Published Papers - Nakajima Nobuhisa

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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Impact of taste/smell disturbances on dietary intakes and cachexia-related quality of life in patients with advanced cancer

Otani, H; Amano, K; Morita, T; Miura, T; Mori, N; Tatara, R; Kessoku, T; Matsuda, Y; Tagami, K; Mori, M; Taniyama, T; Nakajima, N; Nakanishi, E; Kako, J; Shirado, AN; Yokomichi, N; Miyashita, M

SUPPORTIVE CARE IN CANCER ( Supportive Care in Cancer )  31 ( 2 ) 141 - 141   2023.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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PURPOSE: Taste and smell are used to enjoy meals; however, impairments of these sensory perceptions seriously impact health and eating habits. This study is aimed at investigating the impact of taste and smell disturbances on dietary intakes and cachexia-related quality of life (QOL) in patients with advanced cancer. METHODS: Using a self-report questionnaire, we surveyed patients with advanced cancer undergoing treatment at 11 palliative care centers. Multivariate analyses were conducted to explore the impact of taste and smell disturbances on dietary intakes and cachexia-related QOL. Dietary intakes were assessed using the Ingesta-Verbal/Visual Analog Scale, while taste and smell disturbances were assessed using an 11-point Numeric Rating Scale (NRS). Cachexia-related QOL was assessed using the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS). RESULTS: Overall, 378 patients provided consent to participate. After excluding patients with missing data, data were analyzed for 343 patients. Among them, 35.6% (n = 122; 95% [confidence interval (CI)] 0.28-0.38) and 20.9% (n = 72; 95% CI 0.17-0.25) experienced disturbances in taste (NRS ≥ 1) and smell (NRS ≥ 1), respectively. Multivariate analyses revealed that, independent of performance status and cancer cachexia, taste and smell disturbances were significantly associated with worse dietary intakes and deteriorating FAACT ACS scores. CONCLUSION: More severe taste and smell disturbances were associated with poorer dietary intakes and cachexia-related QOL. Diagnosing and treating such disturbances may improve dietary intakes and cachexia-related QOL, regardless of performance status and cachexia.

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Development and validation of questionnaires for eating-related distress among advanced cancer patients and families.

Amano K, Morita T, Miura T, Mori N, Tatara R, Kessoku T, Matsuda Y, Tagami K, Otani H, Mori M, Taniyama T, Nakajima N, Nakanishi E, Kako J, Ishiki H, Matsuoka H, Satomi E, Hopkinson JB, Baracos VE, Miyashita M

Journal of cachexia, sarcopenia and muscle   14 ( 1 ) 310 - 325   2023.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Development and validation of questionnaires for eating-related distress among advanced cancer patients and families

Amano, K; Morita, T; Miura, T; Mori, N; Tatara, R; Kessoku, T; Matsuda, Y; Tagami, K; Otani, H; Mori, M; Taniyama, T; Nakajima, N; Nakanishi, E; Kako, J; Ishiki, H; Matsuoka, H; Satomi, E; Hopkinson, JB; Baracos, VE; Miyashita, M

JOURNAL OF CACHEXIA SARCOPENIA AND MUSCLE   14   310 - 325   2023.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Palliative Care Outcome Scale Assessment for Cancer Patients Eligible for Palliative Care: Perspectives on the Relationship between Patient-Reported Outcome and Objective Assessments

Nakajima, N

CURRENT ONCOLOGY ( Current Oncology )  29 ( 10 ) 7140 - 7147   2022.10 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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(1) Background: The importance of patient-reported outcome (PRO), i.e., prioritizing patient voice, has increased in cancer treatment, as well as palliative and supportive settings. The Integrated Palliative Care Outcome Scale (IPOS), a hybrid evaluation consisting of "patient evaluation" (PRO) and "peer evaluation" by medical professionals, was developed as a successor version of the Support Team Assessment Schedule (STAS) in 2013 and has been utilized worldwide. The Japanese version of the IPOS (IPOS-J) was developed and released in 2019. The purpose of this study was to explore the applicability of the IPOS-J to clinical practice in the future. (2) Methods: We conducted the following two studies with terminally ill cancer patients: (i) Can an evaluation with the IPOS-J performed by medical professionals (peer evaluation) replace the STAS-J evaluation? (ii) Can the quality of palliative care improve by combining the IPOS-J patient evaluation with the peer evaluation? (3) Results: The overall intervention rate and urgent intervention rate for the STAS-J and IPOS-J was 34.4 vs. 34.1% (p = 0.91) and 10.4 vs. 9.9% (p = 0.78), respectively. The patients selected "intervention required" but the medical professionals selected "no intervention required" in 47 cases. The medical team performed appropriate intervention after re-assessment. As a result, more than 70% of the patients were "intervention-free" after 1 week of intervention. (4) Conclusions: The IPOS-J peer evaluation was as useful as the STAS-J evaluation. A hybrid type of evaluation, combining patient evaluation (PRO) and peer evaluation, may help us to understand patient needs and improve the quality of palliative care.

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Beliefs and Perceptions About Parenteral Nutrition and Hydration by Advanced Cancer Patients

Akiko Abe, Koji Amano, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Yoshinobu Matsuda, Keita Tagami, Hiroyuki Otani, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Daisuke Kiuchi, Hiroto Ishiki, Hiromichi Matsuoka, Eriko Satomi, Mitsunori Miyashita

Palliative Medicine Reports ( Mary Ann Liebert Inc )  3 ( 1 ) 132 - 139   2022.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: The beliefs and perceptions of parenteral nutrition and hydration (PNH) by advanced cancer patients have not been elucidated. OBJECTIVES: To clarify their beliefs and perceptions and to explore the relationships between their beliefs and perceptions and cachexia stages. DESIGN/SETTING/SUBJECTS: A questionnaire survey of advanced cancer patients receiving palliative care across Japan. MEASUREMENTS: We asked patients to answer 15 items regarding their beliefs and perceptions of PNH. Frequencies were calculated for the patient characteristics and survey parameters. Comparisons were performed using the Mann-Whitney U test. We conducted a factor analysis and a multiple logistic regression analysis to identify the independent factors affecting cancer cachexia stages. RESULTS: Among 495 patients, 378 responded. Due to missing data, 357 remained in the frequency distribution analysis, and 344 were classified into the noncachexia group (n = 174) and cachexia group (n = 170). Approximately 60% thought that PNH were beneficial. Approximately 70% considered PNH a standard medical practice. Approximately 70% did not feel that they received a sufficient explanation. There were no significant differences in any items between the two groups. We extracted four conceptual groups. The concept of "Belief that PNH are harmful" was identified as an independent factor [odds ratio 2.57 (95% confidence intervals 1.10-6.01), p = 0.030]. CONCLUSION: More than half of the patients thought that PNH were beneficial and standard medical practices with or without cancer cachexia. The negative perception of PNH decreased in patients with cancer cachexia.

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Difficulties in Addressing Artificial Hydration and Nutrition Therapy for Terminal Cancer Patients: What to do if Patients/Families’ Wishes Differ From the Medically Appropriate Treatment Plans?

Nakajima N.

American Journal of Hospice and Palliative Medicine ( American Journal of Hospice and Palliative Medicine )  39 ( 8 ) 926 - 933   2022.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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PURPOSE: Artificial hydration and nutrition therapy (AHNT) initiated by patients/families sometimes differs from medically appropriate treatment plans. We aimed to identify the causes of these differences and examine the ensuing responses and outcomes. METHODS: Of 133 adult cancer patients receiving end-of-life care in the last 2 years, these discrepancies occurred in 41 patients. We retrospectively examined the following issues: (1) The reason why these discrepancies occurred. (2) Based on the causes identified in (1), the following actions were taken: 1) If the consent to change to medically appropriate AHNT was obtained, physical findings using Japan Palliative Oncology Study (JPOS) group and Edmonton Symptom Assessment System (ESAS) were compared before and 1 week after the intervention. 2) If consent was not obtained, time-limited trial (TLT) was conducted, and these results were compared. (3) The communication between patients/families and medical professionals was compared using Support Team Assessment Schedule. RESULTS: (1) Causes: a) the lack of understanding of the disease condition in 26 cases and b) faulty expectation of AHNT in 15 cases. (2) In 30 cases of 1) (20 of a) and 10 of b)) and 11 of 2) in which TLT was performed, JPOS and ESAS improved significantly. (3) The communication above was improved significantly in 1) and 2) (P = .0027 and .0039, respectively). CONCLUSION: Providing medically appropriate AHNT with the consent of patients/families is expected to not only alleviate distressing symptoms but also improve the communication between patients/families and medical professionals, as well as improve the quality of palliative care.

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The impact of cachexia on dietary intakes, symptoms, and quality of life in advanced cancer

Koji Amano, Vickie E. Baracos, Tatsuya Morita, Tomofumi Miura, Naoharu Mori, Ryohei Tatara, Takaomi Kessoku, Akihiro Tokoro, Keita Tagami, Hiroyuki Otani, Masanori Mori, Tomohiko Taniyama, Nobuhisa Nakajima, Erika Nakanishi, Jun Kako, Daisuke Kiuchi, Hiroto Ishiki, Hiromichi Matsuoka, Eriko Satomi, Mitsunori Miyashita

JCSM Rapid Communications ( Wiley )    2022.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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A decision tree prediction model for a short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions: A secondary analysis of a multicenter and prospective observational study (Phase-R)

Kurisu, K; Inada, S; Maeda, I; Ogawa, A; Iwase, S; Akechi, T; Morita, T; Oyamada, S; Yamaguchi, T; Imai, K; Nakahara, R; Kaneishi, K; Nakajima, N; Sumitani, M; Yoshiuchi, K

PALLIATIVE & SUPPORTIVE CARE ( Palliative and Supportive Care )  20 ( 2 ) 153 - 158   2022.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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<title>Abstract</title> <sec id="S1478951521001565_sec_a1"> <title>Objective</title> There is no widely used prognostic model for delirium in patients with advanced cancer. The present study aimed to develop a decision tree prediction model for a short-term outcome. </sec> <sec id="S1478951521001565_sec_a2" sec-type="methods"> <title>Method</title> This is a secondary analysis of a multicenter and prospective observational study conducted at 9 psycho-oncology consultation services and 14 inpatient palliative care units in Japan. We used records of patients with advanced cancer receiving pharmacological interventions with a baseline Delirium Rating Scale Revised-98 (DRS-R98) severity score of ≥10. A DRS-R98 severity score of &lt;10 on day 3 was defined as the study outcome. The dataset was randomly split into the training and test dataset. A decision tree model was developed using the training dataset and potential predictors. The area under the curve (AUC) of the receiver operating characteristic curve was measured both in 5-fold cross-validation and in the independent test dataset. Finally, the model was visualized using the whole dataset. </sec> <sec id="S1478951521001565_sec_a3" sec-type="results"> <title>Results</title> Altogether, 668 records were included, of which 141 had a DRS-R98 severity score of &lt;10 on day 3. The model achieved an average AUC of 0.698 in 5-fold cross-validation and 0.718 (95% confidence interval, 0.627–0.810) in the test dataset. The baseline DRS-R98 severity score (cutoff of 15), hypoxia, and dehydration were the important predictors, in this order. </sec> <sec id="S1478951521001565_sec_a4"> <title>Significance of results</title> We developed an easy-to-use prediction model for the short-term outcome of delirium in patients with advanced cancer receiving pharmacological interventions. The baseline severity of delirium and precipitating factors of delirium were important for prediction. </sec>

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Differential Diagnosis of Cachexia and Refractory Cachexia and the Impact of Appropriate Nutritional Intervention for Cachexia on Survival in Terminal Cancer Patients.

Nakajima N

Nutrients ( Nutrients )  13 ( 3 ) 1 - 8   2021.03 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study subjects were terminal cancer patients admitted for palliative care and were judged refractory cachexia in the last five years. We retrospectively examined to find useful indices for identifying such cachectic patients and for evaluating the effect of nutritional intervention. Out of 223 patients in refractory cachexia, 26 were diagnosed cachexia with starvation after symptom management. Comparing before and one week after this management, Palliative Performance Scale (PPS) and transthyretin significantly improved (p < 0.0001, p = 0.0002, respectively) Then, we started nutritional intervention for these cachectic patients and divided into effective group (n = 17) and non-effective group (n = 9) using the criteria for cachexia. Comparing between the two groups, PPS significantly improved2 weeks after intervention in effective group (p = 0.006). Survival time was significantly longer in effective group (p = 0.008). PPS and transthyretin were useful for differential diagnosis of cachexia and refractory cachexia. PPS was useful for evaluating nutritional intervention for cachectic patients. Appropriate nutritional intervention improved survival.

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Cross-cultural Study about Cancer and Palliative Care in the Okinawa, Tohoku, and Tokyo Metropolitan Area

Naito Akemi, Morita Tatsuya, Kamiya Kohei, Suzuki Naoki, Tagami Keita, Motonari Tokiwa, Takahashi Hidenori, Nakanishi Erika, Nakajima Nobuhisa

Palliative Care Research ( Japanese Society for Palliative Medicine )  16 ( 3 ) 255 - 260   2021 [ Peer Review Accepted ]

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<p>Background: Consideration of cultural aspects is important in medical care. We explored regional differences in cancer and palliative care among Okinawa, Tohoku, and Tokyo metropolitan area. Methods: We conducted a questionnaire survey of physicians involved in cancer medicine from September to November 2020. A total of 11 items related to physician experiences were rated using a 5-point Likert-type scale. Results: Responses were received from 553 physicians (187 in Okinawa, 219 in Tohoku, 147 in the Tokyo metropolitan area). In Okinawa, “When patients die, it is important that all family members are present at the last moment," “Patients/family members primarily consult the elders of the family about the medical treatments," “Family members hope the patients die at home, because the soul will not return when they die at the hospital," “Patients/family members get advice from religious advisors about the medical treatments," and “Family members wish to take the patient home when he/she is about to die and to confirm death at home" were significantly more frequently observed. In Tohoku, “Patients wish to be hospitalized at a specific season" was significantly more frequently reported. In Tohoku and Okinawa, “Patients hide cancer from neighbors and relatives" and “Elderly patients do not want treatment, because they cover the living expenses and education expenses for their children and grandchildren." were significantly more frequently experienced. Conclusion: There are regional differences in cancer and palliative care in Japan. Being sensitive to the culture of the region is needed.</p>

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Challenges of Dental Hygienists in a Multidisciplinary Team Approach During Palliative Care for Patients With Advanced Cancer: A Nationwide Study.

Nakajima N

The American journal of hospice & palliative care ( American Journal of Hospice and Palliative Medicine )    1049909120960708 - 1049909120960708   2020.09 [ Peer Review Accepted ]

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PURPOSE: Palliative care is constructed by various kinds of professionals. This study aimed to identify the challenges that dental hygienists (DHs) encountered when working with other professionals in a multidisciplinary team approach in palliative care for advanced cancer patients. METHODS: We conducted the following two studies: (1) a questionnaire-based survey for DHs who belong to Japanese Society for Oral Care (JSOC) on oral care in palliative care settings (n = 1,290), and (2) surveys on education for DHs in universities. Items in this study included the following: 1) a cross-sectional analysis of the curriculum on palliative care at 10 universities and 2) a questionnaire-based survey on palliative care education at 1 of the 10 universities (n = 75). RESULTS: (1) Seventy-three percent had experience in oral care in palliative care settings. The number of DHs with ≥20 years' experience was significantly higher than those with <10 years' experience (76% vs 66%, p = 0.042). Further, 92% received no formal palliative care education, and 94% perceived a lack of knowledge on palliative care. These data did not differ based on the years of experience. (2) (a) There was no specific curriculum on the subject of palliative care in 10 universities. Lectures on palliative care were provided at 3 universities. (b) Fifty-five percent of students attended lectures on palliative care. However, 88% of them experienced anxiety, and 78% perceived few classes on palliative care. CONCLUSIONS: For DHs, to positively contribute to multidisciplinary palliative care team approach, it is important to establish pregraduate and postgraduate education systems.

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Impact of differential diagnosis of cachexia and refractory cachexia and appropriate nutritional support for cachexia on survival in terminal cancer patients

Nakajima, N

ANNALS OF ONCOLOGY   31   S933 - S933   2020.09 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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The Effectiveness of Artificial Hydration Therapy for Patients With Terminal Cancer Having Overhydration Symptoms Based on the Japanese Clinical Guidelines A Pilot Study.

Nakajima N

The American journal of hospice & palliative care ( American Journal of Hospice and Palliative Medicine )  37 ( 7 ) 521 - 526   2020.07 [ Peer Review Accepted ]

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BACKGROUND: Recently, there has been a growing interest in the use of artificial hydration therapy (AHT) for patients with terminal cancer. The Japanese Society for Palliative Medicine published the guideline for AHT in 2007, and it was revised in 2013 based on the concept of cancer cachexia. OBJECTIVES: The purpose of this study was to evaluate the effects of AHT for patients with terminal cancer having overhydration symptoms based on this revised guideline. METHODS: This is a before-and-after study. We retrospectively analyzed 121 patients, of the 523 patients with terminal cancer who were admitted during the last 4 years, who were receiving "inappropriate hydration therapy." We performed guideline-based AHT and examined the effects on the alleviation of hydration-related symptoms, quality of life (QOL), patient satisfaction, and the feeling of benefit from AHT using a numeric rating scale, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30, satisfaction scale, and benefit scale on day 7 ± 1 compared to those at baseline. RESULTS: Hydration-related symptoms (nausea: 32, abdominal pain/distention: 35, peripheral edema: 42, and dyspnea: 28 cases) were significantly improved after performing guideline-based AHT (5.35 ± 1.26→4.00 ± 1.51, P = .002; 5.41 ± 1.44→4.12 ± 1.52; P = .005; 5.16 ± 1.38→3.29 ± 1.66; P < .0001; and 5.24 ± 1.22→4.21 ± 1.53, P = .002, respectively). The general QOL scores, overall satisfaction, and feeling of benefit were also significantly improved (2.67 ± 1.21→3.98 ± 1.55, P < .0001; 2.25 ± 1.35→3.48 ± 1.44, P < .0001; and 3.12 ± 1.24→4.31 ± 1.38, P = .0001, respectively). CONCLUSIONS: An appropriate AHT could alleviate overhydration-related symptoms and improve the QOL, patient satisfaction, and feeling of benefit.

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Reversibility delirium in ill-hospitalized cancer patients: Does underlying etiology matter?

Matsuda Y, Maeda I, Morita T, Phase-R group (Nakajima N, et al)

Cancer Med   9 ( 1 ) 19 - 26   2020.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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尊厳と安心のある社会に向けた緩和ケアと地域づくり:医療者間コミュニケーションの視点から

中島 信久

医療と社会 ( 公益財団法人 医療科学研究所 )  30 ( 1 ) 43 - 51   2020

Type of publication: Research paper (scientific journal)

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<p>「尊厳と安心のある社会に向けた緩和ケアと地域づくり」を目指すとき，コミュニケーションの視点から取り組むことは大切である。緩和ケアにおけるコミュニケーションは，患者－家族間，医療者間，患者・家族－医療者間の３つに大別される。このうちの２つ目，すなわち医療者間コミュニケーションに焦点を当てて論じる。医療者間のコミュニケーションを考える場合，「連携」がキーワードになる。この「連携」には「他の職種との連携（多職種連携）」，「診療科間の連携」，「専門家とジェネラリスト（一般臨床家）との連携」「病診連携・病病連携」などといった様々なかたちがある。</p><p>がん対策基本法の制定，PEACE研修会の開催，緩和ケア病棟や在宅緩和ケアの充実などにより，近年，わが国の緩和ケアの質は向上した。その一方で，地域間で提供される緩和ケアやがん医療の質に差異があることも事実である。われわれが沖縄で行っている４つの柱からなる包括的なプラン（「緩和ケアを『広める』『高める』『深める』『繋げる』ための取り組み）が，こうした問題を改善し「地域づくり」に役立つと思われるので紹介する。具体的には，①県全体への基本的緩和ケアの普及（＝広める）とともに②地域緩和ケアの中核を担う医療者のレベルアップ（＝高める）を図り，さらには③がん治療と緩和ケアの統合の実践（＝深める）を専門レベルで行う。①，②，③に取り組みながら④多職種連携・地域連携を進める（＝繋げる）ことが，質・量両面で充実したコミュニケーションに基づいた「尊厳と安心のある社会に向けた緩和ケアと地域づくり」の発展につながると期待される。</p>

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Effectiveness of rapid titration with intravenous administration of oxycodone injection in advanced cancer patients with severe pain.

Nakajima N

Japanese journal of clinical oncology ( Japanese Journal of Clinical Oncology )  49 ( 11 ) 1061 - 1064   2019.12 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Some cancer patients suddenly develop severe, excruciating pain that requires rapid management using opioid medication. This study aimed to evaluate the effectiveness of rapid titration using oxycodone injection. Study subjects were advanced cancer patients who experienced severe pain (numeric rating scale ≥7) and needed prompt pain relief. Primary endpoint was (i) time required for the initial sign of significant analgesia to become evident. Secondary endpoints were (ii) pain relief stabilization success rate and (iii) adverse effects. Groups treated with oxycodone (oxycodone group) and morphine (morphine group) were retrospectively compared. The oxycodone group had 33 cases and the morphine group had 32 cases: (i) 15.6 ± 4.3 min in the oxycodone group and 19.3 ± 4.7 min in the morphine group (P = 0.001); (ii) 70 and 63% within 24 hours, and 88 and 84% within 48 hours in the oxycodone group and the morphine group, respectively (P = 0.36, 0.48). Although (iii) adverse effects appeared in both groups in the form of respiratory suppression, etc., the effects were mild. Rapid titration using oxycodone injections may be considered a beneficial choice.

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A pilot survey on the outpatient chemotherapy unit of national university hospitals in Japan for early palliative care

Takahashi, H; Satomi, Y; Suzuki, T; Uneoka, S; Ishii, T; Nanba, A; Iguchi, N; Takemura, K; Nakajima, N; Masuda, M; Arasaki, A

ANNALS OF ONCOLOGY   30   2019.10 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Clinical Guidelines for Management of Gastrointestinal Symptoms in Cancer Patients: The Japanese Society of Palliative Medicine Recommendations.

Hisanaga T, Shinjo T, Imai K, Katayama K, Kaneishi K, Honma H, Takagaki N, Osaka I, Matsuo N, Kohara H, Yamaguchi T, Nakajima N

Journal of palliative medicine ( Journal of Palliative Medicine )  22 ( 8 ) 986 - 997   2019.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Background: Gastrointestinal symptoms, including nausea, vomiting, bowel obstruction, ascites, constipation, and anorexia, are common and often refractory in advanced cancer patients. The palliation of gastrointestinal symptoms is important in improving the quality of life of cancer patients, as well as that of their families and caregivers. Currently published clinical guidelines for the management of gastrointestinal symptoms in cancer patients do not comprehensively cover the topics or are not based on a formal process for the development of clinical guidelines. Methods: The Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of gastrointestinal symptoms in cancer patients after a formal guideline development process. Results: This article summarizes the recommendations along with their rationale and a short summary of the development process of the JSPM gastrointestinal symptom management guidelines. We established 31 recommendations, all of which are based on the best available evidence and agreement of expert taskforce members. Discussion: Future clinical studies and continuous guideline updates are required to improve gastrointestinal symptom management in cancer patients.

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Current pharmacotherapy does not improve severity of hypoactive delirium in patients with advanced cancer: pharmacological audit study of safety and efficacy in real world (Phase-R)

Okuyama T, Yoshiuchi K, Ogawa A, Phase-R group (Nakajima N, et al)

Oncologist   24 ( 7 ) 574 - 582   2019.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Treatment Recommendations for Urological Symptoms in Cancer Patients: Clinical Guidelines from the Japanese Society for Palliative Medicine.

Tsushima T, Miura T, Hachiya T, Nakamura I, Yamato T, Kishida T, Tanaka Y, Irie S, Meguro N, Kawahara T, Nakajima N

Journal of palliative medicine ( Journal of Palliative Medicine )  22 ( 1 ) 54 - 61   2019.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Urological symptoms such as gross hematuria, lower and upper urinary tract symptoms, and bladder pain are common in and distressing for patients with advanced cancer. Although palliation of urological symptoms is important to improve the quality of life of cancer patients and their families and caregivers, clinical guidelines for managing urological symptoms in patients with cancer have not been published. METHODS: Following the formal guideline development process, the Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of urological symptoms in patients with cancer. RESULTS: This article summarizes the recommendations and their rationales and provides a short summary of the development process of the JSPM urological symptom management guidelines. We established five recommendations, all of which were based on the best available evidence and expert consensus. CONCLUSION: JSPM released the first edition of the "Clinical Guidelines for Urological Symptoms in Cancer Patients." Future clinical research and continuous guideline updates are required to improve the quality of managing urological symptoms in patients with cancer.

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Low Transthyretin Levels Predict Poor Prognosis in Cancer Patients in Palliative Care Settings.

Miura T, Amano K, Shirado A, Baba M, Ozawa T, Nakajima N, Suga A, Matsumoto Y, Shimizu M, Shimoyama S, Kuriyama T, Matsuda Y, Iwashita T, Mori I, Kinoshita H

Nutrition and cancer ( Nutrition and Cancer )  70 ( 8 ) 1283 - 1289   2018.11 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Objectives: Although transthyretin (TTR) is a nutritional indicator and is influenced by systemic inflammation, it may be a good prognostic indicator for cancer patients in palliative care settings. This study investigates the correlation between low TTR levels and survival among cancer patients in palliative care settings.Methods: This was a sub-analysis of a prospective, multicenter cohort study. Patients who had advanced-stage cancer and who were newly referred to palliative care services were eligible to participate; however, those receiving anti-tumor therapy were excluded. Survival analyses were performed to clarify predictors of poor prognosis.Results: A total of 144 patients were enrolled (45.1% female; median age, 72years). Cox regression analysis revealed that low TTR levels (<10.9mg/l) (hazard ratio 1.74, P=0.025), poor muscle power (1.71, P=0.045), and fatigue (1.89, P=0.024) were predictors of poor prognosis. Median survival in patients with low TTR levels (<10.9mg/l) was 26days, which was significantly shorter than those with high TTR levels (10.9mg/l) (50days; P<0.001).Conclusion: Low TTR levels may be indicators for poor prognosis among cancer patients in palliative care settings.

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C-reactive protein, symptoms and activity of daily living in patients with advanced cancer receiving palliative care.

Amano K, Maeda I, Morita T, Baba M, Miura T, Hama T, Mori I, Nakajima N, Nishi T, Sakurai H, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Ono S, Ozawa T, Yamamoto R, Yamamoto N, Shishido H, Kinoshita H

Journal of cachexia, sarcopenia and muscle   8 ( 3 ) 457 - 465   2017.06 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: The association between C-reactive protein (CRP) level, symptoms, and activities of daily living (ADL) in advanced cancer patients is unclear. METHODS: Secondary data analysis of a multicenter prospective cohort study consisted of 2426 advanced cancer patients referred to palliative care settings was conducted to examine the cross-sectional relationships between CRP level, symptoms, and ADL disabilities. Laboratory data, symptoms, ADL, and manual muscle testing (MMT) results were obtained at baseline. Participants were divided into four groups: low (CRP < 1 mg/dl), moderate (1 = < CRP <5 mg/dl), high (5 = < CRP < 10 mg/dl), and very high CRP (10 mg/dl = < CRP). The proportions of eight symptoms, five ADL disabilities, and three categories of MMT according to the CRP groups were tested by chi-square tests. Multiple-adjusted odd ratios (ORs) were calculated by using ordinal logistic regression after adjustment for age, gender, site of primary cancer, metastatic disease, performance status, chemotherapy, and setting of care. RESULTS: A total of 1702 patients were analysed. Positive rates of symptoms and ADL disabilities increased with increasing CRP level. In the very high-CRP group, rates of positivity for anorexia, fatigue, and weight loss were 89.8%, 81.0%, and 79.2%, respectively, and over 70% of patients received assistance for bathing, dressing, going to the toilet, and transfer. The grade of MMT also deteriorated with increasing CRP level. Adjusted ORs for the accumulated symptoms significantly increased with increasing CRP level in the moderate-CRP, high-CRP, and very high-CRP groups [1.6 (95% confidence interval 1.2-2.0), P < 0.001; 2.5 (1.9-3.2), P < 0.001; 3.5 (2.7-4.6), P < 0.001, respectively]. Adjusted ORs for the accumulated ADL disabilities significantly increased in the very high-CRP groups [2.1 (1.5-2.9), P < 0.001]. CONCLUSIONS: Associations between CRP level, symptoms, and ADL were observed in advanced cancer patients receiving palliative care.

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Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer.

Nakajima N

The American journal of hospice & palliative care   34 ( 5 ) 430 - 434   2017.06 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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PURPOSE: Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care. METHODS: The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed. RESULTS: There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p < 0.001). 2) Severe cases of dry mouth (Grade-2&3) were noted in 20.0% and 64.8% in good and poor oral intake groups, respectively ( p < 0.0001). Candidiasis complication rate was significantly higher in poor oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3. CONCLUSION: Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.

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The Predictive Risk Factors for Bedsores of Terminal Cancer Patients Receiving Home-based Care

Nishizaki Hisayoshi, Ishikawa Natsue, Hirayama Hideyuki, Miyashita Mitsunori, Nakajima Nobuhisa

Palliative Care Research ( Japanese Society for Palliative Medicine )  12 ( 3 ) 271 - 276   2017 [ Peer Review Accepted ]

Type of publication: Research paper (other science council materials etc.)

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<p>Aim: To clarify the predictive risk factors for bedsores of terminal cancer patients receiving home-based care. Methods: A retrospective study was conducted involving 95 terminal cancer patients receiving home-based care, including people using services provided by home-visit care providers until death. Results: The numbers of patients with and without bedsores were 31 and 64, respectively. Bivariate analyses revealed that significant variables were the Ohura-Hotta scale (P=0.02), hyperactive delirium (P=0.005), contracture (P=0.008), and anemia (P=0.02). According to multivariable logistic analysis, significant variables were contracture (OR=16.55, P=0.0002) and hyperactive delirium (OR=4.22, P=0.008) as independent risk factors for bedsores. Discussion: For terminal cancer patients receiving home-based care, hyperactive delirium should also be considered as a predictive risk factor for bedsores.</p>

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Guidelines for parenteral fluid management for terminal cancer patients.

Higashiguchi T, Ikegaki J, Sobue K, Tamura Y, Nakajima N, Futamura A, Miyashita M, Mori N, Inui A, Ohta K, Hosokawa T

Japanese journal of clinical oncology   46 ( 11 ) 986 - 992   2016.11 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Japan's first guidelines for parenteral fluid management for terminal cancer patients were issued in 2006. These guidelines focused on the fluid levels to administer to patients with a remaining life expectancy of 1-2 months. However, recent refinement of the concept of cachexia is prompting caregivers worldwide to rethink parenteral fluid management for terminal cancer patients. OBJECTIVE: Our objective was to develop guidelines for parenteral fluid management for terminal cancer patients with a remaining life expectancy of 1 month, a point when cachexia generally begins to severely adversely affect the body. METHODS: The Japanese Society for Palliative Medicine appointed a Guidelines Working Practitioner Group consisting of a multidisciplinary team of specialists. In response to 26 clinical questions on parenteral fluid management for terminal cancer patients, the Working Group used the Delphi method to reach consensus on the recommendability and evidence level of 89 relevant manuscripts identified through a systematic literature review. The Working Group then had an outside committee reviews the draft guidelines validity before authoring the final version. RESULTS: The resulting clinically aligned guidelines contain specific recommendations (25 recommendations on physical suffering/remaining life expectancy, 10 nursing-related recommendations and 4 ethical recommendations) assessed using the Delphi method and by an outside committee. CONCLUSIONS: Japanese Society for Palliative Medicine released a revised edition of the Guidelines for Parenteral Fluid Management for Terminal Cancer Patients, which are based on medical evidence and consider the pathologic features of cachexia. We recommend that caregivers carefully evaluate the clinical usefulness of the guidelines.

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Multicenter cohort study on the survival time of cancer patients dying at home or in a hospital: Does place matter?

Hamano J, Yamaguchi T, Maeda I, Suga A, Hisanaga T, Ishihara T, Iwashita T, Kaneishi K, Kawagoe S, Kuriyama T, Maeda T, Mori I, Nakajima N, Nishi T, Sakurai H, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Morita T

Cancer   122 ( 9 ) 1453 - 60   2016.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Although the place of death has a great influence on the quality of death and dying for cancer patients, whether the survival time differs according to the place of death is unclear. The primary aim of this study was to explore potential differences in the survival time of cancer patients dying at home or in a hospital. METHODS: This multicenter, prospective cohort study was conducted in Japan from September 2012 through April 2014 and involved 58 specialist palliative care services. RESULTS: Among the 2426 patients recruited, 2069 patients were analyzed for this study: 1582 receiving hospital-based palliative care and 487 receiving home-based palliative care. A total of 1607 patients actually died in a hospital, and 462 patients died at home. The survival of patients who died at home was significantly longer than the survival of patients who died in a hospital in the days' prognosis group (estimated median survival time, 13 days [95% confidence interval (CI), 10.3-15.7 days] vs 9 days [95% CI, 8.0-10.0 days]; P = .006) and in the weeks' prognosis group (36 days [95% CI, 29.9-42.1 days] vs 29 days [95% CI, 26.5-31.5 days]; P = .007) as defined by Prognosis in Palliative Care Study predictor model A. No significant difference was identified in the months' prognosis group. Cox proportional hazards analysis revealed that the place of death had a significant influence on the survival time in both unadjusted (hazard ratio [HR], 0.86; 95% CI, 0.78-0.96; P < .01) and adjusted models (HR, 0.87; 95% CI, 0.77-0.97; P = .01). CONCLUSIONS: In comparison with cancer patients who died in a hospital, cancer patients who died at home had similar or longer survival. Cancer 2016;122:1453-1460. © 2016 American Cancer Society.

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Concurrent Specialized Palliative Care Upon Initiation of First-Line Chemotherapy for Cancer Progression: Is It Early Enough?

Nakajima N, Abe Y

The American journal of hospice & palliative care   33 ( 4 ) 340 - 5   2016.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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PURPOSE: To evaluate the effectiveness of specialized palliative care (PC) administered at the time of administration of first-line chemotherapy for cancer progression. METHODS: Patients who received regular specialist PC concomitantly with first-line chemotherapy after being diagnosed with progressive disease assigned to PC group. Patients transferred to palliative care unit (PCU) after discontinuation of chemotherapy were assigned to standard care (SC) group. We evaluated quality of palliative care using Support Team Assessment Schedule, quality of life (QOL) using Good Death Inventory, and short-term mortality in PCU. RESULTS: A total of 28 and 63 patients patients were assigned to PC and SC groups, respectively. Physical symptoms, anxiety, communication scores, and QOL scores were significantly higher in the PC group (P < .001). Short-term mortality (<14 days) was significantly higher in the SC group (P = .0005). CONCLUSION: This approach may facilitate high quality of PC.

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Does the Approach of Disclosing More Detailed Information of Cancer for the Terminally Ill Patients Improve the Quality of Communication Involving Patients, Families, and Medical Professionals?

Nakajima N, Kusumoto K, Onishi H, Ishida M

The American journal of hospice & palliative care   32 ( 7 ) 776 - 82   2015.11 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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PURPOSE: Effective and faithful communication between patients and medical professionals could improve patients' quality of life and is an essential and fundamental factor in cancer treatment. The purpose of this study was to examine whether disclosing more detailed information about disease progression toterminally ill patients could improve the quality of communication. METHODS: This was a before/after study of 91 consecutive terminal cancer patients. Based on the previous studies, we categorized cancer disclosure into 4 groups: A;"non-disclosure", B;"disclosure of cancer diagnosis", C;"disclosureof life-threatening disease", and D;"disclosure of poor prognosis". We disclosed more detailed information based on the SPIKES protocol and compared the scores of 3 communication items of Support Team Assessment Schedule (Japanese version) measured between at admission and one-week after this approach. RESULTS: A, B, C and D groups included 8, 25, 40, and 18 cases, respectively. This approach to cancer disclosure was implemented in 37.5% of group A, 60% of group B, and 40% of group C. In group B, all 3 communications were significantly improved (2.40 ± 0.51 vs 1.53 ± 0.83, 1.93 ± 0.96 vs 1.00 ± 0.38, 2.13 ± 0.64 vs 1.13 ± 0.64; p = 0.0035, 0.0062, 0.0013). In group C, all 3 communications were significantly improved (1.25 ± 0.58 vs 0.81 ± 0.66, 1.13 ± 0.34 vs 0.69 ± 0.48, 1.31±0.60 vs 0.56 ± 0.63; p = 0.020, 0.0082, 0.0057). CONCLUSIONS: This study revealed that disclosing more detailed information of cancer for terminally ill cancer patients contributed to improving the quality of communication, irrespective of the stage of disclosure.

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Glasgow prognostic score predicts prognosis for cancer patients in palliative settings: a subanalysis of the Japan-prognostic assessment tools validation (J-ProVal) study.

Miura T, Matsumoto Y, Hama T, Amano K, Tei Y, Kikuchi A, Suga A, Hisanaga T, Ishihara T, Abe M, Kaneishi K, Kawagoe S, Kuriyama T, Maeda T, Mori I, Nakajima N, Nishi T, Sakurai H, Morita T, Kinoshita H

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer   23 ( 11 ) 3149 - 56   2015.11 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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PURPOSE: The Glasgow prognostic score (GPS), which uses C-reactive protein and albumin levels, is a good predictor of prognosis in cancer patients undergoing anti-tumor therapy. The objective of this study was to investigate the correlation between GPS and survival among cancer patients in palliative settings, as findings in such populations have not been well described. METHODS: This was a subanalysis of a multicenter, prospective, cohort study in patients who were adults, diagnosed with advanced cancer, and first referred to palliative care service in Japan. Patients who were not receiving anti-tumor therapy and who had undergone laboratory examinations were eligible. Clinical features were analyzed to investigate prognostic factors. RESULTS: A total of 1160 patients were enrolled (41.6 % female; median age, 72 years). The independent predictors were Eastern Cooperative Oncology Group performance status (ECOG PS) score of 4 (hazard ratio (HR), 1.54), liver metastasis (HR, 1.21), dyspnea (HR, 1.35), edema (HR, 1.25), prognostic performance index (HR, 1.56), neutrophil-lymphocyte ratio (HR, 1.43), and GPS of 2 (HR, 1.36). The sensitivity and specificity for 3-week prognosis of a GPS of 2 were 0.879 and 0.410. Median survival time with GPS of 0, 1, and 2 was 58 days (95 % confidence interval, 48-81), 43 days (37-50), and 21 days (19-24), respectively (log-rank test, p < 0.001). CONCLUSION: The GPS was a good prognostic indicator for cancer patients in palliative settings.

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Independent validation of the modified prognosis palliative care study predictor models in three palliative care settings.

Baba M, Maeda I, Morita T, Hisanaga T, Ishihara T, Iwashita T, Kaneishi K, Kawagoe S, Kuriyama T, Maeda T, Mori I, Nakajima N, Nishi T, Sakurai H, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Ono S, Ozawa T, Yamamoto R, Tsuneto S

Journal of pain and symptom management   49 ( 5 ) 853 - 60   2015.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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CONTEXT: Accurate prognostic information in palliative care settings is needed for patients to make decisions and set goals and priorities. The Prognosis Palliative Care Study (PiPS) predictor models were presented in 2011, but have not yet been fully validated by other research teams. OBJECTIVES: The primary aim of this study is to examine the accuracy and to validate the modified PiPS (using physician-proxy ratings of mental status instead of patient interviews) in three palliative care settings, namely palliative care units, hospital-based palliative care teams, and home-based palliative care services. METHODS: This multicenter prospective cohort study was conducted in 58 palliative care services including 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services in Japan from September 2012 through April 2014. RESULTS: A total of 2426 subjects were recruited. For reasons including lack of followup and missing variables (primarily blood examination data), we obtained analyzable data from 2212 and 1257 patients for the modified PiPS-A and PiPS-B, respectively. In all palliative care settings, both the modified PiPS-A and PiPS-B identified three risk groups with different survival rates (P<0.001). The absolute agreement ranged from 56% to 60% in the PiPS-A model and 60% to 62% in the PiPS-B model. CONCLUSION: The modified PiPS was successfully validated and can be useful in palliative care units, hospital-based palliative care teams, and home-based palliative care services.

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