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Figure 1. An interview form for patients receiving IFN

monotherapy.

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����� �Table 2� ���� ��� ��������������������� 50�� 34��23�� 23������ �� �������������� ���������������!"#$���%&��' (�� �Table 3� )*+� ,�"#$(-.&/�0'1���� �234-.�56�+78�9:���;<=> � � � ?@4 8ABC) 4A�)�DE'1;������� �FG�H�IJ���14 �Table 4����0:�

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Figure 2. An interview form for patients receiving IFN-ribavirin com-

bination therapy

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������� 20���� ���� ��������������� ��������28� 13��!�"����#$%&� '�() 12� �*+,�&��3� �-����*��.�/0����1�$%&15����� � 7 ��0�23�456� 35 � 22�������&� 078�9: ;<=�/16 ��>?@ABC"�D��E�F@GHIJ�D���*#K�� 20�078*LM�&��4� N�6��0���%/O�� PQ�RS�4T�*

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�6� #$yz#aoyz*��&;e@4� ��{������� 3�*|}~��=$�� %"���*#K�&� ����&��'���]=�b�� ��������: ]=*v!�%&��7� IC�GC�35 � 1 ����&� ���(��'������������&� %"����=�U�����=������()� ���������&� IC�GC�4��Z)n����/�&��8� '��� 3�����b�� ��*�� +�&8�

� .��U&��V�&� �,=�a�&�����4� ���V_��+�����/���*�� �� ��V������-K�&�$�=+�2�/��a� ]����4� .��/*Vv!$]=� �0�$�ba�(�� ]�� 41+=1/*�¡2���*�=�&� �&� ����f¢£e¤�36�: ]=¥B¦§;e¨©C�nª�«4: ]=�U*+,�&�

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IFN ���4¬������5a]=*­��/O�� ��* IFN ����q 0Qa0�®6 ¯�6a°±=$ 8�9�� IFN ���#K$0%&RS� Cj²³���0�478 5�7��´S�µ: � �&� ²³��5K$� C j9X²¶

Table 2. Frequency of Side E#ects in Patients Receiving

IFN-ribavirin Combination Therapy �2�Table 1. Frequency of Side E#ects in Patients Receiving

IFN-Ribavirin Combination Therapy �1�

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���������16�� � � IFN ����������� �������������������� �������� !"#�����$%&'�� ()� ����)*���+,&-�����.�� /������0"����� IFN12���345�67� �8�9�:;�<=>�?�.��@>���� @������:����ABCD�EF�G�HI�����J@>�� KL���MNOPQRSN���TUABCD�EF�G�HI��V@>���11�14��� WX����V�� Y��Z[5\)]^_*�>��� ��:�ABCD�EF�G� )>������`a� @������b�����c��V�'^17�� U5)de���Z[�f����gh�>��ijklNmnopqrstuv�wxXo&

�� IFN ��yz�{��� (#L�&n|�}

������ ~*)���<=>� MNQ�P����N�N��\�>)�zs���� IFN ��yz�� 2���zs��:�� ��MjkP��|�}������R��� ����d���l� �8|�}����y�<�=>�s����L��0���� � 3����� 2�4�������<=>�� 2�������<=>�������� ��|�������� �n|�������� �� 6¡&'�� � ����¢ABCD�EF�G�HI�£��¤¥7)*��� n|�¦h� ��|��§�p-��5�5���L����� ��¢Z¨�©=��ª«¬­ �5(U)*� ��ª®��h���¯°¢�±�� n��²���³h�7�´µ� ��ª®�U(7�¶&-��´µ�'��gh�>�� U5)�±�·¸ �¹�5)��º����»��¼&'��

Table 3. Frequency of Serial Change of Side E#ects in Patients Receiv-

ing IFN-Ribavirin Combination Therapy

Table 4. Frequency of Patients with Damaged Daily Life

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��������������� IFN �������� ������������� �� ����������������� ������ �����! �"#� ���$%�&�����������&��� '�(�) 11(��*�+� ��,�- .��'�)/012����3���������� 4������� 56���2���78���9�:#� �����; < =�����>?1��@AB@C��!�� .#2�D �E�F������ IFN ��� "G#2H#$�%$)I�4��&JK12��8�9�� 4������1�'�1�LE�)� '�()�M*N#2+O#� ,��������#�� 0�� �����2�+4����2)�������,�- PQ����R-���4��?��2��� 4���� �,�- .��(��.�O��� S�TU� 3*� 1��,�- PQ���#2��4��/0#��������#�4��V��#2� W�X�6��+����12���� =�2��YZ�[=4���3\�]�^�� P[��4��_4 ���4���`�1�� -�X56ab�7�� 608�c9�� �d:��+�6eR�>�5� ���+���� f<� �34)g+����� ;�h���7�2)i<���=j#2)����� ���8���� �7��� k* ��>�� �?K�]���� W���i<l@b�A0��YZ�BC#�� fD]���m Fn���?�>��>+4��op0�������4��_4����� 0�� qCrsCt�7��E9�� ��� =�2�FG�uv����� wH��+#2#0��S�I��x6:#�� 9 .��3\�Jn�yK�Lz ��?�uM�4� )��?�{� W� � �:# +�3\���� 4� �#2�N|O ��>+�} W� ~&P���4���������4��_4 ����@AB@C��!�������� ��� 5����^��6� �K ���Q��E��)� 181- 14-�7.7������^K12��16�� ���R#� 35-��� 1-�ST-):2���� ����R�*U-���R������

���� k*Fn���2����4��������2�+�V�[���2)��4�� K� ����ST���U����4��_4���4����#2���@AB@C��!�� .#2�� WCX� 8

����Y��Z[K11X� Y���X#2)�\]�^�#��4��/0#2��18�� ������a- .#2�_`��r���\��������4�)���>?1� Y���X .#2)W��Y����#������R��aM)����K�R� IFN ����p��fDN|�D�#2���)����� IFN ��� ��b� qC���C�ab�c�#�d������:������ fDN|ph����+� �|�����/���R�aM���� S4�@e�����:�f|Fgh����#2i�� 2003j 7�����#2�� �Figure 3��  D� �����w¡¢=�£���¤��¥k#� �����"�¦C�§���w�&��¨;� �� ©6lª��+4���m�#2��� 0�� K�R��n«��O������¬���?�������� ����#$ .#2�X�=����� �p��­�$ ����!® �¬#� �R�O��aM����2003j 12��� PEG-IFN a-2a ���19��o

¯����6� ° 1��p±���4�� ����%$�²�4����³q�{�´ª²�K1�� 0��p���WCK12��µ¶ IFN �@AB@C�!���K� S�VU�;rK1�

Figure 3. A communication form connecting hospital

ward and outpatient clinic.

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C������ IFN ���� ��� ���� �� ������������ �!"#$�%�&� '()*+)�,- ���./�0�� 1234 �5678��&9:#0;�1<� 12�56#=�&>? �@A�$� BCDE�FGHIJ� ���KL&0�;��*M��

� �

1� NOPQ� RSTQ� UVW� XYTQ� Z[\]� ��^_`abc�de� fg+ 2004;30: 1579�1584

2� Matsumura H, Moriyama M, Goto I, TanakaN, Okubo H, Arakawa Y. Natural course of

progression of liver fibrosis in Japanese pa-

tients with chronic liver disease type C-a study

of 527 patients at one establishment. J Viral

Hepat 2000; 7: 268�275.3� Yoshida H, Shiratori Y, Moriyama M,

Arakawa Y, Ide T, Sata M, Inoue O, Yano M,

Tanaka M, Fujiyama S, Nishiguchi S, Kuroki

T, Imazeki F, Yokosuka O, Kinoyama S, Ya-

mada G, Omata M, for the IHIT Study Group.

Interferon therapy reduces the risk for hepato-

cellular carcinoma: national surveillance pro-

gram of cirrhotic and noncirrhotic patients

with chronic hepatitis C in Japan. Ann Intern

Med 131; 1999; 131: 174�1814� Imai Y, Kawata S, Tamura S, Yabuuchi I,Noda S, Inada M, Maeda M, MD, Shirai Y,

Fukuzaki T, Kaji I, Ishikawa H, Matsuda Y,

Nishikawa M, Seki K, Matsuzawa Y. Relation

of Interferon Therapy and Hepatocellular Car-

cinoma in Patients with Chronic Hepatitis C.

Ann Intern Med 1998; 129: 94�995� Yoshida H, Arakawa Y, Sata M, Nishiguchi S,Yano M, Fujiyama S, Yamada G, Shiratori Y,

Omata M. Interferon therapy prolonged life

expectancy among chronic hepatitis C patients.

Gastroenterology 2002; 123: 483�4916� McHutchison JG, Gordon SC, Schi# ER,Shi#manML, LeeWM, Rustgi VK, Goodman

ZD, Ling MH, Cort S, Albrecht JK. Interferon

alfa-2b alone or in combination with ribavirin

as initial treatment for chronic hepatitis C.

Hepatitis Interventional Therapy Group. N

Engl J Med 1998; 339: 1485�927� Davis GL, Esteban-Mur R, Rustgi V, Hoefs J,Gordon SC, Trepo C, Shi#man ML, Zeuzem

S, Craxi A, Ling MH, Albrecht J. Interferon

alfa-2b alone or in combination with ribavirin

for the treatment of relapse of chronic hepatitis

C. International Hepatitis Interventional Ther-

apy Group. N Engl J Med 1998; 339: 1493�988� hijk: _lmnopql �IFN�r3:*8�st� �uv 1990; 21: 899�904

9� hijk: C������: '(wx 2001; 47:27�32

10� yYz{� |�}~�� ?z��� �� _lmnopql��S&�A���C��&���������57�9:� ��*a��n�l�� �C+e 1998; 40: 717�721

11� Hunt CM, Dominitz JA, Bute BP, Waters B,Blasi U, Williams DM. E#ect of Interferon-a

Treatment of Chronic Hepatitis C on Health-

Related Quality of Life. Dig Dis Sci 1997; 42:

2482�248612� Ahern M, Imperial J, Lam S. Impact of adesignated hepatology nurse on the clinical

course and quality of life of patients treated

with rebetron therapy for chronic hepatitis C.

Gastroenterol Nurs. 2004; 27: 149�5513� Ware JE, Bayliss MS, Mannocchia M, Davis

GL, and the international hepatitis interven-

tional therapy group.

14� Health-Related Quality of Life in Chronic

Hepatitis C: Impact of Disease and Treatment

Response. Hepatology 1999; 30: 550�555.15� Perrillo R, Rothstein KD, Rubin R, Alam I,Imperial J, Harb G, Hu S, Klaskala W. Com-

parison of quality of life, work productivity

and medical resource utilization of peginter-

feron alpha 2a vs the combination of interferon

alpha 2b plus ribavirin as initial treatment in

patients with chronic hepatitis C. J Viral Hepat

2004; 11: 157�16516� hijk� ���� XR��� �[��� ��� � ¡¢£¤� ¥¦§� |R¨§� ¡©ª

_lmnopql��*567 467

51

�� ��� Genotype 1b������� C ���������������� a-2b �SCH 18908 �������� !"#��������� a-2b $%"#��&'�()*+,-&'./!01!.�!��+2�3456 2002; 18: 565�591

17� Matsumura H, Moriyama M, Goto I, TanakaN, Okubo H, Arakawa Y. Natural course of

progression of liver fibrosis in Japanese pa-

tients with chronic liver disease type C�a studyof 527 patients at one establishment. J Viral

Hepat 2000; 7: 268�75.18� Bernstein D, Kleinman L, Barker CM, Revicki

DA, Green J. Relationship of Health-Related

Quality of Life to Treatment Adherence and

Sustained Response in Chronic Hepatitis C Pa-

tients. Hepatology 2002; 35: 704�708.19� Mchutchison JG, Manns M, Patel K, PoynardT, Lindsay KL, Trepo C, Dienstag J, Lee WM,

Mak C, Garaud JJ, Albrecht JK, for the inter-

national hepatitis interventional therapy

group. Adherence to combination therapy en-

hances sustained response in genotype-1 in-

fected patients with chronic hepatitis C. Gas-

troenterology 2002; 123: 1061�106920� Zeuzem S, Feinman SV, Rasenack J, Heath-cote EJ, Lai MY, Gane E, O[Grady J, Reichen

J, Diago M, Lin A, Ho#man J, Brunda MJ.

Peginterferon alfa-2a in patients with chronic

hepatitis C. N Engl J Med 2000; 343: 1666�1672

789: ;<=>�? @468

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Abstract

A Study on the Side E#ects of Interferon Treatment Using a

Questionnaire for Patients with Chronic Hepatitis C

Noriko Motodate1, Mariko Akutsu1, Seiko Suzuki1, Kimie Yoshikawa1,

Yasuko Jinta1, Hiroshi Yotsuyanagi2, Michihiro Suzuki2,and Fumio Itoh2

An interview form was introduced for study of side e#ects, daily life� and work of patients withchronic hepatitis C who received interferon �IFN� treatment. The first interview form, introduced in June2001, was revised in December 2001. After that, side e#ects, daily life and work of the patients treated by

IFN-ribavirin combination therapy were analyzed. All the patients had some side e#ects. Common side

e#ects were skin itching followed by alopecia and edema. The frequency of each side e#ect is higher than that

on phase-III clinical trial, showing that the interview form can pick up side e#ects more accurately. Daily life

and work were damaged in one-third of the patients. However, no patient stopped treatment due to side

e#ects. Our experience shows the usefulness of interview form for intensive care and safe treatment.

Key words

Chronic hepatitis C, Interferon, Ribavirin, Questionnaire

1 Department of Nursing

2 Department of Internal Medicine, Division of Gastroenterogy and Hepatology, St. Marianna University.

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