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Published Papers 【 display / non-display 】

• Associations of nutrition impact symptoms with depression in patients with advanced cancer

  Amano, K; Okamura, S; Matsuda, Y; Baracos, VE; Mori, N; Miura, T; Tatara, R; Kessoku, T; Tagami, K; Otani, H; Mori, M; Taniyama, T; Nakajima, N; Nakanishi, E; Kako, J; Morita, T; Miyashita, M

  SUPPORTIVE CARE IN CANCER ( Supportive Care in Cancer )  32 ( 7 ) 445 - 445   2024.07 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  PURPOSE: Advanced cancer patients have nutrition impact symptoms (NISs), while many of them have depressive moods. This study aimed to determine the associations of NISs with depression. METHODS: This study was a secondary analysis. The dietary intake and 19 NISs in patients receiving palliative care were evaluated using 10-point scales, and the patients were categorized into two groups (non-depression and depression groups) using the cutoff based on the Patient Health Questionnaire-9 (PHQ-9). To determine associations between depression and the number of NISs with a score of ≥ 4, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the logistic regression model were calculated. RESULTS: A total of 225 participants were divided into the non-depression group (n = 148) and the depression group (n = 77). The prevalence of depression was 34.2%. Dietary intake was lower, and the number of NISs with a score of ≥ 4 was higher in the depression group (both p < 0.001). All NISs were more severe in the depression group. Significant differences were observed in 15 of the 19 NISs. In the logistic regression model, significantly higher adjusted ORs were observed in the groups with 4-6 NISs and 7 or more NISs with a score of ≥ 4 (10.76 [95% CI, 2.07-55.91], p = 0.016; 17.02 [95% CI, 3.08-94.22], p < 0.001) than in the group with no NISs with a score of ≥ 4. CONCLUSION: Having four or more NISs with a score ≥ 4 was associated with depression.

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• Associations of nutrition impact symptoms with dietary intake and eating-related distress in patients with advanced cancer

  Amano, K; Baracos, VE; Mori, N; Okamura, S; Yamada, T; Miura, T; Tatara, R; Kessoku, T; Matsuda, Y; Tagami, K; Otani, H; Mori, M; Taniyama, T; Nakajima, N; Nakanishi, E; Kako, J; Morita, T; Miyashita, M

  CLINICAL NUTRITION ESPEN ( Clinical Nutrition ESPEN )  60   313 - 319   2024.04 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  BACKGROUND & AIMS: There is no definition of nutrition impact symptoms (NISs) in cancer care. Moreover, there is a lack of evidence on the associations of NISs with dietary intake and eating-related distress (ERD) in advanced cancer. Therefore, this study aimed to determine the associations of NISs with dietary intake and ERD in patients with advanced cancer. METHODS: This study entailed a secondary analysis of a multicenter self-reported questionnaire designed to develop measurements that assess ERD experienced by patients. Participants evaluated their dietary intake and 19 symptoms regarded as NISs using a 10-point scale. To determine the association between dietary intake and the number of NISs with a score ≥4, estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the logistic regression model were calculated. Furthermore, to assess the association between ERD and the number of NISs with a score ≥4, multiple regression analysis was performed. RESULTS: A total of 302 patients were included in the analysis. The higher the number of NISs with a score ≥4, the lower the dietary intake tended to be. In the logistic regression model, significantly higher adjusted ORs than in the no NISs with a score ≥4 group were observed in the 4-6 NISs group, 7-9 NISs group, and 10 or more group (0.19 [95% CI, 0.07-0.52], p = 0.001; 0.11 [95% CI, 0.03-0.42], p = 0.001; 0.07 [95% CI, 0.01-0.36], p = 0.002, respectively). In the multiple regression analysis, the number of NISs with a score ≥4 was identified as one of the factors significantly associated with ERD. CONCLUSIONS: Having 4 or more NISs with a score ≥4 was shown to be predictive of the likelihood of reduced dietary intake. Furthermore, the higher the number of NISs with a score ≥4, the more likely the eating-related quality of life was impaired in advanced cancer.

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• Effectiveness of antipsychotics for managing agitated delirium in patients with advanced cancer: a secondary analysis of a multicenter prospective observational study in Japan (Phase-R)

  Kurisu, K; Inada, S; Maeda, I; Nobata, H; Ogawa, A; Iwase, S; Uchida, M; Akechi, T; Amano, K; Nakajima, N; Morita, T; Sumitani, M; Yoshiuchi, K

  SUPPORTIVE CARE IN CANCER ( Supportive Care in Cancer )  32 ( 3 ) 147 - 147   2024.03 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  PURPOSE: Delirium is a common and serious comorbidity in patients with advanced cancer, necessitating effective management. Nonetheless, effective drugs for managing agitated delirium in patients with advanced cancer remain unclear in real-world settings. Thus, the present study aimed to explore an effective pharmacotherapy for this condition. METHODS: We conducted a secondary analysis of a multicenter prospective observational study in Japan. The analysis included patients with advanced cancer who presented with agitated delirium and received pharmacotherapy. Agitation was defined as a score of the Richmond Agitation-Sedation Scale for palliative care (RASS-PAL) of ≥ 1. The outcome was defined as -2 ≤ RASS-PAL ≤ 0 at 72 h after the initiation of pharmacotherapy. Multiple propensity scores were quantified using a multinomial logistic regression model, and adjusted odds ratios (ORs) were calculated for haloperidol, chlorpromazine, olanzapine, quetiapine, and risperidone. RESULTS: The analysis included 271 patients with agitated delirium, and 87 (32%) showed -2 ≤ RASS-PAL ≤ 0 on day 3. The propensity score-adjusted OR of olanzapine was statistically significant (OR, 2.91; 95% confidence interval, 1.12 to 7.80; P = 0.030). CONCLUSIONS: The findings suggest that olanzapine may effectively improve delirium agitation in patients with advanced cancer.

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• Anticholinergic drugs for death rattle in dying patients with cancer: multicentre prospective cohort study

  Yamaguchi, T; Yokomichi, N; Yamaguchi, T; Maeda, I; Matsunuma, R; Tanaka-Yagi, Y; Akatani, A; Suzuki, K; Kohara, H; Taniyama, T; Matsuda, Y; Nakajima, N; Morita, T; Tsuneto, S; Mori, M

  BMJ SUPPORTIVE & PALLIATIVE CARE ( BMJ Supportive and Palliative Care )  13 ( 4 ) 462 - 471   2023.12 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  BACKGROUND: This study aimed to investigate the effectiveness of anticholinergics (AC) for death rattle in dying patients with cancer. METHODS: This is a prospective cohort study enrolled Terminally ill adult (20 years or older) patients with cancer who developed substantial death rattle (Back score ≥2) from 23 palliative care units in Japan. AC treatment for death rattle was prescribed according to primary physician's decision. The primary outcome was the proportion of patients whose death rattle improved, which was defined as a Back score of ≤1. We compared the proportion of improved cases in patients treated with (AC group) and without (non-AC group) AC, controlling potential confounders by employing propensity score weighting. RESULTS: Of the 1896 patients enrolled, we included 196 who developed a substantial death rattle. Of these, 81 received AC. 56.8% in the AC group and 35.4% in the non-AC group had an improved death rattle at 8 hours after baseline. In the weighted analysis, AC group showed significant improvements in death rattle, with an adjusted OR of 4.47 (95% CI 2.04 to 9.78; p=0.0024). All sensitivity analyses achieved essentially the same results. In the subgroup analysis, ACs were strongly associated with death rattle improvement in men, patients with lung cancer, and type 1 death rattle (adjusted OR 5.81, 8.38 and 9.32, respectively). CONCLUSIONS: In this propensity score-weighted analysis, ACs were associated with death rattle improvement in terminally ill patients with cancer who developed substantial death rattle. TRIAL REGISTRATION NUMBER: UMIN-CTR (UMIN00002545).

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• Difficulty swallowing and food bolus obstruction in advanced cancer: association with the cachexia-related quality of life.

  Otani H, Amano K, Morita T, Miura T, Mori N, Tatara R, Kessoku T, Tokoro A, Tagami K, Mori M, Taniyama T, Nakajima N, Nakanishi E, Kako J, Miyashita M

  Annals of palliative medicine   12 ( 4 ) 717 - 728   2023.07 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  BACKGROUND: Swallowing disorders including difficulty swallowing and food bolus obstruction, result in reduced dietary intake-a common occurrence that leads to cachexia in patients with advanced cancer. This study examined the effects of swallowing difficulty and food bolus obstruction on cachexia-related quality of life (QOL). METHODS: This study secondarily analyzed data from a self-reported questionnaire survey of adult patients with advanced cancer at 11 palliative care services. Difficulty swallowing and food bolus obstruction were measured using the 11-point Numeric Rating Scale (NRS), whereas dietary intake and cachexia-related QOL were assessed using the Ingesta-Verbal/Visual Analog Scale and the Functional Assessment of Anorexia/ Cachexia Therapy Anorexia/Cachexia Subscale. A multiple logistic regression model was employed to determine the factors associated with varying degrees of difficulty swallowing and food bolus obstruction. RESULTS: Of the invited 495 patients, 378 agreed to participate (response rate 76.4%). After excluding participants with missing data, the data of 332 participants were analyzed; 26.5% had difficulty swallowing (NRS ≥1) and 28.3% had food bolus obstruction (NRS ≥1). Multivariate analysis revealed a substantial association between difficulty swallowing and food bolus obstruction and a decrease in cachexia-related QOL, regardless of performance status and the existence of cachexia. The coefficients for difficulty swallowing and food bolus obstruction were -6.34 [95% confidence interval (CI): -9.55 to -3.14, P<0.001] and -5.88 (95% CI: -8.68 to -3.09, P<0.001), respectively. CONCLUSIONS: Cachexia-related QOL deteriorated as difficulty swallowing and food bolus obstruction worsened; thus, healthcare providers must diagnose and treat swallowing disorders in a timely manner to prevent progression of cachexia and improve cachexia-related QOL.

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Presentations 【 display / non-display 】

Presentations 【 display / non-display 】

• How to change artificial hydration and nutrition therapy toward the end stage of cancer, which has been provided in parallel with cancer treatment?

  Nobuhisa Nakajima

  46th ESPEN Congress on Clinical Nutrition and Metabolism  2024.09  -  2024.09 

• Building comprehensive palliative care education system in Japan based on the experience at COVID-19 pandemic

  Nobuhisa Nakajima

  13th World Research Congress of European Association for Palliative Care  2024.05  -  2024.05 

• Comprehensive education on palliative care for multidisciplinary medical professionals to “Disseminate”, “Enhance”, “Deepen” and “Collaborate” in a remote-islands prefecture in Japan.

  Nobuhisa Nakajima

  18th World Congress of European Association for Palliative Care  2023.06  -  2023.06 

• The evaluation of the methodological quality of clinical practice guidelines on palliative care for cancer patients in Japan

  Nobuhisa Nakajima

  18th World Congress of European Association for Palliative Care  2023.06  -  2023.06 

• The effectiveness of artificial hydration therapy for terminal cancer patients based on the Japanese clinical guideline

  Nobuhisa Nakajima

  11th World Research Congress Online European Association for Palliative Medicine  2020.10  -  2020.10 

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Academic Awards 【 display / non-display 】

Academic Awards 【 display / non-display 】

• Best paper

  2020.08   JSPM,JPOS,JASCC  

  Winner: Nobuhisa Nakajima

• Orange Circle Award 2010

  1900.01.01   Japan Partnar against Pain  

Grant-in-Aid for Scientific Research 【 display / non-display 】

Grant-in-Aid for Scientific Research 【 display / non-display 】

• Development of a program to implement "integration of oncology and palliative care" in hospitals providing cancer care

  Grant-in-Aid for Scientific Research(C)

  Project Year: 2022.04  -  2025.03 

  Direct: 3,200,000 (YEN)  Overheads: 4,160,000 (YEN)  Total: 960,000 (YEN)

• Development of a program to implement "integration of oncology and palliative care" in hospitals providing cancer care

  Grant-in-Aid for Scientific Research(C)

  Project Year: 2022.04  -  2025.03 

  Direct: 3,200,000 (YEN)  Overheads: 4,160,000 (YEN)  Total: 960,000 (YEN)

• A national registry study to estimate the effect of pharmacotherapy on death rattle in cancer patients

  Grant-in-Aid for Early-Career Scientists

  Project Year: 2018.04  -  2021.03 

  Investigator(s): Nobuhisa Nakajima 

  Direct: 3,200,000 (YEN)  Overheads: 4,160,000 (YEN)  Total: 960,000 (YEN)

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  A total of 196 patients who presented with death rattle were included in the analysis. 1) In the study of all patients, there was no significant difference between the use of anticholinergic drugs (Scopolamine hydrobromide, Scopolamine butylbromide) and the intensity of wheezing. 2) The use of anticholinergic drugs significantly reduced the intensity of wheezing at 12 and 20 hours in patients with a Back scale of 2 or higher than that at T0 (before starting these drugs). There was no significant difference in the type of anticholinergic drug or method of administration (single or continuous). In terms of anticholinergic medication for death rattle, it is possible to obtain significant improvement by making decisions based on the intensity of the wheezing. In the future, interventional studies should be designed to clarify the differences in the therapeutic effects of anticholinergic drugs and administration methods on death rattle.

• A national registry study to estimate the effect of pharmacotherapy on death rattle in cancer patients

  Grant-in-Aid for Early-Career Scientists

  Project Year: 2018.04  -  2021.03 

  Investigator(s): Nobuhisa Nakajima 

  Direct: 3,200,000 (YEN)  Overheads: 4,160,000 (YEN)  Total: 960,000 (YEN)

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  A total of 196 patients who presented with death rattle were included in the analysis. 1) In the study of all patients, there was no significant difference between the use of anticholinergic drugs (Scopolamine hydrobromide, Scopolamine butylbromide) and the intensity of wheezing. 2) The use of anticholinergic drugs significantly reduced the intensity of wheezing at 12 and 20 hours in patients with a Back scale of 2 or higher than that at T0 (before starting these drugs). There was no significant difference in the type of anticholinergic drug or method of administration (single or continuous). In terms of anticholinergic medication for death rattle, it is possible to obtain significant improvement by making decisions based on the intensity of the wheezing. In the future, interventional studies should be designed to clarify the differences in the therapeutic effects of anticholinergic drugs and administration methods on death rattle.