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Oki, Takeshi. "A Narrative Review of Problems in Learning and Practicing Palliative Care in Neurology Clinics in Japan and Proposed Solutions." Brain Sciences 12, no. 12 (December 12, 2022): 1707. http://dx.doi.org/10.3390/brainsci12121707.
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As the understanding of the role of palliative care in neurology increases, there is the need to ensure that these developments include not only care at home and in hospitals but also in clinics. There are no reports on palliative care from neurology clinics in Japan, and this paper considers the problems and proposed solutions for improving palliative care provided at neurology clinics in Japan. In Japan, physicians in neurology clinics are extremely busy both during and after office hours with medical treatment and the preparation of various documents and are unable to conduct case conferences. Moreover, the education system for palliative care, especially for lifelong education, is not sufficient, and multidisciplinary cooperation is difficult due to the lack of specialists and their scattered locations. To improve the care provided for patients and their families, general palliative care should be included in the health insurance system with incentives and recognition, and mandatory lifelong education should be established so that all neurologists can provide palliative care. These proposals may be appropriate for other countries as palliative care in neurology is established.
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Inoue, Akira, Takuhiro Yamaguchi, Keiko Tanaka, Akihiro Sakashita, Keisuke Aoe, and Kenji Eguchi. "Effect of nationwide palliative care education program on lung cancer specialists." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e21715-e21715. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e21715.
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e21715 Background: Although palliative care has owed an essential part of cancer treatment, palliative care specialists are still insufficient. Thus in Japan, the Palliative care Emphasis program on symptom management and Assessment for Continuous Medical Education (PEACE) was launched in 2008 to provide primary palliative care education for all physicians engaged in cancer treatment. However, the effect of PEACE program on participants was uncertain. Methods: We conducted web-based surveys for physicians belonging to the Japan Lung Cancer Society and assessed outcomes of the PEACE program across three domains: knowledge, practices, and difficulties regarding palliative care by using the palliative care knowledge questionnaire for PEACE (PEACE-Q), Palliative Care self-reported Practice Scale (PCPS), and the Palliative Care Difficulties Scale (PCDS), respectively. All of these instruments were already validated in previous studies. Results: In February 2015, the survey was distributed to 5300 physicians and 923 of those surveyed including 455 respiratory physicians, 345 pulmonary surgeons, and 35 medical oncologist responded to all questionnaires. The result of PEACE-Q, PCPS, and PCDS (low score is better) were significantly superior in physicians who had participated in the PEACE program (n = 519) compared with non-participants (n = 404) (28.0 vs. 24.5, 71.8 vs. 67.1, and 34.4 vs. 36.9, respectively). The PEACE participants made significantly better scores than non-participants in all domains of PEACE-Q (philosophy of palliative care, cancer pain, side effects of opioids, dyspnea, nausea and vomiting, psychological distress, delirium, communication, and community-based palliative care) and PCPS (pain, dyspnea, delirium, dying-phase care, communication, and patient- and family-centered care), and 3 domains of PCDS (alleviation of symptoms, expert support, and communication with the patient and family). Conclusions: The PEACE program improved knowledge and practice of palliative care in lung cancer specialists in Japan.
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Kawamoto, Terufumi, Naoki Nakamura, Tetsuo Saito, Ayako Tonari, Hitoshi Wada, Hideyuki Harada, Hikaru Kubota, et al. "Palliative brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer: a nationwide survey in Japan." Japanese Journal of Clinical Oncology 51, no. 6 (February 24, 2021): 950–55. http://dx.doi.org/10.1093/jjco/hyab015.
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Abstract Background International guidelines recommend brachytherapy for patients with dysphagia from esophageal cancer, whereas brachytherapy is infrequently used to palliate dysphagia in some countries. To clarify the availability of palliative treatment for dysphagia from esophageal cancer and explain why brachytherapy is not routinely performed are unknown, this study investigated the use of brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer. Methods Japanese Radiation Oncology Study Group members completed a survey and selected the treatment that they would recommend for hypothetical cases of dysphagia from esophageal cancer. Results Of the 136 invited facilities, 61 completed the survey (44.9%). Four (6.6%) facilities performed brachytherapy of the esophagus, whereas brachytherapy represented the first-line treatment at three (4.9%) facilities. Conversely, external beam radiotherapy alone and chemoradiotherapy were first-line treatments at 61 and 58 (95.1%) facilities, respectively. In facilities that performed brachytherapy, the main reason why brachytherapy of the esophagus was not performed was high invasiveness (30.2%). Definitive-dose chemoradiotherapy with (≥50 Gy) tended to be used in patients with expected long-term survival. Conclusions Few facilities routinely considered brachytherapy for the treatment of dysphagia from esophageal cancer in Japan. Conversely, most facilities routinely considered external beam radiotherapy. In the future, it will be necessary to optimize external beam radiotherapy.
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Shinjo, Takuya, Tatsuya Morita, Daisuke Kiuchi, Masayuki Ikenaga, Hirofumi Abo, Sayaka Maeda, Satoru Tsuneto, and Yoshiyuki Kizawa. "Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey." BMJ Supportive & Palliative Care 9, no. 2 (November 8, 2017): 143–45. http://dx.doi.org/10.1136/bmjspcare-2017-001426.
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ObjectivesVoluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.Methods219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.ResultsA total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).ConclusionsIn Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.
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Nakamura, Yoshiaki, Kohei Shitara, and Jeeyun Lee. "The Right Treatment of the Right Patient: Integrating Genetic Profiling Into Clinical Decision Making in Advanced Gastric Cancer in Asia." American Society of Clinical Oncology Educational Book, no. 41 (June 2021): e166-e173. http://dx.doi.org/10.1200/edbk_321247.
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Gastric cancer is a major global health burden, especially when patients are diagnosed with recurrent or metastatic gastric cancer. Despite recent advances in treatment options with palliative chemotherapy, the median overall survival of patients with gastric cancer remains within 1 or 2 years after the diagnosis of metastatic disease. Gastric cancer is significantly more prevalent in eastern Asia (e.g., Japan and Korea). Next-generation sequencing is rapidly being adopted as part of clinical practice in Korea and Japan, especially in patients with gastric cancer. Approximately 10% to 15% of the patients with gastric cancer who undergo next-generation sequencing of their tumor specimen are allocated to target-matched clinical trials in Japan and Korea. In Japan and Korea, a cell-free DNA next-generation sequencing panel is also actively being investigated as an alternative next-generation sequencing test for patients with gastric cancer, which may reflect the tumor heterogeneity of gastric cancer. In Japan and Korea, multiple biomarkers, such as HER2, mismatch repair, Epstein-Barr virus, PD-L1 (combined positive score), EGFR, FGFR2, and CLDN18.2, are routinely assessed through immunohistochemistry or in situ hybridization before initiation of the first-line treatment in all patients with gastric cancer. Most tertiary cancer centers in Korea routinely perform HER2, mismatch repair, Epstein-Barr virus, and PD-L1 next-generation sequencing before palliative chemotherapy in patients with gastric cancer. Biomarker evaluation for all patients with metastatic gastric cancer enables clinicians to identify available biomarker-based clinical trials early during the course of treatment, which expands treatment opportunities while patients are medically fit for clinical trials, if available. Comprehensive genomic profiling using a tissue or circulating tumor DNA next-generation sequencing panel is considered necessary during second-line or subsequent treatment. It is hoped that a comprehensive molecular profiling strategy will facilitate greater use of precision medicine through molecularly targeted therapies for patients with gastric cancer in the near future.
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Yamakawa, Jun-ichi, Yoshiharu Motoo, Junji Moriya, Masao Ogawa, Hiroaki Uenishi, Sumiyo Akazawa, Toshiyuki Sasagawa, Matomo Nishio, and Junji Kobayashi. "Significance of Kampo, Traditional Japanese Medicine, in Supportive Care of Cancer Patients." Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–10. http://dx.doi.org/10.1155/2013/746486.
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The current standard treatment for cancer is a multidisciplinary therapy whereby various types of treatment are properly combined. Chemotherapy with multiple anticancer drugs is now common, and traditional, complementary, and alternative therapies are adopted as supportive measures. Medical care in Japan is distinguished by the ability for patients to access both Western and Kampo medical cares at the same time. There is a high degree of trust in the safety of Kampo therapies because they are practiced by medical doctors who are educated with fundamental diagnosis of Western medicine. Highly reliable clinical studies are being published, demonstrating that palliative or supportive care for cancer patients using Kampo preparations alleviates adverse effects of chemotherapy or radiotherapy. This paper reports the circumstances around cancer care in Japan where traditional therapeutic Kampo formulas are used for patients undergoing cancer treatment with cutting-edge chemotherapy, specifically to alleviate adverse effects of anticancer drugs.
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Funakoshi, Taro, Takahiro Horimatsu, Michio Nakamura, Koichi Shiroshita, Koichi Suyama, Masashi Mukoyama, Takuro Mizukami, et al. "Chemotherapy in cancer patients undergoing haemodialysis: a nationwide study in Japan." ESMO Open 3, no. 2 (February 2018): e000301. http://dx.doi.org/10.1136/esmoopen-2017-000301.
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BackgroundCancer is a major cause of death in patients undergoing haemodialysis. However, information about the actual clinical practice of chemotherapy for patients with cancer undergoing haemodialysis is lacking. We conducted a nationwide survey using questionnaires on the clinical practice of chemotherapy for such patients.Patients and methodsThe nationwide survey included patients undergoing haemodialysis who were subsequently diagnosed with cancer in 20 hospitals in Japan from January 2010 to December 2012. We reviewed their clinical data, including cancer at the following primary sites: kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast. The questionnaires consisted of the following subjects: (1) patient characteristics; (2) regimen, dosage and timing of chemotherapy; and (3) clinical outcome.ResultsOverall, 675 patients were registered and assessed for main primary cancer site involvement. Of 507 patients with primary site involvement, 74 patients (15%) received chemotherapy (44 as palliative chemotherapy and 30 as perioperative chemotherapy). The most commonly used cytotoxic drugs were fluoropyrimidine (15 patients), platinum (8 patients) and taxane (8 patients), and the dosage and timing of these drugs differed between institutions; however, the dosage of molecular targeted drugs (24 patients) and hormone therapy drugs (15 patients) was consistent. The median survival time of patients receiving palliative chemotherapy was 13.0 months (0.1–60.3 months). Three patients (6.8%) died from treatment-related causes and nine patients (20%) died of causes other than cancer. Of the 30 patients who received perioperative chemotherapy, 6 (20%) died of causes other than cancer within 3 years after the initiation of chemotherapy.ConclusionAmong the haemodialysis patients with cancer who received chemotherapy, the rates of mortality from causes other than cancer might be high for both palliative and perioperative chemotherapy. Indications for the use of chemotherapy in patients undergoing haemodialysis should be considered carefully.
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Tsuboi, Rie, Mihoko Sugishita, Hirohisa Hirakawa, and Yuichi Ando. "Spiritual pain and care needs of elderly cancer patients facing palliative chemotherapy decision-making: Qualitative study." Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 25. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.25.
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25 Background: Although the number of elderly cancer patients who require chemotherapy has increased, few studies have investigated the process of palliative chemotherapy decision-making and care needs of elderly patients with advanced cancer. Methods: The study was conducted at Nagoya University Hospital in Japan from April to October 2017. Face-to-face interviews were conducted with patients over 70 with advanced cancer (n = 15, median age = 77 years, range 70 - 82) who made decisions of palliative chemotherapy initiation within 6 months. Patients’ families and physicians were also interviewed individually. Interview transcripts were qualitatively analyzed using a deductive-inductive approach. Results: Four main themes emerged: physician’s awareness of paternalism, training of communication about serious news, spiritual-care needs assessment, and support with the team. Both the patients and the physicians felt the necessity for physicians’ paternalism in patients’ decision-making. The physicians found treatment decision-making for elderly patients difficult because of the patients’ diversities. Patients had spiritual pains from the time of diagnosis and they continued throughout treatment periods. They fought the illness with the support of surroundings as a team. Conclusions: Paternalism was emphasized from both elderly patients and physicians in palliative chemotherapy decision-making. Improvement of the communication skills of physicians was needed. Patients had spiritual-care needs beginning with the early phase of the treatments and fought as a team with their supporters, including physicians against the cancer. Physicians should be aware of that and be actively involved in whole-patient care.
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Kawamura, Atsufumi, Junji Koyama, Nobuyuki Akutsu, and Mai Azumi. "DIPG-12. PALLIATIVE TREATMENT FOR DIPG (DIFFUSE INTRINSIC PONTINE GLIOMA) AT KOBE CHILDREN’S HOSPITAL IN JAPAN." Neuro-Oncology 20, suppl_2 (June 2018): i51. http://dx.doi.org/10.1093/neuonc/noy059.105.
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Tei, Yo, Tatsuya Morita, Toshimichi Nakaho, Chizuko Takigawa, Akiko Higuchi, Akihiko Suga, Tsukasa Tajima, et al. "Treatment Efficacy of Neural Blockade in Specialized Palliative Care Services in Japan: A Multicenter Audit Survey." Journal of Pain and Symptom Management 36, no. 5 (November 2008): 461–67. http://dx.doi.org/10.1016/j.jpainsymman.2007.11.009.
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Pattanayak, Sibaprashad, Debabrata Saha, Bipin Kishore Bara, and Sanjit Kumar Nayak. "Palliative surgery in management of advanced carcinoma stomach and its outcome." International Surgery Journal 4, no. 1 (December 13, 2016): 300. http://dx.doi.org/10.18203/2349-2902.isj20164459.
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Background:Gastric cancer is the second leading cause of death from malignant disease World-wide and most frequently discovered in advanced stages. The incidence of gastric cancer in India is low compared to developed countries. But in India southern and northeast area more number of cases was diagnosed. More cases of cancer stomach are diagnosed in the early stages in Japan due to effective screening programme. Lack of such screening programme, ignorance about the disease and lack of awareness of warning signs of cancer lead to the detection of many cases in the advanced stage of gastric cancer. Where palliation is the mainstay of treatment. We discussed the different methods of palliative surgery and its outcome in this paper. Methods: This is a prospective study over 5 years February 2011 - 2016 January including 6 months follow up. 104 advanced carcinoma stomach patients were included in this study. To evaluate role of palliative surgery in advanced gastric cancer we analyse the data in the basis of presentation of disease, sex distribution, type of palliative surgery, relive of symptoms, preventions of complications, post-operative mortality morbidity, and overall survival.Results:In our study mean age of presentation is 58 years. Most common affected are male. Stage III disease are more common. Immediate post-operative mortality is 4 patients 7.14% comparable to the non-resection group 1 patients (2.63%). Symptoms relived 46 patients in resection group (82.14%), in non-resection group it is 16 (42.1%). Overall survival is (6 moths - 1 years) 19 (33.9%) patients, and in non-resection group it is only 2 (5.26%) patients. Median survival rate is 10 months.Conclusions:Palliative resection should be carried out for betterment of quality of life where it is possible. Relief from symptoms and complications can be achieved by resection of tumour mass in advanced carcinoma stomach.
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Mendelson, Danuta, and Timothy Stoltzfus Jost. "A Comparative Study of the Law of Palliative Care and End-of-Life Treatment." Journal of Law, Medicine & Ethics 31, no. 1 (2003): 130–43. http://dx.doi.org/10.1111/j.1748-720x.2003.tb00063.x.
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Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan.
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Aoki, Tomokazu, Yoshitaka Narita, Kazuhiko Mishima, and Masao Matsutani. "NQPC-01 CURRENT STATUS AND PROBLEMS OF ADVANCE CARE PLANNING AND PALLIATIVE CARE FOR MALIGNANT BRAIN TUMOR." Neuro-Oncology Advances 1, Supplement_2 (December 2019): ii30. http://dx.doi.org/10.1093/noajnl/vdz039.134.
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Abstract Purpose Genomic medicine is in progress, but the median survival of glioblastoma is 14–16 months. It seems to have the same life prognosis as stage 4 like unresectable pancreatic cancer, lung cancer and colon cancer. Palliative care including Advance care planning (ACP) at first diagnosis of glioblastoma is important We conducted a questionnaire survey to understand the current status of Japanese oncologists. Method In July 2018, a questionnaire of 37 items was sent by e-mail to 767 members of Japanese Society of Neuro Oncology, and in August replies were received from 154 persons (20%). The same 22-item questionnaire in 2012–2013 was compared internationally with a report (Walbert T., et al., 2015) by Society of NeuroOncology and the European Association of NeuroOncology. In addition, we compared domestically with a 30-item questionnaire (Narita et al. 2009) in 2007. The Nonparametric Mann-Whitney’s U test was mainly used. Result 1 Characteristics of Japan in comparison with Western countries(p<0.01): 1. The number of doctors in charge is overwhelmingly male. 2. The specialty is predominantly neurosurgeons. 3. Aging of NeuroOncologists. 4, medical treatment place: the proportion of university is low. 5, frequent regular examination of the patient. Result 2Changes compared with domestic(Japan) data 11 years ago(p<0.01): 1 Explaining the condition in more detail. 2. Explaining to not only the family but also the patient. 3. Continuing chemotherapy more aggressively. 4. The place of death: decreasing at hospitals and increasing at home. 5, Frequency with a respirator decreased. 6, About 70% at the end of the period, nasal injection and gastrostomy are applied. Conclusion In the treatment of malignant brain tumors in Japan, a male neurosurgeon who has over 15 years of experience actively continues chemotherapy and appears to see it with nasal injection.
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Mizutani, Tomonori, Kenichi Nakamura, Haruhiko Fukuda, Asao Ogawa, Tetsuya Hamaguchi, and Fumio Nagashima. "Geriatric Research Policy: Japan Clinical Oncology Group (JCOG) policy." Japanese Journal of Clinical Oncology 49, no. 10 (September 30, 2019): 901–10. http://dx.doi.org/10.1093/jjco/hyz093.
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Abstract Due to the rapid aging of Japan’s population, clinical research focusing on older patients with cancer is urgently needed. The Japan Clinical Oncology Group (JCOG) has conducted several such clinical trials, but there has been no formal policy for geriatric research. We have therefore established a JCOG policy for geriatric cancer research. We defined the patient selection policy based on treatment tolerance and chronological age. Older patients are categorized into three conceptual groups: ‘fit patients’ who can undergo the same standard treatment given to younger patients, ‘frail patients’ for whom best supportive or palliative care is indicated and ‘vulnerable patients’ who fall between the fit and frail categories. Unmet needs often exist for vulnerable patients. The policy recommends that study endpoints include not only survival but also other endpoints such as physical and cognitive function because the objective of therapy in older patients is not only extended life expectancy but also maintenance of the patient’s general condition. In this viewpoint, co-primary or composite endpoints that incorporate geriatric assessment in the study design are often applicable. Study design will differ depending on the study population, clinical question, and treatment. Even for older patients, a randomized clinical trial is still the gold standard when the clinical question asks which treatment is better. An observational study of a broader population is applicable for investigating actual conditions of older patients. This JCOG Geriatric Research Policy includes several practical solutions for various issues in geriatric research. We plan to revise this policy periodically to guide future geriatric research.
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Matsunuma, Ryo, Kozue Suzuki, Yoshinobu Matsuda, Masanori Mori, Hiroaki Watanabe, and Takashi Yamaguchi. "Palliative care physicians’ perspectives of management for terminally ill cancer patients with death rattle: a nationwide survey." Japanese Journal of Clinical Oncology 50, no. 7 (May 18, 2020): 830–33. http://dx.doi.org/10.1093/jjco/hyaa044.
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Abstract Death rattle occurs during the last days of life, and relatives of those afflicted frequently report that it is very distressful. However, there is no effective treatment for it. The purpose of this study was to investigate the perceptions of Japanese palliative care physicians in clinical practice in Japan. We conducted a nationwide survey of 268 physicians via an anonymous, self-report questionnaire. We assessed pharmacological and non-pharmacological management and anticholinergic agent choice. One hundred eighty-nine physicians (70.5%) returned the questionnaires. Fifty-five participants (29.1%) treating patients with Type-1 (real death rattle) and 36 participants (19%) treating patients with Type-2 (pseudo-death rattle) death rattle reported that they would frequently administer an anticholinergic agent. One-fourth would administer scopolamine butylbromide or scopolamine hydrobromide. In conclusion, more Japanese palliative care physicians thought that anticholinergic agents might be effective for treating Type-1 death rattle rather than Type-2. Further clinical trials of these agents are needed.
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Kishimoto, T. "Asbestos-related malignant mesothelioma in Japan." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 18182. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.18182.
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18182 Large amounts of asbestos use from 1960’s induced the increase of death caused by malignant mesothelioma in Japan. However, a national survey of the relationship between malignant mesothelioma and asbestos exposure, as well as diagnosis and treatment of malignant mesothelioma has not done up to today. One hundred and fifty-three cases of malignant mesothelioma diagnosed and treated in the Rosai Hospitals located all over Japan were studied, and 132 cases (80.4%) proved to be the definite diagnosis of malignant mesothelioma; another 21 cases were diagnosed as lung cancer, etc. As for definite 132 cases, 105 cases are male and other 27 cases are female with the ratio of 3.9:1. Ages ranges from 28 to 92 years old with the mean of 66.2 years old. One hundred and twelve cases originated from pleura, 18 cases from peritoneum, and each one case originated from pericardium and testicular tunica vaginalis. Final diagnosis of 104 cases (78.8%) was done by the tumor tissues. According to IMIG classification, stage I was 29 cases, stage II 6 cases, stage III 28 cases and stage IV was 44 cases. For the treatment, 29 cases were done extrapleurectomy, 58 cases were chemotherapy and other 39 cases were best supportive care. Median survival term of 132 cases were 9.5 months with 9.8 months of pleural origin and 5.6 months of peritoneal origin. By the clinical staging, stage I and II were 17.2 months, stage III 10.4 months and stage IV 5.4 months. By the treatment, extrapleurectomy was 18.1 months, chemotherapy 8.0 months and palliative care was 5.7 months. Seventy six percent cases were induced by occupational asbestos exposure and the mean exposuring time was 27.6 years and the mean latency was 43 years. Occupational histories were mainly shipbuilders, carpenters, electricians and piping workers. Summary: Seventy-six percent of Japanese malignant mesothelioma appeared by the occupational exposure to asbestos. Seventy-eight percent of final diagnosis were done by histological examination of tumor tissue. Extrapleurectomy was effective for the prognosis. [Table: see text] No significant financial relationships to disclose.
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Nitta, Toshikatsu, Kensuke Fujii, Yoshimasa Hirata, Tomo Tominaga, Yoshihiro Inoue, Hiroshi Kawasaki, Ken Kawakami, and Takashi Ishibashi. "Reocclusion after Self-Expandable Metallic Stent Placement for Relieving Malignant Colorectal Obstruction as a Palliative Treatment." Case Reports in Gastroenterology 10, no. 3 (December 8, 2016): 733–42. http://dx.doi.org/10.1159/000452200.
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Self-expandable metallic stent (SEMS) placement has been practiced in several hospitals in Japan, including ours, since January 2012. Here, we report the case of an 82-year-old Japanese man who presented to the hospital with a 1-week history of right hypochondrial pain. Computed tomography (CT) findings indicated colorectal cancer. The laboratory findings on admission indicated severe anemia (red blood cell count, 426 × 104/μL; hemoglobin, 7.9 g/dL). We performed SEMS placement because the patient refused to undergo surgery. He did not attend any of the scheduled follow-up visits after SEMS placement. However, a year and a half after the SEMS placement, the patient attended the hospital because of difficulty in passing stool. A plain abdominal CT scan showed bowel reobstruction due to the ascending colon cancer after SEMS placement. We performed an emergency operation, ascending colostomy, on the same day. Colorectal stent placement may be a good treatment option for patients who refuse to undergo conventional therapeutic treatments or in those with unresectable colorectal cancer. Patients should be carefully followed up every few months after SEMS placement because of the risk of reocclusion.
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Omura, Tomoko, Yasuji Miyakita, Makoto Ohno, Masamichi Takahashi, Kenji Fujimoto, Takaki Omura, Hitomi Sato, and Yoshitaka Narita. "QOLP-40. END-OF-LIFE CARE FOR GLIOBLASTOMA PATIENTS IN JAPAN." Neuro-Oncology 21, Supplement_6 (November 2019): vi206—vi207. http://dx.doi.org/10.1093/neuonc/noz175.860.
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Abstract BACKGROUND Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Unlike in other countries, most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in Japan. METHODS We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT: In total, 107 patients died; 27 (25.7%) at home, 24 (22.8%) in hospice care, 8 (7.6%) in nursing homes, 46 (43.9%) in hospitals (long-term care hospitals [LTCH; 19.8%], our hospital [13.3%], and other neurosurgical hospitals [10.4%]). According to our previous research, in 2001–2005, 6% of GBM patients died at home, 3% in hospice case, and 91% in the hospital. The KPSof patients who started palliative home care or transferred to another hospital was 50–60. The median survival time and length of EOL phase for patients who died at home were 498 and 76.5 days; 395 and 103 days in hospice care; 533 days and 149 days in LTCH; 374 days and 52 days in our hospital; 338 and 75.5 days in other neurosurgical hospital; and 557 days and 37 days in nursing homes, respectively. CONCLUSION The number of GBM patients who died at home in Japan is increasing, and we must consider the problems of the EOL phase and improve the quality of EOL care.
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Sano, Motoko, and Kiyohide Fushimi. "Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database." American Journal of Hospice and Palliative Medicine® 34, no. 7 (May 19, 2016): 685–91. http://dx.doi.org/10.1177/1049909116650238.
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Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern. Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database. Methods: We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2 and logistic regression analyses. Results: We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young–old, and patients with primary cancer. Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.
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Fujisawa, Daisuke, Shigeki Umemura, Ayumi Okizaki, Eriko Satomi, Takuhiro Yamaguchi, Tempei Miyaji, Tomoe Mashiko, et al. "Nurse-led, screening-triggered, early specialised palliative care intervention programme for patients with advanced lung cancer: study protocol for a multicentre randomised controlled trial." BMJ Open 10, no. 11 (November 2020): e037759. http://dx.doi.org/10.1136/bmjopen-2020-037759.
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IntroductionIt has been suggested that palliative care integrated into standard cancer treatment from the early phase of the disease can improve the quality of life of patients with cancer. In this paper, we present the protocol for a multicentre randomised controlled trial to examine the effectiveness of a nurse-led, screening-triggered, early specialised palliative care intervention programme for patients with advanced lung cancer.Methods and analysisA total of 206 patients will be randomised (1:1) to the intervention group or the control group (usual care). The intervention, triggered with a brief self-administered screening tool, comprises comprehensive need assessments, counselling and service coordination by advanced-level nurses. The primary outcome is the Trial Outcome Index of the Functional Assessment of Cancer Therapy (FACT) at 12 weeks. The secondary outcomes include participants’ quality of life (FACT-Lung), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), illness perception (Prognosis and Treatment Perceptions Questionnaire), medical service use and survival. A mixed-method approach is expected to provide an insight about how this intervention works.Ethics and disseminationThis study has been approved by the Institutional Review Board of the National Cancer Center Japan (approval number: 2016-235). The findings will be disseminated through peer-reviewed publications and conference presentations and will be reflected on to the national healthcare policy.Trial registration numberUMIN000025491.
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Seino, Yusuke, Yayoi Aizawa, Atsushi Kogetsu, and Kazuto Kato. "Ethical and Social Issues for Health Care Providers in the Intensive Care Unit during the Early Stages of the COVID-19 Pandemic in Japan: a Questionnaire Survey." Asian Bioethics Review 14, no. 2 (November 15, 2021): 115–31. http://dx.doi.org/10.1007/s41649-021-00194-y.
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AbstractThis questionnaire-based observational study was conducted in July 2020 with the aim of understanding the ethical and social issues faced by health care providers (HCPs) registered with the Japanese Society of Intensive Care Medicine in intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic. There were 200 questionnaire respondents, and we analyzed the responses of 189 members who had been involved in COVID-19 treatment in ICUs. The ethical and social issues that HCPs recognized during the pandemic were difficulties in the decision-making process with patients’ families, limitations of life-sustaining treatment, lack of palliative care, and inadequate mental support for patients’ families and HCPs. Regarding decision-making on issues of clinical ethics during the pandemic, more than half of the respondents thought they had failed to provide sufficient palliative care to patients and responded that they experienced moral distress. The free-text responses on moral distress revealed issues such as unusual treatment and care, restricted visits, challenging situations for HCPs, and psychological burden. Additionally, 38.1% of respondents experienced episodes of social prejudice or discrimination and 4.7% experienced a shortage of medical resources. Our study result shows that the moral distress of HCPs was caused by difficulties in patient-centered decision-making and insufficient medical care to patients and their families. These were caused mainly by a lack of communication due to the stronger implementation of infection control measures. We believe that it is important to address ethical and social issues during a pandemic in order to provide appropriate medical care and prevent burnout among HCPs.
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Chen, Hao, Masashi Ishihara, Nobuyuki Horita, Shigeru Tanzawa, Hiroki Kazahari, Ryusuke Ochiai, Takahiko Sakamoto, et al. "Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis." Cancers 13, no. 19 (September 29, 2021): 4873. http://dx.doi.org/10.3390/cancers13194873.
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Background: Malignancy-related ascites (MRA) is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one of the palliative treatments widely conducted in Japan only. Methods: A systematic review following a meta-analysis of CART was performed. The efficiency and adverse events were evaluated. Results: A total of 2567 patients and 6013 procedures of CART were identified in this study. The mean volume of MRA collected was 4.29 (95% confidence interval (CI) 3.47–5.11) L, and the volume reinfused after concentrating was 0.49 (95% CI 0.39–0.60) L. A total of 86.1 (95% CI 77.1–95.2) g protein and 42.9 (95% CI 36.0–50.0) g albumin was reinfused. The mean time to the next paracentesis was 20.7 (95% CI 15.6–25.8) days. The body weight was reduced by 3.38 (95% CI 1.90–4.86; p < 0.01) kg, and abdominal circumference was reduced by 7.86 (95% CI 6.58–9.14; p < 0.001) cm. Serum albumin increased an average of 0.14 (95% CI −0.01–0.28; p = 0.07) mg/dL the day after CART. Abdominal distension, dyspnea, and fatigue were alleviated by 6.0 (95% CI 5.59–6.51), 2.66 (95% CI 2.05–3.28), and 2.64 (95% CI 1.86–3.42) points using a numerical rating scale system ranging from 0 to 10. Overall, 17% (95% CI 0.03–0.31%) of patients had improved performance status after CART. Significant body temperature elevation was observed, at an average of 0.4 °C (95% CI 0.18–0.62 °C). Conclusions: CART might be a safe and effective palliative therapy in MRA and further clinical trials are necessary.
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Shimizu, Masaki, Takaomi Kessoku, Hiroto Ishiki, Tetsuya Matsuura, Yusuke Hiratsuka, Yoshinobu Matsuda, Takaaki Hasegawa, et al. "Naldemedine for opioid-induced constipation in patients receiving palliative care: A real-world registry study (Phase-R OIC Study)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 11582. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.11582.
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11582 Background: Although naldemedine, a new peripherally-acting mu-opioid receptor antagonist, was approved for the management of opioid-induced constipation (OIC), its safety and effectiveness in real world clinical practice is unknown. Methods: We conducted a real world registry study in 14 hospital palliative care teams and inpatient palliative care units in Japan between April and December 2018. Consecutive cancer patients who received naldemedine for OIC were enrolled in a 7-day observational study. All treatment and assessment procedures were performed according to the accepted clinical practice. The primary outcome of the study was the proportion of patients who experienced spontaneous bowel movement within 24 hours after the initial administration of naldemedine. Adverse events, which indicated a possible or stronger causal relationship with naldemedine treatment, were reported according to the Common Terminology Criteria for Adverse Events (CTCAE) ver 4.0. Results: Overall, 204 patients were enrolled in the study. The mean age of the patients was 63±14 years, and 103 (50.5%) were male. The most common primary cancer site was lung (23.5%), followed by gastrointestinal (13.7%), and urological organs (9.3%). The proportion of patients undergoing active cancer treatment was 59.9%. Oxycodone was the most frequently used regular opioid (n = 115, 56.4%), and the median oral morphine-equivalent daily dose of opioids was 30 mg (interquartile range: 20-60 mg). Magnesium oxide (64.2%) and Senna (17.2%) were used as concomitant laxatives. All patients received 0.2 mg of naldemedine orally once daily. Most patients (90.2%) completed the 7-day observation. In 146 patients, spontaneous bowel movement was observed within 24 hour after the first administration of naldemedine (71.6%, 95% confidence interval 65.4-77.8%). Nearly two-thirds of the patients experienced increased frequency of spontaneous bowel movement in the week after naldemedine administration. The most prevalent adverse events were diarrhea (CTCAE grade 1-2, 35 cases; grade 3, 1 case) and abdominal pain (CTCAE grade 1-2, 10 cases; grade 3, 1 case). No serious adverse events including gastrointestinal perforation were reported. Conclusions: Naldemedine for opioid-induced constipation is safe and effective in the real world oncology and palliative care settings. Clinical trial information: UMIN000031381.
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Nitta, Toshikatsu, Jun Kataoka, Masato Ohta, Kensuke Fujii, Tomo Tominaga, Yoshihiro Inoue, Hiroshi Kawasaki, and Takashi Ishibashi. "Clinical outcomes of self-expandable metal stent (SEMS) placement as palliative treatment for malignant colorectal obstruction: A single-center study from Japan." Annals of Medicine and Surgery 19 (July 2017): 33–36. http://dx.doi.org/10.1016/j.amsu.2017.05.008.
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Harano, K., K. Yonemori, K. Hashimoto, M. Yunokawa, C. Shimizu, K. Tamura, N. Katsumata, M. Ando, and Y. Fujiwara. "What factors affect the place of end-of-life care for patients with metastatic breast cancer?" Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 218. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.218.
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218 Background: Despite the early detection and treatment, advanced breast cancer is still impossible to cure. Palliative care has become the standard of care at the time of end-of-life (EOL). However, there are limited data about the degree of access to such care and the factors that affect the choice of place to die. The purpose of this study is to identify factors that affect the place of EOL care in patients with metastatic breast cancer in Japan. Methods: Our study included breast cancer patients who were diagnosed with recurrence or metastatic diseases between 2004 and 2010 at the National Cancer Center Hospital and received EOL care. The following data were obtained: treatments, place of EOL care, and social background such as age, whether patients had young children, whether patients had elderly family members who needed nursing care, whether patients had jobs at the time of recurrence, and where they lived in. Results: Overall, 124 patients met our inclusion criteria. Among them, only 13% of patients received EOL care at home and 43.5% of patients at hospices, while 43.5% of patients died in acute care beds. Patients who had jobs at the time of recurrence were significantly more likely to receive EOL care in acute care beds (odds ratio 2.46; 95% CI 1.04−5.83). Other social backgrounds were not significantly related to the place of EOL care. Conclusions: A sizable proportion of patients, especially patients who had jobs at the time of recurrence, received acute care at the EOL and did not have access to palliative care at home or hospices. Familial backgrounds were not the determinant to choose the place of EOL.
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Matsusaki, Keisuke, Akitaka Yoshizawa, and Keiichiro Ohta. "Palliative benefit of novel cell-free and concentrated ascites reinfusion therapy (CART) for refractory ascites associated with cancerous peritonitis." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20591-e20591. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20591.
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e20591 Background: Refractory ascites associated with cancerous peritonitis causes severe abdominal distention, dyspnea and appetite loss, resulting in loss of patients’ activities of daily living (ADL) and discontinuation of their treatment for cancer such as chemotherapy. To improve the symptoms, we have developed a novel cell-free and concentrated ascites reinfusion therapy (CART) which is modified from a conventional CART approved by the Ministry of Health, Labor and Welfare in Japan and examined the efficacy in a pilot study. Methods: 87 patients with cancerous ascites were enrolled and subjected to novel CART from April 2012 to November 2012. The response was assessed by improvement of their ADL. Patients were asked in the form of questionnaires about general malaise, abdominal distention, abdominal pain, nausea, dyspnea, sleep disturbance, appetite loss, disturbance in gait, discomfort and frustration before and after treatment and each point was scored on a scale of zero to ten (ten being severe). Abdominal and thigh circumferences were also examined before and after treatment to evaluate efficacy. This study was approved by the ethics review committee of Kaname-cho hospital. Results: On average, 8.3 ± 4.4 L (range 2.3-27.0) of cancerous ascites was filtrated and concentrated to 0.69 ± 0.28 L (range 0.2-1.6) by novel CART. Any severe adverse events except fever were not observed. After treatment, the scores of all points were significantly improved. For example, abdominal distention was improved by 8.1 ± 2.4 vs. 2.0 ± 2.4 (p<0.0001), dyspnea by 3.7 ± 3.3 vs. 1.3 ± 2.1 (p<0.0001), and appetite loss by 5.3 ± 4.3 vs. 3.1 ± 3.4 (p<0.0001). Abdominal and thigh circumferences were also decreased by -13.3 ± 7.5 cm (p<0.0001) and -2.7 ± 2.6 cm (p<0.0001), respectively. Conclusions: This novel CART system is capable to process over 20 L of cancerous ascites and immediately improve their ADL and edematous lesions. Some patients also restarted anticancer treatment such as chemotherapy. Taken together, this CART is safe and effective for palliative care of patients with cancerous ascites.
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Matsushima, Tatsuko, Akira Akabayashi, Brian Taylor Slingsby, and Kenji Nishitateno. "Evaluation of a program to celebrate seasonal events for Japanese hospice patients." Palliative and Supportive Care 5, no. 3 (September 2007): 251–54. http://dx.doi.org/10.1017/s1478951507000417.
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Objective: Palliative care of the terminally ill requires not only treatment of physical pain, but also care for a patient's spiritual and social needs. In Japan, where many customs correlate closely with the seasons of fall, winter, spring, and summer, seasonal events carry significance for patients who have reached a terminal stage of disease. This study determined how Japanese hospice patients evaluate a program that celebrates seasonal events and considers the modality and significance of season events at hospices.Methods: A questionnaire survey was conducted for 1 year between August 2000 and July 2001 at a hospice located in the suburbs of Tokyo, Japan. Of the original 48 instruments, a total of 43 instruments were returned (response rate: 89.6%).Results: Results showed that 72.1% of respondents participated in seasonal events, and the majority of participants positively evaluated their experiences of seasonal events. Positive aspects included being able to get a feeling for the seasons (74.2%) and being able to interact with staff and volunteers (51.6%). Negative aspects included that the events were too long (9.7%) and tiring (6.5%), and that the events made one feel sad (6.5%). Reasons for participating in seasonal events included seeming fun (71.0%), recreative (58.1%), and being entertaining (48.4%).Significance of results: Overall findings suggest that there is significance in celebrating the seasons with a monthly event at hospices. Further research is needed on the modality and experiences of celebrating the seasons at hospices in other nations.
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Kitano, Masayuki, Yasutaka Chiba, Kentaro Yamao, Takeshi Ogura, Takaaki Eguchi, Ichiro Moriyama, Yukitaka Yamashita, et al. "107 UNCOVERED VERSUS COVERED SELF-EXPANDABLE METAL STENTS IN PALLIATIVE ENDOSCOPIC TREATMENT OF MALIGNANT GASTRIC OUTLET OBSTRUCTION: A LARGE MULTICENTER RANDOMIZED TRIAL IN WEST JAPAN." Gastrointestinal Endoscopy 87, no. 6 (June 2018): AB48—AB49. http://dx.doi.org/10.1016/j.gie.2018.04.019.
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Hiramoto, Shuji, Kiyofumi Oya, Rie Tokutani, Toshihiko Kirishima, Isseki Maeda, Hori Tetsuo, Koji Amano, Toshihiro Yamauchi, and Yusuke Hiratsuka. "Prognostic impact of systemic anti-cancer therapy on patients with advanced cancer at end of life: Analysis of a multicenter prospective cohort study using propensity score methods." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 12029. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.12029.
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12029 Background: Prognosis is said to worsen when systemic anti-cancer therapy (SACT) is administered until a patient’s end of life (EOL) and professional palliative care is delayed. However, the prognostic impact of SACT at EOL is unclear. Methods: In this pre-planned secondary analysis of a multicenter, prospective East Asian cross-cultural collaborative cohort study, consecutive patients with advanced cancer admitted to palliative care units between January and December 2017 were divided into four groups: patients who had and had not received SACT (SACT vs. non-SACT) and patients whose last administration of SACT was before or within 1 month of study enrolment (non-1M SACT vs. 1M SACT). The primary endpoint was difference in survival time from a palliative performance scale (PPS) of < 20 to death between the SACT and non-SACT groups, and the 1M SACT and non-1M SACT groups. The analysis was adjusted for age; sex; primary cancer site; metastatic site; comorbidity (Charlson comorbidity index); and history of radiotherapy, smoking, and psychiatric disorders. Weighting for inverse probability of treatment was applied. A secondary endpoint was to identify EOL symptom and care factors prognostic for survival time using a Cox proportional hazards model. Results: The 1396 study patients (712 men, 684 women; median age: 73 years) came from 21 institutions throughout Japan. Primary tumor sites were upper gastrointestinal (471 patients), lower gastrointestinal (193 patients), lung (241 patients), breast (93 patients), urologic (101 patients), gynecologic (82 patients), head and neck (56 patients), central nervous system (25 patients), and hematologic (39 patients). Metastatic sites were liver (554 patients), lung (522 patients), bone (373 patients), and brain (199 patients). The SACT, non-SACT, 1M SACT, and non-1M SACT groups consisted of 853, 539, 126, and 1270 patients, respectively. Survival time was significantly shorter in the SACT group (6.83 days, p = 0.03) than in the non-SACT group (9.01 days). No significant difference between the 1M SACT group (7.57 days) and the non-1M SACT group (7.36 days) was evident. Prognostic factors were use of opioids (HR 1.289), antipsychotics (HR 0.787), and anxiolytics (HR 0.867); infusion of more than 1 L daily (HR 0.727); and apnea (HR 0.874), dyspnea (HR 1.874), nausea (HR 0.612), fatigue (HR 1.284), and ascites (HR 1.236). Conclusions: Prognosis was shorter for patients with a history of SACT than for those without a history of SACT at EOL. However, SACT at EOL was not a prognostic factor. This information is useful in advance care planning for selecting and explaining treatment at EOL to patients and their families.
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Masuda, Ken, Hiroto Ishiki, Naosuke Yokomichi, Takuhiro Yamaguchi, Tetsuya Ito, Hana Takatsu, Koji Amano, et al. "Effect of paracentesis on the survival of patients with terminal cancer and ascites: A propensity score-weighted analysis of the EASED study." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e24063-e24063. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24063.
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e24063 Background: Malignant ascites (MA) is associated with progressive deterioration in quality of life and poor prognosis of patients with cancer. Paracentesis is among the most widely utilised treatments for MA. However, reports on the usefulness of paracentesis in patients with MA are limited. Thus, this study aimed to investigate whether paracentesis affects the duration of survival in such patients. Methods: We performed a post - hoc analysis of a prospective multicentre observational study that investigated the dying process and end-of-life care in patients with terminal cancer, who were admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used the inverse probability of treatment weighting (IPTW) method to control for baseline covariates between the two groups. Furthermore, subgroup analyses were performed to investigate the IPTW-adjusted hazard ratio (HR) of the paracentesis and non-paracentesis groups according to some of the baseline covariates, including age, sex, Karnofsky Performance Status, primary tumor site, liver dysfunction, and renal dysfunction. Results: Among the 1,896 patients, who were initially enrolled, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The most common primary tumour site was the gastrointestinal tract (51.9%, n = 295), followed by the pancreas (22.7%, n = 129). The non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16–25) and 12 days (95% CI: 11–13) in the paracentesis and non-paracentesis groups, respectively (HR: 0.69, [95% CI: 0.54–0.88]; p = 0.003). The IPTW-adjusted median durations of survival were 22 days (95% CI: 16–25) and 16 days (95% CI: 12–22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64–1.24; p = 0.492). There were no serious adverse events in the paracentesis group. According to the baseline covariates, a weighted subgroup analysis was performed to compare the survival of patients in the non-paracentesis and paracentesis groups. There was no significant heterogeneity across all subgroups. Paracentesis was not associated with a significant survival risk in any of the subgroups. Conclusions: Paracentesis does not negatively affect the survival of patients with cancer and MA; hence, it can be used as a standard treatment in palliative care settings.
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Watanabe, Ryohei, Yoichi Nakamura, Yasushi Nagaoka, Koji Asai, Toshiyuki Enomoto, Manabu Watanabe, Yoshihisa Saida, Shinya Kusachi, and Jiro Nagao. "The treatment for unresectable advanced gastric cancer with pyloric stenosis." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 194. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.194.
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194 Background: Inability of oral intake due to advanced gastric cancer with pyloric stenosis (AGCPS) should be avoided, because the key drug of chemotherapy for gastric cancer is S-1 in Japan. We have performed palliative gastrectomy (PG), gastrojejunostomy (GJ) or stent placement (SP) for unresectable AGCPS. We investigated therapeutic outcomes (gastric outlet obstruction scoring system: GOOSS, chemotherapy introduction rate: CIR and median survival time: MST) of each therapy retrospectively. Methods: Between April 1999 and April 2013, 42 patients with unresectable AGCPS were included in this study (PG/GJ/SP, 13/10/19). We compared therapeutic outcomes (GOOSS, CIR and MST) between the 3 groups. Results: The demographic characteristics of patients were similar across the three groups. We evaluated the Glasgow Prognostic Score (GPS) of all cases before treatment. GPS tended to be 1 in the PG group, 0 in the GJ group and 2 in the SP group. The proportion of GPS 2 in the SP group was higher than in PG or GJ group significantly (p=0.0056 for SP vs. PG, p=0.0191 for SP vs. GJ and p=0.007 for SP vs. Surgery). GOOSS scores of all patients were improved. GOOSS score 3 of PG/GJ/SP groups after treatment were 84.6 / 90 / 68.4% respectively. CIR, MST and post-operative complication rate of PG/GJ/SP groups were 53.8 / 90 / 42.1%, 222.5 / 435.5 / 74 days and 46.2 / 10 / 0%, respectively. The proportion of patients receiving chemotherapy was higher in the GJ group than in the PG group, and survival was longer in the GJ group than in the PG group. Post-operative complication rate was lower in GJ group than in PG group. Conclusions: GJ is well tolerated and offers improved survival compared with PG and SP in the patients with AGCPS. High CIR improved MST. Success of chemotherapy introduction might improve survival. Enabling oral intake is important for chemotherapy. However, it is very difficult to select a treatment method that suits the patient individually. GPS might be an important predictor in the selection of the treatment method for unresectable AGCPS.
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Fahmi, Yassine. "Peer review report 2 on “Clinical outcomes of self-expandable metal stent (SEMS) placement as palliative treatment for malignant colorectal obstruction: A single-center study from Japan”." Annals of Medicine and Surgery 13 (January 2017): 146. http://dx.doi.org/10.1016/j.amsu.2017.05.020.
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Guha, Soumya. "Peer review report 1 on “Clinical outcomes of self-expandable metal stent (SEMS) placement as palliative treatment for malignant colorectal obstruction: A single-center study from Japan”." Annals of Medicine and Surgery 13 (January 2017): 152. http://dx.doi.org/10.1016/j.amsu.2017.05.021.
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Kusano, Shimpei, Junya Fujimura, Megumi Fujiwara, Akinori Yaguchi, Takeshi Ishibashi, Osamu Tomita, Hiroyuki Tamaichi, Akihide Kondo, and Toshiaki Shimizu. "ETMR-15. USE OF HIGH-DOSE CHEMOTHERAPY FOR TWO CHILDREN WITH EMBRYONAL TUMOR WITH MULTILAYERED ROSETTES." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii326. http://dx.doi.org/10.1093/neuonc/noaa222.219.
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Abstract Embryonal tumor with multilayered rosettes (ETMR) is new entity defined in the 4th revised edition of the WHO classification of tumors of the central nervous system. Although radical resection, radiotherapy, and multiagent chemotherapy are considered to be necessary for ETMR, the efficacy of chemotherapy for ETMR in Japan has not been established. Here, we report different clinical courses for two children with localized ETMR treated with the St. Jude medulloblastoma-96 (SJMB96) regimen, which consists of four cycles of high-dose chemotherapy with autologous peripheral blood stem cell transplantation. For both children, the diagnosis of ETMR, C19MC-altered was confirmed after gross total tumor resection. Multiagent chemotherapy was administered following cranio-spinal irradiation with local boost. One month after completion of the treatment, one patient experienced local recurrence but has been in remission for over 2 years after tumor resection and stereotactic irradiation with a CyberKnife and treatment every three weeks with bevacizumab. The other patient also experienced local recurrence after the third cycle of chemotherapy and several times thereafter. Although she again underwent tumor resection and local irradiation, her tumor grew larger and invaded. Because her prognosis was very poor, her parents choose only palliative care. Based on our experience, we believe that continuous chemotherapy at conventional doses is preferred over intensive-dose chemotherapy such as SJMB96. However, the number of reports on chemotherapy for ETMR is still small, and a prospective multicenter trial is needed to establish effective chemotherapy for ETMR.
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Morita, Tatsuya, Takuya Kawahara, Patrick Stone, Nigel Sykes, Guido Miccinesi, Carsten Klein, Stephanie Stiel, et al. "Intercountry and intracountry variations in opinions of palliative care specialist physicians in Germany, Italy, Japan and UK about continuous use of sedatives: an international cross-sectional survey." BMJ Open 12, no. 4 (April 2022): e060489. http://dx.doi.org/10.1136/bmjopen-2021-060489.
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ObjectivesTo explore intercountry and intracountry differences in physician opinions about continuous use of sedatives (CUS), and factors associated with their approval of CUS.SettingsSecondary analysis of a questionnaire study.ParticipantsPalliative care physicians in Germany (N=273), Italy (N=198), Japan (N=334) and the UK (N=111).Primary and secondary outcome measuresPhysician approval for CUS in four situations, intention and treatment goal, how to use sedatives and beliefs about CUS.ResultsThere were no significant intercountry or intracountry differences in the degree of agreement with statements that (1) CUS is not necessary as suffering can always be relieved with other measures (mostly disagree); (2) intention of CUS is to alleviate suffering and (3) shortening the dying process is not intended. However, there were significant intercountry differences in agreement with statements that (1) CUS is acceptable for patients with longer survival or psychoexistential suffering; (2) decrease in consciousness is intended and (3) choice of neuroleptics or opioids. Acceptability of CUS for patients with longer survival or psychoexistential suffering and whether decrease in consciousness is intended also showed wide intracountry differences. Also, the proportion of physicians who agreed versus disagreed with the statement that CUS may not alleviate suffering adequately even in unresponsive patients, was approximately equal. Regression analyses revealed that both physician-related and country-related factors were independently associated with physicians’ approval of CUS.ConclusionVariations in use of sedatives is due to both physician- and country-related factors, but palliative care physicians consistently agree on the value of sedatives to aid symptom control. Future research should focus on (1) whether sedatives should be used in patients with longer survival or with primarily psychoexistential suffering, (2) understanding physicians’ intentions and treatment goals, (3) efficacy of different drugs and (4) understanding the actual experiences of patients receiving CUS.
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Sato, Kazuki, Mitsunori Miyashita, Tatsuya Morita, Makiko Sanjo, Yasuo Shima, and Yosuke Uchitomi. "Quality of end-of-life treatment for cancer patients in general wards and the palliative care unit at a regional cancer center in Japan: a retrospective chart review." Supportive Care in Cancer 16, no. 2 (October 5, 2007): 113–22. http://dx.doi.org/10.1007/s00520-007-0332-x.
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Yuda, Sayako, Ken Kato, Yusuke Sasaki, Naoki Takahashi, Hirokazu Shoji, Atsuo Takashima, Natsuko T. Okita, et al. "Risks of severe adverse events of docetaxel, cisplatin, and 5-fluorouracil (DCF) combination chemotherapy of esophageal cancer." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 43. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.43.
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43 Background: Although adding docetaxel to cisplatin plus 5-fluorouracil (i.e. the DCF regimen) for esophageal cancer treatment may improve outcomes, this regimen has increased toxicity. However, the risk factors for severe non-hematological toxicities remain unknown. Methods: We analyzed data on esophageal cancer patients given at least one cycle of DCF between July 2009 and April 2014 at the National Cancer Center Hospital, Japan. DCF consisted of docetaxel 70 mg/m2/day (day 1), cisplatin 70 mg/m2/day (day 1), and continuous infusion of 5-fluorouracil 750 mg/m2/day (days 1–5), repeated every 3 weeks. Data on adverse events developing within three cycles were collected from medical records. Risk factors for severe adverse events were analyzed. Results: One hundred patients were enrolled, with a median age of 63 (range, 37 to 76); 81 male and 19 female; 96 squamous cell carcinomas and 4 adenocarcinomas; clinical situation neoadjuvant/induction/palliative: 69/23/8/1; clinical stage I/II/III/IV: 1/12/64/23; and performance status (PS) 0/1/2: 44/55/1. Forty patients (40%) developed grade 3 or more non-hematological adverse events, including anorexia (12%), mucositis (6%), and esophagitis (2%); 45 developed grade 4 hematological adverse events. Seventeen experienced febrile neutropenia (FN). There was one case of treatment-related death from serious infection. In multivariate analysis, age≥63 was at significantly increased risk of FN (P=0.013). Conclusions: DCF chemotherapy was safe in most patients and its toxicity was controllable. However, elderly patients may suffer from intense toxicity during DCF therapy.
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Ogata, Takatsugu, Yukiya Narita, Ryosuke Kumanishi, Taiko Nakazawa, Yuki Matsubara, Kazuki Nozawa, Kyoko Kato, et al. "Clinical impact of oral intake on second-line treatment of advanced gastric cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e16560-e16560. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e16560.
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e16560 Background: Trifluridine/tipiracil, an oral drug, was approved in Japan for patients (pts) with advanced gastric cancer (AGC). Insufficient oral intake (INSUF) is one of the most common complications. We evaluated the clinical characteristics and impact of oral intake during 2nd line chemotherapy (CT). Methods: We retrospectively evaluated AGC pts receiving 2nd line CT from January 2012 to December 2018 at a single institution. We defined “INSUF” as a requirement for daily intravenous fluids or hyperalimentation and “improvement of oral intake (IMP)” as no such requirement for > 1 week. Exacerbation (EXA) was defined as a change from “sufficient oral intake (SUF)” to INSUF. Results: We enrolled 495 pts, of which 67 (13%) and 428 (87%) pts had INSUF and SUF at the start of 2nd line CT, respectively. Patient characteristics are summarized in the Table. There was no difference in the cytotoxic drugs of 2nd line CT. The causes of INSUF were peritoneal metastases (79%), cachexia (15%), and primary complications (3%). The objective response rates of INSUF and SUF pts were 9% and 26%, respectively. INSUF pts had poorer progression-free survival (PFS) (1.7 vs. 3.7 months [M]; adjusted HR [aHR], 1.51; p < 0.001) and overall survival (3.2 vs. 10.1 M; aHR, 2.01; p < 0.001) than SUF pts. At the end of 2nd line CT, 147 (32%) and 314 (68%) pts had INSUF and SUF, respectively. In SUF pts, the factors correlated with EXA were poor ECOG PS (odds ratio [OR], 5.26; p < 0.001), massive or moderate ascites (OR, 2.04; p = 0.031), palliative operation history (OR, 2.90; p = 0.007), and ramucirumab use (OR, 0.50; p = 0.034). Median PFS was shorter after CT in pts with EXA than in those without (1.7 vs. 4.2 M; aHR, 2.05; p < 0.001). Among INSUF pts, 11 pts (16%) achieved IMP; the rate of IMP did not differ according to regimen. Median PFS was shorter in pts without IMP than in pts with IMP (1.1 vs. 3.3 M; aHR, 4.97; p = 0.001). Subsequent CT was administered to 29% and 71% of INSUF and SUF pts, respectively. Conclusions: INSUF at the start of 2nd line CT was a poor prognostic factor. For appropriate use of oral drugs, CT should be changed in SUF pts with factors associated with EXA. [Table: see text]
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Kanai, Masashi, Hiroshi Ishiguro, Yukiko Mori, Toshiyuki Kitano, Takafumi Nishimura, Shigemi Matsumoto, Kazuhiro Yanagihara, Tsutomu Chiba, and Masakazu Toi. "Association of temporary blood pressure drop after bevacizumab administration with clinical course of advanced colorectal cancer." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 528. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.528.
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528 Background: Hypertension is a common adverse event of bevacizumab and recent data demonstrates that this event is associated with a better clinical course. However, a blood pressure drop after bevacizumab administration and its clinical significance have not yet been reported. Methods: Between August 2007 and October 2010, 85 patients with colorectal cancer underwent palliative chemotherapy using bevacizumab at Kyoto University Hospital. For these patients, we obtained data using both the designated database system (CyberOncology, CyberLaboratory Co. Ltd., Ibaragi, Japan) and the hospital’s electronic medical records system on blood pressure values at 0 min (before administration), at 90 min and 180 min after the initiation of bevacizumab during the first three cycles of bevacizumab treatment. Out of the 85 patients, there were 81 for whom two or more sets of blood pressure data from the first three cycles were available. Therefore, we retrieved data from a total of 162 bevacizumab administrations in 81 patients (data from 2 separate administrations per patient). Results: Twenty-five patients (30%) demonstrated an average temporary drop of 20 mm Hg or more in systolic blood pressure between 0 and 90 min. We classified these 25 patients as group A and the others as group B. In group A the mean blood pressure drop between 0 and 90 min was 25 and 30 mm Hg in the first and second monitoring, respectively, compared with 3 and 5 mm Hg in group B. There were no significant differences between the 2 groups in their baseline characteristics. Interestingly, median time to treatment failure (TTF) was significantly longer in group A compared to group B (291 vs. 162 days; hazard ratio, 0.53; 95% CI, 0.31 – 0.89; P = 0.02). Furthermore, the proportion of patients who required intervention with antihypertensive drugs during bevacizumab treatment was significantly higher in group A compared to group B (36% vs 4%; P < 0.01). Conclusions: Our current study suggests that a temporary blood pressure drop after bevacizumab administration could be a predictive marker for bevacizumab treatment.
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Serizawa, Toru, Yoshinori Higuchi, Masaaki Yamamoto, Shigeo Matsunaga, Osamu Nagano, Yasunori Sato, Kyoko Aoyagi, et al. "Comparison of treatment results between 3- and 2-stage Gamma Knife radiosurgery for large brain metastases: a retrospective multi-institutional study." Journal of Neurosurgery 131, no. 1 (July 2019): 227–37. http://dx.doi.org/10.3171/2018.4.jns172596.
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OBJECTIVEIn order to obtain better local tumor control for large (i.e., > 3 cm in diameter or > 10 cm3 in volume) brain metastases (BMs), 3-stage and 2-stage Gamma Knife surgery (GKS) procedures, rather than a palliative dose of stereotactic radiosurgery, have been proposed. Here, authors conducted a retrospective multi-institutional study to compare treatment results between 3-stage and 2-stage GKS for large BMs.METHODSThis retrospective multi-institutional study involved 335 patients from 19 Gamma Knife facilities in Japan. Major inclusion criteria were 1) newly diagnosed BMs, 2) largest tumor volume of 10.0–33.5 cm3, 3) cumulative intracranial tumor volume ≤ 50 cm3, 4) no leptomeningeal dissemination, 5) no more than 10 tumors, and 6) Karnofsky Performance Status 70% or better. Prescription doses were restricted to between 9.0 and 11.0 Gy in 3-stage GKS and between 11.8 and 14.2 Gy in 2-stage GKS. The total treatment interval had to be within 6 weeks, with at least 12 days between procedures. There were 114 cases in the 3-stage group and 221 in the 2-stage group. Because of the disproportion in patient numbers and the pre-GKS clinical factors between these two GKS groups, a case-matched study was performed using the propensity score matching method. Ultimately, 212 patients (106 from each group) were selected for the case-matched study. Overall survival, tumor progression, neurological death, and radiation-related adverse events were analyzed.RESULTSIn the case-matched cohort, post-GKS median survival time tended to be longer in the 3-stage group (15.9 months) than in the 2-stage group (11.7 months), but the difference was not statistically significant (p = 0.65). The cumulative incidences of tumor progression (21.6% vs 16.7% at 1 year, p = 0.31), neurological death (5.1% vs 6.0% at 1 year, p = 0.58), or serious radiation-related adverse events (3.0% vs 4.0% at 1 year, p = 0.49) did not differ significantly.CONCLUSIONSThis retrospective multi-institutional study showed no differences between 3-stage and 2-stage GKS in terms of overall survival, tumor progression, neurological death, and radiation-related adverse events. Both 3-stage and 2-stage GKS performed according to the aforementioned protocols are good treatment options in selected patients with large BMs.
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Kumagai, Koshi, Toshifumi Yamaguchi, Atsuo Takashima, Kengo Nagashima, Yosuke Kano, Masanori Terashima, Hiroshi Yabusaki, et al. "Comparison between S-1 monotherapy and S-1 plus cisplatin as postoperative chemotherapy after R0 resection for stage IV gastric cancer patients with oligometastasis: A multicenter retrospective study." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 123. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.123.
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123 Background: Gastric cancer (GC) with liver metastasis (M1: HEP) and para-aortic lymph node metastasis (M1: LYM) is categorized as stage IV. Based on the retrospective reports, surgical resection is weakly recommended for oligo-metastasis (O-Meta), if resectable, in the Japanese GC Treatment Guidelines 2018. Whereas S-1 monotherapy as adjuvant chemotherapy after surgery for stage II/III GC and S-1 plus cisplatin (SP) as palliative chemotherapy for unresectable stage IV GC are standard treatments, there is no consensus about post-operative chemotherapy (Post-Cx) after R0 resection of stage IV GC with O-Meta. Methods: The criteria for this retrospective study were: 1) no prior treatment for GC, 2) R0 resection including O-Meta (HEP or LYM) at 20 institutions in the Stomach Cancer Group of the Japan Clinical Oncology Group between 2007 and 2012, 3) histological confirmation of adenocarcinoma for primary tumor and O-Meta (M1: HEP or LYM), 4) no other distant metastasis such as peritoneal metastasis. Results: A total of 110 patients were collected. Of the 94 eligible patients, 84 patients underwent gastrectomy followed by Post-Cx with S-1 (S-1 group: n = 55), SP (SP group: n = 22) or others (Others group: n = 7), and 10 patients did not receive post-Cx (non-Cx group). Median age for the S-1, SP, Others and non-Cx groups were 66, 60, 61, and 79 years old. Sites of oligo-metastasis (HEP/LYM) was 21/34, 9/13, 2/5, and 7/3 in the S-1, SP, Others and non-Cx groups. The 3- / 5-year overall and relapse free survival (OS and PFS) rates of all the patients were 45.6/31.4% and 24.5/21.3%, respectively. Median OS was 28.5 and 36.5 months in the S-1 and SP groups (HR 0.99; 95% CI 0.54-1.82, p = 0.986). In multivariate analysis, no Post-Cx, over 70 years old were identified as the independent poor prognostic factor for OS (p < 0.05). Conclusions: R0 resection followed by Post-Cx for GC patients with O-Meta showed favorable survival, while there seems no additional benefit of cisplatin to S-1 alone.
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Matsuoka, Hiromichi, Katherine Clark, Belinda Fazekas, Shunsuke Oyamada, Linda Brown, Hiroto Ishiki, Yoshinobu Matsuda, et al. "Phase III, international, multicentre, double-blind, dose increment, parallel-arm, randomised controlled trial of duloxetine versus pregabalin for opioid-unresponsive neuropathic cancer pain: a JORTC-PAL16 trial protocol." BMJ Open 12, no. 2 (February 2022): e050182. http://dx.doi.org/10.1136/bmjopen-2021-050182.
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IntroductionManagement of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy (CIPN) has already been confirmed in two randomised controlled trials (RCTs) compared with placebo. Duloxetine offers the potential of analgesia in opioid refractory NCP. However, there are no RCT of duloxetine for the management of opioid-refractory NCP as a first line treatment. Both classes of drugs have the potential to reduce NCP, but there has been no head-to-head comparison for the efficacy and safety, especially given differing side effect profiles.Methods and analysisAn international, multicentre, double-blind, dose increment, parallel-arm, RCT is planned. Inclusion criteria include: adults with cancer experiencing NCP refractory to opioids; Brief Pain Inventory (BPI)-item 3 (worst pain) of ≥4; Neuropathic Pain on the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale of ≥12 despite of an adequate trial of regular opioid medication (≥60 mg/day oral morphine equivalent dose). Patients with CIPN are excluded.The study will recruit from palliative care teams (both inpatients and outpatients) in Japan and Australia. Participants will be randomised (1:1 allocation ratio) to duloxetine or pregabalin arm. Dose escalation is until day 14 and from day 14 to 21 is a dose de-escalation period to avoid withdrawal effects. The primary endpoint is defined as the mean difference in BPI item 3 for worst pain intensity over the previous 24 hours at day 14 between groups. A sample size of 160 patients will be enrolled between February 2020 and March 2023.Ethics and disseminationEthics approval was obtained at Osaka City University Hospital Certified Review Board and South Western Sydney Local Health District Human Research Ethics Committee. The results of this study will be submitted for publication in international journals and the key findings presented at international conferences.Trial registration numbersjRCTs051190097, ACTRN12620000656932.
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Ito, Takahiko, Yoshitaka Honma, Takahiro Miyamoto, Hidekazu Hirano, Hirokazu Shoji, Natsuko Okita, Satoru Iwasa, Atsuo Takashima, Ken Kato, and Narikazu Boku. "PS02.133: THE EFFICACY AND SAFETY OF S-1 MONOTHERAPY FOR RECURRENT OR METASTATIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA REFRACTORY OR INTOLERABLE TO PLATINUM PLUS 5-FU." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 158–59. http://dx.doi.org/10.1093/dote/doy089.ps02.133.
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Abstract Background Platinum plus 5-fluorouracil (FP) is recognized as the standard regimen of palliative chemotherapy for recurrent or metastatic esophageal squamous cell carcinoma (ESCC). Although taxane is widely selected for 2nd line regimen, other options are very limited. In Japan, S-1 is available for esophageal cancer. In this retrospective study, we evaluated the efficacy of S-1 monotherapy for recurrent or metastatic (advanced) ESCC refractory or intolerable to FP. Methods The subjects of this study were 11 patients with advanced ESCC who received S-1 after failure of FP. The endpoints evaluating efficacy were overall survival (OS), progression free survival (PFS), and overall response rate (ORR) in patients with target lesions (TLs). Results The characteristics of the subjects were: median age 69 years, PS (0/1) 5/6, number of prior chemotherapy regimens (1/2/3 ≥ ) 4/4/3. 9 patients were refractory and 2 were intolerant to prior FP. 9 patients had good control of the primary lesions. Only 2 patients received post-S-1 therapy. The median OS and PFS were 11.7and 3.0 months. Two of 9 patients with TLs, one refractory and the other intolerant to prior FP, achieved partial response (PR) while the remaining 7 patients showed progressive disease (ORR 22%). The other 2 patients without TLs showed nonCR/nonPD. Common treatment-related adverse events included grade 3 leukopenia for 1 patients (9.1%), but there were no serious cases. Conclusion ORR of 22% suggests modest activity of S-1 for advanced ESCC refractory or intolerable to platinum plus 5-FU (FP). However, more than half of the patients showed progressive disease. Future study exploring optimal patient selection for S-1 is warranted. Disclosure All authors have declared no conflicts of interest.
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Kobayashi, K., A. Tsuji, Y. Hata, S. Morita, and T. Horimi. "Retrospective study of the patients with unresectable gastric cancer (UNGC) who underwent a gastrectomy after receiving S-1 or S-1 combination chemotherapy (S-1+α)." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e15668-e15668. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e15668.
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e15668 Background: At the 2007 ASCO annual meeting, JCOG 9912 and the SPIRITS trial showed that S-1 (S) and CDDP/S-1 (S+P) therapy to now be an accepted standard chemotherapy for advanced and recurrent gastric cancer (ARGC). Today in Japan, S- 1+αincluding S+DTX, S+CPT-11 and S+PTX are the mainstay treatments for ARGC. There are some case reports of pts with UNGC who were operated on due to the good anti-tumor effect of S-1+α, however, no consensus for performing a gastrectomy after chemotherapy has yet been reached. This study aims to identify the factors which make it appropriate to perform a gastrectomy after S- 1+α and to examine the validity of this chemotherapeutic regimen in combination with surgery. Methods: Twenty-five chemo-naïve pts with UNGC who received S-1+α (excluding neo-adjuvant) between May 2005 and Dec. 2007 were retrospectively reviewed, using the RESIST, Kaplan-Meier method, and Japanese Classification of Gastric Carcinoma (Eng. ed.). Results: The characteristics were: mean age 62; sex: M/F=18/7; cancer status; locally advanced (L):11, distant metastasis (D):9, lymph node swelling ≥group 3 (N):12, and peritoneal dissemination (P):11. Treatment regimens; S:13, S+DTX:3, and S+P:9. The median number of courses was 5. RR was 56% (PR:14, SD:9, PD:2). MST was 780 days. Twelve pts underwent a gastrectomy. The reasons for performing an operation were downstaging (DOWN):8, and palliative (PAL):4 (anemia:2/passage disturbance:2). The features were DOWN (M/F=5/3/65 yrs/PR:8/L:6, D:0, N:4, P:3) and PAL (M/F=4/0/57 yrs/SD:4/L:1, D:3, N:1 P:1). The median PFS and mean OS were 445 days and 312 days, respectively. No significant difference was observed between DOWN and PAL regarding the PFS and OS. All PAL cases were free from painful symptoms. Three pts received a curative A resection. In addition, 8 pts experienced histological changes, in particular, one pt achieved Grade 3 (No viable tumor cells were found.). Ten pts received adjuvant chemotherapy. Nine pts are alive at this writing. Conclusions: The findings of this study suggest that the above described chemotherapeutic regimen combined with a second-look gastrectomy might therefore be a new potentially effective strategy for the treatment of UNGC. No significant financial relationships to disclose.
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Hasegawa, Hiroko, Tetsuya Iwasaki, Akio Ishihara, Yuko Sakakibara, Tomohumi Akasaka, Shoichi Nakazuru, Hisashi Ishida, Motohiro Hirao, and Eiji Mita. "Prognostic factor analysis in third-line chemotherapy for elderly patients with metastatic gastric cancer." Journal of Clinical Oncology 37, no. 4_suppl (February 1, 2019): 82. http://dx.doi.org/10.1200/jco.2019.37.4_suppl.82.
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82 Background: Recently, the proportion of elderly patients (pts) with metastatic gastric cancer (mGC) has increased in Japan. Survival benefits of salvage treatment after second-line chemotherapy (CTX) for mGC were shown in several prospective studies. However, the role of salvage treatment in elderly pts remains controversial. Methods: We reviewed 185 pts with mGC who received palliative CTX aged ≥ 70 years at our institution between April 2007 and March 2018. Eligibility criteria were as follows: PS 0-2, refractory to first-line and second-line CTX. The purpose of this study was to evaluate the clinicopathologic factors that affected overall survival for elderly pts with mGC, univariate and multivariate analyses were performed on the baseline factors at the beginning of third-line CTX. Results: Of all, 71 pts were eligible. Median age was 75 years (71-85). Median progression-free survival (PFS) and overall survival (OS) for third-line CTX were 3.2 and 7.5 months, respectively and an overall response rate and disease control rate were 4.2% and 43.7%, respectively. In univariate analysis, the following four factors were identified to have prognostic significance: performance status (PS) (ECOG 0–1 or 2), serum albumin level (< 3.5 or ≥ 3.5 g/dl), serum LDH level (≤ 240 or > 240 IU/l), PFS under second-line CTX (< 3 or ≥ 3 months). Multivariate analysis found three prognostic factors affecting poor survival following third-line CTX: PS of 2 (hazard ratio (HR) 8.89, 95% confidence interval (CI) 3.99–20.2; P = 0.001), serum LDH level > 240 IU/l (HR 2.75, 95% CI 1.48–5.05; P = 0.002) and median PFS under second-line CTX of < 3 months (HR 1.89, 95% CI 1.01–3.43; P = 0.045). A prognostic index was constructed, dividing pts into low- (0 factor), intermediate- (1-2 risk factors), or high- (3 risk factors) risk groups. Median OS for each group were 12.6, 6.0 and 3.0 months, respectively ( P < 0.001). Conclusions: This analysis suggests that some clinicopathologic factors might be helpful in identifying the subgroup of elderly pts most likely to benefit from third-line CTX for metastatic gastric cancer.
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Sharma, Anup, and Pradip Thapa. "Surgical Management of Gastric Cancer: An Institutional Experience." Journal of Nepalgunj Medical College 17, no. 2 (December 31, 2019): 82–85. http://dx.doi.org/10.3126/jngmc.v17i2.31662.
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Introduction: Gastric cancer (GC) is the second most common cause of cancer-related deaths causing about 800,000 deaths worldwide/year. In Nepal gastric cancer is the second common cancer among males after the lung cancer. Gastric cancer shows a wide variation in incidence worldwide, being highest in Korea and Japan. It is detected early due to the low threshold for upper gastrointestinal endoscopy and screening programs. In the rest of the world and particularly in developing countries, GC is advanced in most of the cases. Inspite of controversies in extent of resection and lymphadenectomy, surgery remains the gold standard treatment. The study was conducted to determine the outcome of the patients with gastric cancer.
Methods: The study was conducted in the department of surgery at Nepalgunj Medical College and Teaching Hospital Kohalpur from November 2015 to Dec 2018. Patients diagnosed with GC were studied. The patients with resectable disease underwent radical resection followed by adjuvant chemo-radiation as indicated. Patient’s demography, clinical presentation, stage of disease, types of surgery performed and survival were analysed.
Results: 58 patients were diagnosed with gastric cancer. The age ranged from 20-83 years with the mean of 61.26±11.28. Male to female ratio was 2.41: 1. The common clinical presentations were weight loss, anorexia and anemia, 17 (29.31%) had gastric outlet obstruction at initial presentation and 4 (6.89%) presented with perforation peritonitis. Antropyloric region was the commonest site of tumor location seen in 41 (70.68%). 7 (12.06%) patients had distant metastasis and 5 (8.62%) had ascites at presentation. Out of 58 patients, 43 (74.13%) were operated. Only 18 (41.86%) patients underwent R0 resection. 14 (24.13%) underwent palliative gastrojejunostomy. Two (3.44%) patients underwent primary repair for perforation and in 9 (15.51%) the procedure was abandoned due to and presence of metastasis. There was one post-operative mortality. The histology of gastric cancer was found to be adenocarcinoma in all patients. There was no patient in stage I. 3(16.66%) patients were in stage II and 15 (83.33%) in stage III. 17 (29.31%) had stage IV disease. Out of 43 operated patients, 13 lost follow up. All 17 resected patients and those with metastatic disease were followed up. There was no death and no local recurrence in stage II. In stage III, 78.57% were alive and in stage IV 35.29% were alive.
Conclusion: Gastric cancer is one of the common gastrointestinal malignancies affecting predominantly male gender. Stage of the disease is one of the major prognostic factors related with the survival. Adenocarcinoma is the commonest histology. Radical resection followed by adjuvant chemotherapy is the standard of care. Palliative chemotherapy can prolong the overall survival in patients with metastatic disease.
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Sahu, Upasana, Matthew P. Mullarkey, Bangxing Hong, and Balveen Kaur. "Abstract LB020: PTEN-L expressing HSV induces glioma stem cell differentiation and sensitizes glioblastoma to radiation in mice." Cancer Research 82, no. 12_Supplement (June 15, 2022): LB020. http://dx.doi.org/10.1158/1538-7445.am2022-lb020.
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Abstract GBM, a WHO classified Grade IV glioma, is one of the most lethal and heterogeous primary brain tumors with inevitable recurrence, limiting the median survival time less than 21 months. Current standard-of-care treatment including surgical resection followed by chemo- and radio-therapy remains palliative because of therapy resistance, majorly conferred by GBM stem cells (GSCs), leading to tumor recurrence. With no current effective treatments, novel approaches to overcome GSCs-mediated resistance to chemotherapy and irradiation are urgently required in order to achieve long-term success in GBM therapy. Oncolytic viral (OV) therapy represents a novel and promising biological therapy for solid tumor that preferentially targets tumor cells for lytic destruction, sparing the healthy cells and in the process activating host anti-tumor immune response. Among all OVs, oncolytic Herpes Simplex Virus (oHSV) is substantially ahead in the clinic, with an oHSV T-VEC approved by the FDA for metastatic melanoma treatment. Recently, G47∆, another HSV1 virus, has been granted conditional approval for the treatment of GBM in Japan. Further, several other oHSVs including G207 and HSV1716 are currently being tested for safety and efficacy against GBM. This has fueled great expectations towards OVs as a promising alternative to conventional therapies. Our group has previously shown that PTENα expression by an oHSV (HSV-P10) resulted in further improved long-term survivors in intracranial tumor-bearing mice compared to HSVQ treatment. Here we aim to dissect the molecular mechanisms associated with improved therapeutic efficacy of HSV-P10 against GBM, and if HSV-P10 can overcome GBM cell radioresistance. The RNA sequencing and GSEA analyses of primary human GBM cells infected with control HSVQ or HSV-P10 reveals that while HSVQ virus infection leads to an increase in genes regulating IL6-STAT3 pathway, pivotal in maintaining stemness properties, HSV-P10 infection causes a reduction in the genes regulating this pathway. As a consequence, HSV-P10 reduces CD133+/CD44+ stem cell fraction, induces DNA damage and sensitizes the GBM cells to irradiation. Our findings reveal a novel mechanism induced by HSV-P10 in combination with irradiation whereby HSV-P10 modulates IL6-STAT3 signaling downregulating Sox2, a core transcription factor in the maintenance of GSCs, with a simultaneous decrease in Nestin expression and enhanced GFAP expression promoting GSC differentiation. HSV-P10 infection in combination with irradiation reduces GSC tumor sphere formation in vitro and sensitizes GBMs to radiotherapy in an intracranial mouse xenograft model. Collectively, our findings provide a potential avenue to overcome GSC-mediated therapy resistance to improve the therapeutic efficacy for GBM patients. Citation Format: Upasana Sahu, Matthew P. Mullarkey, Bangxing Hong, Balveen Kaur. PTEN-L expressing HSV induces glioma stem cell differentiation and sensitizes glioblastoma to radiation in mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB020.
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Saito, Shin, Yoshinori Hosoya, Takashi Ui, Joji Kitayama, Rihito Kanamaru, Hidenori Haruta, Kentaro Kurashina, Shiro Matsumoto, Naohiro Sata, and Alan Lefor. "PS02.150: SEVEN PATIENTS WITH GASTRIC-TUBE CANCER AFTER ESOPHAGECTOMY." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 163–64. http://dx.doi.org/10.1093/dote/doy089.ps02.150.
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Abstract Background The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). The incidence of gastric tube cancer after esophagectomy has been reported to be 1.3–6.3% in Japan. Patients with early stage gastric tube cancer can be treated by endoscopic resection, however patients with advanced gastric tube cancer need to undergo the resection of the gastric tube. Methods A total of 497 patients underwent esophagectomy with gastric tube reconstruction between 2001 and 2015 at our institution. During the same period, gastric tube cancer was detected in seven patients including three by endoscopic submucosal dissection (ESD) and three by surgery. We investigated the clinicopathological study of these seven patient with gastric tube cancer. Results The incidence of gastric tube cancer was 1.4% (7/497) at our hospital. Average age was 73 years old (range, 62–84). Six patients were men and one was women. Average interval from esophagectomy to initial treatment was 78.3 ± 61.0 (months). Among seven patients with gastic tube cancer, three were treated by ESD and 3 underwent surgery. One patient went to a palliative therapy. All seven patient with gastric tube cancer, who didn’t have specific complains, were detected by regular upper gastrointestinal endoscopy. We observed a very high proportion of patients with H. pylori infection (at least five patients among seven). Conclusion ESD for gastric tube cancer after esophagectomy is a technically difficult procedure because of the limited working space and unusual fluid-pooling area in the reconstructed gastrictube as well as the presence of severe gastric fibrosis with staples under the suture line. A highly skilled endoscopist can perform the procedure successfully. An operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and video scope-assisted surgery enabled the resection of gastric tube without performing a sternotomy. Disclosure All authors have declared no conflicts of interest.
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Sharma, Shubham, Connor Wells, Joey C. Del Paggio, Wilma M. Hopman, Bishal Gyawali, C. S. Pramesh, Richard Sullivan, and Christopher M. Booth. "Methodology, results, and publication of oncology clinical trials: Insights from all the world’s randomized controlled trials (RCTs) 2014-2017." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 2019. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2019.
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2019 Background: Clinical cancer research is now a global effort. Most published overviews of oncology trials are restricted to a specific disease site or cohort of high-profile journals. Here we describe authorship, trial characteristics, design, and results of all oncology RCTs published globally during 2014-2017. Methods: A structured literature search was designed using PUBMED to identify all RCTs evaluating anti-cancer therapies published during 2014-2017. Data were captured regarding authorship, participants, study characteristics, design, and results. Among superiority RCTs that met the primary endpoint (i.e. statistically “positive”), we calculated the ESMO-MCBS to identify trials with substantial clinical benefit (MCBS scores 4/5 or A/B). Outcomes were compared with Chi Square or Fisher’s Exact tests. Results: The study cohort included 694 RCTs. The most common cancers evaluated were breast (17%, 121/694), lung (15%, 104/694) and colorectal (8%, 58/694). Treatment intent was curative, adjuvant/neoadjuvant, and palliative in 10% (68/694), 25% (176/694), and 65% (448/694) of trials respectively. Median sample size was 443 (IQR 246-718). Seventy percent (488/694) of RCTs were supported by industry; 87% (601/694) of experimental arms tested systemic therapy. Ninety-two percent (636/694) of RCTs were led by investigators in 28 high-income countries; the most common countries leading these trials were US (27%, 174/636), France (10%, 64/636), Germany (10%, 62/636), Japan (9%, 59/636), and UK (9%, 57/636). The most common primary endpoints were PFS (32%, 220/694), OS (31%, 215/694), and DFS (11%, 79/694); Forty-six percent of all trials (318/694) met their primary endpoint. Among superiority trials with “positive” results, 33% met ESMO-MCBS threshold for substantial clinical benefit. The median impact factor (IF) of journals which published the overall study cohort of trials was 21 (IQR 7-27); trials meeting their primary endpoint were published in higher profile journals (median IF 25 vs 18, p < 0.001). Conclusions: At the global level, oncology clinical trials are dominated by high-income countries and study diseases which do not necessarily reflect the global burden of cancer. The vast majority of trials are funded by industry and only one third of “positive” trials meet ESMO-MCBS threshold for substantial clinical benefit.
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Taga, Takashi, Akiko Saito, Kazuko Kudo, Daisuke Tomizawa, Kiminori Terui, Hiroshi Moritake, Akitoshi Kinoshita, et al. "Refractory / Relapsed Myeloid Leukemia of Down Syndrome Is Resistant to Second-Line Chemotherapy and Hardly Salvaged by Hematopoietic Stem Cell Transplantation: A Retrospective Study by the Japanese Pediatric Leukemia / Lymphoma Study Group (JPLSG)." Blood 118, no. 21 (November 18, 2011): 4276. http://dx.doi.org/10.1182/blood.v118.21.4276.4276.
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Abstract Abstract 4276 Introduction: Myeloid leukemia in Down syndrome patients (ML-DS) is known to have good sensitivity against cytotoxic agents, especially to cytarabine, and outcomes in recent clinical trials are favorable with more than 80 % probability of long-term event-free survival (EFS). However, little have been focused on refractory / relapsed cases, since most of the treatment failures consist of toxicities rather than resistant or recurrent leukemia. We present here a retrospective analysis of the patients with refractory / relapsed ML-DS. Patients and Method: Among the ML-DS patients diagnosed between 2000 and 2011 at the 120 hospitals in Japan, twenty-nine refractory / relapsed patients were enrolled in this retrospective study. Result: Median follow-up period for all 29 patients was 10.9 months (range, 2.8 –76.7 months). Male/Female ratio was 18/11. The age at initial diagnosis for ML-DS was between 7 months and 16 years old (median, 2 years old). All the patients were initially treated with one of the protocols specifically designed for ML-DS; twenty patients with AML99 Down protocol, eight with JPLSG AML-D05 protocol, and one with JCCLSG AML9805 Down protocol. There were 3 induction failures and 26 relapsed cases. Among the 26 relapsed cases, duration from initial diagnosis to relapse was 2.4 month to 71.8 months (median 8.6 months); Twenty-eight relapsed at bone marrow and one patient relapsed at skin site. Twenty-six out of the 29 patients received various re-induction chemotherapies and 13 of them achieved complete remission (CR). Eight of the 13 patients with CR subsequently received allogeneic stem cell transplantation (SCT) and 4 survived. On the other hand, five of the 13 cases with CR were treated with chemotherapy alone, and 4 were alive with no evidence of leukemia. All the 12 patients who failed to achieve CR and the 2 patients who only received palliative therapy eventually died. The 3-year overall survival rate was 22.6 ± 8.8 %. Achievement of CR with second-line chemotherapy and longer duration from initial diagnosis to relapse were significant favorable prognostic factors. SCT did not influence the prognosis even if performed after achieving further remission. Conclusion: The Japanese strategy treating ML-DS have been successful with very low-intensive chemotherapy regimen, however, rescue of refractory / relapsed patients with ML-DS seems difficult even with SCT. No relevant conflicts of interest to declare. Disclosures: No relevant conflicts of interest to declare.