area, Kyunggido Area and Cheju Area. The extended number of mobi-lized investigator amounted to 800 people. Of these survivors at the investigation period were given free medical checkup by our fund at the St. Mary´s Hospital so that we could get more detailed status of each patient.
4. Gross results of information collection.
We pulled out more than 6000 charts but had to discard those charts which were poorly recorded and thus not fit for analysis. Actually selected charts were 3675 charts of stomach cancer surgery, 654 charts of colorectal surgery and 298 charts of breast cancer surgery. The sum was 4627 charts.
5. Computer analysis of results.
Informations about each patient reached nearly 80 items and it was nearly impossible to analyze with ordinary calculating machine. We therefore decided to use service of Seoul Computer Center (Hyujedong,Chongrokii, Seoul). Each patient’s information was divided into 80 categories and each category was numbered with Arabic letter and was punched at the appropriate bracket of a punch card. These punch cards were then transferred to the center who fed these information to the Computer (CDC 3300, Control Data Coorporation, U.S.A.
The merit of computer analysis was tremendous in that fast and correct data could be obtained on a vast amount of material. There was however some demerits of this system. For example, when we ask an answer for a subject which had three or more components to analyze, we met difficulty to interpret results if any analyzed patient did not have one of three information under analysis.
6. Difficult problems we encountered during this follow-up studies.
Obviously quite different to animal experiment or linear survey of certain disease at a set time, the follow-up study deals with patients treated during extended of many years. They don´t stay at the initial address but move around the whole country. Patient´s address itself changed due to rapidly developing urban cities thus changing the address to a new one. We traced each patient to the birth record of governmental office of Myun,, Eup or Dong but, we were met with negative result quite often due to lack of information an each house-holds head´s name(Sedaeju): When we visited some government office for reference to national serial number registry (3umin-deungrokbu, officers were quite adamant to cooperate. One of our investigating student as mis-taken as a spy and was once handed to police station. Large number of patients from rural area became bankrupt after high costed medical case and had animosity against doctors and refused to answer questionnaire, especially when the patient had already died of the disease. One of us reached to the house of a subject patient at Chungam and was met by funeral cart which hap-pened to carry the very patient he was visiting. There were a number of incidence that patient or patient´s family became extremely angry about our open question to the cancer. These patient had been made to believe that the disease had been benign rather than malignant by their families.
In conclusion the future investigation of this category should be carried out by organized unit,
such as Public Health Service, or by medical centers with strong logistic support of the govern-ment officers.
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