Publications by authors named "Mika Baba"

36 Publications

Does Urinary Catheterization Affect the Quality of Death in Patients with Advanced Cancer? A Secondary Analysis of Multicenter Prospective Cohort Study.

J Palliat Med 2021 Oct 11. Epub 2021 Oct 11.

Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan.

Patients with life-limiting illnesses frequently experience urinary difficulties, and urinary catheterization is one of the interventions for managing them. However, evidence supporting the effects of urinary catheters on the quality of death (QoD) is lacking in this population. To investigate whether urinary catheterization affects QoD in patients with advanced cancer in palliative care units. A secondary analysis of a multicenter, prospective cohort study. The study enrolled consecutive patients with advanced cancer admitted to palliative care units in Japan between January and December 2017. Those who were not catheterized on admission and who died while in a palliative care unit were analyzed. QoD was evaluated at death using the Good Death Scale (GDS). Of 885 patients, 297 (33.6%) were catheterized during their palliative care unit stay. Females and patients with a long palliative care unit stay were more likely to be catheterized. In inverse probability-weighted propensity score analysis, patients with urinary catheterization during their palliative care unit stay had higher total GDS scores than those without catheterization (coefficient 0.410, 95% confidence interval 0.068-0.752). In subgroup analyses stratified by sex, age, and length of palliative care unit stay, urinary catheterization was associated with higher total GDS scores in patients younger than 65 years of age and those who died after a palliative care unit stay of 21 days or fewer. This study suggested that urinary catheterization during a palliative care unit stay may have a positive impact on overall QoD in patients with advanced cancer. This study was registered in the UMIN Clinical Trials Registry (UMIN000025457).
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http://dx.doi.org/10.1089/jpm.2021.0178DOI Listing
October 2021

Relationship Between the Activities of Gloss-Selective Neurons in the Macaque Inferior Temporal Cortex and the Gloss Discrimination Behavior of the Monkey.

Cereb Cortex Commun 2021 10;2(1):tgab011. Epub 2021 Feb 10.

Brain Science Institute, Tamagawa University, Tokyo 194-8610, Japan.

In the macaque monkey, neurons that selectively respond to specific gloss are present in a restricted region of the central part of the inferior temporal (IT) cortex. Although the population activity of these neurons is known to represent the perceptual gloss space, the involvement of their activity in gloss perception has not been directly tested. In the present study, we examined the causal relationship between the activities of gloss-selective neurons and gloss perception by applying electrical microstimulation or injection of small amounts of muscimol (GABA agonist) to manipulate neural activities while monkeys performed a gloss discrimination task. We found that microstimulation within or in the vicinity of the region where gloss-selective neurons were recorded induced bias toward higher gloss judgment. With muscimol injection, gloss discrimination performance was degraded in one monkey after the first injection into the region where gloss-selective neurons were recorded. These results suggest that gloss discrimination behavior is mediated by the activities of a gloss-selective network that includes the gloss-selective region in the central IT cortex examined here.
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http://dx.doi.org/10.1093/texcom/tgab011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152851PMC
February 2021

C-Reactive Protein and Its Relationship with Pain in Patients with Advanced Cancer Cachexia: Secondary Cross-Sectional Analysis of a Multicenter Prospective Cohort Study.

Palliat Med Rep 2021 5;2(1):122-131. Epub 2021 May 5.

Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.

Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer. To investigate the relationship between serum levels of CRP and subtypes of pain. A secondary cross-sectional analysis of a prospective cohort study. Patients with advanced cancer admitted to 23 palliative care units in Japan. Patients rated the severity of pain on the numerical rating scale (NRS) and physicians evaluated pain on the integrated palliative care outcome scale (IPOS). Physicians assessed neuropathic pain and breakthrough pain based on their presence or absence. Patients were divided into four groups according to CRP levels. Comparisons were performed using the Kruskal-Wallis test or chi-squared test. To evaluate the relationship between CRP and subtypes of pain, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in logistic models were calculated. We divided 1513 patients into four groups: low CRP ( = 234), moderate CRP ( = 513), high CRP ( = 352), and very high CRP ( = 414). Spearman's correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 ( < 0.001) and 0.16 ( < 0.001), respectively. In the models of pain NRS and pain IPOS, significantly higher adjusted ORs than in the low CRP group were observed in the very high CRP group (1.81 [95% CI 1.14-2.88],  = 0.01; 1.74 [95% CI 1.18-2.57],  = 0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain. The results indicated direct relationships between CRP, pain NRS, and pain IPOS.
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http://dx.doi.org/10.1089/pmr.2021.0004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241396PMC
May 2021

Efficacy of Proportional Sedation and Deep Sedation Defined by Sedation Protocols: A Multicenter, Prospective, Observational Comparative Study.

J Pain Symptom Manage 2021 Jun 10. Epub 2021 Jun 10.

Division of Palliative and Supportive Care (T.M., N.Y., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan.

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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http://dx.doi.org/10.1016/j.jpainsymman.2021.06.005DOI Listing
June 2021

Comparison of the prevalence and associated factors of hyperactive delirium in advanced cancer patients between inpatient palliative care and palliative home care.

Cancer Med 2021 02 12;10(3):1166-1179. Epub 2020 Dec 12.

Shinjo-clinic, Hyogo, Japan.

Background: Hyperactive delirium is known to increase family distress and the burden on health care providers. We compared the prevalence and associated factors of agitated delirium in advanced cancer patients between inpatient palliative care and palliative home care on admission and at 3 days before death.

Methods: This was a post hoc exploratory analysis of two multicenter, prospective cohort studies of advanced cancer patients, which were performed at 23 palliative care units (PCUs) between Jan and Dec 2017, and on 45 palliative home care services between July and Dec 2017.

Results: In total, 2998 patients were enrolled and 2829 were analyzed in this study: 1883 patients in PCUs and 947 patients in palliative home care. The prevalence of agitated delirium between PCUs and palliative home care was 5.2% (95% CI: 4.2% - 6.3%) vs. 1.4% (0.7% - 2.3%) on admission (p < 0.001) and 7.6% (6.4% - 8.9%) vs. 5.4% (4.0% - 7.0%) 3 days before death (p < 0.001). However, multivariate logistic regression analysis revealed that the place of care was not significantly associated with the prevalence of agitated delirium at 3 days before death after adjusting for prognostic factors, physical risk factors, and symptoms.

Conclusions: There was no significant difference in the prevalence of agitated delirium at 3 days before death between inpatient palliative care and palliative home care after adjusting for the patient background, prognostic factors, symptoms, and treatment.
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http://dx.doi.org/10.1002/cam4.3661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897964PMC
February 2021

The Principles of Revised Clinical Guidelines about Palliative Sedation Therapy of the Japanese Society for Palliative Medicine.

J Palliat Med 2020 09 13;23(9):1184-1190. Epub 2020 Apr 13.

Department of Palliative Medicine, Yodogawa Christian Hospital, Osaka, Japan.

When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Consensus methods using the Delphi technique were used. The main principles of the guidelines that were newly defined or developed are as follows: (1) palliative sedation was defined as "administration of sedatives for the purpose of alleviating refractory suffering" (excluding the aim of reducing patient consciousness); (2) palliative sedation was classified according to the method of administration of sedatives: respite sedation versus continuous sedation (including (continuous) proportional sedation and continuous deep sedation); (3) a description of state-of-the-art recommended treatments for difficult symptoms such as delirium, dyspnea, and pain before the symptom was determined as refractory was included; (4) the principle of proportionality was newly defined from an ethical point of view; and (5) families' consent was regarded as being desirable (mandatory in the previous version). We described the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Further consensus building is necessary.
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http://dx.doi.org/10.1089/jpm.2019.0626DOI Listing
September 2020

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

Nutr Cancer 2018 Nov-Dec;70(8):1283-1289. Epub 2019 Jan 20.

a Department of Palliative Medicine , National Cancer Center Hospital East , Kashiwa , Japan.

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, 72 years). Cox regression analysis revealed that low TTR levels (<10.9 mg/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 (<10.9 mg/l) was 26 days, which was significantly shorter than those with high TTR levels (≥10.9 mg/l) (50 days; P < 0.001).

Conclusion: Low TTR levels may be indicators for poor prognosis among cancer patients in palliative care settings.
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http://dx.doi.org/10.1080/01635581.2018.1557213DOI Listing
September 2019

A combination of routine laboratory findings and vital signs can predict survival of advanced cancer patients without physician evaluation: a fractional polynomial model.

Eur J Cancer 2018 12 2;105:50-60. Epub 2018 Nov 2.

Department of Palliative and Supportive Care, Palliative Care Team, Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan. Electronic address:

Introduction: There have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model.

Methods: A multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method.

Results: Data from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation.

Conclusion: We developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research.
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http://dx.doi.org/10.1016/j.ejca.2018.09.037DOI Listing
December 2018

"What I Did for My Loved One Is More Important than Whether We Talked About Death": A Nationwide Survey of Bereaved Family Members.

J Palliat Med 2018 03 20;21(3):335-341. Epub 2017 Nov 20.

6 Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine , Sendai, Japan .

Background: Actions in preparation for death and talks about death between advanced cancer patients and their families are considered essential to achieve a good death. However, little is known about the prevalence of such actions compared with talks and their association with bereaved families' psychological morbidity.

Objective: To clarify the prevalence of bereaved families having acted in preparation for death and talked about death with their loved one, and to explore their associations with bereaved families' depression and complicated grief (CG).

Design: A nationwide survey. Setting/Subject: A total of 999 bereaved families of cancer patients admitted to 133 inpatient hospices in Japan.

Measurements: The prevalence of families' actions in preparation for and talks about death, Patient Health Questionnaire (PHQ)-9, and Brief Grief Questionnaire (BGQ).

Results: Among 678 bereaved families (response rate = 68%), 513 (76%) acted in preparation for death, and 315 (46%) talked about death with their loved one. Those who acted and talked were significantly less likely to suffer depression (PHQ-9 ≥ 10) than those who neither acted nor talked (odds ratio [OR], 0.405; 95% confidence interval [CI], 0.195-0.845; adjusted p = 0.016). Families who acted were significantly less likely to suffer complicated grief (CG; BGQ ≥8), whether they talked (OR, 0.394; 95% CI, 0.185-0.84; adjusted p = 0.016) or not (OR, 0.421; 95% CI, 0.191-0.925; adjusted p = 0.031).

Conclusions: Most families acted in preparation for death, and those who acted were less likely to suffer depression and CG. Clinicians may minimize families' later psychological morbidity by helping patients and families act in preparation for death.
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http://dx.doi.org/10.1089/jpm.2017.0267DOI Listing
March 2018

Development and validation of a set of six adaptable prognosis prediction (SAP) models based on time-series real-world big data analysis for patients with cancer receiving chemotherapy: A multicenter case crossover study.

PLoS One 2017 24;12(8):e0183291. Epub 2017 Aug 24.

Department of Clinical Oncology, Kyoto University Hospital, Kyoto city, Japan.

Background: We aimed to develop an adaptable prognosis prediction model that could be applied at any time point during the treatment course for patients with cancer receiving chemotherapy, by applying time-series real-world big data.

Methods: Between April 2004 and September 2014, 4,997 patients with cancer who had received systemic chemotherapy were registered in a prospective cohort database at the Kyoto University Hospital. Of these, 2,693 patients with a death record were eligible for inclusion and divided into training (n = 1,341) and test (n = 1,352) cohorts. In total, 3,471,521 laboratory data at 115,738 time points, representing 40 laboratory items [e.g., white blood cell counts and albumin (Alb) levels] that were monitored for 1 year before the death event were applied for constructing prognosis prediction models. All possible prediction models comprising three different items from 40 laboratory items (40C3 = 9,880) were generated in the training cohort, and the model selection was performed in the test cohort. The fitness of the selected models was externally validated in the validation cohort from three independent settings.

Results: A prognosis prediction model utilizing Alb, lactate dehydrogenase, and neutrophils was selected based on a strong ability to predict death events within 1-6 months and a set of six prediction models corresponding to 1,2, 3, 4, 5, and 6 months was developed. The area under the curve (AUC) ranged from 0.852 for the 1 month model to 0.713 for the 6 month model. External validation supported the performance of these models.

Conclusion: By applying time-series real-world big data, we successfully developed a set of six adaptable prognosis prediction models for patients with cancer receiving chemotherapy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183291PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5570326PMC
October 2017

Talking About Death With Terminally-Ill Cancer Patients: What Contributes to the Regret of Bereaved Family Members?

J Pain Symptom Manage 2017 12 8;54(6):853-860.e1. Epub 2017 Aug 8.

Department of Community Health, Tohoku University Graduate School of Medicine, Sendai, Japan.

Context: Talking about death is an important issue for terminally-ill cancer patients and their families. Little is known about how often and which bereaved families regret not having talked about death with their deceased loved one.

Objectives: To explore the prevalence of a regret of not having talked about death with a deceased loved one among bereaved family members of adult cancer patients, and to systematically explore factors contributing to their regret.

Methods: We conducted a nationwide survey of 999 bereaved families of cancer patients admitted to 133 inpatient hospices in Japan and surveyed families' regret on talking about death. Exploratory analyses identified the underlying structures of process, option, and outcome subscales of factors contributing to regret.

Results: Among 678 bereaved families (response rate 68%), 224 (33%) regretted not having talked about death sufficiently, whereas 40 (5.9%) conversely regretted having talked about death. Three process factors ("prognostic disclosure to patient" [β = 0.082, P = 0.039], "upsetting of patient and family" [β = 0.127, P = 0.001], and "family's sense of uncertainty about when to act based on terminal awareness" [β = 0.141, P = 0.000]) and an outcome factor ("having achieved a good death" [β = -0.152, P = 0.000]) contributed to the regret of talking insufficiently.

Conclusion: A third of bereaved families of adult cancer patients regretted not having talked about death sufficiently. Clinicians may minimize this regret by facilitating a shared understanding of the disease and prognosis, advising families explicitly when to talk based on terminal awareness, providing continuous emotional support, and validating their decision on talking about death.
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http://dx.doi.org/10.1016/j.jpainsymman.2017.02.021DOI Listing
December 2017

Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study.

J Palliat Med 2017 04 28;20(4):352-359. Epub 2017 Feb 28.

23 Research Hospital, The Institute of Medical Science, The University of Tokyo , Tokyo, Japan .

Background: Corticosteroids are often used to treat fatigue and anorexia, but occasionally produce delirium. Information on the predictors of delirium in corticosteroid-treated cancer patients remains limited.

Objective: To identify potential factors predicting the development of delirium in corticosteroid-treated cancer patients.

Design: An exploratory, multicenter, prospective, observational study.

Setting/subjects: Inclusion criteria for this study were patients who had metastatic or locally advanced cancer and a fatigue or anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale.

Measurement: Univariate and multivariable analyses were performed to identify the predictors of delirium diagnosed by the Confusion Assessment Method (CAM) within three days of initiation of corticosteroids.

Results: Among 207 patients administered corticosteroids, 35 (17%; 95% confidence interval [CI] 12%-23%) developed at least one episode of delirium diagnosed by the CAM. Factors predictive of the development of delirium were as follows: Palliative Performance Scale ≤20, Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 4, the Support Team Assessment Schedule (STAS) score of drowsiness >1, concurrent opioid use, parenteral hydration volume ≤500 mL, and the absence of lung metastasis. A multivariable analysis identified the independent factors predicting responses as ECOG PS = 4 (odds ratio [OR] 4.0; 95% CI 1.7-9.3), STAS score of drowsiness >1 (OR 3.4; 95% CI 1.4-8.2), and concurrent opioid use (OR 3.7; 95% CI 1.0-13).

Conclusion: Delirium in corticosteroid-treated advanced cancer patients may be predicted by PS, drowsiness, and concurrent opioid use. Larger prospective studies are needed to confirm these results.
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http://dx.doi.org/10.1089/jpm.2016.0323DOI Listing
April 2017

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

J Cachexia Sarcopenia Muscle 2017 Jun 1;8(3):457-465. Epub 2017 Mar 1.

Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.

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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http://dx.doi.org/10.1002/jcsm.12184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476854PMC
June 2017

A prospective, multicenter cohort study to validate a simple performance status-based survival prediction system for oncologists.

Cancer 2017 Apr 7;123(8):1442-1452. Epub 2016 Dec 7.

Department of Primary Care Service, Shinsei Hospital, Nagano, Japan.

Background: Survival prediction systems such as the Palliative Prognostic Index (PPI), which includes the Palliative Performance Scale (PPS), are used to estimate survival for terminally ill patients. Oncologists are, however, less familiar with the PPS in comparison with the Eastern Cooperative Oncology Group (ECOG) performance status (PS). This study was designed to validate a simple survival prediction system for oncologists, the Performance Status-Based Palliative Prognostic Index (PS-PPI), which is a modified form of the PPI based on the ECOG PS.

Methods: This multicenter, prospective cohort study enrolled all consecutive patients who were referred to 58 palliative care services in Japan. The primary responsible physicians rated the variables required to calculate the PS-PPI and the PPI. Patient survival in these risk groups was compared, and the sensitivity and specificity of the PS-PPI and the PPI were evaluated. Patients were subclassified as patients receiving care from in-hospital palliative care teams, palliative care units, or home-based palliative care services. Subsets of patients receiving chemotherapy were also analyzed.

Results: This study included 2346 patients. Survival predictions based on the PPI and the PS-PPI differed significantly among the 3 risk groups (P < .001). The PS-PPI was more sensitive, whereas the PPI was more specific. All areas under the receiver operating characteristic curves of both indices were >0.78 for predicting survival at all times, from 3 weeks to 180 days.

Conclusions: In predicting the prognosis of patients with advanced cancer, the PS-PPI was as accurate as the PPI. The PS-PPI was useful for short- and long-term survival prediction and for the prediction of survival for patients undergoing chemotherapy. Cancer 2017;123:1442-1452. © 2016 American Cancer Society.
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http://dx.doi.org/10.1002/cncr.30484DOI Listing
April 2017

Predictors of responses to corticosteroids for anorexia in advanced cancer patients: a multicenter prospective observational study.

Support Care Cancer 2017 01 18;25(1):41-50. Epub 2016 Aug 18.

Research Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.

Purpose: Although corticosteroids are widely used to relieve anorexia, information regarding the factors predicting responses to corticosteroids remains limited. The purpose of the study is to identify potential factors predicting responses to corticosteroids for anorexia in advanced cancer patients.

Methods: Inclusion criteria for this multicenter prospective observational study were patients who had metastatic or locally advanced cancer and had an anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale (NRS). Univariate and multivariate analyses were conducted to identify the factors predicting ≥2-point reduction in NRS on day 3.

Results: Among 180 patients who received corticosteroids, 99 (55 %; 95 % confidence interval [CI], 47-62 %) had a response with ≥2-point reduction. Factors that significantly predicted responses were Palliative Performance Scale (PPS) > 40 and absence of drowsiness. In addition, factors that tended to be associated with ≥2-point reduction in NRS included PS 0-3, absence of diabetes mellitus, absence of peripheral edema, presence of lung metastasis, absence of peritoneal metastasis, baseline anorexia NRS of >6, presence of pain, and presence of constipation. A multivariate analysis showed that the independent factors predicting responses were PPS of >40 (odds ratio = 2.7 [95 % CI = 1.4-5.2]), absence of drowsiness (2.6 [1.3-5.0]), and baseline NRS of >6 (2.4 [1.1-4.8]).

Conclusions: Treatment responses to corticosteroids for anorexia may be predicted by PPS, drowsiness, and baseline symptom intensity. Larger prospective studies are needed to confirm these results.
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http://dx.doi.org/10.1007/s00520-016-3383-zDOI Listing
January 2017

Adding items that assess changes in activities of daily living does not improve the predictive accuracy of the Palliative Prognostic Index.

Palliat Med 2017 03 19;31(3):258-266. Epub 2016 Jul 19.

20 Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.

Background: 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.

Aim: To clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index.

Design: Multicenter prospective cohort study.

Setting: A total of 58 palliative care services in Japan.

Participants: Patients aged >20 years 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 6 months later.

Results: 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 3 weeks. 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.

Conclusion: Adding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.
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http://dx.doi.org/10.1177/0269216316650788DOI Listing
March 2017

Prospective Validation of the Objective Prognostic Score for Advanced Cancer Patients in Diverse Palliative Settings.

J Pain Symptom Manage 2016 09 4;52(3):420-7. Epub 2016 Jul 4.

Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.

Context: Prognostication is an essential part of palliative care to aid decision making and negotiate goals of care. The Objective Prognostic Score (OPS) is an easy-to-use prognosticating tool to predict survival among far-advanced cancer patients in palliative care units (PCUs) in Korea.

Objectives: This study aimed to prospectively validate the OPS for advanced cancer patients in the palliative care teams (PCTs), PCUs, and home-based palliative care (HPC) in Japan.

Methods: This was a substudy of a multicenter prospective cohort study that was conducted to validate and compare prognostic tools among advanced cancer patients in Japan. Participants' survival was calculated according to OPS 3 as a cutoff for predicting survival of less than three weeks. Overall accuracy and area under the receiver operator characteristic curves of OPS 3 were calculated for PCT, PCU, and HPC, respectively.

Results: A total of 1146 cases (PCTs 441, PCUs 519, and HPCs 186 cases) were included in final analyses. The overall accuracy of OPS 3 for predicting three-week survival ranged from 0.70 to 0.78 across diverse palliative care settings. The c-statistics ranged from 0.742 to 0.808 across three settings. Participants in the PCT showed the highest overall accuracy and c-statistics for OPS.

Conclusion: The OPS can be used for prognostication among advanced cancer patients in PCT, PCU, and HPC settings.
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http://dx.doi.org/10.1016/j.jpainsymman.2016.03.015DOI Listing
September 2016

Effects of generalized pooling on binocular disparity selectivity of neurons in the early visual cortex.

Philos Trans R Soc Lond B Biol Sci 2016 06;371(1697)

Graduate School of Frontier Biosciences, Osaka University, 1-4 Yamadaoka, Suita, Osaka 565-0871, Japan Center for Information and Neural Networks (CiNet), 1-4 Yamadaoka, Suita, Osaka 565-0871, Japan

The key problem of stereoscopic vision is traditionally defined as accurately finding the positional shifts of corresponding object features between left and right images. Here, we demonstrate that the problem must be considered in a four-dimensional parameter space; with respect not only to shifts in space (X, Y), but also spatial frequency (SF) and orientation (OR). The proposed model sums outputs of binocular energy units linearly over the multi-dimensional V1 parameter space (X, Y, SF, OR). Theoretical analyses and physiological experiments show that many binocular neurons achieve sharp binocular tuning properties by pooling the output of multiple neurons with relatively broad tuning. Pooling in the space domain sharpens disparity-selective responses in the SF domain so that the responses to combinations of unmatched left-right SFs are attenuated. Conversely, pooling in the SF domain sharpens disparity selectivity in the space domain, reducing the possibility of false matches. Analogous effects are observed for the OR domain in that the spatial pooling sharpens the binocular tuning in the OR domain. Such neurons become selective to relative OR disparity. Therefore, pooling allows the visual system to refine binocular information into a form more desirable for stereopsis.This article is part of the themed issue 'Vision in our three-dimensional world'.
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http://dx.doi.org/10.1098/rstb.2015.0266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901460PMC
June 2016

Predictors of Responses to Corticosteroids for Cancer-Related Fatigue in Advanced Cancer Patients: A Multicenter, Prospective, Observational Study.

J Pain Symptom Manage 2016 07 24;52(1):64-72. Epub 2016 May 24.

Research Hospital, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan.

Context: Although corticosteroids are widely used to relieve cancer-related fatigue (CRF), information regarding the factors predicting responses to corticosteroids remains limited.

Objectives: The aim of this study was to identify potential factors predicting responses to corticosteroids for CRF in advanced cancer patients.

Methods: Inclusion criteria for this multicenter, prospective, observational study were patients who had metastatic or locally advanced cancer and had a fatigue intensity score of 4 or more on a 0-10 Numerical Rating Scale (NRS). Univariate and multivariate analyses were conducted to identify the factors predicting two-point reduction or more in NRS on day 3.

Results: Among 179 patients who received corticosteroids, 86 (48%; 95% CI 41%-56%) had a response with two-point reduction or more. Factors that significantly predicted responses were performance status score of 3 or more, Palliative Performance Scale score more than 40, absence of ascites, absence of drowsiness, absence of depression, serum albumin level greater than 3 mg/dL, serum sodium level greater than 135 mEq/L, and baseline NRS score greater than 5. A multivariate analysis showed that the independent factors predicting responses were baseline NRS score greater than 5 (odds ratio [OR] 6.6, 95% CI 2.8-15.4), Palliative Performance Scale score more than 40 (OR 4.4, 95% CI 2.1-9.3), absence of drowsiness (OR 3.4, 95% CI 1.7-6.9), absence of ascites (OR 2.3, 95% CI 1.1-4.7), and absence of pleural effusion (OR 2.2, 95% CI 1.0-5.0).

Conclusion: Treatment responses to corticosteroids for CRF may be predicted by baseline symptom intensity, performance status, drowsiness, and severity of fluid retention symptoms. Larger prospective studies are needed to confirm these results.
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http://dx.doi.org/10.1016/j.jpainsymman.2016.01.015DOI Listing
July 2016

Clinical Implications of C-Reactive Protein as a Prognostic Marker in Advanced Cancer Patients in Palliative Care Settings.

J Pain Symptom Manage 2016 05 28;51(5):860-7. Epub 2016 Jan 28.

Department of Palliative Medicine, National Cancer Hospital East, Kashiwa, Chiba, Japan.

Context: Plasma C-reactive protein (CRP) levels are elevated in patients with advanced cancer.

Objectives: To investigate CRP as a prognostic marker in palliative settings.

Methods: 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 < 1 mg/dL), moderate-CRP (1 ≤ CRP <5 mg/dL), high-CRP (5 ≤ CRP <10 mg/dL), and very high-CRP (10 mg/dL ≤ CRP) 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.

Results: 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).

Conclusion: Clear dose-effect relationships between elevated CRP levels and prognoses indicate that CRP could be useful in predicting prognoses in patients with advanced cancer.
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http://dx.doi.org/10.1016/j.jpainsymman.2015.11.025DOI Listing
May 2016

Effect of continuous deep sedation on survival in patients with advanced cancer (J-Proval): a propensity score-weighted analysis of a prospective cohort study.

Lancet Oncol 2016 Jan 29;17(1):115-22. Epub 2015 Nov 29.

Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Background: Continuous deep sedation (CDS) before death is a form of palliative sedation therapy that has become a focus of strong debate, especially with respect to whether it shortens survival. We aimed to examine whether CDS shortens patient survival using the propensity score-weighting method, and to explore the effect of artificial hydration during CDS on survival.

Methods: This study was a secondary analysis of a large multicentre prospective cohort study that recruited and followed up patients between Sept 3, 2012, and April 30, 2014, from 58 palliative care institutions across Japan, including hospital palliative care settings, inpatient palliative care units, and home-based palliative care services. Adult patients (aged ≥ 20 years) with advanced cancer who received care through the participating palliative care services were eligible for this secondary analysis. Patients with missing data for outcome variables or who lived for more than 180 days were excluded. We compared survival after enrolment between patients who did and did not receive CDS. We used a propensity score-weighting method to control for patient characteristics, disease status, and symptom burden at enrolment.

Findings: Of 2426 enrolled patients with advanced cancer, we excluded 289 (12%) for living longer than 180 days and 310 (13%) with missing data, leaving an analysis population of 1827 patients. 269 (15%) of 1827 patients received CDS. Unweighted median survival was 27 days (95% CI 22-30) in the CDS group and 26 days (24-27) in the no CDS group (median difference -1 day [95% CI -5 to 4]; HR 0·92 [95% CI 0·81-1·05]; log-rank p=0·20). After propensity-score weighting, these values were 22 days (95% CI 21-24) and 26 days (24-27), respectively (median difference -1 day [95% CI -6 to 4]; HR 1·01 [95% CI 0·87-1·17]; log-rank p=0·91). Age (p(interaction)=0·67), sex (p(interaction)=0·26), performance status (p(interaction)=0·90), and volume of artificial hydration (p(interaction)=0·14) did not have an effect modification on the association between sedation and survival, although care setting did have a significant effect modification (p(interaction)=0·021).

Interpretation: CDS does not seem to be associated with a measurable shortening of life in patients with advanced cancer cared for by specialised palliative care services, and could be considered a viable option for palliative care in this setting.

Funding: Japanese National Cancer Center Research and Development Fund.
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http://dx.doi.org/10.1016/S1470-2045(15)00401-5DOI Listing
January 2016

Supranormal orientation selectivity of visual neurons in orientation-restricted animals.

Sci Rep 2015 Nov 16;5:16712. Epub 2015 Nov 16.

Graduate School of Frontier Biosciences, Osaka University, Suita, Osaka 565-0871, Japan.

Altered sensory experience in early life often leads to remarkable adaptations so that humans and animals can make the best use of the available information in a particular environment. By restricting visual input to a limited range of orientations in young animals, this investigation shows that stimulus selectivity, e.g., the sharpness of tuning of single neurons in the primary visual cortex, is modified to match a particular environment. Specifically, neurons tuned to an experienced orientation in orientation-restricted animals show sharper orientation tuning than neurons in normal animals, whereas the opposite was true for neurons tuned to non-experienced orientations. This sharpened tuning appears to be due to elongated receptive fields. Our results demonstrate that restricted sensory experiences can sculpt the supranormal functions of single neurons tailored for a particular environment. The above findings, in addition to the minimal population response to orientations close to the experienced one, agree with the predictions of a sparse coding hypothesis in which information is represented efficiently by a small number of activated neurons. This suggests that early brain areas adopt an efficient strategy for coding information even when animals are raised in a severely limited visual environment where sensory inputs have an unnatural statistical structure.
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http://dx.doi.org/10.1038/srep16712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644951PMC
November 2015

Integration of Multiple Spatial Frequency Channels in Disparity-Sensitive Neurons in the Primary Visual Cortex.

J Neurosci 2015 Jul;35(27):10025-38

Graduate School of Frontier Biosciences, Osaka University, Suita, Osaka 565-0871, Japan, and Center for Information and Neural Networks (CiNet), Osaka 565-0871, Japan

Unlabelled: For our vivid perception of a 3-D world, the stereoscopic function begins in our brain by detecting slight shifts of image features between the two eyes, called binocular disparity. The primary visual cortex is the first stage of this processing, and neurons there are tuned to a limited range of spatial frequencies (SFs). However, our visual world is generally highly complex, composed of numerous features at a variety of scales, thereby having broadband SF spectra. This means that binocular information signaled by individual neurons is highly incomplete, and combining information across multiple SF bands must be essential for the visual system to function in a robust and reliable manner. In this study, we investigated whether the integration of information from multiple SF channels begins in the cat primary visual cortex. We measured disparity-selective responses in the joint left-right SF domain using sequences of dichoptically flashed grating stimuli consisting of various combinations of SFs and phases. The obtained interaction map in the joint SF domain reflects the degree of integration across different SF channels. Our data are consistent with the idea that disparity information is combined from multiple SF channels in a substantial fraction of complex cells. Furthermore, for the majority of these neurons, the optimal disparity is matched across the SF bands. These results suggest that a highly specific SF integration process for disparity detection starts in the primary visual cortex.

Significance Statement: Our visual world is broadband, containing features with a wide range of object scales. On the other hand, single neurons in the primary visual cortex are narrow-band, being tuned narrowly for a specific scale. For robust visual perception, narrow-band information of single neurons must be integrated eventually at some stage. We have examined whether such an integration process begins in the primary visual cortex with respect to binocular processing. The results suggest that a subset of cells appear to combine binocular information across multiple scales. Furthermore, for the majority of these neurons, an optimal parameter of binocular tuning is matched across multiple scales, suggesting the presence of a highly specific neural integration mechanism.
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http://dx.doi.org/10.1523/JNEUROSCI.0790-15.2015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605418PMC
July 2015

Survival prediction for advanced cancer patients in the real world: A comparison of the Palliative Prognostic Score, Delirium-Palliative Prognostic Score, Palliative Prognostic Index and modified Prognosis in Palliative Care Study predictor model.

Eur J Cancer 2015 Aug 11;51(12):1618-29. Epub 2015 Jun 11.

Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Electronic address:

Purpose: The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model).

Patients And Methods: This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy.

Results: We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores.

Conclusion: The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.
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http://dx.doi.org/10.1016/j.ejca.2015.04.025DOI Listing
August 2015

Longitudinal Study of the Decline in Renal Function in Healthy Subjects.

PLoS One 2015 10;10(6):e0129036. Epub 2015 Jun 10.

Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Background: Chronic kidney disease is an important concern in preventive medicine, but the rate of decline in renal function in healthy population is not well defined. The purpose of this study was to determine reference values for the estimated glomerular filtration rate (eGFR) and rate of decline of eGFR in healthy subjects and to evaluate factors associated with this decline using a large cohort in Japan.

Methods: Retrospective cross-sectional and longitudinal studies were performed with healthy subjects aged ≥18 years old who received a medical checkup. Reference values for eGFR were obtained using a nonparametric method and those for decline of eGFR were calculated by mixed model analysis. Relationships of eGFR decline rate with baseline variables were examined using a linear least-squares method.

Results: In the cross-sectional study, reference values for eGFR were obtained by gender and age in 72,521 healthy subjects. The mean (±SD) eGFR was 83.7±14.7 ml/min/1.73 m2. In the longitudinal study, reference values for eGFR decline rate were obtained by gender, age, and renal stage in 45,586 healthy subjects. In the same renal stage, there was little difference in the rate of decline regardless of age. The decline in eGFR depended on the renal stage and was strongly related to baseline eGFR, with a faster decline with a higher baseline eGFR and a slower decline with a lower baseline eGFR. The mean (±SD) eGFR decline rate was ‒1.07±0.42 ml/min/1.73 m2/year (‒1.29±0.41%/year) in subjects with a mean eGFR of 81.5±11.6 ml/min/1.73 m2.

Conclusions: The present study clarified for the first time the reference values for the rate of eGFR decline stratified by gender, age, and renal stage in healthy subjects. The rate of eGFR decline depended mainly on baseline eGFR, but not on age, with a slower decline with a lower baseline eGFR.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0129036PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464887PMC
April 2016

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

J Pain Symptom Manage 2015 May 12;49(5):853-60. Epub 2014 Dec 12.

Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.

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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http://dx.doi.org/10.1016/j.jpainsymman.2014.10.010DOI Listing
May 2015

The determinants of patients in a palliative care unit being discharged home in Japan.

Am J Hosp Palliat Care 2014 May 2;31(3):244-6. Epub 2013 Apr 2.

1Department of Palliative Care, Palliative Care Team, Saito-Yukoukai Hospital, Osaka, Japan.

In Japan, regarding the place of end-of-life care, many people preferred the home. However, there is a discrepancy between patients' wishes and the actual circumstances. The primary aim of this study was to explore the factors that determine discharge home of patients in a palliative care unit. A total of 31 patients met the criteria. The patients who could be discharged home (group 1; n = 23) were compared with the others (group 2; n = 8). Palliative prognostic index was significantly lower in group 1 than in group 2 (P = .032). Regarding routes of feeding, oral intake was significantly higher in group 1 than in group 2 (P = .043). That is to say, factors determining discharge home of patients may be influenced by the patient's prognosis and the necessity of a feeding device.
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http://dx.doi.org/10.1177/1049909113484384DOI Listing
May 2014

Effect of nutritional support on terminally ill patients with cancer in a palliative care unit.

Am J Hosp Palliat Care 2013 Nov 12;30(7):730-3. Epub 2012 Dec 12.

1Department of Palliative Care, Palliative Care Team and Nutrition Support Team, Saito-Yukoukai Hospital Ibaraki, Japan.

The role of nutritional support on terminally ill patients with cancer in a palliative care unit has not been clarified. A total of 63 patients were retrospectively investigated; the patients receiving individualized nutritional support (intervention group [n = 22]) were compared to the others (control group [n = 41]). The intervention group received individualized nutritional support. There were no significant differences in the characteristics of patients between the groups. The prevalence of bedsores was significantly lower in the intervention group (14% vs 46%, P = .012). The prevalence of edema and the use of antibiotic therapies tended to be lower in the intervention group than in the control group (36% vs 54%, P = .19; 14% vs 27%, P = .34, respectively). Some terminally ill patients with cancer in a palliative care unit might benefit from nutritional support.
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http://dx.doi.org/10.1177/1049909112469273DOI Listing
November 2013

[Case of acute exacerbation of neuropathic cancer pain rapidly relieved by simultaneous oral intake of immediate release oxycodone and pregabalin].

Masui 2012 Oct;61(10):1148-52

Department of Palliative Care, Saito Yukoukai Hospital, Ibaraki 567-0085.

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.
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October 2012

[Retrospective evaluation of pregabalin for cancer-related neuropathic pain].

Masui 2012 Feb;61(2):147-54

Department of Palliative Care, Saito Yukoukai Hospital, Ibaraki 567-0085.

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.
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February 2012
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