BACKGROUND:Cox proportional hazard regression (CPH) model relies on the proportional hazard (PH) assumption: the hazard of variables is independent of time. CPH has been widely used to identify prognostic markers of the transcriptome. However, the comprehensive investigation on PH assumption in transcriptomic data has lacked.RESULTS:The whole transcriptomic data of the 9,056 patients from 32 cohorts of The Cancer Genome Atlas and the 3 lung cancer cohorts from Gene Expression Omnibus were collected to construct CPH model for each gene separately for fitting the overall survival. An average of 8.5% gene CPH models violated the PH assumption in TCGA pan-cancer cohorts. In the gene interaction networks, both hub and non-hub genes in CPH models were likely to have non-proportional hazards. Violations of PH assumption for the same gene models were not consistent in 5 non-small cell lung cancer datasets (all kappa coefficients < 0.2), indicating that the non-proportionality of gene CPH models depended on the datasets. Furthermore, the introduction of log(t) or sqrt(t) time-functions into CPH improved the performance of gene models on overall survival fitting in most tumors. The time-dependent CPH changed the significance of log hazard ratio of the 31.9% gene variables.CONCLUSIONS:Our analysis resulted that non-proportional hazards should not be ignored in transcriptomic data. Introducing time interaction term ameliorated performance and interpretability of non-proportional hazards of transcriptome data in CPH.

Epithelial ovarian cancer is extremely difficult to treat due to its high recurrence rate and acquired tolerance to chemotherapy. Immune checkpoint inhibitors (ICIs) are expected to be promising solutions for treatment failure. However, the low response rate to a single ICI agent was demonstrated in approximately all published clinical trials. Surprisingly patients with complete response were also noticed as an anecdote. Proper indicators of treatment response were urgently required. Programmed death- ligand 1 expression levels in the tumor tissues provide relatively limited discrimination. Tumor mutation burden (TMB) serves as a more reliable parameter. Here we presented an ovarian cancer case with multiple gene mutations and high TMB, who benefited from a short-term treatment of pembrolizumab and experienced a long-lasting complete response of 2 years till now. The patient was irradiated in the pelvic before pembrolizumab. Our study demonstrated that ICIs might provide survival benefits for ovarian cancer with high TMB and that pelvic radiation might have synergistical effects with immunotherapy.

目的:探讨在宫颈癌同步放化疗期间一级预防使用聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)是否能改善患者的骨髓造血功能和生活质量.方法:回顾性分析2018年5月至2019年1月经本院病理证实为宫颈癌,有同步放化疗指征患者共58例.按病例处理方式的不同分为两个队列:①PEG-rhG-CSF组(PEG组):在患者同步放化疗期间给予一级预防使用长效粒细胞集落刺激因子——PEG-rhG-CSF进行处理;②rhG-CSF组(G-CSF组):在患者同步放化疗期间出现中性粒细胞下降才给予重组人粒细胞刺激因子(rhG-CSF)进行处理.两组队列各29例患者.采用t检验或r检验比较患者同步放化疗期间骨髓抑制,同步化疗次数及生活质量的差别.结果:PEG组出现Ⅲ～Ⅳ度粒细胞减少的比率明显低于rhG-CSF组(31.8％ vs 62.06％,P=0.007).PEG组和G-CSF组中出现Ⅲ～Ⅳ度血小板下降的比率无明显统计学差异(20.68％vs 31.03％,P=0.551).PEG组同步化疗＞4周期的患者明显多于G-CSF组(P=0.008).生活质量QLQ-C30(V3.0)评估显示PEG组疲劳乏力症状明显低于G-CSF组(P=0.018),其他症状无明显差异(P>0.05).PEG组功能领域评估和总体健康状况明显高于G-CSF组(P＜0.05).结论:在宫颈癌同步放化疗期间一级预防使用PEG-rhG-CSF,可明显降低同步放化疗期间重度骨髓抑制的风险,提高患者的生活质量,具有良好的临床应用前景.

Objectives: MiR-34b is a tumour suppressor in different kinds of carcinomas. This study investigated the role of miR-34b in proliferation and apoptosis of cervical cancer. Materials and methods: The expression of miR-34b in 60 cervical cancer patients were quantified by RT-PCR and correlated with their clinicopathological parameters. Besides, there is a significant reverse relationship between miR-43b and TGF-β1 expression in tumour tissues. Cell proliferation and apoptosis was detected by CCK-8 assays and flow cytometry in cell lines transfected with miR-34b mimics. Western blotting, quantitative reverse transcription-PCR (RT-PCR) and luciferase assays were conducted to analyze the regulation of TGF-β1 by miR-34b in cell lines. Results: Here, we found expression of miR-34b to be downregulated in cervical cancer in comparison with the adjacent normal tissues. Expression levels of miR-34b were associated with enhanced malignant potential, such as tumour stage and stromal invasion. The overexpression of miR-34b potently suppressed cell proliferation and induced the apoptosis of cell lines. Conclusions: MiR-34b and TGF-β1 contribute to cervical cancer cell proliferation and apoptosis and are potential targets for cervical cancer therapeutics.

PurposeThe aim of this study was to evaluate the efficacy of using nedaplatin to replace cisplatin for concurrent chemoradiotherapy (CCRT) in patients with newly diagnosed locally advanced cervical cancer.MethodsThe medical records of 155 patients with cervical cancer who had undergone CCRT with cisplatin (n = 85) or nedaplatin (n = 70) between January 2012 and January 2017 were retrospectively reviewed. Propensity score analysis with 1:1 matching with the nearest neighbor matching method was performed to assess response rates, progression-free survival, overall survival, and toxicity between 2 groups.ResultsPropensity score matching identified 63 patients in each group. After matching, compared with patients treated with cisplatin-based concurrent chemoradiotherapy (CisRT), we found that patients treated with nedaplatin-based concurrent chemoradiotherapy (NedaRT) had a significant higher recurrence rate (25.4% vs 42.9%; P = 0.04). In addition, the 3-year progression-free survival rate for NedaRT group was also worse than that for the CisRT group (52.2% vs 63.4%, P = 0.03). There was no difference in the overall response rates between the CisRT and NedaRT groups (87.3% and 90.5%, respectively; P = 0.57). The rates of 3-year overall survival and grades 3 to 4 toxicities were similar between the 2 groups.ConclusionsThe clinical outcome of this cohort of patients with locally advanced cervical cancer treated with CCRT did in no way provide support for the use of nedaplatin in place of cisplatin in chemoradiation and demonstrated no equivalence of the 2 drugs. Cautions should be taken for the replacement among platinum complexes in cancer treatment.

Objective:To predict the risk factors of severe late rectal toxicity (SLRT,late rectal toxicity ≥ grade 3) in cervical cancer patients treated with definitive radiotherapy.Methods:Between January 2008 and December 2013,211 cases of stage Ⅱ A-Ⅲ B cervical cancer patients treated with definitive radiotherapy were retrospectively evaluated.All analyses were performed using SPSS 17.0 software.Results:After following up,18 patients had SLRT,193 patients had no or slight late rectal toxicity (NSLRT).No significant value was shown in the 3 year overall survival (OS) rate between SLRT group and NSLRT group (P＞0.05).Univariable and multivariate analysis revealed only EQD2R(the equivalent dose in 2 Gy fractions of rectal point) and severity of acute rectal toxicity (ART) were predictors for SLRT (P＜0.05).The receiver-operating characteristic(ROC)curve analysis revealed the optimum cut-off points of EQD2R and ART were 74.3 Gy3and grade 2,and their area under the ROC curve (AUC) were 0.983 and 0.892,respectively.Conclusion:It has been demonstrated that EQD2R and severity of ART were risk factors for SLRT.For those cervical cancers treated with definitive radiotherapy,we suggest the EQD2R＜74.3Gy3 and active therapeutic interventions for patients suffered from ART≥grade 2 to reduce the occurrence of SLRT.

The aim of the present retrospective analysis was to determine the effectiveness of pelvic radiotherapy (RT) as postoperative adjuvant therapy for low-risk cervical cancer. Between June 2003 and April 2011, the clinical data of 225 International Federation of Gynecology and Obstetrics (FIGO) Stage IB1-IIA cervical cancer patients with low-risk factors were retrospectively reviewed, to analyze the relationship between adjuvant pelvic RT after radical hysterectomy and tumor recurrence or the patients' survival. The 5-year overall survival (OS) of 225 patients was 91.2% and 5-year disease-free survival (DFS) was 84.5%. The 5-year DFS and local regional disease-free survival was significantly better for patients in the RT group compared with that in the non-RT group (5-year DFS, 91.2% vs. 77.1%, P = 0.006; 5-year local regional disease-free survival 94.6% vs. 79.0%, P = 0.001). There were no statistically significant differences in the 5-year OS (92.9% vs. 89.4%, P = 0.371) and distant metastasis-free survival (96.4% vs. 96.5%, P = 0.887) between the two groups. Grade 3-4 treatment-related acute and late toxicities were not significantly different between the two groups. Subgroup analysis shows the 5-year DFS of RT alone, chemotherapy (CT) alone, non-RT/CT, RT and CT was, respectively, 90.5%, 62.9%, 81.4%, 92.5% separately (P = 0.002). The 5-year OS was not significantly different (91.6% vs. 78.2% vs. 92.9% vs. 96.9%, P = 0.887) between the four groups. Performing univariate analysis, postoperative CT was the only significant risk factor for DFS. Our results indicate that postoperative adjuvant pelvic RT has a tendency to improve DFS especially local regional disease-free survival for FIGO Stage IB1-IIA cervical cancer patients with low-risk factors, without increased Grade 3-4 treatment-related acute and late toxicities, but non-standard CT is harmful to the prognosis (DFS) of these patients.

Objective To determine if it could improve the overall survival ( OS) to receive palliative radio-therapy in patients with stage IV non-small cell lung cancer (NSCLC), while it could improve the healthy-related quality of life ( HQROL, and to analyze the different clinical outcomes with different choice of treatment and total does of radiotherapy. Methods From Jan. 2007 to Dec. 2011, 209 patients of stage IV NSCLC were included in this a-nalysis. Their information and treatment of radiotherapy were recorded and followed-up. SPSS 13. 0 was used for sta-tistical analysis of the patient's survival. Results Among the 209 cases, the median survival time ( MST) was 13. 7 months of all the cases, one-year and two-year overall survival ( OS) rates were 53. 1% and 18. 2%. The MST of one-year and two-year overall survival rates in the palliative radiaotherapy group was higher than that of the untreated group (15 months, 62. 9% and 22. 9% vs. 12 months, 43. 3% and 13. 5%, P<0. 05). Conclusion For the stage Ⅳ NSCLC patients, the palliative therapy not only can relieve symptoms,but also can improve their OS.

Objective In order to provide guidance for locating tumor in clinical radiotherapy, the effectiveness of two different therapeutic set-up methods on the accuracy of the location of tumor in radiotherapy was analysed when the sagittal laser line was obscured. Methods Specific location of experimental models which made by thermoplastic film of head, neck and shoulder were marked with tag lines of radiotherapy via the VARIAN IX linear accelerator and recorded the corresponding couch position. The actual couch position and the reference couch position were set up and recorded with method A and method B respectively. Finally, the results were analyzed. Results The differences between the actual set-up couch position and the reference couch position in the direction of Vertical (VRT), Longitudinal (LNG) and Lateral (LAT) by the method A and B set-up were as follows: (0.35±0.65)mm, (0.88±1.12)mm, (0.63±1.37)mm and (0.25±0.75)mm,(0.9±1.1)mm, (2.43±2.57)mm. Comparing the set-up errors between method A and B, there were no statistically significant differences (P>0.05) in the direction of VRT and LNG, and statistically significant differences existed (P=0.000) in LAT direction. Conclusion More differences originate from the different setup methods about left and right position, which causes error for patient during therapeutic set-ups when the sagittal laser line is obscured. Therefore, it is important to use the “+” sign method (method A) strictly and comparatively during the therapeutic set-up for patients.

Cervical cancer metastasis to the small intestine is a rare occurrence that is easily misdiagnosed as a small bowel obstruction. The present study reports the case of a 46-year-old cervical cancer patient with metastasis to the small intestine, which presented as an acute abdomen due to intestinal obstruction. Enteroscopy revealed no primary intestinal tumors. The patient underwent exploratory laparotomy and resection of the tumor of the small intestine. Pathology revealed the mass to be squamous cell carcinoma, limited to the outer muscular layer and serosa. This case demonstrates that small intestine seeding must be considered in the differential diagnosis of acute abdomen in patients with cervical cancer.

Objective To explore the key prognostic factors in patients with cervical cancer by analyzing the clinical data.Methods The clinical data of 195 patients with cervical cancer were retrospectively analyzed .Results According to the univariate analysis, the 5-year survival rates for stage Ⅰ,Ⅱ,Ⅲ+Ⅳwere 88.2%, 70.4%and 39.3%, respec-tively (all P<0.01).The 5-year survival rate of patients undergoing surgery was higher than that of patients who did not undergo surgery (70.1%vs 40.5%, P<0.01).The 2-year survival rates of patients with and without retroperitoneal lymph node metastasis were 20.4%and 84.1%(P<0.01).Multivariate analysis demonstrated that stage , surgical treat-ment and retroperitoneal lymph node metastasis were independent prognostic factors for patients with cervical cancer .Con-clusion The clinical stages , surgical treatment and retroperitoneal lymph node metastasis are significantly associated with the prognosis of patients with cervical cancer .

Objective To analyze the setup errors in postoperative radiotherapy for endometrial and cervical cancer and to determine the margin required for clinical target volume (CTV) extending to planning target volume (PTV) (MPTV).Methods The setup errors of 26 endometrial and cervical cancer patients receiving postoperative radiotherapy from April to June 2013 were measured and analyzed in this study.Linear errors(x,y,z axis) were obtained by cone beam CT (CBCT).MPTV were determined.Results Setup errors were unavoidable in postoperative endometrial and cervical cancer irradiation.The setup errors(systemic ± random) on x (left-right),y (superior-inferior),z (anterior-posterior) directions were (0.21 ± 3.23),(0.55 ± 3.51) and (0.08 ± 2.76) mm,respectively.The spatial distributions of setup error was maximum in y direction,the second in x direction and the minimum in z direction.The difference of setup errors in x,y,z directions was not statistically significant.MPTV was 5.44 mm in x axis,7.26 mm in y axis,5.68 mm in z axis,repectively.Conclusions The influence of setup errors of a PTV margin would be suggested by 5.5,7.5 and 6 mm on x (left-right),y (superior-inferior),z (anterior-posterior)directions for postoperative radiotherapy for endometrial and cervical cancer.

Diverse strategies of analgesic adjustment are often, respectively, used to sustain analgesic efficiency for opioid-tolerant patients with different refractory factors of pain. In order to select effective analgesic adjustment strategy for hospice patient without knowing explicit causes of diminishing analgesic efficiency, a retrospective data of 743 patients among 3760 hospice patients were analyzed. The efficacy and adverse effects were not significantly different among analgesic adjustment strategies at each adjustment. Opioid duration was not associated with clinical characteristics. For opioid-tolerant hospice patients, the analgesic adjustment strategy can be selected for individual patient. After repeated analgesic adjustments, opioid tapering may also occur.

Objective: To investigate the postoperative adjuvant therapy effect and prognosis factor in 177 stage II breast cancer, and to explore the relationship between the clinicopathological factors and patients' prognosis. Methods: The clinical/pathological materials of 177 stage II breast cancer cases were collected between Jan. 2000 and Dec. 2005 who received postoperative adjuvant treatment, including radiotherapy, chemotherapy and endocrine therapy. Age, menstruation, stages, pathological types, lymph node dissection, the expression of estrogen receptor(ER), progestrone receptor(PR), and human epidermal growth factor receptor-2(HER-2), surgical method types, and postoperative adjuvant therapy were evaluated in relation to the prognosis of breast cancer. Results: In 177 stage II breast cancer cases, only 29.94% cases were compliance with NCCN guidelines, and mean follow-up time was 62 months. Analysis revealed that overall survival of this group were significantly associated with menopausal status, HER-2status, and adjuvant treatment (P<0.05), while patients' age, the number of dissected lymph nodes, TNM staging, time interval between onset and treatment, pathology type had no significant independent prognosis value (P>0.05). Conclusion: Our data demonstrate that menopausal status, HER-2 status, incipient symptoms, and adjuvant treatment are significant independent indicators of prognosis in stage II breast cancer respectively. Compliance with NCCN guidelines for postoperative adjuvant treatment of stage II breast cancer was low, and adjuvant treatment should follow NCCN guidelines.

Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related mortality worldwide. Mitochondrial dysfunction has been postulated to render cancer cells resistant to apoptosis based on the Warburg hypothesis. However, few studies have investigated the prognostic value of mitochondrial DNA (mtDNA) content and G10398A polymorphism in NSCLC patients. mtDNA copy number and G10398A polymorphism in 128 NSCLC tissue samples were assessed by real-time PCR (RT-PCR) and PCR-RFLP respectively, and their relationship to prognosis were analyzed by survival analysis and Cox proportional hazards model. In vitro, an mtDNA deletion A549 ρ(0) cell model was utilized to assess the function of mtDNA on radiosensitivity. Cell cycle distribution and reactive oxygen species (ROS) were analyzed to elucidate the potential mechanisms. For the whole group, the median follow-up time and overall survival time were 22.5 and 23.4 months, respectively. Patients with high mtDNA content had a marginally longer survival time than patients with low mtDNA content (P=0.053). Moreover, patients with high mtDNA content plus 10398G had a significantly longer overall survival time compared with those having low mtDNA content plus 10398A (47 vs. 27 months, P<0.05). In addition, multivariate analysis showed that stage and low mtDNA content plus 10398A were the two most independent prognostic factors. In vitro, the A549 ρ(0) cells showed more resistance to radiation than ρ(+) cells. Following radiation, ρ(0) cells showed delayed G2 arrest and lower ROS level as compared to ρ(+) cells. In conclusion, the present study suggests that in patients with NSCLC, low mtDNA content plus 10398A could be a marker of poor prognosis which is associated with resistance to anticancer treatment caused by low mtDNA content plus 10398A polymorphism resulting in mitochondrial dysfunction.

Objective To evaluate the effect of home-made immobilization device with KV-CBCT in lung-SBRT and investigate its clinical use value.Methods Choosing 10 lung tumor patients (half centre type tumor;half peripheral type) random analysis the interfractional and intrafractional setup errors in the SBRT process by this fixed device with KV-CBCT.The concrete method is using Varian's KV-CBCT scans the patients before and after the SBRT each time,then make the registration between the reconstructed 3 d image and the planned CT image (both based on bone landmark),we then obtain the average setup errors in LR,AP and SI directions.Simultaneously,this research make contrastive analysis of setup errors among this fixed device and other fixed devices such as vacuum pad,phantom in body IMRT.All data make one-factor analysis of variance by SSPS 17.0.Results All the setup errors data was gaussian distribution,the centre type interfraction was at (0.01 ±0.32) cm (LR),(-0.08 ±0.38) cm (AP),(0.14 ±0.36) cm (SI) of the cross section,peripheral type interfraction was at (0.01 ± 0.32) cm (LR),(-0.08 ± 0.38) cm (AP),(0.14 ± 0.36) cm (SI) of the cross section (P =0.001).We found out that the average of lung tumor's setup error at all three directions have no significant difference-the largest was the AP directions (P =0.003),the second was the SI direction (P =0.003) and the smallest was the LR direction (P =0.001).The central type has no significant difference at three directions.Compare to the other fixed device,the average setup errors of our device are (0.09 ± 0.33) cm (LR),(-0.10 ± 0.44) cm (SI),(0.17 ±0.35) cm (AP) better than the report at present paper.As the interfraction setup error was small enough by using this fixed device while it has beyond the system algorithm,the registration software of system shows (0.0 ± 0.0 cm).Conclusions The range of lung tumor motion can be cut down obviously and enhance each placement accuracy,repeatability,on SBRT with home-made immobilization device.

Objective: To analyze prognostic factors and clinic pathological features of elderly patients with nonsmall cell lung cancer(NSCLC).Methods: A total of 150 elderly NSCLC patients(age ≥70 years) were retrospectively reviewed.The clinic pathological features and prognostic factors were evaluated by univariate and multivariate analysis.Results: Among the 150 cases with median age of 73 years,advanced lung cancer(clinical stage of Ⅲa-Ⅳ) accounted for 90% of the cases.118 patients were males and 70% of all were smokers.The onset symptoms were cough,sputum,etc.20% patients had chronic lung disease.Of the 150 patients,133 received chemotherapy,radiotherapy or surgery,the rest 17 received best supportive care(BSC) therapy.The median survival time of multimodality therapy group(22 months) and single surgical group(29 months) were significantly higher than in BSC group(10 months, P < 0.05).The median survival time of female patients was 22 months,higher than that of males’patients(14 months,P < 0.05).The older patients had the lower survival rate,especially for who’re older than 80.The 2-years survival rate were 12.07% and 48.91%(P < 0.01) respectively in group that lose weight more than 5% in 6 months and group that lose weight less than 5%.The 2-years survival rate in ECOG≤2 group was 41.18% versus 20.83% in ECOG > 2 group(P < 0.05).Multivariate analysis of prognostic factors using COX’s proportional hazard model showed that weight loss more than 5%,older than 80 years,BSC-treatment-only were the independent prognostic factors.Conclusion: Female, relatively young patients,ECOG≤2 and multimodality treatment were beneficial prognostic factors in elderly NSCLC patients.The elderly patients tend to have longer life expectance when diagnosed in early stage and with good performance status,whereas resection and multidisciplinary treatments may prolong the survival time.

The Rho-associated serine-threonine protein kinase (ROCK) is a downstream effector of Rho GTPases that is frequently activated in the epithelial to mesenchymal transition (EMT) of human ovarian cancer cells. On the other hand, endothelin-1 (ET-1) and its receptor endothelin A receptor (ET(A)R) are overexpressed in primary and metastatic ovarian carcinoma, which suggests that ET-1 promotes tumor dissemination. Hence, two human ovarian carcinoma cell lines, SK-OV-3 and CaOV3, were chosen to study the effects of ET-1/ET(A)R and ROCK in promoting EMT of ovarian cancer cells. We found that ET-1 exposure induced EMT of SK-OV-3 and CaOV3 by monitoring cells morphology, enhanced fibronectin, and reduced E-cadherin protein. At the same time, ET-1/ET(A)R enhanced the level of transcription of SLUG a transcriptional repressor of E-cadherin. More importantly, a constitutively active mutant of ROCK enhanced the transcription of SLUG by stimulating SLUG promoter activity. Furthermore, ROCK inhibitor Y27632 reversed the increase in fibronectin induced by ET-1/ET(A)R. Our data suggest that ROCK cooperated with ET-1/ET(A)R to promote EMT of human ovarian carcinoma cells through upregulation of SLUG mRNA.

Aim: To study the role of ROCK/SLUG signaling pathway in endothelin-1 (ET-1) induced epithelial to mesenchymal transition (EMT) in human ovarian cancer cells. Method: ET-1 was used to treat SK-OV-3 and CaOV3 cells, and the cells were transfected with constitutively active mutant of ROCK, or the cells were added with ROCK inhibitor (Y27632), or the cells were transfected with SLUG promoter-pGL3 construct and Renilla plasmid. At the end of experiment, Boyden Chamber invasion assay was used to detect the cells invasive capacity, and immunofluorescence stains were employed to observe the cells morphologic change, and reporter gene assay kit was adopted to detect SLUG promoter activity, and real time PCR and western blot were used to detect the expression of some genes related with EMT. Result: ET-1 induced morphologic and genetic changes were consistent with EMT in SK-OV-3 and CaOV3 cells, and increased the invasive capacity of the cells; ET-1 combined with its receptor endothelin A receptor (ET AR) increased the transcription of SLUG; ET-1 increased the expression of ROCK and fibronectin, and when the cells were con-transfected with constitutively active mutant of ROCK, the enhancement of fibronectin and the invasive capacity of cells were increased further. On the contrary, ROCK inhibitor Y27632 inhibited the increase of fibronectin and invasive capacity of the cells induced by ET-1 ; when the cells were transfected with constitutively active mutant of ROCK, the SLUG promoter activity was enhanced and then the transcription of SLUG was increased, the transcription of E-cadherin was reduced. On the contrary, ROCK inhibitor Y27632 inhibited SLUG promoter activity. Conclusion: ET-1 induces epithelial to mesenchymal transition in human ovarian cancer cells via ROCK/SLUG signaling pathway.

To evaluate the relationship between pain and quality of life (QoL) in patients newly admitted to Wuhan Hospice Center, China. A total of 1,634 patients were analyzed in this retrospective study. A Numerical Rating Scale and Chinese-QoL instrument were used to assess pain score and QoL, respectively. Most patients experienced moderate to severe pain, which significantly impaired QoL. The pain was significantly correlated with appetite, mood, sleep, fatigue, pain intensity, daily activity, side effect, general appearance, and support from family. But there was no correlation with support from society, understanding of cancer, or attitude toward treatment. In our study, the relationship between pain and QoL was found to be reciprocal. The staff can offer a multidisciplinary care perspective for improving hospice care for this special group of population.