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Huang HL, Chen PJ, Mori M, Suh SY, Wu CY, Peng JK, Shih CY, Yao CA, Tsai JS, Chiu TY, Hiratsuka Y, Kim SH, Morita T, Yamaguchi T, Tsuneto S, Hui D, Cheng SY. Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study. Oncologist 2024; 29:e553-e560. [PMID: 37758042 PMCID: PMC10994251 DOI: 10.1093/oncolo/oyad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. METHODS This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. RESULTS Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores. CONCLUSIONS Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Family Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
| | - Chien-Yi Wu
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Republic of China
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chih-Yuan Shih
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
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Amano K, Okamura S, Baracos VE, Mori N, Sakaguchi T, Uneno Y, Hiratsuka Y, Hamano J, Miura T, Ishiki H, Yokomichi N, Hatano Y, Morita T, Mori M. Impacts of fluid retention on prognostic abilities of cachexia diagnostic criteria in cancer patients with refractory cachexia. Clin Nutr ESPEN 2024; 60:373-381. [PMID: 38479937 DOI: 10.1016/j.clnesp.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS The international cancer cachexia criteria with a cutoff of 5% weight loss (WL) was proposed in Western patients. The Asian Working Group for Cachexia (AWGC) developed new criteria in Asian patients. The AWGC criteria are not cancer-specific and employ a cutoff of 2% WL. However, it is unclear whether both criteria are useful in patients with very advanced cancer because WL can be underestimated owing to fluid retention. Therefore, this study aimed to investigate the impacts of fluid retention on the prognostic abilities of both criteria in cancer patients with weeks of survival. METHODS This study involved a secondary analysis of a prospective cohort study. The inclusion criteria constrained the study to adult patients with advanced cancer. Patients were divided into Non-cachexia and Cachexia groups using the international criteria and AWGC criteria. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests, and by conducting univariate and multivariate Cox regression analyses. RESULTS A total of 402 patients were included in the analysis. Using the international criteria, the p-values for the log-rank test and stratified log-rank test for the mixed patients with and without fluid retention were 0.55 and 0.18, respectively. Using the AWGC criteria, the p-values for the log-rank test and stratified log-rank test for the mixed patients with and without fluid retention were 0.38 and 0.12, respectively. Without considering the impacts of fluid retention, no significant differences were observed between the Non-cachexia and Cachexia groups for both criteria. After adjusting for the status of fluid retention, significantly higher risks of mortality were not observed in the Cox proportional hazard model for the Cachexia group compared with the Non-cachexia group, for both criteria. However, significant associations were observed between fluid retention and overall survival. CONCLUSIONS The international criteria and AWGC criteria lost their prognostic abilities in cancer patients with weeks of survival. Since measurements of %WL were significantly confounded by fluid retention, fluid retention-adjusted criteria for cachexia need to be developed for cancer patients with refractory cachexia.
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Affiliation(s)
- Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan.
| | - Satomi Okamura
- Department of Medical Innovation, Osaka University Hospital, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G1Z2, Canada.
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
| | - Tatsuma Sakaguchi
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8315, Japan.
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Jun Hamano
- Department of Palliative and Supportive Care, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu, Shizuoka 433-8558, Japan.
| | - Yutaka Hatano
- Department of Palliative Care, Kyowakai Medical Corporation, Daini Kyoritsu Hospital, 5-28 Sakaemachi, Kawanishi, Hyogo 666-0033, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu, Shizuoka 433-8558, Japan.
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Chuo-ku, Hamamatsu, Shizuoka 433-8558, Japan.
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Amano K, Okamura S, Baracos V, Mori N, Sakaguchi T, Uneno Y, Hiratsuka Y, Hamano J, Miura T, Ishiki H, Yokomichi N, Hatano Y, Morita T, Mori M. Fluid retention and weight loss in refractory cancer cachexia. BMJ Support Palliat Care 2024:spcare-2024-004820. [PMID: 38395597 DOI: 10.1136/spcare-2024-004820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES It is unknown to what extent the fluid retention (FR) status disrupts the detection of weight loss rate (WLR) in adult patients with advanced cancer. This study aimed to determine the association of FR status with WLR. METHODS This study was a secondary analysis of a prospective cohort study. FR was evaluated as follows: oedema (0, no; 1, yes), pleural effusion (0, no; 1, yes but asymptomatic; 2, symptomatic) and ascites (0, no; 1, yes but asymptomatic; 2, symptomatic). Patients were divided into three groups according to their FR scores: no-FR (0), moderate-FR (1-2) and high-FR (3-5). Multiple regression analysis was performed. RESULTS Four hundred and twenty patients were categorised: no-FR group (n=164), moderate-FR group (n=158) and high-FR group (n=98). The prevalence of oedema, pleural effusion and ascites was 63.9%, 27.8% and 36.7% in the moderate-FR group, and 93.9%, 61.3% and 82.6% in high-FR group. The means of WLR were 9.2, 8.4 and 3.8 in the groups. The high-FR group and the FR score of 5 were correlated with WLR (estimate -4.71, 95% CI -7.84 to -1.58; estimate -10.29, 95% CI -17.84 to -2.74). CONCLUSIONS The coexistence of FR was significantly correlated with WLR.
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Affiliation(s)
- Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, Suita, Japan
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Satomi Okamura
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Vickie Baracos
- Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Aichi Medical University, Nagakute, Japan
| | - Tatsuma Sakaguchi
- Department of Palliative and Supportive Medicine, Aichi Medical University, Nagakute, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Kyoto University, Kyoto, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, University of Tsukuba, Tsukuba, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Naosuke Yokomichi
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Ohinata H, Aoyama M, Hiratsuka Y, Mori M, Kikuchi A, Tsukuura H, Matsuda Y, Suzuki K, Kohara H, Maeda I, Morita T, Miyashita M. Symptoms, performance status and phase of illness in advanced cancer: multicentre cross-sectional study of palliative care unit admissions. BMJ Support Palliat Care 2024; 13:e1174-e1180. [PMID: 36302613 DOI: 10.1136/spcare-2022-003806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To clarify the relationship between Phase of Illness at the time of admission to palliative care units and symptoms of patients with advanced cancer. METHODS This study was a secondary analysis of the East Asian collaborative cross-cultural Study to Elucidate the Dying process. Palliative physicians recorded data, including Phase of Illness, physical function and the Integrated Palliative care Outcome Scale. We used multinomial logistic regression to analyse ORs for factors associated with Phase of Illness. Twenty-three palliative care units in Japan participated from January 2017 to September 2018. RESULTS In total, 1894 patients were analysed-50.9% were male, mean age was 72.4 (SD±12.3) years, and Phase of Illness at the time of admission to the palliative care unit comprised 177 (8.9%) stable, 579 (29.2%) unstable, 921 (46.4%) deteriorating and 217 (10.9%) terminal phases. Symptoms were most distressing in the terminal phase for all items, followed by deteriorating, unstable and stable (p<0.001). The stable phase had lower association with shortness of breath (OR 0.73, 95% CI 0.57 to 0.94) and felt at peace (OR 0.73, 95% CI 0.56 to 0.90) than the unstable phase. In the deteriorating phase, weakness or lack of energy (OR 1.20, 95% CI 1.02 to 1.40) were higher, while drowsiness (OR 0.82, 95% CI 0.71 to 0.97) and felt at peace (OR 0.81, 95% CI 0.71 to 0.94) were significantly lower. CONCLUSION Our study is reflective of the situation in palliative care units in Japan. Future studies should consider the differences in patients' medical conditions and routinely investigate patients' Phase of Illness and symptoms. TRIAL REGISTRARION NUMBER UMIN000025457.
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Affiliation(s)
- Hironori Ohinata
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Nursing, International University of Health and Welfare, Narita, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University, Sendai, Japan
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Ayako Kikuchi
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Yosuke Matsuda
- Department of Palliative Medicine, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan
| | - Hiroyuki Kohara
- Department of General Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tagami K, Chiu SW, Kosugi K, Ishiki H, Hiratsuka Y, Shimizu M, Mori M, Kubo E, Ikari T, Arakawa S, Eto T, Shimoda M, Hirayama H, Nishijima K, Ouchi K, Shimoi T, Shigeno T, Yamaguchi T, Miyashita M, Morita T, Inoue A, Satomi E. Cancer Pain Management in Patients Receiving Inpatient Specialized Palliative Care Services. J Pain Symptom Manage 2024; 67:27-38.e1. [PMID: 37730073 DOI: 10.1016/j.jpainsymman.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
CONTEXT Cancer pain is a common complication that is frequently undertreated in patients with cancer. OBJECTIVES This study is aimed at assessing the time needed to achieve cancer pain management goals through specialized palliative care (SPC). METHODS This was a multicenter, prospective, longitudinal study of inpatients with cancer pain who received SPC. Patients were continuously followed up until they considered cancer pain management successful, and we estimated this duration using the Kaplan-Meier method. We investigated the effectiveness of pain management using multiple patient-reported outcomes (PROs) and quantitative measures, including pain intensity change in the Brief Pain Inventory. A paired-sample t-test was used to compare the pain intensity at the beginning and end of the observation period. RESULTS Cancer pain management based on the PROs was achieved in 87.9% (385/438) of all cases. In 94.5% (364/385) of these cases, cancer pain management was achieved within 1 week, and the median time to pain management was 3 days (95% confidence interval [CI], 2-3). The mean worst pain intensity in the last 24 h at the start and end of observation were 6.9 ± 2.2 and 4.0 ± 2.3, respectively, with a difference of -2.9 (95% CI, -3.2 to -2.6; p < 0.01). Overall, 81.6% of the patients reported satisfaction with cancer pain management, and 62 adverse events occurred. CONCLUSION SPC achieved cancer pain management over a short period with a high level of patient satisfaction resulting in significant pain reduction and few documented adverse events.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Shih-Wei Chiu
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizu Wakamatsu, Fukushima, Japan
| | - Masaki Shimizu
- Department of Palliative Care (M.S.), Kyoto-Katsura Hospital, Nishikyo-ku, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Emi Kubo
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Sayaka Arakawa
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Eto
- Department of Palliative Medicine (K.K., E.K., T.E.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mayu Shimoda
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hideyuki Hirayama
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Kaoru Nishijima
- Department of Palliative Care (K.N.), Kyowakai Medical Corporation, Daini Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Kota Ouchi
- Department of Medical Oncology (K.O.), Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology (T.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Shigeno
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics (S-W.C., M.S., T.Y.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing (H.H., T.S., M.M.), Tohoku University Graduate School of Medicine, Aoba-Ku, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (M.M., T.M.), Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan; Research Association for Community Health (T.M.), Hamamatsu, Shizuoka, Japan
| | - Akira Inoue
- Department of Palliative Medicine (K.T., Y.H., T.I., A.I.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (H.I., S.A., E.S.), National Cancer Center Hospital, Tokyo, Japan
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Hiratsuka Y, Suh SY, Yoon SJ, Choi SE, Kim SH, Hui D, Cheng SY, Huang HL, Chen PJ, Peng JK, Mori M, Yamaguchi T, Maeda I, Tsuneto S, Morita T. How different are accuracies of clinicians' prediction of survival by assessment methods? Ann Palliat Med 2024; 13:49-56. [PMID: 38124473 DOI: 10.21037/apm-23-393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND No standardized method has been established for evaluating the accuracy of a clinicians' prediction of survival (CPS). Till now, no study has compared the accuracy of CPS according to the evaluation methods using the same dataset. We aimed to examine the accuracy of CPS by different statistical approaches in patients with far-advanced cancer. METHODS The current study was a secondary analysis of an international multicenter prospective cohort study. Newly admitted patients with advanced cancer were enrolled in palliative care units (PCUs) in Japan, Korea, and Taiwan. We obtained the temporal CPS at enrollment. The patients were classified into groups of days (≤7 days) and weeks (≤30 days) based on CPS and actual survival (AS). We evaluated the accuracy of CPS by the distribution, area under the receiver operating characteristics curve (AUROCs), and an estimate ±33% of AS. RESULTS A total of 2,571 patients were assessed and admitted in 37 PCUs between January 2017 and September 2018. As for the "days" category, the distribution of AS is larger than that of CPS, however, the results are reversed in the "weeks" category. The AUROCs showed over 80% discrimination for both the "days" and "weeks" categories. Accurate CPS within ±33% of AS was approximately 30% in both "days" and "weeks" categories. CONCLUSIONS We showed a discrepancy of approximately 30-80% in the accuracy of CPS among three different analysis methods: distribution, AUROC, and AS comparison. Considering the low accuracy of AS comparisons, clinicians should provide a wide range of survival time. CPS was able to effectively discriminate and may be useful for risk stratification.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Seok Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Sun Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Hiratsuka Y, Suh SY, Yoon SJ. Comparison of Simplified Palliative Prognostic Index and Palliative Performance Scale in Patients with Advanced Cancer in a Home Palliative Care Setting. J Palliat Care 2023:8258597231214896. [PMID: 38115739 DOI: 10.1177/08258597231214896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Objective: The Palliative Performance Scale (PPS) has been reported to be as accurate as Palliative Prognostic Index (PPI). PPS is a component of the simplified PPI (sPPI). It is unknown whether PPS is as accurate as sPPI. This study aimed to compare the prognostic performance of the PPS and sPPI in patients with advanced cancer in a home palliative care setting in South Korea. Methods: This was a secondary analysis of a prospective cohort study that included Korean patients with advanced cancer who received home-based palliative care. We used the medical records maintained by specialized palliative care nurses. We computed the prognostic performance of PPS and sPPI using the area under the receiver operating characteristic curve (AUROC) and calibration plots for the 3- and 6-week survival. Results: A total of 80 patients were included, with a median overall survival of 47.0 days. The AUROCs of PPS were 0.71 and 0.69 at the 3- and 6-week survival predictions, respectively. The AUROCs of sPPI were 0.87 and 0.73 at the 3- and 6-week survival predictions, respectively. The calibration plot demonstrated satisfactory agreement across all score ranges for both the PPS and sPPI. Conclusions: This study showed that the sPPI assessed by nurses was more accurate than the PPS in a home palliative care setting in predicting the 3-week survival in patients with advanced cancer. The PPS can be used for a quick assessment.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Seok Joon Yoon
- Department of Family Medicine and Hospice-Palliative Care Team, Chungnam National University Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea
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8
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Hiratsuka Y, Tagami K, Inoue A, Sato M, Matsuda Y, Kosugi K, Kubo E, Natsume M, Ishiki H, Arakawa S, Shimizu M, Yokomichi N, Chiu SW, Shimoda M, Hirayama H, Nishijima K, Ouchi K, Shimoi T, Shigeno T, Yamaguchi T, Miyashita M, Morita T, Satomi E. Prevalence of opioid-induced adverse events across opioids commonly used for analgesic treatment in Japan: a multicenter prospective longitudinal study. Support Care Cancer 2023; 31:632. [PMID: 37843639 PMCID: PMC10579154 DOI: 10.1007/s00520-023-08099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Although opioids have been shown to be effective for cancer pain, opioid-induced adverse events (AEs) are common. To date, little is known about the differences in risks of AEs by opioid type. This study was performed to compare the prevalence of AEs across opioids commonly used for analgesic treatment in Japan. METHODS This study was conducted as a preplanned secondary analysis of a multicenter prospective longitudinal study of inpatients with cancer pain who received specialized palliative care for cancer pain relief. We assessed daily AEs until termination of follow-up. We rated the severity of AEs based on the Common Terminology Criteria for Adverse Events version 5.0. We computed adjusted odds ratios for each AE (constipation, nausea and vomiting, delirium, and drowsiness) with the following variables: opioid, age, sex, renal dysfunction, and primary cancer site. RESULTS In total, 465 patients were analyzed. Based on the descriptive analysis, the top four most commonly used opioids were included in the analysis: oxycodone, hydromorphone, fentanyl, and tramadol. With respect to the prevalence of AEs among all analyzed patients, delirium (n = 25, 6.3%) was the most frequent, followed by drowsiness (n = 21, 5.3%), nausea and vomiting (n = 19, 4.8%), and constipation (n = 28, 4.6%). The multivariate logistic analysis showed that no single opioid was identified as a statistically significant independent predictor of any AE. CONCLUSION There was no significant difference in the prevalence of AEs among oxycodone, fentanyl, hydromorphone, and tramadol, which are commonly used for analgesic treatment in Japan.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mamiko Sato
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasufumi Matsuda
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Emi Kubo
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Maika Natsume
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Sayaka Arakawa
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Masaki Shimizu
- Department of Palliative Care, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shih-Wei Chiu
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mayu Shimoda
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideyuki Hirayama
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Nishijima
- Department of Palliative Care, Kyowakai Medical Corporation, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Kota Ouchi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Shigeno
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- Research Association for Community Health, Hamamatsu, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
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9
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Yoon SJ, Suh SY, Hiratsuka Y, Choi SE, Kim SH, Koh SJ, Park SA, Seo JY, Kwon JH, Park J, Park Y, Hwang SW, Lee ES, Ahn HY, Cheng SY, Chen PJ, Yamaguchi T, Tsuneto S, Mori M, Morita T. Validation of Modified Models of Objective Prognostic Score in Patients With Advanced Cancer. J Palliat Med 2023; 26:1064-1073. [PMID: 37200448 DOI: 10.1089/jpm.2022.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Background: The objective prognostic score (OPS) needs to be modified to reflect practical palliative care circumstances. Objectives: We aimed to validate modified models of OPS with few or no laboratory tests for patients with advanced cancer. Design: An observational study was performed. Setting/Subjects: A secondary analysis of an international, multicenter cohort study of patients in East Asia was performed. The subjects were inpatients with advanced cancer in the palliative care unit. Measurements: We developed two modified OPS (mOPS) models to predict two-week survival: mOPS-A consisted of two symptoms, two objective signs, and three laboratory results, while mOPS-B consisted of three symptoms, two signs, and no laboratory data. We compared the accuracy of the prognostic models using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Calibration plots for two-week survival and net reclassification indices (NRIs) were compared for the two models. Survival differences between higher and lower score groups of each model were identified by the log-rank test. Results: We included a total of 1796 subjects having median survival of 19.0 days. We found that mOPS-A had higher specificity (0.805-0.836) and higher AUROCs (0.791-0.797). In contrast, mOPS-B showed higher sensitivity (0.721-0.725) and acceptable AUROCs (0.740-0.751) for prediction of two-week survival. Two mOPSs showed good concordance in calibration plots. Considering NRIs, replacing the original OPS with mOPSs improved overall reclassification (absolute NRI: 0.47-4.15%). Higher score groups of mOPS-A and mOPS-B showed poorer survival than those of lower score groups (p < 0.001). Conclusions: mOPSs used reduced laboratory data and had relatively good accuracy for predicting survival in advanced cancer patients receiving palliative care.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Shin Ae Park
- Hospice and Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Ji-Yeon Seo
- Hospice and Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
| | - Youngmin Park
- Department of Family Medicine, Hospice and Palliative Care Center, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang-si, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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10
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Yang CH, Chen PJ, Mori M, Morita T, Cheng SY, Suh SY, Kim SH, Yokomichi N, Imai K, Ito S, Yamaguchi T, Hiratsuka Y, Tsuneto S, Maeda S. Cross-cultural comparison of continuous deep sedation for advanced cancer patients in East Asian countries: prospective cohort study. Jpn J Clin Oncol 2023:7145896. [PMID: 37114920 DOI: 10.1093/jjco/hyad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Cultural, social, and legal factors have been known to affect physicians' practice of continuous deep sedation. There have been few quantitative studies to compare continuous deep sedation practice in Asian countries. We aimed to describe and compare clinical characteristics of continuous deep sedation in Japan, Korea and Taiwan. METHODS Patients with advanced cancer admitted to participating palliative care units were enrolled from January 2017 to September 2018. We evaluated and compared (i) the prevalence of continuous deep sedation, (ii) the characteristics of sedated and non-sedated groups in each country, and (iii) continuous deep sedation administration patterns among the three countries. RESULTS A total of 2158 participants were included in our analysis, and 264 received continuous deep sedation. The continuous deep sedation prevalence was 10, 16 and 22% in Japan, Korea and Taiwan, respectively. Delirium was the most frequent target symptom in all countries, along with dyspnoea (in Japan) and psychological symptoms (in Korea). Midazolam was most frequently used in Japan and Taiwan, but not in Korea (P < 0.001). Among the patients receiving continuous deep sedation, the hydration amount on the final day was significantly different, with median volumes of 200, 500 and 0 mL in Japan, Korea and Taiwan, respectively (P < 0.001). In Korea, 33% of the continuous deep sedation administration caused a high degree of physicians' discomfort, but 3% in Japan and 5% in Taiwan (P < 0.001). CONCLUSIONS Clinical practices of continuous deep sedation and physicians' discomfort related to continuous deep sedation initiation highly varied across countries. We need to develop optimal decision-making models of continuous deep sedation and hydration during continuous deep sedation in each country.
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Affiliation(s)
- Chiu-Hsien Yang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoko Ito
- Hospice, The Japan Baptist Hospital, Kyoto, Japan
| | - Takashi Yamaguchi
- Division of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Maeda
- Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
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11
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Lee ES, Hiratsuka Y, Suh SY, Won SH, Kim SH, Yoon SJ, Choi SE, Choi H, Ahn HY, Kim Y, Hui D, Cheng SY, Chen PJ, Wu CY, Mori M, Morita T, Yamaguchi T, Tsuneto S. Clinicians' Prediction of Survival and Prognostic Confidence in Patients with Advanced Cancer in Three East Asian Countries. J Palliat Med 2023. [PMID: 36888535 DOI: 10.1089/jpm.2022.0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background: Little is known about accuracy and confidence of clinicians' prediction of survival (CPS) in East-Asian countries. Objective: We aimed to examine accuracy of CPS for 7-, 21-, and 42-day survival in palliative inpatients and its association with prognostic confidence. Design: An international prospective cohort study in Japan (JP), Korea (KR), and Taiwan (TW). Setting/Subjects: Subjects were inpatients with advanced cancer admitted to 37 palliative care units in three countries. Measurements: Discrimination of CPS was investigated through sensitivity, specificity, overall accuracy, and area under the receiver operating characteristics curves (AUROCs) according to 7-, 21-, and 42-day survival. The accuracies of CPS were compared with those of Performance Status-based Palliative Prognostic Index (PS-PPI). Clinicians were instructed to rate confidence level on a 0-10-point scale. Results: A total of 2571 patients were analyzed. The specificity was highest at 93.2-100.0% for the 7-day CPS, and sensitivity was highest at 71.5-86.8% for the 42-day CPS. The AUROCs of the seven-day CPS were 0.88, 0.94, and 0.89, while those of PS-PPI were 0.77, 0.69, and 0.69 for JP, KR, and TW, respectively. As for 42-day prediction, sensitivities of PS-PPI were higher than those of CPS. Clinicians' confidence was strongly associated with the accuracy of prediction in all three countries (all p-values <0.01). Conclusions: CPS accuracies were highest (0.88-0.94) for the seven-day survival prediction. CPS was more accurate than PS-PPI in all timeframe prediction except 42-day prediction in KR. Prognostic confidence was significantly associated with the accuracy of CPS.
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Affiliation(s)
- Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, Inje University, College of Medicine, Goyang, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea.,Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Hana Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Yoonjoo Kim
- Department of Nursing, College of Healthcare Science, Far East University, Eumseong-gun, Chungcheongbuk-do, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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12
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Hiratsuka Y, Hamano J, Mori M, Maeda I, Morita T, Suh SY. Prediction of Survival in Patients with Advanced Cancer: A Narrative Review and Future Research Priorities. J Hosp Palliat Care 2023; 26:1-6. [PMID: 37753320 PMCID: PMC10519719 DOI: 10.14475/jhpc.2023.26.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Hamano
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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13
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Hiratsuka Y, Oishi T, Miyashita M, Morita T, Mack JW, Imai H, Mori T, Sakayori M, Mori M, Maeda I, Hamano J, Ishioka C, Inoue A. Prognostic awareness in Japanese patients with advanced cancer: a follow-up cohort study. Jpn J Clin Oncol 2023; 53:410-418. [PMID: 36647604 DOI: 10.1093/jjco/hyad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with advanced cancer have been reported to be more likely to receive goal-concordant care if they have accurate prognostic awareness. However, many patients do not have this awareness. This study aimed to examine the prognostic awareness among Japanese patients with advanced cancer. METHODS This single-center, follow-up cohort study included Japanese patients with advanced cancer who received chemotherapy at Tohoku University Hospital between January 2015 and January 2016. Patients were surveyed at enrollment and followed up for clinical events for 5 years thereafter. We compared (i) the patients' prognostic awareness with both actual survival time and physician's prediction of survival and (ii) physician's prediction of survival time with actual survival. Factors associated with accurate prognostic awareness were identified by univariate analysis. RESULTS Of the 133 patients eligible for the study, 57 patients were analyzed. Only 10 (17.5%) patients had accurate prognostic awareness. Forty-three patients (75.4%) were optimistic about their prognosis; >80% of patients were more optimistic than their physicians about their prognosis. The physicians' predictions were accurate in for patients (37.5%). Accurate prognostic awareness was associated with physician's explanation of the prognosis and patients' perception of a good death. CONCLUSIONS A majority of the patients with advanced cancer in this study had prognostic awareness that was more optimistic in comparison with their actual survival, and most were more optimistic than their physicians about their prognosis. Further research is needed to develop programs to facilitate the discussion of life expectancy with patients in a manner that is consistent with their preferences.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Oishi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Jennifer W Mack
- Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Mori
- Department of Medical Oncology and Hematology, Okinawa Chubu Hospital, Uruma, Japan
| | - Masato Sakayori
- Department of Internal Medicine, Sodegaura Satsukidai Hospital, Sodegaura, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan.,Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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14
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Hiratsuka Y, Inoue A. Perspectives on screening tools to identify palliative care needs in patients with advanced cancer. Ann Palliat Med 2023; 12:13-15. [PMID: 36627851 DOI: 10.21037/apm-22-1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan; Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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15
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Hamano J, Hiratsuka Y, Morita T, Kizawa Y, Maeda I, Mori M. Preference of Japanese cancer patients for being informed about their prognosis. Ann Palliat Med 2022; 11:3426-3435. [DOI: 10.21037/apm-22-772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
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Ikari T, Hiratsuka Y, Cheng SY, Miyashita M, Morita T, Mori M, Uneno Y, Amano K, Uehara Y, Yamaguchi T, Maeda I, Inoue A. Factors associated with good death of patients with advanced cancer: a prospective study in Japan. Support Care Cancer 2022; 30:9577-9586. [PMID: 36125610 DOI: 10.1007/s00520-022-07363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/12/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE It is important for palliative care providers to identify what factors are associated with a "good death" for patients with advanced cancer. We aimed to identify factors associated with a "good death" evaluated by the Good Death Scale (GDS) score among inpatients with advanced cancer in palliative care units (PCUs) in Japan. METHODS The study is a sub-analysis of a multicenter prospective cohort study conducted in Japan. All variables were recorded on a structured data collecting sheet designed for the study. We classified each patient into better GDS group or worse GDS group, and examined factors associated with better GDS using multivariate analysis. RESULTS Between January and December 2017, 1896 patients were enrolled across 22 PCUs in Japan. Among them, a total of 1157 patients were evaluated. Five variables were significantly associated with a better GDS score in multivariate analysis: preferred place of death at PCU (odds ratio [OR] 2.85; 95% confidence interval [CI] 1.72-4.71; p < 0.01), longer survival time (OR 1.02; 95% CI 1.00-1.03; p < 0.01), not sudden death (OR 1.96; 95% CI 1.27-3.04; p < 0.01), better spiritual well-being in the last 3 days in life (OR 0.53; 95% CI 0.42-0.68; p < 0.01), and better communication between patient and family (OR 0.81; 95% CI 0.66-0.98; p = 0.03). CONCLUSIONS We identified factors associated with a "good death" using GDS among advanced cancer patients in Japanese PCUs. Recognition of factors associated with GDS could help to improve the quality of end-of-life care.
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Affiliation(s)
- Tomoo Ikari
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan. .,Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Uehara
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Isseki Maeda
- Department of Palliative Care Senri-Chuo Hospital, Toyonaka, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Hiratsuka Y, Suh SY, Hui D, Morita T, Mori M, Oyamada S, Amano K, Imai K, Baba M, Kohara H, Hisanaga T, Maeda I, Hamano J, Inoue A. Are Prognostic Scores Better Than Clinician Judgment? A Prospective Study Using Three Models. J Pain Symptom Manage 2022; 64:391-399. [PMID: 35724924 DOI: 10.1016/j.jpainsymman.2022.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT Several prognostic models such as the Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) have been developed to complement clinician's prediction of survival (CPS). However, few studies with large scales have been conducted to show which prognostic tool had better performance than CPS in patients with weeks of survival. OBJECTIVES We aimed to compare the prognostic performance of the PPS, PPI, PaP, and CPS in inpatients admitted to palliative care units (PCUs). METHODS This study was part of a multi-center prospective observational study involving patients admitted to PCUs in Japan. We computed their prognostic performance using the area under the receiver operating characteristics curve (AUROC) and calibration plots for seven, 14-, 30- and 60-day survival. RESULTS We included 1896 patients with a median overall survival of 19 days. The AUROC was 73% to 84% for 60-day and 30-day survival, 75% to 84% for 14-day survival, and 80% to 87% for seven-day survival. The calibration plot demonstrated satisfactory agreement between the observational and predictive probability for the four indices in all timeframes. Therefore, all four prognostic indices showed good performance. CPS and PaP consistently had significantly better performance than the PPS and PPI from one-week to two-month timeframes. CONCLUSION The PPS, PPI, PaP, and CPS had relatively good performance in patients admitted to PCUs with weeks of survival. CPS and PaP had significantly better performance than the PPS and PPI. CPS may be sufficient for experienced clinicians while PPS may help to improve prognostic confidence for inexperienced clinicians.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sang-Yeon Suh
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - David Hui
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Morita
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masanori Mori
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shunsuke Oyamada
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koji Amano
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kengo Imai
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mika Baba
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Kohara
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isseki Maeda
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Jun Hamano
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Inoue
- Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Kim YJ, Hiratsuka Y, Suh SY, Won SH, Jung EH, Kang B, Lee SW, Ahn HY, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW, Kim JH, Lee JS. Performance of mid-upper arm circumference and other prognostic indices based on inflammation and nutrition in oncology outpatients: a tertiary cancer center study. Ann Palliat Med 2022; 11:3171-3180. [PMID: 36226642 DOI: 10.21037/apm-22-481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to compare the performance of established inflammation and nutrition-based prognostic indices with a relatively novel index 'mid-upper arm circumference (MUAC)' in outpatients with advanced cancer. METHODS This study was a secondary analysis of a prospective cohort study that enrolled 200 outpatients with advanced cancer visiting a medical oncology clinic at a tertiary hospital. All patients were followed until death, and the Glasgow Prognostic Score (GPS), modified GPS (mGPS), Prognostic Nutritional Index (PNI), neutrophil/lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), and MUAC were compared by calculating the area under the receiver operating characteristic curves (AUROCs). RESULTS The mean age of the patients was 64.4 years, 64.0% were male, and the median overall survival was 32.4 weeks [95% confidence interval (CI): 5.6-142.7]. Overall, all indices showed similarly high AUROCs for estimating 12-week (0.68 to 0.75) and 24-week survival (0.67 to 0.74). When confined to the GPS, mGPS, and MUAC, the AUROCs for 12-week survival were 0.75 (95% CI: 0.66-0.82), 0.74 (95% CI: 0.65-0.82), and 0.72 (95% CI: 0.64-0.79), respectively. For 24-week survival, the AUROCs were 0.70 (95% CI: 0.62-0.76), 0.67 (95% CI: 0.60-0.74), and 0.72 (95% CI: 0.64-0.79), respectively. MUAC had the highest specificity for estimating 12-week survival (86.0%), while GPS showed the highest sensitivity for estimating 12-week survival (81.1%). CONCLUSIONS Inflammation and nutrition-based prognostic indices showed similar acceptable accuracies in estimating the 12- and 24-week survival of oncology outpatients. Notably, a simple and non-invasive index MUAC, showed comparable performance with established indices including GPS and mGPS.
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Affiliation(s)
- Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea; Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Eun Hee Jung
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Beodeul Kang
- Division of Medical Oncology, Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University Medical School, Seoul, South Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Jung E, Hiratsuka Y, Suh SY, Won SH, Choi SE, Kang B, Lee S, Kim Y, Suh K, Kim JW, Kim S, Kim J, Lee KW. Association between mid-upper arm circumference and functional status in patients with advanced cancer. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Won SH, Hiratsuka Y, Suh SY, Bae H, Choi SE, Kim YJ, Kang B, Lee SW, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW. Mid-upper Arm Circumference as an Indicator of Quality of Life of Patients with Advanced Cancer. J Palliat Care 2022; 38:24-29. [PMID: 36065585 DOI: 10.1177/08258597221121321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mid-upper arm circumference (MUAC) has been used to assess malnutrition and health status across various disease groups. However, it is unclear whether MUAC is associated with quality of life (QOL) of patients with advanced cancer. Our goal was to investigate the relationship between MUAC and QOL in ambulatory out-patients with advanced cancer. METHOD This was a cross-sectional study conducted in a tertiary cancer center in South Korea. A total of 200 patients with advanced cancer at oncology clinics of Seoul National University Bundang Hospital from March 2016 to January 2019 were enrolled. Out-patients with advanced cancer whose survival was expected to be less than one year by their oncologists were enrolled. QOL of patients was evaluated using the European Organization for Research and Treatment of Cancer quality of life questionnaire core 30 (EORTC QLQ-C30). Associations of QOL with MUAC and nutritional parameters were examined with generalized linear models. RESULTS The most common cancer sites were the lung, colon or rectum, and genitourinary tract. In univariate analyses, significant factors associated with higher summary score of EORTC QLQ-C30 were higher MUAC (≥ 26.5 cm, p < 0.001), higher body mass index (BMI) (≥ 22 kg/m2, p < 0.001), higher serum albumin (≥ 3.7 g/dL, p < 0.01), higher creatinine (≥ 0.8 mg/dL, p = 0.023), and higher uric acid (≥ 5 mg/dL, p < 0.01). In multivariate analysis, higher serum albumin (≥ 3.7 g/dL, p < 0.01) and higher MUAC (≥ 26.5 cm, p = 0.03) were independently associated with better summary score of EORTC QLQ-C-30. CONCLUSION MUAC was highly associated with QOL in terms of summary score and overall health status. Thus, MUAC, with its simplicity, can be a useful tool to reflect QOL in patients with advanced cancer.
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Affiliation(s)
- Seon-Hye Won
- Department of Family Medicine, 373765Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, 38047Tohoku University School of Medicine, Sendai, Japan.,Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, 373765Dongguk University Ilsan Hospital, Goyang-si, South Korea.,Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Hayoung Bae
- Department of Family Medicine, 373765Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Sung-Eun Choi
- Department of Statistics, 34942Dongguk University-Seoul, Seoul, South Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Beodeul Kang
- Division of Medical Oncology, 299466Bundang Medical Center, CHA University, Seongnam-si, South Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, 37991Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, South Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, 37990Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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Hiratsuka Y, Kim YJ, Suh SY, Won SH, Choi SE, LeBlanc TW, Kang B, Lee SW, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW. The association between changes in symptoms or quality of life and overall survival in outpatients with advanced cancer. Ann Palliat Med 2022; 11:2338-2348. [DOI: 10.21037/apm-22-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
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22
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Hiramoto S, Oya K, Tokutani R, Kirishima T, Maeda I, Tetsuo H, Amano K, Yamauchi T, Hiratsuka Y. 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. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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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Affiliation(s)
| | | | | | | | | | | | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Kim YJ, Yoon SJ, Suh SY, Hiratsuka Y, Kang B, Lee SW, Ahn HY, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW, Kim JH, Lee JS. Performance of clinician prediction of survival in oncology outpatients with advanced cancer. PLoS One 2022; 17:e0267467. [PMID: 35446910 PMCID: PMC9022805 DOI: 10.1371/journal.pone.0267467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background
We aimed to investigate the performance of clinician prediction of survival (CPS) and the association between CPS and the prognostic confidence of clinicians in ambulatory medical oncology outpatients.
Methods
Eight medical oncologists estimated the expected survival of their patients in a prospective cohort study. They were asked to provide a temporal type of CPS in weeks, together with their level of confidence for each prediction (0–100%). We analyzed the accuracy of CPS, the association between CPS and the prognostic confidence, and the characteristics of patients showing inaccurate CPS.
Results
A total of 200 advanced cancer patients were enrolled and the median overall survival was 7.6 months. CPS was accurate in 67 (33.5%) patients, underestimated in 87 (43.5%), and overestimated in 46 (23.0%). The overall accuracy of CPS for 12-week, 24-week, 36-week, and 48-week survival was 83.0%, 72.0%, 75.5%, and 74.0%, respectively. The specificity was highest for 12-week survival (90.2%) and the sensitivity was highest for 48-week survival (96.1%). The sensitivity of 12-week CPS was 51.4% and the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% confidence interval [CI] 0.71–0.87). The prognostic confidence of clinicians was not significantly associated with the accuracy of prediction (P = 0.359). Patients with overestimated survival had significantly poorer global health status and physical/role/emotional functioning in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Additionally, they showed significantly higher levels of fatigue, nausea/vomiting, pain, dyspnea, and loss of appetite.
Conclusion
The overall accuracy of CPS in predicting 12-week to 48-week survival was high in medical oncology outpatients. However the sensitivity of 12-week CPS was low and prognostic confidence was not associated with the accuracy of CPS. Patients with overestimated CPS showed poorer quality of life and higher symptom burden.
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Affiliation(s)
- Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seok Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, Dongguk University Medical School, Seoul, South Korea
- * E-mail:
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Beodeul Kang
- Division of Medical Oncology, Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University Medical School, Seoul, South Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Hiratsuka Y, Miyashita M, Uneno Y, Oya K, Okamoto S, Kessoku T, Mawatari H, Oyamada S, Nozato J, Tagami K, Inoue A. Development and Validation of the Death Pronouncement Burden Scale for Oncology Practice. Palliat Med Rep 2022; 3:39-46. [PMID: 35558865 PMCID: PMC9081014 DOI: 10.1089/pmr.2021.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Informing families of a patient's death is one of the most challenging responsibilities of clinicians who provide care for terminally ill patients. Although death pronouncement can be a highly stressful event for clinicians, no previous study has reported qualitative characteristics of the burden experienced by clinicians related to death pronouncements. Moreover, no scale has been developed to assess this burden. Objective: This study sought to develop a scale to evaluate clinicians' burden related to death pronouncement (Death Pronouncement Burden Scale for oncology practice [DPBS-oncol]) and examine its reliability and validity in Japan. Methods: We presented the DPBS-oncol to clinicians involved in oncology practice and examined its reliability and discriminant validity. To investigate the test-retest reliability of the scale, the DPBS-oncol was presented a second time to a subsample of the clinicians. Results: Factor analysis required a grouping of the 15 DPBS-oncol items into one factor. Cronbach's α coefficient of the total score of DPBS-oncol was 0.94, and the intraclass correlation coefficient of the total score of DPBS-oncol was 0.89. Regarding discriminant validity, DPBS-oncol total score was moderately correlated with other available scales for assessing clinicians' attitudes to end-of-life care. Conclusion: This study was the first to develop a scale to evaluate clinicians' burden related to death pronouncement. The DPBS-oncol, which includes 15 items, was validated and shown to have sufficient reliability.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyohumi Oya
- Department of Internal Medicine, Palliative Care, Peace Home Care Clinic, Shiga, Japan
| | - Soichiro Okamoto
- Department of Internal Medicine, Palliative Care, Medical Corporation Teieikai Chiba Home Care Clinic, Chiba, Japan
| | - Takaomi Kessoku
- Department of Palliative Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Hironori Mawatari
- Department of Palliative and Supportive Care, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | | | - Junko Nozato
- Department of Internal Medicine, Palliative Care, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Hiratsuka Y, Suh SY, Won SH, Kim SH, Yoon SJ, Koh SJ, Kwon JH, Park J, Ahn HY, Cheng SY, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, Mori M, Inoue A. Prevalence and severity of symptoms and signs in patients with advanced cancer in the last days of life: the East Asian collaborative cross-cultural study to elucidate the dying process (EASED). Support Care Cancer 2022; 30:5499-5508. [PMID: 35304634 DOI: 10.1007/s00520-022-06969-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/10/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Few large-scale studies have focused on the prevalence of symptoms and signs during the last days of patients diagnosed with advanced cancer. Identifying the patterns of specific symptoms according to cancer type is helpful to provide end-of-life care for patients with advanced cancer. We investigated the prevalence and severity of symptoms and signs associated with impending death in patients with advanced cancer. METHODS In this secondary analysis of an international multicenter cohort study conducted in three East Asian countries, we compared the severity of symptoms and signs among dying patients in the last 3 days of life according to the type of primary cancer using one-way analysis of variance (ANOVA). Post hoc analysis was conducted for multiple comparisons of each symptom according to the type of primary cancer. RESULTS We analyzed 2131 patients from Japan, Korea, and Taiwan. The prevalence of most symptoms and signs were relatively stable from 1 week after admission to the last 3 days of life. According to cancer type, edema of the lower extremities was the most common symptom and fatigue/ ascites were the most severe symptoms in digestive tract cancer. For lung cancer, respiratory secretion was the most prevalent and dyspnea/respiratory secretion were the most severe symptoms. CONCLUSION We demonstrated the prevalence and severity of symptoms and signs associated with the impending death of patients with advanced cancer in East Asia. Our study can enable clinicians to recognize the specific symptoms and signs at the very end of life.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
- Department of Medicine, Dongguk University Medical School, Pildong 1-30, Jung-gu, Seoul, South Korea.
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Su-Jin Koh
- Department Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, South Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Hatano Y, Morita T, Mori M, Aoyama M, Yoshida S, Amano K, Terabayashi T, Oya K, Tsukuura H, Hiratsuka Y, Isseki M, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. Association between experiences of advanced cancer patients at the end of life and depression in their bereaved caregivers. Psychooncology 2022; 31:1243-1252. [DOI: 10.1002/pon.5915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care Daini Kyoritsu Hospital Kawanishi Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division Seirei Mikatahara General Hospital Hamamatsu Japan
| | - Masanori Mori
- Palliative Care Team Seirei Mikatahara General Hospital Hamamatsu Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University Sendai Japan
| | - Koji Amano
- Department of Palliative Medicine National Cancer Center Hospital Tokyo Japan
| | | | - Kiyofumi Oya
- Department of Palliative and Transitional Care Aso Iizuka Hospital Iizuka Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Medicine Tohoku University School of Medicine Sendai Japan
- Department of Palliative Medicine Takeda General Hospital Aizu Wakamatsu Japan
| | - Maeda Isseki
- Department of Palliative Care Senri‐chuo Hospital Toyonaka Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yasuo Shima
- Tsukuba Medical Center Foundation, Home Care Service, Tsukuba Medical Center Hospital, Department of Palliative Medicine Tsukuba Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
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Wu CY, Chen PJ, Cheng SY, Suh SY, Huang HL, Lin WY, Hiratsuka Y, Kim SH, Yamaguchi T, Morita T, Tsuneto S, Mori M. Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process. Cancer 2022; 128:1699-1708. [PMID: 35103989 DOI: 10.1002/cncr.34108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/26/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Artificial hydration (AH) is a challenging issue in terminally ill patients with cancer, because it influences patients' symptoms control, quality of life, and quality of dying (QOD). To date, it is not clear how much AH supply is proper for imminently dying patients. This study aimed to investigate the association between the amount of AH and QOD. METHODS This study is part of the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) conducted in Japan, Korea, and Taiwan from January 2017 to September 2018. Patients' demographics, symptoms, and managements on admission to palliative care units (PCUs) and before death were recorded. The AH amount was classified into different groups by 250-mL intervals to compare their difference. The Good Death Scale (GDS) was used to measure QOD, with patients classified into higher or lower QOD groups using GDS = 12 as the cutoff point. We used logistic regression analysis to assess the association between AH amount and QOD. RESULTS In total, 1530 patients were included in the analysis. Country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with QOD. After conducting regression analysis, patients administered with 250 to 499 mL AH had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH. CONCLUSIONS AH use impacts the QOD of terminally ill patients with cancer admitted to PCUs. Communication with patients and their families on appropriate AH use has a positive effect on QOD. LAY SUMMARY Our prospective cross-cultural multicenter study aims to investigate the relationship between artificial hydration (AH) amount and quality of dying among terminally ill patients with cancer. The findings reveal that country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with quality of death (QOD). After multivariable logistic regression, patients administered with AH amount 250 to 499 mL had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH. Communication with patients and their families regarding AH is recommended as it may help them be better prepared for the end-of-life stage and achieve a good death.
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Affiliation(s)
- Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, England
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.,Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
| | - Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Yokota S, Amano K, Oyamada S, Ishiki H, Maeda I, Miura T, Hatano Y, Uneno Y, Hori T, Matsuda Y, Kohara H, Suzuki K, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Tsukuura H, Yamauchi T, Naito AS, Yoshioka A, Hiramoto S, Kikuchi A, Tanaka K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Oya K, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Sakashita A, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Nakagawa J, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Hiratsuka Y, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Appointed S, Iriyama T, Kaneishi K, Baba M, Matsumoto Y, Okizaki A, Watanabe YS, Uehara Y, Satomi E, Nishijima K, Shimoinaba J, Nakahori R, Hirohashi T, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. Effects of artificial nutrition and hydration on survival in patients with head and neck cancer and esophageal cancer admitted to palliative care units. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Okamoto S, Uneno Y, Kawashima N, Oyamada S, Hiratsuka Y, Tagami K, Muto M, Morita T. Difficulties Facing Junior Physicians and Solutions Toward Delivering End-of-Life Care for Patients with Cancer: A Nationwide Survey in Japan. Palliat Med Rep 2022; 3:255-263. [PMID: 36341469 PMCID: PMC9629909 DOI: 10.1089/pmr.2022.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Junior physicians' perceived difficulty in end-of-life care of patients with cancer has not been structurally investigated; therefore, current challenges and solutions in this area remain unknown. OBJECTIVES To identify some difficulties junior physicians face in delivering end-of-life care for patients with cancer and to clarify the support required to reduce these difficulties. DESIGN A nationwide survey was conducted in over 300 institutions selected randomly from 1037 clinical training hospitals in Japan. PARTICIPANTS From each of these institutions, two resident physicians of postgraduate year (PGY) 1 or 2, two clinical fellows of PGY 3-5, and an attending physician were requested to respond to the survey. MEASUREMENTS The survey investigated issues regarding end-of-life care using the palliative care difficulties scale with two additional domains ("discussion about end-of-life care" and "death pronouncement"). Items related to potential solutions for alleviating the difficulties as well were investigated. RESULTS A total of 198 resident physicians, 134 clinical fellows, and 96 attending physicians responded to the survey (response rate: 33.0%, 22.3%, and 32.0%). The results revealed that junior physicians face difficulties within specific domains of end-of-life care. The most challenging domain comprised communication and end-of-life discussion with patients and family members, symptom alleviation, and death pronouncement. The most favored supportive measure for alleviating these difficulties was mentorship, rather than educational opportunities or resources regarding end-of-life care. CONCLUSION The findings of this study reveal the need for further effort to enrich the mentorship and support systems for junior physicians delivering end-of-life care.
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Affiliation(s)
- Soichiro Okamoto
- Medical Corporation Teieikai Chiba Home Care Clinic, Chiba, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- *Address correspondence to: Yu Uneno, MD, Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
| | - Natsuki Kawashima
- Department of Palliative Care, Tsukuba Medical Center, Tsukuba, Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Care, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Keita Tagami
- Department of Palliative Care, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Morita
- Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Yokomichi N, Yamaguchi T, Maeda I, Mori M, Imai K, Shirado Naito A, Yamaguchi T, Terabayashi T, Hiratsuka Y, Hisanaga T, Morita T. Effect of continuous deep sedation on survival in the last days of life of cancer patients: A multicenter prospective cohort study. Palliat Med 2022; 36:189-199. [PMID: 35067124 DOI: 10.1177/02692163211057754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Continuous deep sedation is ethically controversial with respect to whether it shortens a patient's life. AIM To examine whether continuous deep sedation shortens patient survival from the day of Palliative Performance Scale decline to 20 (PPS20). DESIGN A part of a multicenter prospective cohort study (EASED study). SETTING/PARTICIPANTS We recruited consecutive adult patients with advanced cancer admitted to 23 participating palliative care units in 2017 in Japan. We compared survival from PPS20 between those who did and did not receive continuous deep sedation. Continuous deep sedation was defined as the continuous administration of sedative medication with the intention to keep a patient continuously unconscious to alleviate otherwise uncontrollable symptoms, but the dose of sedatives was adjusted to achieve adequate symptom relief for each patient. The propensity score-weighting method was used to control for potential confounders, and five sensitivity analyses were performed. RESULTS A total of 1926 patients were enrolled. Patients discharged alive were excluded, and we analyzed 1625 patients of whom 156 (9.6%) received continuous deep sedation. Median survival from PPS20 of 1625 patients was 81 h (95% CI: 77-88). The RASS scores decreased to ⩽-4 was 66% at 24 h. Continuous deep sedation was not associated with a significant survival risk (adjusted hazard ratio: 1.06, 95% CI: 0.85-1.33). All sensitivity analyses, including continuous deep sedation defined as the RASS score was ⩽-4 achieved the essentially the same results. CONCLUSIONS Continuous deep sedation with careful dose adjustment was not associated with shorter survival in the last days of life in patients with advanced cancer.
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Affiliation(s)
- Naosuke Yokomichi
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | | | | | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Hatano Y, Morita T, Mori M, Maeda I, Oyamada S, Naito AS, Oya K, Sakashita A, Ito S, Hiratsuka Y, Tsuneto S. Complexity of desire for hastened death in terminally ill cancer patients: A cluster analysis. Palliat Support Care 2021; 19:646-655. [PMID: 33641697 DOI: 10.1017/s1478951521000080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups. METHODS Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD. RESULTS Data from 971 patients, whose Richmond Agitation-Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16-20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): "physical distress," cluster 2 (21%, 37/173): "dependent and burdensome," cluster 3 (19%, 33/173): "hopelessness," cluster 4 (17%, 30/173): "profound fatigue," and cluster 5 (7%, 12/173): "extensive existential suffering." CONCLUSIONS A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.
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Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
| | | | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Kiyofumi Oya
- Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
| | - Satoko Ito
- Hospice, The Japan Baptist Hospital, Kyoto, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Imai K, Morita T, Yokomichi N, Kawaguchi T, Kohara H, Yamaguchi T, Kikuchi A, Odagiri T, Watanabe YS, Kamura R, Maeda I, Kawashima N, Ito S, Baba M, Matsuda Y, Oya K, Kaneishi K, Hiratsuka Y, Naito AS, Mori M. Efficacy of Proportional Sedation and Deep Sedation Defined by Sedation Protocols: A Multicenter, Prospective, Observational Comparative Study. J Pain Symptom Manage 2021; 62:1165-1174. [PMID: 34118372 DOI: 10.1016/j.jpainsymman.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE To investigate the efficacy of two types of palliative sedation: proportional and deep sedation, defined by sedation protocols. METHODS From a multicenter prospective observational study, we analyzed the data of those patients who received the continuous infusion of midazolam according to the sedation protocol. The primary endpoint was goal achievement at 4 hours: in proportional sedation, symptom relief (Integrated Palliative care Outcome Scale: IPOS ≤ 1) and absence of agitation (modified Richmond Agitation-Sedation Scale: RASS ≤ 0); in deep sedation, the achievement of deep sedation (RASS ≤ -4). Secondary endpoints included deep sedation as a result of proportional sedation, communication capacity (Communication Capacity Scale item 4 ≤ 2), IPOS and RASS scores, and adverse events. RESULTS A total of 81 patients from 14 palliative care units were analyzed: proportional sedation (n = 64) and deep sedation (n = 17). At 4 hours, the goal was achieved in 77% (n = 49; 95% confidence interval: 66-87) with proportional sedation; and 88% (n = 15; 71-100) with deep sedation. Deep sedation was necessary in 45% of those who received proportional sedation. Communication capacity was maintained in 34% with proportional sedation and 10% with deep sedation. IPOS decreased from 3.5 to 0.9 with proportional sedation, and 3.5 to 0.4 with deep sedation; RASS decreased from +0.3 to -2.6, and +0.4 to -4.2, respectively. Fatal events related to the treatment occurred in 2% (n = 1) with proportional and none with deep sedation. CONCLUSION Proportional sedation achieved satisfactory symptom relief while maintaining some patients' consciousness, and deep sedation achieved good symptom relief while the majority of patients lost consciousness.
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Affiliation(s)
- Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital (K.I.), Hamamatsu, Japan.
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy (T.K.), Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hiroyuki Kohara
- Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Takashi Yamaguchi
- Division of Palliative Care (T.Y.), Konan Medical Center, Kobe, Japan
| | - Ayako Kikuchi
- Department of Oncology and Palliative Medicine (A.K.), Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Takuya Odagiri
- Komaki City Hospital (T.O.), Palliative Care, Komaki, Japan
| | - Yuki Sumazaki Watanabe
- Department of Palliative Medicine (Y.S.W.), National Cancer Center Hospital East, Kashiwa, Japan
| | - Rena Kamura
- Hospice (R.K.), Yodogawa Christian Hospital, Osaka, Japan
| | - Isseki Maeda
- Department of Palliative Care (I.M.), Senri-Chuo Hospital, Toyonaka, Japan
| | - Natsuki Kawashima
- Department of Palliative Medicine (N.K.), Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Satoko Ito
- Hospice (S.I.), The Japan Baptist Hospital, Kyoto, Japan
| | - Mika Baba
- Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan
| | - Yosuke Matsuda
- Palliative Care Department (Y.M.), St. Luke's International Hospital, Tokyo, Japan
| | - Kiyofumi Oya
- Transitional and Palliative Care (K.O.), Aso Iizuka Hospital, Iizuka, Japan
| | - Keisuke Kaneishi
- Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine (Y.H.), Tohoku University School of Medicine, Sendai, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care (A.S.N.), Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Amano K, Satomi E, Oyamada S, Ishiki H, Sakashita A, Miura T, Maeda I, Hatano Y, Yamauchi T, Oya K, Nakagawa J, Hiratsuka Y, Hirohashi T, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Tsukuura H, Naito AS, Uneno Y, Yoshioka A, Hiramoto S, Kikuchi A, Hori T, Matsuda Y, Kohara H, Funaki H, Tanaka K, Suzuki K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Iriyama T, Kaneishi K, Baba M, Matsumoto Y, Okizaki A, Sumazaki Watanabe Y, uehara Y, Nishijima K, Shimoinaba J, Nakahori R, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units. Clinical Nutrition Open Science 2021. [DOI: 10.1016/j.nutos.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hiratsuka Y, Yoon SJ, Suh SY, Choi SE, Hui D, Kim SH, Lee ES, Hwang SW, Cheng SY, Chen PJ, Mori M, Yamaguchi T, Morita T, Tsuneto S, Inoue A. Comparison of the accuracy of clinicians' prediction of survival and Palliative Prognostic Score: an East Asian cross-cultural study. Support Care Cancer 2021; 30:2367-2374. [PMID: 34743238 DOI: 10.1007/s00520-021-06673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE No study has been conducted to compare the clinicians' prediction of survival (CPS) with Palliative Prognostic Scores (PaP) across countries. We aimed to compare the performance of the CPS in PaP (PaP-CPS), the PaP without the CPS, and the PaP total scores in patients with advanced cancer in three East Asian countries. METHODS We compared the discriminative accuracy of the three predictive models (the PaP-CPS [the score of the categorical CPS of PaP], the PaP without the CPS [sum of the scores of only the objective variables of PaP], and the PaP total score) in patients admitted to palliative care units (PCUs) in Japan, Korea, and Taiwan. We calculated the area under the receiver operating characteristic curve (AUROC) for 30-day survival to compare the discriminative accuracy of these three models. RESULTS We analyzed 2,072 patients from three countries. The AUROC for the PaP total scores was 0.84 in patients in Japan, 0.76 in Korea, and 0.79 in Taiwan. The AUROC of the PaP-CPS was 0.82 in patients in Japan, 0.75 in Korea, and 0.78 in Taiwan. The AUROC of the PaP without the CPS was 0.75 in patients in Japan, 0.66 in Korea, and 0.67 in Taiwan. CONCLUSION The PaP total scores and the PaP-CPS consistently showed similar discriminative accuracy in predicting 30-day survival in patients admitted to PCUs in Japan, Korea, and Taiwan. It may be sufficient for experienced clinicians to use the CPS alone for estimating the short-term survival (less than one month) of patients with far-advanced cancer. The PaP may help to improve prognostic confidence and further reduce subjective variations.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, South Korea. .,Department of Medicine, Dongguk University Medical School, Pildong 1-30, Jung-gu, Seoul, South Korea.
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, South Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Ikari T, Hiratsuka Y, Yamaguchi T, Mori M, Uneno Y, Taniyama T, Matsuda Y, Oya K, Amano K, Tagami K, Inoue A. Is the 1-day surprise question a useful screening tool for predicting prognosis in patients with advanced cancer?-a multicenter prospective observational study. Ann Palliat Med 2021; 10:11278-11287. [PMID: 34670389 DOI: 10.21037/apm-21-1718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND For cancer patients nearing death, the prediction of their prognosis by physicians is crucial. This study examined the usefulness of the 1-Day Surprise Question (1DSQ). METHODS This study was conducted as part of a multicenter prospective observational study. The physicians answered the 1DSQ "Would I be surprised if this patient died in the next 1 day?" when patients have palliative performance scale (PPS) ≤20. We calculated the sensitivity and specificity of the 1DSQ. Moreover, using multivariate analysis, we evaluated the characteristics of patients who died among those whose physicians answered the 1DSQ as "not surprised". RESULTS Overall, 1,896 patients were enrolled, and 1,411 (74.4%) were analyzed between January and December 2017. Among these, 847 (60.0%) patients were placed in the "not surprised" group. The sensitivity, specificity, and positive and negative predictive values of the 1DSQ were 82.0% [95% confidence interval (CI): 77.5-85.8%], 45.5% (95% CI: 44.4-46.4%), 27.4% (95% CI: 25.9-28.7%), and 91.0% (95% CI: 88.9-92.9%), respectively. Multivariate analysis revealed that urine output over last 12 hours <100 mL, decreased response to visual stimuli, respiration with mandibular movement, pulselessness of radial artery, and saturation of percutaneous oxygen <90% were characteristics of patients who died as predicted by the physicians. CONCLUSIONS The 1DSQ is a helpful screening tool for identifying cancer patients with impending death.
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Affiliation(s)
- Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiko Taniyama
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan
| | - Kiyofumi Oya
- Department of Palliative Care, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Suh SY, Won SH, Hiratsuka Y, Choi SE, Cheng SY, Mori M, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, LeBlanc TW, Kim SH, Yoon SJ, Lee ES, Hwang SW. Assessment of Changes in Symptoms Is Feasible and Prognostic in the Last Weeks of Life: An International Multicenter Cohort Study. J Palliat Med 2021; 25:388-395. [PMID: 34668798 DOI: 10.1089/jpm.2021.0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Symptoms are not typically part of established various prognostic factors and scoring systems but are among the most frequently assessed issues in patient care. Objectives: To evaluate that, changes in symptoms can provide additional useful prognostic information. Design: A secondary analysis of an international cohort study in Japan, Korea, and Taiwan. Setting/Subjects: Subjects were adult patients with advanced cancer (n = 2074) who were admitted to 37 palliative care units (PCUs) in 3 countries from January 2017 to September 2018. Measurements: Symptoms (dyspnea, fatigue, dry mouth, and drowsiness) were assessed at admission and one-week later. Dyspnea was assessed by the presence of resting and exertional dyspnea, whereas other symptoms were assessed using the Integrated Palliative care Outcome Scales (IPOS) (range 0-4). For analysis, we grouped patients by symptom change, as either Improved, Stable, or Worsened (by having at least a one increment decrease, no change, or at least a one increment increase, respectively). Results: Worsened groups had the shortest survival (median survival 15-21 days) compared with those with Improved (median survival 23-31 days) and Stable symptoms (median survival 27-29 days) across all four symptoms (dyspnea, fatigue, dry mouth, and drowsiness). Survival differences were statistically significantly different across all three groups for all symptoms (all p < 0.001). Interestingly, Improved symptoms were associated with similar survival compared with Stable groups, with no statistical differences. Conclusions: Worsened symptoms at one week after admission were useful predictors of survival for patients with advanced cancer in PCUs during the final weeks of life. Longitudinal assessments are needed to reflect passage of time as well as impact of treatments.
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Affiliation(s)
- Sang-Yeon Suh
- Department of Medicine, Dongguk University-Seoul, Seoul, South Korea.,Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang si, South Korea
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang si, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University-Seoul, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Thomas W LeBlanc
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Hiratsuka Y, Suh SY, Kim SH, Cheng SY, Yoon SJ, Koh SJ, Park SA, Seo JY, Kwon JH, Park J, Park Y, Hwang SW, Lee ES, Ahn HY, Hui D, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, Mori M, Inoue A. Factors related to spiritual well-being in the last days of life in three East Asian countries: An international multicenter prospective cohort study. Palliat Med 2021; 35:1564-1577. [PMID: 34148395 DOI: 10.1177/02692163211022179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some factors associated with spiritual well-being in dying patients have previously been reported. However, there has been no cross-cultural study comparing factors related to spiritual well-being. The current investigation may shed light on this under-investigated area through a comparison of diverse factors. AIM We aimed to (1) examine factors associated with spiritual well-being in the last days and (2) compare those factors across three East Asian countries. DESIGN This is an international multicenter prospective cohort study. SETTING/PARTICIPANTS Newly admitted inpatients with far advanced cancer in palliative care units in Japan, Korea and Taiwan were enrolled. Each patient was classified into one of two groups based on spiritual well-being score in the last days of life. Univariate and multivariate analyses were performed to identify the factors related to better spiritual well-being score in each country. RESULTS A total of 1761 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. Seven variables were significant in Japan, three in Korea, and five in Taiwan. "Good death scale [acceptance]," "fatigue" and "expressed wish for hastened death" were unique in Japan. "Visit from a pastoral care worker within 48 h of death" was unique in Korea. "Patient's preferences for place of death," "dyspnea" and "continuous deep sedation" were unique in Taiwan. CONCLUSIONS This study found novel factors related to spiritual well-being in the last days of life, several of which differed according to country. Recognition of factors associated with spiritual well-being can improve the quality of palliative care.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea.,Department of Medicine, Dongguk University Medical School, Seoul, South Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Su-Jin Koh
- Department Hematology and Oncology, Ulsan University Hospital Ulsan University College of Medicine, Ulsan, South Korea
| | - Shin Ae Park
- Hospice & Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Ji-Yeon Seo
- Hospice & Palliative Care Center, Department of Family Medicine, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeanno Park
- Department of Internal Medicine, Bobath Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Youngmin Park
- Department of Family Medicine, Hospice and Palliative Care Center, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Eunpyeong-gu, Seoul, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang-si, Gyeonggi-do, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University, Seoul, South Korea
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
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Tagami K, Masukawa K, Inoue A, Morita T, Hiratsuka Y, Sato M, Kohata K, Satake N, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units. Support Care Cancer 2021; 30:931-940. [PMID: 34417885 DOI: 10.1007/s00520-021-06493-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients' and families' experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n = 515) of all responses were analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%), or none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-perceived appropriateness of SPC referral timing was associated with their good death process. After excluding "none of these" responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate timing is at the time of diagnosis or during anti-cancer treatment.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Kento Masukawa
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Mamiko Sato
- Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Katsura Kohata
- Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Noriaki Satake
- Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Hospital, 1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Yasuo Shima
- Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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39
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Kim YJ, Hiratsuka Y, Suh SY, Kang B, Lee SW, Ahn HY, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW, Kim JH, Lee JS. A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients. Cancer Res Treat 2021; 54:621-629. [PMID: 34265891 PMCID: PMC9016316 DOI: 10.4143/crt.2021.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic. Materials and Methods In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. Results The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found six significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥ 2), not undergoing chemotherapy, anorexia, a low lymphocyte level (< 12%), a high lactate dehydrogenase (LDH) level (≥ 300 IU/L), and a low mid-arm circumference (< 23 cm). We developed a prognostic model (score, 0–8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥ 4.0 points had a short survival of less than 3 months (p < 0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve was 0.88. Conclusion The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.
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Affiliation(s)
- Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.,Department of Medicine, Dongguk University Medical School, Seoul, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Bundang Medical Center, CHA University, Seongnam, Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University Medical School, Seoul, Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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40
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Hiratsuka Y, Oishi T, Miyashita M, Morita T, Mack JW, Sato Y, Takahashi M, Komine K, Saijo K, Ishioka C, Inoue A. Factors related to specialized palliative care use and aggressive care at end of life in Japanese patients with advanced solid cancers: a cohort study. Support Care Cancer 2021; 29:7805-7813. [PMID: 34169330 DOI: 10.1007/s00520-021-06364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to (1) describe characteristics of aggressive care at the end of life (EOL) and (2) identify factors associated with specialized palliative care use (SPC) and aggressive care at the EOL among Japanese patients with advanced cancer. METHODS This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death. RESULTS We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20-59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30-12.91; p = 0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07-17.37; p = 0.04) were associated with chemotherapy in the last month before death. CONCLUSION Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Oishi
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Jennifer W Mack
- Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yuko Sato
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Masahiro Takahashi
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Ken Saijo
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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41
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Amano K, Maeda I, Ishiki H, Miura T, Hatano Y, Tsukuura H, Taniyama T, Matsumoto Y, Matsuda Y, Kohara H, Morita T, Mori M, Inoue S, Yokomichi N, Imai K, Yamauchi T, Naito AS, Uneno Y, Yoshioka A, Hiramoto S, Kikuchi A, Hori T, Funaki H, Tanaka K, Suzuki K, Kamei T, Azuma Y, Uno T, Miyamoto J, Katayama H, Kashiwagi H, Matsumoto E, Oya K, Yamaguchi T, Okamura T, Hashimoto H, Kosugi S, Ikuta N, Matsumoto Y, Ohmori T, Nakai T, Ikee T, Unoki Y, Kitade K, Koito S, Ishibashi N, Ehara M, Kuwahara K, Ueno S, Nakashima S, Ishiyama Y, Sakashita A, Matsunuma R, Takatsu H, Yamaguchi T, Ito S, Terabayashi T, Nakagawa J, Yamagiwa T, Inoue A, Yamaguchi T, Miyashita M, Yoshida S, Hiratsuka Y, Tagami K, Watanabe H, Odagiri T, Ito T, Ikenaga M, Shimizu K, Hayakawa A, Kamura R, Okoshi T, Nishi T, Kosugi K, Shibata Y, Hisanaga T, Higashibata T, Yabuki R, Hagiwara S, Shimokawa M, Miyake S, Nozato J, Iriyama T, Kaneishi K, Baba M, Okizaki A, Watanabe YS, Uehara Y, Satomi E, Nishijima K, Shimoinaba J, Nakahori R, Hirohashi T, Hamano J, Kawashima N, Kawaguchi T, Uchida M, Sato K, Matsuda Y, Tsuneto S, Maeda S, Kizawa Y, Otani H. Effects of enteral nutrition and parenteral nutrition on survival in patients with advanced cancer cachexia: Analysis of a multicenter prospective cohort study. Clin Nutr 2021; 40:1168-1175. [DOI: 10.1016/j.clnu.2020.07.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
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Hiratsuka Y, Oishi T, Miyashita M, Morita T, Mack JW, Takahashi M, Shirota H, Otsuka K, Ishioka C, Inoue A. Patients' understanding of communication about palliative care and health condition in Japanese patients with unresectable or recurrent cancer: a cross-sectional survey. Ann Palliat Med 2021; 10:2650-2661. [PMID: 33549021 DOI: 10.21037/apm-20-2045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/08/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Understanding treatment goal is essential for decision-making among patients with unresectable/recurrent solid cancers. However, no previous studies in Japan have examined the association between patients' understanding and physicians' explanations. We aimed to examine agreement between patients' and physicians' reports of communication about palliative care and current health condition among patients with unresectable/recurrent cancer and explore factors associated with optimistic understanding in Japan. METHODS In this cross-sectional, multicenter, observational survey in Japan, 178 patients with unresectable/ recurrent solid cancers and 16 physicians responded to questionnaires. The primary outcome was agreement between patients' and physicians' reports of communication about palliative care and current health condition. RESULTS Of 56 patients who reported their communication about palliative care, 25/56 (44.6%) agreed with physician reports, and 31/56 (55.4%) were more optimistic than their physicians. Regarding current overall health condition, 45/122 (36.9%) patients gave reports that agreed with physicians' reports, and 77/122 (63.1%) were optimistic relative to physicians. Physicians' general approach about disclosure were not associated with patients' understanding. CONCLUSIONS Fewer than 50% of Japanese patients with unresectable/recurrent cancer agreed with their physicians, whereas most others were more optimistic about palliative care communication and their health condition as compared to physicians. Effective communication is essential to ensure informed decisionmaking.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan.
| | - Takayuki Oishi
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, Sendai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Jennifer W Mack
- Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Masahiro Takahashi
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Hidekazu Shirota
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Kazunori Otsuka
- Department of Clinical Oncology, Miyagi Cancer Center, Natori, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Tagami K, Matsuoka H, Ariyoshi K, Oyamada S, Hiratsuka Y, Kizawa Y, Koyama A, Inoue A. The current clinical use of adjuvant analgesics for refractory cancer pain in Japan: a nationwide cross-sectional survey. Jpn J Clin Oncol 2021; 50:1434-1441. [PMID: 32869060 DOI: 10.1093/jjco/hyaa147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although adjuvant analgesics are used to treat opioid-refractory cancer pain, there is insufficient evidence to support this practice and limited data to guide the choice depending on cancer pain pathophysiology, dose titration and starting dose. This survey aimed to clarify the current use of adjuvant analgesics for treating opioid-refractory cancer pain. METHODS In this cross-sectional study, we sent an online survey questionnaire to 208 certified palliative care specialists. Primary outcomes were (i) effective pathophysiological mechanism of cancer pain and (ii) initiating doses and time period to the first response to each adjuvant analgesic therapy. RESULTS In total, 87 (42%) palliative care specialists responded. Of all patients with cancer pain, 40% of patients (median) with refractory cancer pain were prescribed adjuvant analgesics. Additionally, 94.3, 93.1 and 86.2% of palliative care specialists found dexamethasone/betamethasone effective for neuropathic pain caused by tumor-related spinal cord compression, pregabalin effective for malignant painful radiculopathy and dexamethasone/betamethasone effective for brain tumor or leptomeningeal metastases-related headache, respectively. The median starting dose of pregabalin, dexamethasone/betamethasone, lidocaine and ketamine were 75, 4, 200, and 50 mg/day, respectively, and the median time to the first response of those medications were 5, 3, 2 and 3 days, respectively. CONCLUSIONS Many palliative care specialists select adjuvant analgesics depending on the pathophysiological mechanism of cancer pain in each case. They used such adjuvant analgesics in low doses for cancer pain with short first-response periods.
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Affiliation(s)
- Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiromichi Matsuoka
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan.,Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuko Koyama
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tsugita H, Aoyama M, Satake N, Saito M, Hiratsuka Y, Inoue A, Takayama S, Miyashita M. High Feasibility and Safety, but Negligible Efficacy of Acupressure for Treating Nausea in Cancer Patients Admitted to the Palliative Care Unit: A Pilot Study. TOHOKU J EXP MED 2021; 254:155-161. [PMID: 34219104 DOI: 10.1620/tjem.254.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Management of nausea is an important dimension of palliative care. The first choice for treating nausea is antiemetics, but their efficacy is inadequate. Acupressure intervention for nausea in cancer patients has been studied as a non-pharmacological therapy, and appears to have had some effect. However, such a therapy has not been well reviewed in patients with terminal cancer. The purpose of this study was to clarify the feasibility of acupressure intervention and examine its safety and preliminary efficacy. We recruited cancer patients that fulfilled the eligibility criteria and were admitted to the palliative care unit, from August 2018 to February 2019, in Tohoku University Hospital, Japan. We conducted a longitudinal assessment of acupressure intervention in a single arm. We identified the patient's research accomplishments and evaluated possible fainting due to the vagal reflex and symptom severity. Descriptive statistics were used to calculate the completion rate for the feasibility and Wilcoxon signed-rank tests to compare the average of continuous variables for the safety and efficacy. Twelve patients participated in this study and completed the procedure. Their average age was 70 years (SD = 9.3), and the most common primary cancer sites were the rectum and pancreas. The blood pressure and pulse rate did not drop sharply. Four patients exhibited decreased nausea but there was no statistically significant difference (P = 0.5). We suggested that acupressure has high feasibility and safety, as an intervention for patients with terminal cancer. However, no significant differences were observed regarding its effect on nausea.
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Affiliation(s)
- Hiroyuki Tsugita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
| | - Noriaki Satake
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
| | | | - Yusuke Hiratsuka
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
| | - Akira Inoue
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
| | - Shin Takayama
- Department of Education and Support for Regional Medicine, Tohoku University Hospital.,Department of Kampo Medicine, Tohoku University Hospital
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine
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Ikari T, Hiratsuka Y, Yamaguchi T, Maeda I, Mori M, Uneno Y, Taniyama T, Matsuda Y, Oya K, Tagami K, Inoue A. "3-Day Surprise Question" to predict prognosis of advanced cancer patients with impending death: Multicenter prospective observational study. Cancer Med 2020; 10:1018-1026. [PMID: 33347734 PMCID: PMC7897938 DOI: 10.1002/cam4.3689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background The study aimed to clarify the efficacy of the “3‐Day Surprise Question (3DSQ)” in predicting the prognosis for advanced cancer patients with impending death. Patients and Methods This study was a part of multicenter prospective observational study which investigated the dying process in advanced cancer patients in Japan. For patients with a Palliative Performance Scale ≤20, the 3DSQ “Would I be surprised if this patient died in the next 3 days?” was answered by their physicians. In addition to the sensitivity and specificity of the 3DSQ, the characteristics of patients who survived longer than expected were examined via multivariate analysis. Results Among the 1896 patients enrolled, 1411 were evaluated. Among 1179 (83.6%) patients who were classified into the “Not surprised” group, 636 patients died within 3 days. Among 232 (16.4%) patients of “Yes surprised” group, 194 patients lived longer than 3 days. The sensitivity, specificity, positive predictive value, and negative predictive value of the 3DSQ were 94.3% (95% confidence interval [CI]: 92.7% to 95.8%), 26.3% (95% CI: 24.8% to 27.6%), 53.9% (95% CI: 53.0% to 54.7%), and 83.6% (95% CI: 78.7% to 87.7%), respectively. Multivariate analysis showed palpable radial artery, absent respiration with mandibular movement, SpO2 ≥ 90%, opioid administration, and no continuous deep sedation as characteristics of patients who lived longer than expected. Conclusions The 3‐Day Surprise Question can be a useful screening tool to identify advanced cancer patients with impending death.
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Affiliation(s)
- Tomoo Ikari
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Toyonaka, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiko Taniyama
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan
| | - Kiyofumi Oya
- Aso Iizuka Hospital, Transitional and Palliative Care, Iizuka ciyu, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Hiratsuka Y, Suh SY, Maeda I, Morita T, Mori M, Ito S, Nishi T, Hisanaga T, Iriyama T, Kaneishi K, Ikari T, Tagami K, Inoue A. Factors influencing spiritual well-being in terminally ill cancer inpatients in Japan. Support Care Cancer 2020; 29:2795-2802. [DOI: 10.1007/s00520-020-05802-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
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Hiratsuka Y, Aoyama M, Kaneta T, Masukawa K, Tagami K, Miyashita M, Inoue A. Impressions of Interfaith Chaplain's Activities among Patients in a Palliative Care Unit: A Semi-Structured Interview-Based Qualitative Study. TOHOKU J EXP MED 2020; 251:91-96. [PMID: 32581192 DOI: 10.1620/tjem.251.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Providing spiritual care in light of a patient's religious and/or spiritual background can help improve the quality of end-of-life care. Rinsho-shukyo-shi is a Japanese interfaith chaplain who provides religious and spiritual care to patients. In this study, we qualitatively explore the impressions of patients in a palliative care unit of the activities of an interfaith chaplain in a hospital in Japan. The authors used semi-structured interviews carried out by a male nurse experienced in qualitative and quantitative research in palliative care. The male nurse asked only a few predetermined questions in the interviews, which were conducted from January 19 to December 26, 2018. The interviewees were 15 patients diagnosed with advanced cancer (five men and 10 women; aged 53-81 years), and they were admitted to the palliative care unit of Tohoku University Hospital (the hospital has no religious affiliation). Patients who had spoken to the interfaith chaplain at the hospital at least twice were included in the study. The interviews were digitally audio-recorded, transcribed verbatim, and analyzed. Three main themes were identified through thematic analysis. Resistance varied across patients; no patient felt resistance to the intervention by, or to the presence of, the interfaith chaplain once he/she had spoken with him. Opinions about the interfaith chaplain also varied, with 10 patients claiming that his role was necessary for end-of-life care and beneficial for the chaplain himself. Finally, the patients' religious beliefs varied widely. In conclusion, the interfaith chaplain is deemed helpful by the interviewed patients in relieving their anxieties.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine
| | - Maho Aoyama
- Department of Palliative Nursing, Tohoku University School of Medicine
| | - Taiko Kaneta
- Department of Palliative Medicine, Tohoku University Hospital
| | - Kento Masukawa
- Department of Palliative Nursing, Tohoku University School of Medicine
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine
| | | | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine
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Amano K, Maeda I, Ishiki H, Miura T, Hatano Y, Oya K, Sakashita A, Ito S, Hiratsuka Y, Morita T, Mori M. Significance of fluid retention, body mass index, and weight loss in patients with advanced cancer. JCSM Clinical Reports 2020. [DOI: 10.1002/crt2.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Koji Amano
- Department of Palliative Medicine National Cancer Center Hospital 5‐1‐1 Tsukiji, Chuo‐ku Tokyo 104‐0045 Japan
- Department of Palliative and Supportive Medicine Graduate School of Medicine, Aichi Medical University 1‐1 Yazakokarimata Nagakute City Aich 480‐1195 Japan
| | - Isseki Maeda
- Department of Palliative Care Senri‐chuo Hospital Toyonaka Osaka Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine National Cancer Center Hospital 5‐1‐1 Tsukiji, Chuo‐ku Tokyo 104‐0045 Japan
| | - Tomofumi Miura
- Department of Palliative Medicine National Cancer Center Hospital East Kashiwa Chiba Japan
| | - Yutaka Hatano
- Department of Palliative Care, Kyowakai Medical Corporation Daini Kyoritsu Hospital Kawanishi Hyogo Japan
| | - Kiyofumi Oya
- Department of Palliative and Transitional Care Aso Iizuka Hospital Iizuka Fukuoka Japan
| | - Akihiro Sakashita
- Department of Palliative Medicine Kobe University School of Medicine Kobe Hyogo Japan
| | - Satoko Ito
- Hospice The Japan Baptist Hospital Kyoto Kyoto Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine Tohoku University School of Medicine Sendai Miyagi Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division Seirei Mikatahara General Hospital Hamamatsu Shizuoka Japan
| | - Masanori Mori
- Palliative Care Team Seirei Mikatahara General Hospital Hamamatsu Shizuoka Japan
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Hiratsuka Y, Yamaguchi T, Maeda I, Morita T, Mori M, Yokomichi N, Hiramoto S, Matsuda Y, Kohara H, Suzuki K, Tagami K, Yamaguchi T, Inoue A. The Functional Palliative Prognostic Index: a scoring system for functional prognostication of patients with advanced cancer. Support Care Cancer 2020; 28:6067-6074. [PMID: 32303826 DOI: 10.1007/s00520-020-05408-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE For appropriate advance care planning, functional prognostication is necessary. However, there are no studies of functional prognostication in patients with cancer. The aim of this study was to develop a functional prognostic scoring system for patients with advanced cancer. METHODS In this multicenter prospective observational study, 1896 patients were enrolled. First, Cox regression analysis and the combination of forward and backward variable selection were used to identify the best subset of predictors. Second, the prognostic score value was defined from each regression coefficient of a significant prognostic factor. The Functional Palliative Prognostic Index (FPPI) was calculated by summing the prognostic scores. RESULTS Patients were classified into three groups by the FPPI. For walking, the 14-day functional survival probability was > 72.8% for group A (score 0), 28.4-72.8% for group B (score 1), and < 28.4% for group C (score 2-3). For eating, the 14-day functional survival probability was > 71.8% for group A (score 0-3), 29.6-71.8% for group B (score 3.5-5.5), and < 29.6% for group C (score 6-9). For communicating, the 14-day functional survival probability was > 76.6% for group A (score 0-6.5), 22.6-76.6% for group B (score 7-10), and < 22.6% for group C (score 10.5-16). Regarding each item, group B functionally survived significantly longer than group C, and group A functionally survived significantly longer than either of the others. CONCLUSION We firstly developed a functional prognostic scoring system for patients with advanced cancer. This FPPI system promises to be helpful in advance care planning.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University School of Medicine, Sendai, Japan
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naosuke Yokomichi
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shuji Hiramoto
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yosuke Matsuda
- Palliative Care Department, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroyuki Kohara
- Department of Palliative Care, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan
| | | | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan.
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Shimizu M, Kessoku T, Ishiki H, Matsuura T, Hiratsuka Y, Matsuda Y, Hasegawa T, Imai K, Maeda I, Oyamada S, Satomi E. Naldemedine for opioid-induced constipation in patients receiving palliative care: A real-world registry study (Phase-R OIC Study). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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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Affiliation(s)
- Masaki Shimizu
- Department of Palliative Medicine,National Cancer Center Hospital, Tokyo, Japan
| | - Takaomi Kessoku
- Department of palliative care center, Yokohama City University Hospital, Yokohama, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine,National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Matsuura
- Department of palliative care center, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Yoshinobu Matsuda
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Takaaki Hasegawa
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Kengo Imai
- Department of Palliative Medicine,Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | | | - Eriko Satomi
- Department of Palliative Medicine,National Cancer Center Hospital, Tokyo, Japan
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