Publications by authors named "Wen-Li Lin"

12 Publications

  • Page 1 of 1

Age as a modifier of the effects of chemoradiotherapy with infusional 5-fluorouracil after D2 dissection in gastric cancer.

Aging (Albany NY) 2021 07 5;13(13):17337-17348. Epub 2021 Jul 5.

Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan.

Adjuvant concurrent chemoradiotherapy (CCRT) is the standard care for patients with resected advanced gastric cancer, but its survival benefits remain undetermined in patients undergoing D2 lymph node dissection (D2 dissection). We evaluated safety and efficacy of adjuvant CCRT with 5-fluorouracil (5-FU) versus chemotherapy alone in 110 gastric cancer patients with D2 dissection treated in Taiwan between January 2009 and January 2013. All the 71 patients receiving adjuvant CCRT were treated with daily infusional 5-FU and radiotherapy. Adjuvant CCRT was associated with higher risks of major hematologic (56.3% vs. 23.8%, = 0.002) and gastrointestinal (46.9% vs. 14.3%, = 0.027) toxicities and death (12.5% vs. 0.0%, = 0.041) in patients above 70 years old, but this was not the case in those ≤70 years of age. Univariate Cox proportional regressions identified adjuvant CCRT as a factor for better overall survival (OS) (hazard ratio [HR]=0.52; 95% confidence interval [CI]: 0.27-0.99) and disease-free survival (DFS) (HR=0.46, 95% CI: 0.24-0.88), but it was not a significant factor for OS or DFS after adjusting for other factors in the multivariate analysis. However, in stratified analyses by age, we found adjuvant CCRT was an independent prognostic factor for better OS (HR=0.07; 95% CI: 0.01-0.38) in patients ≤70 years old, but not in those above 70 years of age. Therefore, it was concluded that age may to be a modifier of the effects of adjuvant CCRT.
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http://dx.doi.org/10.18632/aging.203223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312439PMC
July 2021

The effects of exercise on chemotherapy-induced peripheral neuropathy symptoms in cancer patients: a systematic review and meta-analysis.

Support Care Cancer 2021 Sep 4;29(9):5303-5311. Epub 2021 Mar 4.

College of Nursing, Kaohsiung Medical University, 3F/4F, First Teaching Building 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan, Republic of China.

Purpose: To conduct a systematic review and meta-analysis of current studies to determine whether exercise affects chemotherapy-induced peripheral neuropathy (CIPN) symptoms in cancer patients.

Design: The Medline, Embase, Cochrane Library, CINAHL, PubMed, and National Central Library databases, and the reference lists of the included studies were surveyed. The Consolidated Standards of Reporting Trials (CONSORT) extension checklist for non-pharmacologic treatment was used to evaluate the literature.

Setting And Participants: Exercise interventions offered in hospitals or at home. A total of 178 participants from 5 studies were assessed in the meta-analysis, with their mean age ranging from 48.56 to 71.82 years.

Methods: The randomized control trials were summarized in a systematic review. The effects of the exercise interventions were compiled for meta-analysis. A forest plot was constructed using a fixed effect model to obtain a pooled mean difference.

Results: The pooled results indicated that exercise interventions significantly improved the CIPN symptoms of the participants (mean difference: 0.5319; 95% confidence interval: 0.2295 to 0.8344; Z = 3.45; P = 0.0006). A combination of exercise protocols including a nerve gliding exercise intervention was found to have improved CIPN symptoms. In addition, a sensorimotor-based exercise intervention was found to have reduced CIPN-induced loss of postural stability.

Conclusions And Implications: The findings indicated that the effects of exercise could improve CIPN symptoms in cancer patients. Nevertheless, further investigations of different exercise protocols and intensity of intervention utilizing larger sample sizes and more specific outcome measures will further inform the best practices for cancer patients.
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http://dx.doi.org/10.1007/s00520-021-06082-3DOI Listing
September 2021

Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution.

J Clin Med 2019 Jun 19;8(6). Epub 2019 Jun 19.

Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan.

The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated.
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http://dx.doi.org/10.3390/jcm8060875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616913PMC
June 2019

Effectiveness of the Multidisciplinary Team Model in Treating Colorectal Cancer.

Gastroenterol Nurs 2018 Nov/Dec;41(6):491-496

Wen-Li Lin, MSN, Cancer Center, Chi Mei Medical Center, Liouying, Taiwan. Jia-Ling Sun, PhD, Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan. Shu-Chan Chang, MSN, Cancer Center, Chi Mei Medical Center, Liouying, Taiwan. Tsung-Chih Tsai, MD, Department of Surgery, Chi Mei Medical Center, Liouying, Taiwan. Pei-Hua Wu, MSN, Cancer Center, Chi Mei Medical Center, Liouying, Taiwan. Wen-Tsung Huang, MD, Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Taiwan. Chao-Jung Tsao, MD, Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Taiwan. Chien-Liang Lin, MD, Department of Hematology and Oncology, Chi Mei Medical Center, Liouying, Taiwan.

The multidisciplinary team (MDT) model involves multiple medical professionals providing integrated medical care. Colorectal cancer (CRC) has the highest prevalence of cancer in Taiwan. This study examines and evaluates the survival rates of CRC patients treated under the MDT model. In this retrospective and prospective study, 651 CRC patients were recruited. They were divided into 2 groups: the MDT group and the traditional care (TC) group. The MDT group comprised 326 patients who received care from a MDT. The TC group comprised 325 patients who received care from a TC. The outcome variables were survival rates, follow-up appointment compliance, and 14-day readmission rates. Adopting the MDT model for CRC care increased patient follow-up appointment compliance rates at the first week, first month, and third month (p = .032, p = .007, p = .001, respectively). The model also effectively reduced patients' 14-day readmission rates. The results indicated that the survival rates of the MDT care were superior to those of TC. The adoption of the MDT model to treat CRC effectively enhanced clinical treatment adherence, increased survival rates, and reduced the 14-day readmission rate.
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http://dx.doi.org/10.1097/SGA.0000000000000348DOI Listing
April 2019

Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study.

Pediatr Neonatol 2018 04 20;59(2):136-140. Epub 2017 Jul 20.

Department of Pediatrics, MacKay Children's Hospital, Taipei 10449, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan. Electronic address:

Background: Patent ductus arteriosus (PDA) is one of the most common cardiac conditions in preterm infants. Closure of the PDA in symptomatic patients can be achieved medically or surgically. Atropine is commonly administered in general anesthesia as a premedication in this age group but with limited evidence addressing the effect of its use. Our study examined the association of the use of atropine as a premedication in PDA ligation and the risk of post-operative respiratory complications.

Methods: This retrospective cohort study included 150 newborns who have failed medical treatment for PDA and received PDA ligation during 2008-2012 in a single tertiary medical center. Ninety-two of them (61.3%) received atropine as premedication for general anesthesia while 58 (38.7%) did not. Post-operative respiratory condition, the need of cardiopulmonary resuscitation and the presence of bradycardia were measured.

Results: Patients with atropine use were associated with increased odds of respiratory acidosis in both univariate analysis (22.9% vs 7.3%; OR = 3.785, 95% CI = 1.211-11.826, p = 0.022) and multivariate analysis (OR = 4.030, 95% CI = 1.230-13.202, p = 0.021), with an even higher odds of respiratory acidosis in patients receiving both atropine and ketamine.

Conclusion: The use of atropine as premedication in general anesthesia for neonatal PDA ligation is associated with higher risk of respiratory acidosis, which worsens with the combined use of ketamine.
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http://dx.doi.org/10.1016/j.pedneo.2017.04.005DOI Listing
April 2018

Management of Bacillus Calmette-Guérin osteomyelitis/osteitis in immunocompetent children-A systematic review.

Vaccine 2015 Aug 26;33(36):4391-7. Epub 2015 Jul 26.

Centers for Disease Control, No. 6, Linsen S. Rd., Jhongjheng District, Taipei 10050, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 17, Xuzhou Rd., Taipei 10055, Taiwan; Department of Pediatrics, National Taiwan University Hospital, National Taiwan University, College of Medicine, No. 8, Zhongshan S. Rd., Taipei 10041, Taiwan. Electronic address:

Background: Bacillus Calmette-Guérin (BCG) osteomyelitis/osteitis in immunocompetent children is a rare but serious complication of BCG immunization. Rationale for its treatment is unclear.

Methods: Due to the rarity of this complication, no randomized control trials has ever been conducted to evaluate methods of intervention. As such, we searched the literature for any reported BCG vaccination-related osteomyelitis/osteitis among immunecompetent children published before April 15, 2014. We summarized the data from different affected regions of the body by recording the number of reported cases, while noting outcomes and their medical and/or surgical interventions.

Results: From 34 eligible studies gleaned from a screening of 804 articles, a total of 331 cases were enrolled. Involvement of the lower limbs was present in 55.6%, followed by the axial skeleton (26.0%), the upper limbs (15.4%), and multiple bones (3.0%). Of the 64 patients having records of detailed chemotherapy regimens, 45 patients (70%) received two or fewer drugs. Among the 80 patients with detailed surgical records, 50 (62.5%) received surgical procedures for diagnostic purposes. While there were uneventful outcomes for those receiving diagnostic procedures, 7 of the 30 (23.3%) patients receiving surgical interventions had major complications (p=0.002, Fisher's exact test). The overall prognosis was good with a 97.6% cure rate. Nevertheless, eight patients (2.4%) suffered major complications.

Conclusions: The rationale for treatment of BCG osteomyelitis/osteitis in immunocompetent children is highly subjective. However, patients receiving diagnostic procedures instead of surgical interventions may avoid major complications. Because only a few of the publications had detailed treatment information, further studies are needed to identify proper treatments, while infant BCG vaccination is still in use.
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http://dx.doi.org/10.1016/j.vaccine.2015.07.039DOI Listing
August 2015

Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis.

J Microbiol Immunol Infect 2016 Oct 1;49(5):723-728. Epub 2014 Nov 1.

Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan. Electronic address:

Background: Cerebrospinal fluid (CSF) cell count and biochemical examinations and cultures form the basis for the diagnosis of bacterial meningitis. However, some patients do not have typical findings and are at a higher risk of being missed or having delayed treatment. To better understand the correlation between CSF results and outcomes, we evaluated CSF data focusing on the patients with atypical findings.

Methods: This study enrolled CSF culture-proven bacterial meningitis patients aged from 1 month to 18 years in a medical center. The patients were divided into "normal" and "abnormal" groups for each laboratory result and in combination. The correlations between the laboratory results and the outcomes were analyzed.

Results: A total of 175 children with confirmed bacterial meningitis were enrolled. In CSF examinations, 16.2% of patients had normal white blood cell counts, 29.5% had normal glucose levels, 24.5% had normal protein levels, 10.2% had normal results in two items, and 8.6% had normal results in all three items. In logistic regression analysis, a normal CSF leukocyte count and increased CSF protein level were related to poor outcomes. Patients with meningitis caused by Streptococcus pneumoniae and hyponatremia were at a higher risk of mortality and the development of sequelae.

Conclusions: In children with bacterial meningitis, nontypical CSF findings and, in particular, normal CSF leukocyte count and increased protein level may indicate a worse prognosis.
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http://dx.doi.org/10.1016/j.jmii.2014.08.013DOI Listing
October 2016

The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: a randomized controlled trial.

J Nurs Res 2014 Sep;22(3):155-64

1PhD, Cancer Center, Chi Mei Medical Center 2PhD, School of Nursing, Fooyin University 3MSN, RN, Cancer Center, Chi Mei Medical Center 4PhD, RN, Assistant Professor, School of Nursing, Fooyin University 5MD, Cancer Center, Chi Mei Medical Center 6MD, Cancer Center, Chi Mei Medical Center.

Background: Depression, anxiety, and fatigue are among the most significant problems that influence the quality of life of patients with breast cancer who receive adjuvant chemotherapy. Although evidence has shown yoga to decrease anxiety, depression, and fatigue in patients with cancer, few studies on the effects of yoga have targeted patients with breast cancer. Yoga interventions should be tested to promote the psychological and physical health of women with breast cancer.

Purpose: This study examines the effectiveness of an 8-week yoga exercise program in promoting the psychological and physical health of women with breast cancer undergoing adjuvant chemotherapy in terms of depression, anxiety, and fatigue.

Methods: A sample of 60 women with nonmetastatic breast cancer was recruited. Participants were randomly assigned into either the experimental group (n = 30) or the control group (n = 30). A 60-minute, twice-per-week yoga exercise was implemented for 8 weeks as the intervention for the participants in the experimental group. The control group received standard care only.

Results: Analysis using the Johnson-Neyman procedure found that the yoga exercise reduced overall fatigue and the interference of fatigue in everyday life for the experimental group participants. Significant reductions were obtained after 4 weeks of intervention participation for those experimental group patients with relatively low starting baseline values (baseline item mean value < 3.31 and 3.22, respectively) and after 8 weeks for most patients (approximately 75%) with moderate starting baseline values (baseline item mean value < 7.30 and 5.34, respectively). The 8-week intervention did not significantly improve the levels of depression (F = 1.29, p > .05) or anxiety (F = 2.7, p > .05).

Conclusions/implications For Practice: The 8-week yoga exercise program developed in this study effectively reduced fatigue in patients with breast cancer but did not reduce depression or anxiety. Oncology nurses should strengthen their clinical health education and apply yoga to reduce the fatigue experienced by patients with breast cancer who undergo adjuvant chemotherapy.
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http://dx.doi.org/10.1097/jnr.0000000000000044DOI Listing
September 2014

Factors predicting survival of patients with gastric cancer.

Asian Pac J Cancer Prev 2014 ;15(14):5835-8

Cancer Center, Chi Mei Medical Center, Liouying, Taiwan E-mail :

Background: Gastric cancer is one of the most common causes of cancer death in Taiwan. The literature has previously shown that age, tumor site, T categories, and number of metastatic nodes significantly affect prognosis. The aim of this study was to determine the long-term survival of patients with gastric cancer, as well as the effect of particular prognostic factors on survival.

Materials And Methods: This was a survival analysis study with retrospective design. We reviewed the records of 64 patients with adenocarcinoma of the stomach who had undergone gastrectomy with curative intent between 2009 and 2012 at a teaching hospital in southern Taiwan. Data extracted from patient documents included age, gender distribution, tumor location, and pathological grading.

Results: The median follow-up time was 4 years, and there were 31 deaths attributed to gastric cancer. Kaplan-Meier analysis revealed that retrieval of less than 15 lymph nodes from a patient was a significant predictor of survival. A significant predictor of poorer survival was higher pathological grading.

Conclusions: Our results indicate that the number of lymph nodes retrieved and pathological grading could be viewed as crucial prognostic factors affecting the survival of individuals with gastric cancer.
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http://dx.doi.org/10.7314/apjcp.2014.15.14.5835DOI Listing
June 2015

Development and application of telephone counseling services for care of patients with colorectal cancer.

Asian Pac J Cancer Prev 2014 ;15(2):969-73

Cancer Center, Chi Mei Medical Center, Liouying, Taiwan E-mail :

Background: The number of colorectal cancer (CRC) patients in Taiwan has increased in recent years; therefore, the effective dissemination of information related to symptom care has become especially important. Previous studies indicated that the physical and psychological status of cancer patients can be effectively improved by telephone counseling services (TCS). Thus, determining the most effective means of establishing a TCS to support the clinical practice of oncology has become a crucial goal for nursing. The purposes of this study were to analysis the content of the TCS for CRC and explore stratification of the TCS.

Materials And Methods: The study design was retrospective. A total of 850 calls were made to CRC patients in the cancer center of Southern Taiwan during the period of January 2007- December 2011. A structure questionnaire was adopted to analysis satisfaction.

Results: Responses provided by the TCS included information regarding nutrition, side effects resulting from chemotherapy and pain. Moreover, 28.7% of CRC patients needed advanced treatment. More than 90% satisfaction with all aspects of the calls was found.

Conclusions: The TCS coulkd be shown to provide an effective means by which to expand the reach of nursing care to different times, places and patients, allowing for greater cost efficiency and more rapid service.
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http://dx.doi.org/10.7314/apjcp.2014.15.2.969DOI Listing
November 2014

[Improving the cancer screening model: experience applying an integrated operating system].

Hu Li Za Zhi 2009 Dec;56(6):55-62

Cancer Center, Chimei Hospital, ROC.

Background & Problems: Cancer patient numbers have continued to rise in recent years. In terms of deaths from various cancers, malignancies are involved in 28.9% of cases. Over the course of disease contraction, treatment and aftercare, patients face unease and pressure of various forms and degrees. Patients may abort treatment due to treatment pain and discomfort. The case manager may play a positive role by following up at appropriate moments to understand patient needs and deliver proper resources in order to avoid cancer recrudescence, which may delay treatment progress.

Purpose: The objective of this study was to improve nursing quality and management performance in cancer patient care. Through the integration of the management information system, A "Cancer Case Screening System" was built using a management information system to shorten the amount of time spent on scanning new cases and to reduce the rate of scanning error.

Resolution: Using a decision matrix, the research team proposed the following solution: (1) Define the system infrastructure currently employed in hospitals; (2) Discuss the Cancer Cases Screening System workflow and determine system specifications; (3) Write the Cancer Cases Screening System program to establish an effective management information system.

Results: The time spent on scanning case per day dropped from 117.14 to 28.57 minutes. The error rate was also reduced from 34.65% to 8.87%. These results achieved the objective of the project.

Conclusion: Promoting the developed screening system in the broader medical community can help reduce medical treatment costs and increase treatment continuity. This project may be considered and referenced by managers of relevant medical organizations.
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December 2009
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