Publications by authors named "Naosuke Yokomichi"

27 Publications

  • Page 1 of 1

Hydration Volume Is Associated with Development of Death Rattle in Patients with Abdominal Cancer.

J Palliat Med 2021 Oct 18. Epub 2021 Oct 18.

Division of Palliative Care, Konan Medical Center, Kobe, Japan.

Death rattle occurs frequently in dying patients with malignancies. The association the between hydration volume and death rattle development is controversial. A secondary analysis using data from two multicenter prospective observational studies, including a total of 471 consecutive advanced cancer patients. Of these, we analyzed patients with abdominal malignancies. The association of an artificial hydration volume one week before death with the development of death rattle 48 hours before death was evaluated with the adjustment of potential confounders using the propensity score-weighting method. We analyzed 300 patients. The prevalence of death rattle was significantly higher in those receiving artificial hydration >500 mL/day than those receiving ≤500 mL/day (23.1% vs. 13.6%, respectively; adjusted odds ratio: 2.56; 95% confidence interval: 1.37-4.80;  = 0.0036). The hydration volume might be associated with death rattle development in patients with abdominal malignancies. Volume reduction may alleviate or prevent death rattle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jpm.2021.0297DOI Listing
October 2021

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).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jpm.2021.0178DOI Listing
October 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

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

Visualizing How to Use Parenteral Opioids for Terminal Cancer Dyspnea: A Pilot, Multicenter, Prospective, Observational Study.

J Pain Symptom Manage 2021 May 13. Epub 2021 May 13.

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

Context: How physicians use opioids for dyspnea in imminently dying cancer patients (terminal dyspnea) varies markedly, which could hamper quality care.

Objectives: To examine the adherence to an algorithm-based treatment for terminal dyspnea, and explore its outcomes over 24 hours.

Methods: This was a pre-planned subgroup analysis of a multicenter prospective observational study. Inclusion criteria were: advanced cancer patients admitted to palliative care units, ECOG performance status = 3-4, and a dyspnea intensity ≥2 on the Integrated Palliative care Outcome Scale (IPOS). We developed an algorithm to visualize how palliative care physicians would use parenteral opioids. Participating physicians (palliative care specialists) initiated parenteral opioids, choosing whether to use the algorithm based on their preference. We measured the adherence rate to the algorithm over 24 hours (predefined goal = 70%), and compared dyspnea IPOS scores and adverse events between patients with and without algorithm-based treatment.

Results: Of 164 patients (median survival = 5 days), 71 (43%) received algorithm-based treatment, and 70 (99%; 95% confidence interval = 92%-100%) adhered to it over 24 hours. In a complete case analysis, mean dyspnea IPOS scores significantly decreased from 2.9 (standard error = 0.1) to 1.5 (0.1) in the algorithm group (n = 54; P < 0.001), and 2.9 (0.1) to 1.6 (0.1) in the non-algorithm group (n = 72; P < 0.001). There was no significant between-group difference in changes in dyspnea IPOS scores (P = 0.65). Adverse events were rare (n = 5).

Conclusion: The algorithm-based treatment was feasible, and might be as effective and safe as the usual care by palliative care specialists. Its implementation may help physicians provide quality care for terminal dyspnea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2021.05.001DOI Listing
May 2021

Optimal Paracentesis Volume for Terminally Ill Cancer Patients With Ascites.

J Pain Symptom Manage 2021 Apr 29. Epub 2021 Apr 29.

Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan.

Context: Patients with malignant ascites often suffer from distressing symptoms, especially in their end-of-life stage. Although paracentesis is the most common treatment modality to alleviate such symptoms, the optimal volume of paracentesis is not known.

Objectives: To explore the efficacy and safety of paracentesis by the drainage volume for terminally ill cancer patients with malignant ascites.

Methods: This was part of a multicenter prospective observational study (EASED study). Consecutive adult patients with advanced cancer admitted to 23 participating palliative care units were eligible. We analyzed patients with malignant ascites who received paracentesis. We compared paracentesis-free survival (PFS) using Cox regression among three groups with different paracentesis volumes: minimum: ≤ 1500 mL, small: 1500-2500 mL, and moderate: > 2500 mL. Trends of the difference in the numerical rating scale of abdominal distension (0-10) and adverse events were compared among the 3 groups.

Results: Of the 1926 patients enrolled, 673 developed ascites (symptomatic, n = 374 and asymptomatic, n = 299). Finally, we analyzed 87 patients with paracentesis. Median PFS was 7 days. Compared with a moderate volume, small-volume paracentesis was not a significant risk for shorter PFS (HR: 1.14, 95% CI: 0.69-1.93), while a minimum volume was a significant risk (HR: 2.34). The abdominal distension intensity significantly decreased after paracentesis (median: 7.5 to 4.0), while the difference did not significantly increase as the volume of paracentesis rose (P = 0.61). No severe adverse event was observed.

Conclusion: Even small-volume paracentesis could alleviate abdominal distension of terminally ill cancer patients with malignant ascites without shortening the paracentesis interval compared with moderate-volume paracentesis. Small-volume paracentesis was a well-balanced treatment for these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2021.04.010DOI Listing
April 2021

Comparison between patient-reported and clinician-reported outcomes: Validation of the Japanese version of the Integrated Palliative care Outcome Scale for staff.

Palliat Support Care 2021 Mar 5:1-7. Epub 2021 Mar 5.

Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Objectives: The goal of palliative and supportive care is to improve patients' quality of life (QoL). Patient-reported outcome measures (PROMs) are the gold standard for the assessment of QoL and symptoms; however, when self-reporting is complicated, PROMs are often substituted with proxy-reported outcome measures, such as clinician-reported outcome measures. The objective of this study was to assess the validity and reliability of the Japanese version of the Integrated Palliative care Outcome Scale (IPOS) for staff (IPOS-Staff).

Methods: This multicenter, cross-sectional observational study was conducted concurrently with the validation of the IPOS for patients (IPOS-Patient). Japanese adult patients with cancer and their staff were recruited. We assessed the characteristics of the patients and staff members, missing values, prevalence, and total IPOS scores. For the analysis of criterion validity, intra-rater, and inter-rater reliability, we calculated intraclass correlations (ICCs).

Results: One hundred and forty-three patients completed the IPOS-Patient, and 79 medical staff members completed the IPOS-Staff. The most common missing values from IPOS-Staff were Family Anxiety (3.5%) and Sharing Feelings (3.5%). Over half of the patients scored themselves moderate or worse for Poor Mobility, Anxiety, and Family Anxiety, while staff members scored patients moderate or worse for Weakness, Anxiety, and Family Anxiety. For criterion validity (patient-staff agreement) as well as intra-rater and inter-rater reliability, ICCs ranged from 0.114 (Sharing Feelings) to 0.826 (Nausea), 0.720 (Anxiety) to 0.933 (Nausea), and -0.038 (Practical Problems) to 0.830 (Nausea), respectively.

Significance Of Results: The IPOS-Staff is easy to respond to; it has fair validity and reliability for physical items but poor for psycho-social items. By defining the context and objectives of its use and interpretation, the IPOS-Staff can be a useful tool for measuring outcomes in adult patients with cancer who cannot complete self-evaluations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1478951521000018DOI Listing
March 2021

Low-Dose Trazodone for Delirium in Patients with Cancer Who Received Specialist Palliative Care: A Multicenter Prospective Study.

J Palliat Med 2021 06 11;24(6):914-918. Epub 2021 Feb 11.

Department of Palliative Medicine, Saitama Medical University, Saitama Medical University, Iruma-gun, Japan.

Clinical usefulness of trazodone for delirium in patients receiving palliative care is unclear. To examine the safety and effectiveness of trazodone for delirium. A secondary analysis of a multicenter prospective observational study. The setting involves nine psycho-oncology consultation services and 14 inpatient palliative care units in Japan. The measurement involves the Delirium Rating Scale (DRS) Revised-98 for effectiveness and the CTCAE (Common Terminology Criteria for Adverse Events) version 4 for safety assessments. Thirty-eight patients enrolled the study. Mean age was 75 years. After three-day observation, the DRS total score (11.6 ± 5.3 to 8.7 ± 6.5 [difference -2.9, 95% confidence interval -5.3 to -0.5,  = 0.02]); sleep-wake cycle disturbance ( = 0.047), lability of affect ( < 0.001), and motor agitation subscales ( < 0.001) were significantly decreased. The most frequent adverse event was somnolence ( = 9). Low-dose trazodone treatment was generally safe and may be effective in reducing delirium severity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jpm.2020.0610DOI Listing
June 2021

How Successful Is Parenteral Oxycodone for Relieving Terminal Cancer Dyspnea Compared With Morphine? A Multicenter Prospective Observational Study.

J Pain Symptom Manage 2021 08 5;62(2):336-345. Epub 2020 Dec 5.

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

Context: Parenteral morphine is widely used for dyspnea of imminently dying cancer patients (terminal dyspnea). However, the efficacy of other opioids such as oxycodone remains largely unknown.

Objectives: To explore the efficacy of parenteral oxycodone vs. morphine by continuous infusion over 24 hours in cancer patients with terminal dyspnea.

Methods: This was a pre-planned subgroup analysis of a multicenter prospective observational study. Inclusion criteria were advanced cancer patients admitted to palliative care units, Eastern Cooperative Oncology Group performance status = 3-4, and a dyspnea intensity ≥2 on the Integrated Palliative care Outcome Scale (IPOS) for which oxycodone or morphine was initiated by continuous infusion. We measured dyspnea IPOS scores over 24 hours.

Results: We analyzed 164 patients who received oxycodone (n = 26) and morphine (n = 138) for dyspnea (median survival = 5 days). The mean age was 70 years, 58 patients (35%) had lung cancer, and 97 (59%) had lung metastases. Complete case analysis revealed that mean dyspnea IPOS scores decreased from 3.0 (standard deviation = 0.7) to 1.5 (0.7) in the oxycodone group (difference in means = 1.5; P < 0.001), and from 2.9 (0.7) to 1.6 (1.0) in the morphine group (difference in means = 1.3; P < 0.001). No significant between-group differences existed in the IPOS scores at 24 hours (P = 0.753). Adverse events were seen in no and 5 patients in the oxycodone and morphine groups, respectively.

Conclusion: Parenteral oxycodone may be equally effective and safe as morphine in the treatment of terminal dyspnea in cancer patients. Future randomized controlled trials should confirm the efficacy and safety of opioids other than morphine for terminal dyspnea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2020.11.037DOI Listing
August 2021

Diagnostic accuracy of patient-reported dry mouth as a predictor for oral dryness in terminally ill cancer patients.

Support Care Cancer 2021 May 28;29(5):2743-2748. Epub 2020 Sep 28.

Division of Preventive Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

Purpose: The aim of the study was to determine the diagnostic accuracy of patient-reported dry mouth using an oral moisture-checking device in terminally ill cancer patients.

Methods: The study was conducted following the STARD guidelines, and the participants were recruited prospectively from the Palliative Care Unit, Kyoto Medical Center, Japan, between 1 January 2017 and 30 November 2018. Patients reporting dry mouth were asked to rate oral dryness on a 5-point rating scale. The outcome was oral dryness at the lingual mucosa, measured using an oral moisture-checking device. Receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR), and overall diagnostic accuracy were calculated.

Results: Of 103 participants, the prevalence of oral dryness was 65.0%. ROC analysis indicated that patient-reported dry mouth was a poor predictor of oral dryness, with an area under the curve of 0.616 (95% confidence interval: 0.508-0.723), a sensitivity of 46.3%, a specificity of 75.8%, a PPV of 55.9%, an NPV of 68.1, a positive LR of 1.9, a negative LR of 0.7, and an overall diagnostic accuracy of 64.1%, with a cut-off value of 3 points.

Conclusion: In conclusion, patient-reported dry mouth is not a useful parameter for the assessment of oral dryness in terminally ill cancer patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-020-05798-yDOI Listing
May 2021

Are common delirium assessment tools appropriate for evaluating delirium at the end of life in cancer patients?

Psychooncology 2020 11 12;29(11):1842-1849. Epub 2020 Oct 12.

Department of Palliative Medicine, Saitama Medical University, Irima-gun, Japan.

Objectives: The objectives of this study are to investigate how many advanced cancer patients became unconscious or non-communicative after pharmacological treatment for delirium, and to explore whether existing delirium assessment tools can successfully evaluate its severity at the end of life.

Methods: This was a secondary analysis of a registry study that examined the efficacy and safety of antipsychotics for advanced cancer patients with delirium. A total of 818 patients were recruited from 39 specialized palliative care services in Japan. The severity of delirium was measured using the Richmond Agitation-Sedation Scale-Palliative care version, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Nursing Delirium Screening Scale (Nu-DESC) on Day 3. Data from 302 patients with motor anxiety with an Agitation Distress Scale score ≥2 on Day 0 were analyzed for this study. The patients were categorized into four treatment response groups: complete response (CR: no agitation and fully communicative), partial response (PR: no/mild agitation and partially communicative), unconscious/non-communicative (UC), and no change (NC).

Results: On Day 3, 29 (10%; 95% confidence intervals [CI], 7-13) and 2 (1%; 95% CI, 0-2) patients became unconscious and non-communicative, respectively. Forty-four patients were categorized as CR, 97 as PR, 31 as UC, and 96 as NC. The scores of the DRS-R-98 and Nu-DESC in the UC group were rated higher than patients in the NC group were.

Conclusions: A considerable number of cancer patients with delirium became unconscious or non-communicative. Existing delirium assessment tools may be inappropriate for measuring the severity of delirium in end-of-life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pon.5499DOI Listing
November 2020

The Bereaved Families' Preferences for Individualized Goals of Care for Terminal Dyspnea: What Is an Acceptable Balance between Dyspnea Intensity and Communication Capacity?

Palliat Med Rep 2020 14;1(1):42-49. Epub 2020 May 14.

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

Toward the individualized care of terminally ill patients with dyspnea ("terminal dyspnea"), it is essential to identify individualized goals of care (GOC) to achieve an acceptable balance between dyspnea intensity and communication capacity. To explore preferences for individualized GOC for terminal dyspnea, and factors associated with the preferences. A nationwide cross-sectional survey. In total, 1055 bereaved families of cancer patients admitted to 167 inpatient hospices in Japan. Preferences for individualized GOC for terminal dyspnea to achieve an acceptable balance between dyspnea intensity and communication capacity, should individuals experience continuous moderate or severe/overwhelming dyspnea despite optimal palliative care, and perceptions about a good death. Among 548 participants (response rate = 52%), we analyzed responses of 477 families whose loved one suffered dyspnea in the last week of life. In total, 167 (45%; 95% confidence interval [CI] = 40%-50%) and 272 (80%; 95% CI = 75%-84%) participants would prioritize dyspnea relief over communication capacity, should they continuously suffer moderate or severe/overwhelming dyspnea, respectively. In multivariate analyses, the determinants of the prioritization of dyspnea relief were perceiving physical comfort as important for a good death (odds ratio [OR] = 1.389; 95% CI = 1.062-1.818;  = 0.017) in moderate dyspnea, and perceiving physical comfort (OR = 2.505; 95% CI = 1.718-3.651;  < 0.001) and not perceiving mental awareness (OR = 0.695; 95% CI = 0.529-0.913;  = 0.009) as important in severe/overwhelming dyspnea. Preferences for individualized GOC for terminal dyspnea can vary among individuals and with different symptom intensity, and may be influenced by perceptions about a good death. Outcome measurements incorporating an acceptable balance between dyspnea intensity and communication capacity should be developed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/pmr.2020.0035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241337PMC
May 2020

The Functional Palliative Prognostic Index: a scoring system for functional prognostication of patients with advanced cancer.

Support Care Cancer 2020 Dec 17;28(12):6067-6074. Epub 2020 Apr 17.

Department of Palliative Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Sendai, Miyagi, 980-8575, Japan.

Purpose: For appropriate advance care planning, functional prognostication is necessary. However, there are no studies of functional prognostication in patients with cancer. The aim of this study was to develop a functional prognostic scoring system for patients with advanced cancer.

Methods: In this multicenter prospective observational study, 1896 patients were enrolled. First, Cox regression analysis and the combination of forward and backward variable selection were used to identify the best subset of predictors. Second, the prognostic score value was defined from each regression coefficient of a significant prognostic factor. The Functional Palliative Prognostic Index (FPPI) was calculated by summing the prognostic scores.

Results: Patients were classified into three groups by the FPPI. For walking, the 14-day functional survival probability was > 72.8% for group A (score 0), 28.4-72.8% for group B (score 1), and < 28.4% for group C (score 2-3). For eating, the 14-day functional survival probability was > 71.8% for group A (score 0-3), 29.6-71.8% for group B (score 3.5-5.5), and < 29.6% for group C (score 6-9). For communicating, the 14-day functional survival probability was > 76.6% for group A (score 0-6.5), 22.6-76.6% for group B (score 7-10), and < 22.6% for group C (score 10.5-16). Regarding each item, group B functionally survived significantly longer than group C, and group A functionally survived significantly longer than either of the others.

Conclusion: We firstly developed a functional prognostic scoring system for patients with advanced cancer. This FPPI system promises to be helpful in advance care planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-020-05408-xDOI Listing
December 2020

Heterogeneity of Epigenetic and Epithelial Mesenchymal Transition Marks in Hepatocellular Carcinoma with Keratin 19 Proficiency.

Liver Cancer 2019 Jul 21;8(4):239-254. Epub 2018 Aug 21.

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

Objective: Keratin 19 (K19) expression is a potential predictor of poor prognosis in patients with hepatocellular carcinoma (HCC). To clarify the feature of K19-proficient HCC, we traced epigenetic footprints in cultured cells and clinical materials.

Patients And Methods: In vitro, promoter methylation was analyzed and 5-aza-2'-deoxycytidine with trichostatin A (TSA) treatment was performed. Among 564 surgically resected HCCs, the clinicopathological relevance of K19-proficent HCCs was performed in comparison with hepatocytic (HepPar-1 and arginase-1), epithelial-mesenchymal transition (E-cadherin and vimentin), biliary differentiation-associated (K7 and NOTCH-1) markers, and epigenetic markers ( promoter/long interspersed nucleotide element-1 [] methylation status).

Results: promoter methylation was clearly associated with K19 deficiency and 5-aza-2'-deoxycytidine with TSA treatment-stimulated K19 re-expression, implicating DNA methylation as a potential epigenetic process for K19 expression. After excluding HCCs with recurrence, TNM stage as IIIB or greater, preoperative therapy, transplantation, and combined hepatocellular cholangiocarcinoma, we assessed 125 of 564 HCC cases. In this cohort, K19 expression was found in 29 HCCs (23.2%) and corresponded with poor survival following surgery ( = 0.025) and extrahepatic recurrence-free survival ( = 0.017). Compared with K19-deficient HCCs, lower promoter methylation level was observed in K19-proficient HCCs ( < 0.0001). Conversely, HCC with genome-wide hypermethylation was frequently observed in K19-proficient HCCs ( = 0.0079). Additionally, K19 proficiency was associated with K7 proficiency ( = 0.043), and reduced E-cadherin and HepPar-1 expression ( = 0.043 and < 0.0001, respectively).

Conclusions: K19-proficient HCC exhibited poor prognosis owing to extrahepatic recurrence, with molecular signatures differing from those in conventional cancer stem cells, providing novel insights of the heterogeneity underlying tumor development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000490806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738240PMC
July 2019

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).

Oncologist 2019 07 4;24(7):e574-e582. Epub 2019 Jan 4.

Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan

Background: Pharmacotherapy is generally recommended to treat patients with delirium. We sought to describe the current practice, effectiveness, and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer, and to explore predictors of the deterioration of delirium symptoms after starting pharmacotherapy.

Subjects, Materials, And Methods: We included data of patients with advanced cancer who were diagnosed with hypoactive delirium and received pharmacotherapy for treatment of delirium. This was a pharmacovigilance study characterized by prospective registries and systematic data-recording using internet technology, conducted among 38 palliative care teams and/or units. The severity of delirium and other outcomes were assessed using established measures at days 0 (T0), 3 (T1), and 7 (T2).

Results: Available data were obtained from 218 patients. The most frequently used agent was haloperidol (37%). A total of 67 and 42 patients (31% and 19%) had died or discontinued pharmacotherapy by T1 and T2, respectively. Delirium symptoms deteriorated between T0 and T1, but this trend did not reach statistical significance. The most prevalent adverse event was sedation (9%). Delirium severity worsened after starting pharmacotherapy in 121 patients (56%) at T1. In patients whose death was expected within a few days and those with delirium caused by organ failure, symptoms of delirium were significantly more likely to deteriorate after starting pharmacotherapy.

Conclusion: Current pharmacotherapy for hypoactive delirium in patients with advanced cancer is not recommended, especially in those whose death is expected within a few days and in those with delirium caused by organ failure.

Implications For Practice: Delirium is common among patients with advanced cancer, and hypoactive delirium is the dominant motor subtype in the palliative care setting. Pharmacotherapy is recommended and regularly used to treat delirium. This article describes the effectiveness and adverse effects of pharmacotherapy for hypoactive delirium in patients with advanced cancer. The findings of this study do not support the use of pharmacotherapy for treatment of hypoactive delirium in the palliative care setting. Pharmacotherapy should especially be avoided in patients whose death is expected within a few days and in those with delirium caused by organ failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1634/theoncologist.2018-0242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656448PMC
July 2019

Validation of the Edmonton Symptom Assessment System: Ascites Modification.

J Pain Symptom Manage 2018 06 23;55(6):1557-1563. Epub 2018 Mar 23.

Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan. Electronic address:

Context: Few patient-reported outcomes are available to measure the symptoms associated with malignant-related ascites in patient care and clinical research. Although the Edmonton Symptom Assessment System: Ascites Modification (ESAS:AM) is a brief tool to measure symptoms associated with malignant-related ascites, it remains to be fully validated.

Objectives: The objective of the study was to validate the ESAS:AM in Japanese cancer patients.

Methods: We assessed the internal consistency, test-retest reliability, concurrent validity, and construct validity in 292 Japanese adult patients with cancer. They completed Japanese versions of the ESAS:AM, M.D. Anderson Symptom Inventory, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and abdominal pain/ascites subscales of the EORTC Core Quality of Life Questionnaire, 26-item pancreatic cancer module.

Results: Cronbach's alpha coefficient of the ESAS:AM was 0.89. The intraclass correlation coefficient on test-retest examination of its total score was 0.93 (P < 0.001). Pearson correlation coefficients of the total score of the ESAS:AM with the total score of the M.D. Anderson Symptom Inventory and abdominal pain/ascites subscales of the EORTC Core Quality of Life Questionnaire, 26-item pancreatic cancer module ranged from 0.44 to 0.81 (P < 0.001) and those with global health status/quality of life and functional subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 ranged from -0.40 to -0.61 (P < 0.001). The total scores of the ESAS:AM were significantly higher in 20 patients with symptomatic ascites (34 [SD, 26]) than 267 patients without symptomatic ascites (23 [SD, 19]) (P = 0.018).

Conclusion: The ESAS:AM is a reliable and valid tool for measuring symptoms associated with malignant-related ascites and can be used in daily patient care and future epidemiological studies and clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2018.03.016DOI Listing
June 2018

Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation.

Support Care Cancer 2018 Jun 14;26(6):1763-1771. Epub 2017 Dec 14.

Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan.

Purpose: This study investigated the effect of two types of palliative sedation defined using intervention protocols: proportional and deep sedation.

Methods: We retrospectively analyzed prospectively recorded data of consecutive cancer patients who received the continuous infusion of midazolam in a palliative care unit. Attending physicians chose the sedation protocol based on each patient's wish, symptom severity, prognosis, and refractoriness of suffering. The primary endpoint was a treatment goal achievement at 4 h: in proportional sedation, the achievement of symptom relief (Support Team Assessment Schedule (STAS) ≤ 1) and absence of agitation (modified Richmond Agitation-Sedation Scale (RASS) ≤ 0) and in deep sedation, the achievement of deep sedation (RASS ≤ - 4). Secondary endpoints included mean scores of STAS and RASS, deep sedation as a result, and adverse events.

Results: Among 398 patients who died during the period, 32 received proportional and 18 received deep sedation. The treatment goal achievement rate was 68.8% (22/32, 95% confidence interval 52.7-84.9) in the proportional sedation group vs. 83.3% (15/18, 66.1-100) in the deep sedation group. STAS decreased from 3.8 to 0.8 with proportional sedation at 4 h vs. 3.7 to 0.3 with deep sedation; RASS decreased from + 1.2 to - 1.7 vs. + 1.4 to - 3.7, respectively. Deep sedation was needed as a result in 31.3% (10/32) of the proportional sedation group. No fatal events that were considered as probably or definitely related to the intervention occurred.

Conclusion: The two types of intervention protocol well reflected the treatment intention and expected outcomes. Further, large-scale cohort studies are promising.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-017-4011-2DOI Listing
June 2018

Efficacy and safety of reinfusion of concentrated ascitic fluid for malignant ascites: a concept-proof study.

Support Care Cancer 2018 May 22;26(5):1489-1497. Epub 2017 Nov 22.

Department of Palliative Care, Hoshigaoka Medical Center, Osaka, Japan.

Purpose: Malignant ascites is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one treatment modality, but controlled trials are limited. The primary aim of this study was to explore the efficacy and safety of CART, as well as their predictors, to obtain data for planning a further controlled trial.

Methods: This was a single center retrospective cohort study in patients with refractory malignant ascites. Consecutive adult patients who underwent CART were enrolled. The primary endpoints were the time to next paracentesis and seven patient-reported symptoms (e.g., abdominal pain and distension). The secondary endpoints were adverse events, laboratory findings, and physical findings.

Results: A total of 104 CART procedures for 51 patients were analyzed. The median time to next paracentesis was 27 days (95% CI, 21-35). Intensities of all seven symptoms were significantly improved after CART (p < 0.0001 for all symptoms). Grade 3 hypotension occurred during one procedure, and mild fever occurred in 5%. Total protein, albumin, and estimated glomerular filtration rate were significantly increased. Hemorrhagic ascites, ascites white blood cell count, serum total protein, and lymphocyte percentages were the independent predictors of the time to next paracentesis.

Conclusion: The effects of reinfusion of concentrated ascitic fluid may be maintained for 1 month, being potentially longer than that of total paracentesis alone. This study had no comparison groups and examined the short-term effect. A randomized controlled study to compare the long-term effects of total paracentesis alone vs. CART is necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-017-3980-5DOI Listing
May 2018

Continuous Deep Sedation: A Proposal for Performing More Rigorous Empirical Research.

J Pain Symptom Manage 2017 01 13;53(1):146-152. Epub 2016 Oct 13.

Palliative Care Center, Department of Palliative Medicine, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.

Continuous deep sedation until death (CDS) is a type of palliative sedation therapy, and it has recently become a focus of intense debate. Marked inconsistencies in intervention procedures (i.e., what is CDS?) and unstandardized descriptions of patient backgrounds lead to difficulty in comparing the results in the literature. The primary aim of this article was to propose a conceptual framework to perform empirical studies on CDS. We propose the definition of CDS using the intervention protocol. As there are two types of CDS proposed in world-wide literature, we recommend to prepare two types of intervention protocol for CDS: "continuous deep sedation as a result of proportional sedation" (gradual CDS) and "continuous deep sedation to rapidly induce unconsciousness" (rapid CDS). In addition, we recommend that researchers characterize study patients' general condition using a validated prognostic tool, Prognosis in Palliative Care Study predictor model-A. Using this conceptual framework, we can compare the outcomes following the same exposures among homogenous patients throughout the world. This article proposes a provisional definition of two types of CDS. Defining CDS using the intervention protocol and describing patient backgrounds using validated prognostic tools enable comparisons and interpretations of empirical research about CDS. More empirical studies are urgently needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2016.08.012DOI Listing
January 2017

Validation of the Japanese Version of the Edmonton Symptom Assessment System-Revised.

J Pain Symptom Manage 2015 Nov 11;50(5):718-23. Epub 2015 Jul 11.

Psycho-Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address:

Context: The Edmonton Symptom Assessment System-revised (ESAS-r) is a brief and widely used symptom measurement tool.

Objectives: To validate the Japanese version of the ESAS-r in Japanese patients with cancer.

Methods: We assessed the internal consistency, test-retest reliability, concurrent validity, and known-group validity in 292 Japanese adult patients with cancer. They completed Japanese versions of the ESAS-r, M. D. Anderson Symptom Inventory, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30.

Results: Cronbach's alpha coefficient of the Japanese version of the ESAS-r was 0.87. The intraclass correlation coefficient in the test-retest examination ranged from 0.82 to 0.91 for each symptom score and was 0.90 for the total score. Pearson correlation coefficients of each ESAS-r symptom score with corresponding M. D. Anderson Symptom Inventory and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 items ranged from 0.45 to 0.80. The total score of the ESAS-r was significantly higher in patients with an Eastern Cooperative Oncology Group performance status of 2-4 than in those with a performance status of 0 and 1 (P < 0.0001).

Conclusion: The Japanese version of the ESAS-r is a reliable and valid tool for measuring symptoms in Japanese adult patients with cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2015.05.014DOI Listing
November 2015

Clinical Significance of MLH1 Methylation and CpG Island Methylator Phenotype as Prognostic Markers in Patients with Gastric Cancer.

PLoS One 2015 29;10(6):e0130409. Epub 2015 Jun 29.

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan.

Background: To improve the outcome of patients suffering from gastric cancer, a better understanding of underlying genetic and epigenetic events in this malignancy is required. Although CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) have been shown to play pivotal roles in gastric cancer pathogenesis, the clinical significance of these events on survival outcomes in patients with gastric cancer remains unknown.

Methods: This study included a patient cohort with pathologically confirmed gastric cancer who had surgical resections. A cohort of 68 gastric cancers was analyzed. CIMP and MSI statuses were determined by analyzing promoter CpG island methylation status of 28 genes/loci, and genomic instability at 10 microsatellite markers, respectively. A Cox's proportional hazards model was performed for multivariate analysis including age, stage, tumor differentiation, KRAS mutation status, and combined CIMP/MLH1 methylation status in relation to overall survival (OS).

Results: By multivariate analysis, longer OS was significantly correlated with lower pathologic stage (P = 0.0088), better tumor differentiation (P = 0.0267) and CIMP-high and MLH1 3' methylated status (P = 0.0312). Stratification of CIMP status with regards to MLH1 methylation status further enabled prediction of gastric cancer prognosis.

Conclusions: CIMP and/or MLH1 methylation status may have a potential to be prognostic biomarkers for patients with gastric cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0130409PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488282PMC
March 2016

Unique association between global DNA hypomethylation and chromosomal alterations in human hepatocellular carcinoma.

PLoS One 2013 2;8(9):e72312. Epub 2013 Sep 2.

Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan ; Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Global DNA hypomethylation is a characteristic feature of cancer cells that closely associates with chromosomal instability (CIN). However, the association between these characteristics during hepatocarcinogenesis remains unclear. Herein, we determined the relationship between hypomethylation and CIN in human hepatocellular carcinoma (HCC) by analyzing 179 HCCs, 178 matched non-tumor livers and 23 normal liver tissues. Hypomethylation at three different repetitive DNA (rDNA) sequences and hypermethylation of 12 CpG loci, including 11 tumor suppressor gene (TSG) promoters, were quantified using MethyLight or combined bisulfite restriction analysis. Fractional allelic loss (FAL) was used as a marker for CIN, calculated by analyzing 400 microsatellite markers. Gains and losses at each chromosome were also determined using semi-quantitative microsatellite analysis. The associations between rDNA hypomethylation and FAL, as well as between TSG hypermethylation and FAL were investigated. Significantly more hypomethylation was observed in HCC tissues than in normal liver samples. Progression of hypomethylation during carcinogenesis was more prominent in hepatitis C virus (HCV)-negative cases, which was in contrast to our previous reports of significantly increased TSG methylation levels in HCV-positive tumors. Absence of liver cirrhosis and higher FAL scores were identified as independent contributors to significant hypomethylation of rDNA in HCC. Among the chromosomal alterations frequently observed in HCC, loss of 8p, which was unique in the earliest stages of hepatocarcinogenesis, was significantly associated with hypomethylation of rDNA by multivariable analysis (p=0.0153). rDNA hypomethylation was also associated with a high FAL score regardless of tumor differentiation (p=0.0011, well-differentiated; p=0.0089, moderately/poorly-differentiated HCCs). We conclude that DNA hypomethylation is an important cause of CIN in the earliest step of HCC, especially in a background of non-cirrhotic liver.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072312PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759381PMC
April 2014

Advanced hepatocellular carcinoma with lymph node metastases showing epithelial to mesenchymal transition effectively treated with systemic chemotherapy: Report of a case.

Hepatol Res 2013 Dec 15;43(12):1368-73. Epub 2013 May 15.

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama.

We present a case in which combination chemotherapy was used to successfully treat hepatocellular carcinoma (HCC) with rapid progression of lymph node (LN) metastases after liver resection. In addition, epithelial to mesenchymal transition (EMT) markers were examined immunohistochemically. A 43-year-old man who had been diagnosed with HCC showed an enlarged LN near the hepatic artery proper. After extended left lobectomy with lymphadenectomy in the hepatoduodenal ligament, he experienced rapid progression of metastases to the para-aortic and mediastinal LN. Partial remission was achieved after induction and maintenance of combination chemotherapy using etoposide, carboplatin, epirubicin and 5-fluorouracil. As a consequence of this treatment, the patient survived 10 months. Immunohistochemical studies demonstrated that HCC cells in the metastatic LN showed low expression of E-cadherin and high expression of N-cadherin and vimentin, indicating EMT. Combination chemotherapy may prove effective for patients with HCC accompanied by LN metastases that show features of EMT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hepr.12080DOI Listing
December 2013

Case of emphysematous cholecystitis in a patient with type 2 diabetes mellitus associated with schizophrenia.

J Diabetes Investig 2012 Dec 21;3(6):534-5. Epub 2012 Aug 21.

Department of Medicine and Clinical Science Okayama Japan.

Emphysematous cholecystitis is a rare, but life-threatening, form of acute cholecystitis caused by gas-forming organisms in the gallbladder. A 73-year-old male patient with type 2 diabetes mellitus complicated with neuropathy associated with schizophrenia was admitted to Okayama University Hospital, Okayama, Japan, because of a high fever and general malaise. On the fourth hospital day, despite normal liver function tests and little abdominal pain, his abdominal computed tomography showed huge gas formation in the gallbladder lumen along with a dilated gallbladder with a thickened wall, consistent with emphysematous cholecystitis. The patient underwent an emergency open cholecystectomy. Few abdominal symptoms appeared because of the hyposensitivity to pain caused by not only diabetic neuropathy, but also antipsychotic agents the patient was taking for schizophrenia. Emphysematous cholecystitis should be taken into consideration for the differential diagnosis of high fever in diabetic patients with schizophrenia, irrespective of the level of liver function tests and clinical symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.2040-1124.2012.00232.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015433PMC
December 2012

[A case of early poorly-differentiated neuroendocrine carcinoma of stomach].

Gan To Kagaku Ryoho 2010 Feb;37(2):319-21

Dept. of Surgery, Tottori Municipal Hospital.

A 45-year-old male was admitted to our hospital complaining of anemia. Gastric endoscopy showed a type IIa+IIc tumor at the anterior wall of the gastric angle. Based on the pathology of the biopsy specimen, poorly-differentiated adenocarcinoma was diagnosed. Computed tomography scans showed regional lymph node swelling. Distal gastrectomy with a D2 lymph node dissection was performed. On pathology, the tumor was immunohistochemically positive for chromogranin A and synaptophysin. The Ki67 index was 70%. The tumor was diagnosed as poorly-differentiated neuroendocrine carcinoma of the stomach. He was treated with S-1 and CPT-11. Neuroendocrine cell carcinoma of the stomach is rare and usually has a very poor prognosis. Thus, we are reporting this case of early poorly-differentiated neuroendocrine carcinoma of the stomach that was curatively resected and had 12-month survival without recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2010

[A case of gastric cancer with peritoneal dissemination who achieved long survival by successive treatments with S-1 in combination with CDDP, paclitaxel and irinotecan].

Gan To Kagaku Ryoho 2009 Oct;36(10):1741-4

Dept. of Surgery, Tottori Municipal Hospital.

The patient was a 63-year-old male with multiple peritoneal disseminations of advanced gastric cancer. He underwent chemotherapy with a combination of S-1 120 mg/day (3 weeks administration and 2 weeks rest) and cisplatin (CDDP) 60 mg/m(2) (day 8). After 3 courses of this regimen, CT revealed no evidence of ascites. He then underwent laparatomy. Peritoneal dissemination appeared, and the findings were sT3, N0, H0, P1, CY1, M1(PLE), sStage IV. A bypass operation was performed. As second-line chemotherapy, he received combination chemotherapy with S-1 and paclitaxel (PTX) 60 mg/m(2) (div), 20 mg/m(2) ( ip) (day 1, 8). However, he complained of ascites after 16 courses. We tried weekly administration of PTX and tri-weekly administration of irinotecan (50 mg/m(2)) with S-1. This treatment was successfully continued for 20 courses. The adverse effect was anemia (grade 2). He died two years eight months after surgery. The chemotherapy with S-1/CDDP, S-1/PTX, and S-1/PTX/irinotecan was thought to be effective for advanced gastric cancer with peritoneal dissemination.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2009

[A case of stage IV AFP producing cecal cancer responding to mFOLFOX6 leading to a partial response].

Gan To Kagaku Ryoho 2009 Aug;36(8):1375-7

Dept. of Surgery, Tottori Municipal Hospital.

We report a case of stage IV AFP producing cecal cancer responding to mFOLFOX6 leading to a partial response. The patient was a 72-year-old female with multiple liver metastases of cecal cancer. She underwent a right hemicolectomy and right salpingo-oophorectomy in a non-curative resection. Final findings revealed cecal cancer, type 3, 60 x 55 mm, pSI (right ovary), pN3, sH3, sP0, cM0, fStage IV, respectively. After surgery, chemotherapy with mFOLFOX6 was performed. After 4 courses, a significant tumor reduction (PR) was obtained. She died 1 year 2 months after surgery. This case suggests that chemotherapy with mFOLFOX6 is a potential regimen for AFP producing colon cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2009
-->