Background
: Although fatigue is the most common symptom in primary care, both doctors and patients tend to overlook it. According to one study, 27% of the adults felt fatigued for one week and 6% of the adults complained of unexplained fatigue for over two weeks. Stress play an important role in the etiology of fatigue. Thus, antioxidants are currently taken by people who complain of fatigue. Vitamin C is one of the most common antioxidants. We intend to find out whether intravenous vitamin C is really helpful or not in people who complain of fatigue.

Methods : We have investigated 19 outpatients who chiefly complained of fatigue and visited the department of family medicine at one university hospital from July 1, 2004 to Nov 30, 2005. The patients were treated by Vitamin C 10g and Vitamin B complex injection for 4 weeks, and they conducted a questionnaire survey concerning the severity of symptom before and after injection. The questionnaire with 9 questions consisted of 7 score index. The results were statistically analyzed with Wilcoxon Signed Ranks test and a P-value under 0.05 was considered significant.

Results : Three patients were males and 16 patients were females. The average age group was 47.7±13.6 years. While the fatigue severity score of the patients before vitamin C injection was 5.2 (3.0∼7.0), the fatigue severity score after injection was 3.3 (1.4∼4.8), which was significantly decreased (P＜0.0001).

Conclusion : We think that the vitamin C intravenous injection to people who complained of fatigue was helpful.

Background
: In terminal cancer patients, alleviation of suffering is as important as the cure of disease. But their symptoms are often intractable. In such a case, sedation is usually considered to relieve these refractory symptoms. However, the decision to sedate has been an ethical concern to health care worker because of an effect on survival time of cancer patients. The aim of this study was to investigate the use of sedation in terminal cancer patients and its relationship with intractable symptoms.

Methods : One hundred and fifty six patients admitted to National Heath Insurance Corporation Ilsan Hospital, Department of Family Medicine for hospice care from September 2000 to the end of October 2001 were enrolled in the study. Demographic data, clinical symptoms, the use of sedation, the choice of medication, reasons for administration, and frequency were recorded.

Results : There were 81(51.9%) men and 75(48.1%) women. The mean age was 64.6±13.3 years. The primary sites of cancer were stomach 36(23.1%), lung 27(17.3%), and colo-rectal 19(12.2%). Common symptoms were pain, nausea/vomiting, and dyspnea. Among the subjects, 55(35.3%) receive sedation. The drugs used for sedation were lorazepam in 37(67.3%), haloperidol in 21(38.2%), and diazepam in 18(32.7%). Sedation was administered to relieve insomnia in 20(36.4%), agitated delirium in 20(36.4%), severe pain in 9(16.4%), dyspnea in 5(8.0%), and nausea/ vomiting in 1(1.8%)

Conclusion : Among the subjects, 55(35.3%) of 156 terminal cancer patients received sedation. Though most common symptoms were pain and dyspnea, the use of sedation was mostly limited to insomnia and delirium. Therefore, the use of sedation is not yet prevalent in Korea.

Background
: Life expectancy is ever increasing due to medical advancements, but cancer death rate is also increased. Quality of life is an important issue in cancer patients. Despite developments of early diagnosis and treatments for cancer, the medical costs is increasing due to extended survival against cancer and the absolute numbers of terminal cancer patients. We assessed the medical costs and quality of life in terminal cancer patients by the types of medical facilities, which would contribute to effective management.
Method: A total 159 patients (males 70, females 89) with terminal cancer patients who were treated and died in various types of medical facilities(home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1, 1997 and January 31, 1999 were included in the study. After the confirmation that the demographic factors correlated with factors of quality of life, the differences in the medical costs and quality of life(pain, depression, ADLs, family APGAR score) during the last 1 week of life in the various types of medical facilities analyzed by multi-way ANOVA with interaction of the significant demographic factors.

Results : The mean cost of types of medical facilities during the last week of patients as 65,332.5 won in charity hospital hospice unit, 105,165.5 won in home hospice, 702,083.4 won in university hospital hospice unit, and 1,037,358.6 won in university hospital non-hospice unit. The difference between free hospital hospice unit and home hospice in medical costs as not statistically significant, but the difference among charity hospital hospice unit and home hospice, university hospital hospice unit, and university hospital non-hospice unit as significant (p<0.001). The demographical factors of quality of life in terms of pain, depression, ADLs, and family APGAR score were compared among various facilities. The ADL score of home hospice was 8.2±3.3, which was lower than free hospital hospice unit and university hospital hospice unit(p<0.05). The mean pain score of home hospice as 1.7±1.7 and that of university hospital hospice as 1.2±1.2, and pain scores of home hospice were lower than free hospital hospice unit, and pain scores of university hospital hospice were lower than free hospital hospice unit and university hospital non-hospice unit(p<0.05). In depressions categorical scale of home hospice the score was 4.8±1.3, which was higher than those of free hospital hospice unit and university hospital non-hispice unit(p<0.05), signifying less depression. The family APGAR score was statistically insignificant among various types of medical facilities.

Conclusion : The cost of hospice care is less than the non-hospice care. We found that the patients of home hospice experienced less pain and depression even with low ADLs, and increased the quality of life in both psychological and physical aspects.