PubMed | Shizuoka Saiseikai General Hospital, Shonan International Village Clinic, Osaka Kita Homecare Clinic, Tokyo Shinjuku Medical Center and 15 more.
Type: | Journal: Palliative medicine | Year: 2016
Changes in activities of daily living in cancer patients may predict their survival. The Palliative Prognostic Index is a useful tool to evaluate cancer patients, and adding an item about activities of daily living changes might improve its predictive value.To clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index.Multicenter prospective cohort study.A total of 58 palliative care services in Japan.Patients aged >20years diagnosed with locally extensive or metastatic cancer (including hematological neoplasms) who had been admitted to palliative care units, were receiving care by hospital-based palliative care teams, or were receiving home-based palliative care. Palliative care physicians recorded clinical variables at the first assessment and followed up patients 6months later.A total of 2425 subjects were recruited and 2343 of these had analyzable data. The C-statistic of the original Palliative Prognostic Index was 0.801, and those of modified Palliative Prognostic Indices ranged from 0.793 to 0.805 at 3weeks. For 6-week survival predictions, the C-statistic of the original Palliative Prognostic Index was 0.802, and those of modified Palliative Prognostic Indices ranged from 0.791 to 0.799. The weighted kappa of the original Palliative Prognostic Index was 0.510, and those of modified Palliative Prognostic Indices ranged from 0.484 to 0.508.Adding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.
PubMed | Komaki City Hospital, Mitui Memorial Hospital, National Cancer Hospital East, Kameda Medical Center and 12 more.
Type: Journal Article | Journal: Journal of pain and symptom management | Year: 2016
Plasma C-reactive protein (CRP) levels are elevated in patients with advanced cancer.To investigate CRP as a prognostic marker in palliative settings.This multicenter prospective cohort study comprised 2426 patients. Laboratory data were obtained at baseline, and all patients were followed until death or six months after their enrollment. A total of 1511 patients were eligible for the analyses. They were divided into four groups: low-CRP (CRP < 1mg/dL), moderate-CRP (1CRP <5mg/dL), high-CRP (5CRP<10mg/dL), and very high-CRP (10mg/dLCRP) groups. Survival was investigated by the Kaplan-Meier method with the log-rank test. The 30-, 60-, and 90-day mortality rates were tested by Chi-squared tests. Univariate- and multivariate-adjusted hazard ratios (HRs) and 95% CIs in each group were calculated using Cox proportional hazard models.Survival rate decreased and mortality rate increased with increasing CRP level. The differences in survival and 30-, 60-, and 90-day mortality rates among the groups were statistically significant (P<0.001). Baseline CRP level was significantly associated with a higher risk of mortality after adjustment for age, gender, primary tumor site, metastasis, chemotherapy, Eastern Cooperative Oncology Group Performance Status, and setting of care (moderate-CRP: HR 1.47 [95% CI 1.24-1.73], high-CRP: HR 2.09 [95% CI 1.74-2.50], and very high-CRP: HR 2.55 [95% CI 2.13-3.05] vs. low-CRP).Clear dose-effect relationships between elevated CRP levels and prognoses indicate that CRP could be useful in predicting prognoses in patients with advanced cancer.
Efficacy and safety of sublingual fentanyl orally disintegrating tablet at doses determined by titration for the treatment of breakthrough pain in Japanese cancer patients: a multicenter, randomized, placebo-controlled, double-blind phase III trial
Shimoyama N.,Jikei University School of Medicine |
Gomyo I.,Saito Yukoukai Hospital |
Gomyo I.,Red Cross |
Katakami N.,Institute of Biomedical Research and Innovation Hospital |
And 4 more authors.
International Journal of Clinical Oncology | Year: 2015
Background: Breakthrough cancer pain typically has a rapid onset and relatively short duration. Due to this temporal profile, it may not be adequately relieved by oral opioid analgesics. The sublingual fentanyl orally disintegrating tablet is a formulation by which fentanyl can be rapidly absorbed across the oral mucosa producing rapid-onset analgesia, and which may be effective for breakthrough pain treatment. Methods: A multicenter, randomized, placebo-controlled, double-blind comparative study was conducted to evaluate the efficacy and safety of the sublingual fentanyl tablet at optimized doses for breakthrough pain treatment in cancer patients treated with strong opioid analgesics at fixed intervals. The optimal dose was determined by open-label dose titration. The efficacy and safety of a 12-week extended treatment were also evaluated. Results: Eleven of 42 subjects who received the sublingual fentanyl tablet experienced adverse drug reactions. Common reactions were somnolence, constipation, nausea, and vomiting. No serious adverse reactions occurred. Sublingual fentanyl tablets at optimal doses and placebo were administered to 37 subjects in a double-blinded manner. A significant analgesic effect of the sublingual fentanyl tablet was present compared to placebo at 30 min after administration. The sublingual fentanyl tablet was also effective and safe during extended treatment, in which changes in basal opioid doses as well as sublingual fentanyl tablet doses were made as needed. Conclusion: Sublingual fentanyl tablets at doses determined by titration were effective and safe for breakthrough pain treatment in cancer patients treated with strong opioid analgesics at fixed intervals. Extended treatment up to 12 weeks was also effective and safe. © 2014, Japan Society of Clinical Oncology.
Chun H.J.,Catholic University of Korea |
Osuga K.,Osaka University |
Fahrni M.,Kantonsspital Baden AG |
Nakamura H.,Saito Yukoukai Hospital
Japanese Journal of Radiology | Year: 2010
Although melanoma frequently metastasizes to the liver, its spontaneous rupture is rare. We report herein an unusual case of a 73-year-old man with rupture of multiple hepatic metastases from scalp melanoma and resulting massive intraperitoneal bleeding, which was successfully controlled by transarterial embolization. © 2010 Japan Radiological Society.
Baba M.,Saito Yukoukai Hospital |
Gomyo I.,Saito Yukoukai Hospital
Japanese Journal of Anesthesiology | Year: 2012
Cancer pain consists of continuous pain lasting almost all day and transient exacerbation of pain called breakthrough pain. Breakthrough pain is classified as somatic pain and visceral pain, neuropathic pain according to the character of pain. Although the immediate release opioid is used as the first treatment of choice to breakthrough pain, the effect is not enough when it shows the character of neuropathic pain. Pregabalin has become the first medicine for the treatment of neuropathic pain, and it sometimes reveals prompt analgesic effect based on its pharmacological profile. It has also been reported that pregabalin used with oxycodine reveals analgesic effect with smaller dosage than pregabalin alone. We experienced a young patient with lung cancer suffering from sudden exacerbation of symptomatic sciatica, whose pain was markedly reduced within 30 minutes by taking immediate release oxycodone 5 mg and pregabalin 75 mg simultaneously. Conclusions : Pregabalin with immediate release oxycodone simultaneously may be able to improve acute exacerbation of neuropathic cancer pain rapidly.
Baba M.,Saito Yukoukai Hospital |
Gomyo I.,Saito Yukoukai Hospital
Japanese Journal of Anesthesiology | Year: 2012
Background: Evidence to support the use of pregabalin in combination with opioid analgesics for the treatment of cancer-related neuropathic pain is limited. Methods: We carried out a retrospective investigation on patients hospitalized in our department with cancer-related neuropathic pain and under pregabalin treatment. Patients were divided into two groups: A group (= <300 mg pregabalin daily) and B group (>300 mg pregabalin daily). The two groups were compared in terms of a suite of factors (e. g., age starting and maimtenance dose of pregabaline, adverse effect). Results: Patient's age was significantly lower in the B group (>300 mg pregabalin daily). Of the total number of patients involved in the study, 67% experienced mild and moderate somnolence. Conclusions: In this retrospective investigation, we conclude that the younger cancer patients may need lager doses of pregabalin to relieve cancer-related neuropathic pain. In addition, the mild and moderate somnolence occurs frequently when pregabalin is administered with opioid analgesics for the treatment of cancer-related neuropathic pain.
Nakatani K.,Saito Yukoukai Hospital |
Fukunishi Y.,Saito Yukoukai Hospital
Nihon Hōshasen Gijutsu Gakkai zasshi | Year: 2015
Computed tomographic angiography (CTA) has been used recently for the evaluation of intracerebral aneurysms, but it is difficult to use this technique to visualize aneurysms near the base of the skull because of the presence of bone. So, subtracted CTA has been used to separate vessels from bony structures. However, we see some misregistration when using subtraction method because of the patient moving, the disaccord of the X-ray tube orbit between the mask image and the live image, the expanding focus, and the bed bending. So, attentioning the difference of bone CT number in any tube voltages, we examined to make the image containing less misregistration by changing the tube voltage of mask image. Making a sham blood vessel, we examined the bone misregistration, the blood vessel volume, and the smoothness when changing the tube voltages of mask images. Comparing with 120 kV, as the tube voltage of the mask image was 80 kV, the bone misregistration decreased significantly, however the blood vessel volume decreased. As for the tube voltage of 100 kV, the bone misregistration decreased significantly, and the blood vessel volume and the smoothness were not significantly different so we could get coordinative image of 120 kV. When the tube voltage of the mask image becomes lower than that of the live image and the effective energy becomes different, the effect of misregistration is less. This method deals with changing the tube voltage only. So, it may be easy to make volume rendering (VR) image and this method may be used in every facility.
PubMed | Osaka University and Saito Yukoukai Hospital
Type: Journal Article | Journal: Anticancer research | Year: 2016
Regorafenib and TAS-102 are novel antitumor agents for patients with metastatic colorectal cancer (mCRC) whose disease has progressed after standard therapies. In randomized trials, regorafenib and TAS-102 prolonged survival in patients with mCRC. However, the appropriate selection of regorafenib or TAS-102 in treatment strategy has not yet been established.We performed a retrospective analysis, between March 2013 and July 2015, on the efficacy and safety of regorafenib or TAS-102.Thirty-seven patients with mCRC treated with regorafenib or TAS-102 were included. Of these 37 patients, 23 first received regorafenib and 14 received TAS-102. The median progression-free survival and overall survival were 3.0 and 5.8 months, respectively, in the regorafenib group and 2.1 and 6.3 months, respectively, in the TAS-102 group. Drug-related adverse events (AEs) and grade 3 AEs were 23 (100%) and 10 (43.5%), respectively, in the regorafenib group and 13 (92.9%) and 2 (14.3%), respectively, in the TAS-102 group. The most frequent grade 3 AEs were hepatotoxicity (17.4%) and hand-foot syndrome (13.0%) in the regorafenib group, and neutropenia (14.3%) in the TAS-102 group. In subgroup analysis, the median overall survival was 11.5 months in patients receiving crossover treatment with regorafenib to TAS-102, and 7.6 months in those receiving crossover treatment with TAS-102 to regorafenib.Our results showed that regorafenib and TAS-102 have comparable efficacy but different toxicity profiles in patients with mCRC. Both are considered new salvage treatment options. Differences in the toxicity profiles between the two treatments will help in choosing regorafenib or TAS-102.
PubMed | Red Cross, Saito Yukoukai Hospital and Kanazawa University
Type: | Journal: Australasian physical & engineering sciences in medicine | Year: 2016
The image characteristics in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) depend on the partial Fourier fraction and contrast medium concentration. These characteristics were assessed and the modulation transfer function (MTF) was calculated by computer simulation. A digital phantom was created from signal intensity data acquired at different contrast medium concentrations on a breast model. The frequency images [created by fast Fourier transform (FFT)] were divided into 512 parts and rearranged to form a new image. The inverse FFT of this image yielded the MTF. From the reference data, three linear models (low, medium, and high) and three exponential models (slow, medium, and rapid) of the signal intensity were created. Smaller partial Fourier fractions, and higher gradients in the linear models, corresponded to faster MTF decline. The MTF more gradually decreased in the exponential models than in the linear models. The MTF, which reflects the image characteristics in DCE-MRI, was more degraded as the partial Fourier fraction decreased.
Terauchi K.,Saito Yukoukai Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2012
Radial scan method collects blades rotated about the k-space origin. The one blade is the group of the echo acquired each repetition time (TR) in concentric strips. Because each of the blades has the phase-encode direction, it can be expected to be dispersing flow artifact which appear in the phase-encode direction. We examined how to produce flow artifact in radial scan method without motion correction. Flow artifact does not appear like a mass in radial scan method. Background noise in radial scan method tended to decrease when width of the blade is thinner and a number of blades is larger under a number of echo is keeping. In conclusion, unlike past countermeasures against flow artifact in Cartesian method, flow artifact becomes inconspicuous to be dispersed by 360 degrees in radial scan method.