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Katayama H, Tabata M, Kamei H, Mimura Y, Maeda Y. Relationship Between Corticosteroid Administration and Survival Period in Terminal Cancer Patients. J Palliat Care 2024; 39:238-243. [PMID: 38115751 DOI: 10.1177/08258597231221924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Objective: Corticosteroids are commonly used for symptom relief in patients with terminal cancer, but their use may have an impact on patient survival. We compared the survival of patients with terminal cancer who did and did not receive corticosteroid treatment for symptom relief, stratified by their predicted prognosis. Methods: We retrospectively reviewed consecutive patients with cancer who received corticosteroid treatment for symptom relief in a single palliative care unit. We stratified the patients according to their predicted prognosis using the palliative prognostic (PaP) score either before starting the corticosteroid treatment or at admission for control patients who did not receive a corticosteroid treatment. The 2 groups were compared for survival based on the PaP Scores. Results: We analyzed 204 patients treated with a corticosteroid during the study period and 139 control patients who did not receive corticosteroids during their treatment. No difference was observed in the survival between the treatment and control groups. Conclusion: Corticosteroid treatment for symptom relief in patients with terminal cancer did not affect survival time.
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Affiliation(s)
- Hideki Katayama
- Department of Palliative and Supportive Care, Okayama University Hospital, Okayama city, Japan
| | - Masahiro Tabata
- Department of Palliative and Supportive Care, Okayama University Hospital, Okayama city, Japan
- Clinical Cancer Center, Okayama University Hospital, Okayama city, Japan
| | - Haruhito Kamei
- National Hospital Organization Yamaguchi-Ube Medical Center, Ube city, Japan
| | - Yusuke Mimura
- National Hospital Organization Yamaguchi-Ube Medical Center, Ube city, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama city, Japan
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Fujii H, Yamada Y, Iihara H, Suzuki A. The role of pharmacists in multimodal cancer cachexia care. Asia Pac J Oncol Nurs 2023; 10:100280. [PMID: 38197038 PMCID: PMC10772181 DOI: 10.1016/j.apjon.2023.100280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/27/2023] [Indexed: 01/11/2024] Open
Abstract
Cancer cachexia is a complex syndrome, and multidisciplinary management has the potential to improve patient outcomes and efficiency of care. Multidisciplinary management consists primarily of exercise, nutrition, and pharmacotherapy. The pharmacist's role in cancer cachexia is to contribute to appropriate pharmacotherapy practices. For example, anamorelin is an oral drug with ghrelin-like effects that may improve the pathogenesis of cancer cachexia by stimulating appetite and increasing food intake and body weight. Many patients with cancer cachexia are under treatment with anticancer agents, and pharmacists need to determine whether symptoms such as anorexia and nausea are due to cancer cachexia or anticancer agents. Based on that determination, they are then expected to suggest supportive care to the physician. Provision of multidisciplinary care for cancer cachexia requires communication with not only physicians but also with nurses, dietitians, and other professionals so that nutritional therapy can be provided at the time cachexia is detected. However, the role of pharmacists in the management of cancer cachexia is not well established, and there is no evidence that pharmacist interventions are of benefit to patients. In this article, to contribute to the treatment of cancer cachexia by multidisciplinary care, we describe the role of pharmacists in cancer cachexia as currently practiced at our hospital. We also consider future challenges to this type of multidisciplinary care. Evidence concerning multidisciplinary treatment of cancer cachexia is scarce, including therapeutic agents, and there is a current lack of collaboration among medical professionals and education in cancer cachexia. Solving these problems will require efforts in the practice and evaluation of treatment for cancer cachexia.
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Affiliation(s)
- Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Yunami Yamada
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
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3
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Venkataramu VN, Ghotra HK, Chaturvedi SK. Management of psychiatric disorders in patients with cancer. Indian J Psychiatry 2022; 64:S458-S472. [PMID: 35602367 PMCID: PMC9122176 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Santosh K Chaturvedi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.,Leicestershire Partnership NHS Trust, Thurmaston, Leicestershire, UK E-mail:
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Miura T, Okizaki A, Hasuo H, Satomi E, Tagami K, Imai K, Kojima T, Satake H, Ishiki H, Inoue A, Yamaguchi T. Dexamethasone 8 mg for Cancer-Related Fatigue in Inpatients with Advanced Cancer Undergoing Palliative Care: A Multicenter Phase II Trial. Palliat Med Rep 2021; 2:316-323. [PMID: 34927157 PMCID: PMC8675272 DOI: 10.1089/pmr.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: No standard treatment for cancer-related fatigue (CRF) for inpatients in a palliative care setting exists. The aim of this study was to validate the previous study-derived efficacy of dexamethasone 8 mg for CRF among inpatients in a palliative care setting. Methods: Inpatients with moderate fatigue (≥4/10) were enrolled in a multicenter phase II trial. Dexamethasone 8 mg p.o. or 6.6 mg i.v. was administered for seven days and 4 mg p.o. or 3.3 mg i.v. for seven consecutive days. The primary endpoint was a threshold average change of Functional Assessment of Chronic Illness Therapy (FACIT)-fatigue subscale score of 3. The secondary endpoints were evaluated with the anorexia-cachexia subscale (ACS), and the Edmonton symptom assessment scale-revised Japanese version. Results: A total of 32 patients were enrolled. On day 8, the mean change of FACIT-fatigue subscale from day 1 was 5.2 (95% confidence interval 0.8–10.0), in which the lower bound was above 0 but not above the prespecified threshold value of 3.0 (p = 0.72). Edmonton symptom assessment system (ESAS)-fatigue was significantly improved by day 3 (p = 0.02), but not on day 8 or day 15. ACS, physical well-being, and ESAS-lack of appetite significantly improved by day 8 and day 15. Adverse events were tolerable. Conclusion: This study showed that dexamethasone 8 mg failed to achieve the preset efficacy for CRF among inpatients in a palliative care setting. However, this treatment improved fatigue and would be an option for CRF. jRCT (jRCTs031180068).
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Affiliation(s)
- Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ayumi Okizaki
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Kojima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hironaga Satake
- Cancer Treatment Center, Kansai Medical University Hospital, Hirakata, Japan
| | - Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
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5
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Ren LL, Tian XB, He ZC, Song EH, Tang TT. Cancer-related fatigue in hospitalised patients treated for lymphoma and its burden on family caregivers. Eur J Cancer Care (Engl) 2021; 31:e13547. [PMID: 34918408 DOI: 10.1111/ecc.13547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 10/01/2021] [Accepted: 12/02/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the prevalence of cancer-related fatigue (CRF) in patients with lymphoma and to explore the burden of CRF on the family caregivers (FCs). METHODS A cross-sectional study was conducted in a university-affiliated tertiary care hospital in China. Patients with lymphoma who received treatment in the in-patient ward of the Haematology Department were consecutively recruited. Face-to-face interviews were conducted to gather information related to the patients' sociodemographic characteristics and perceived CRF and its burden on the FCs. Cochran-Armitage trend analysis and Multivariable logistic regression analyses were employed to determine the association between CRF and the FCs' burden. RESULTS Of the 116 cancer patient-FC dyads, about 70% of patients experienced some level of fatigue, while 51% of unpaid family members suffered some degree of depression. The Cochran-Armitage trend analysis showed that the FCs' burden significantly increased with the severity of CRF. Logistic regression indicated that the FCs of the patients reporting fatigue experienced a higher burden in both the unadjusted and adjusted models. CONCLUSION The prevalence of CRF appeared to be high among patients with lymphoma. It might be important to design innovative health-promoting practices for ameliorating or preventing the impact of fatigue.
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Affiliation(s)
- Lin-Li Ren
- Department of Hematology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-Bing Tian
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Zheng-Cang He
- Department of Hematology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - En-Hui Song
- Department of Hematology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ting-Ting Tang
- Department of Hematology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Crivelli F, Perfetti E, Sartorello B, Cantele V, Ostano P, Ilardi F, Di Massimo DS, Clerico M. Survey on symptoms in patients receiving chemotherapy in an Italian department of oncology: a comparison between period prevalences. Support Care Cancer 2020; 29:255-261. [PMID: 32346798 DOI: 10.1007/s00520-020-05486-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the prevalence over time of the measured side effects using a self-assessment questionnaire in normal clinical practice. METHODS The prevalence of symptoms reported by patients on the questionnaire was evaluated over two 1-year periods: from 1 June 2006 to 31 May 2007 and from 1 July 2013 to 30 June 2014. Descriptive statistics were used to describe population. The 2006-2007 and 2013-2014 datasets were compared with each other using the chi-squared test for equality of proportion, Pearson's chi-squared test, and chi-squared test for trend in proportion. RESULTS We analyzed 1974 questionnaires from 283 patients in 2006-2007 and 2619 questionnaires from 403 patients in 2013-2014. The most frequently encountered symptom in both periods was fatigue; nausea and constipation decreased in 2013-2014 compared with 2006-2007, while alopecia increased. CONCLUSIONS Using the self-assessment questionnaire in normal clinical practice has allowed us to carry out an accurate prevalence survey on symptoms in patients receiving chemotherapy that takes into account not only reports of the presence of symptoms but also of their absence. Between 2006-2007 and 2013-2014, there was an increase in patients treated at the Oncological Day Hospital of the Biella Hospital, whose characteristics were comparable in the two periods, except for the type of therapies carried out. Some symptoms were in decline: fatigue, nausea, and constipation.
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Affiliation(s)
- Francesca Crivelli
- S.C. Oncologia ASL BI, Fondazione Edo ed Elvo Tempia, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy.
| | - Elisa Perfetti
- S.C.Oncologia ASL BI, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy
| | - Barbara Sartorello
- S.C.Oncologia ASL BI, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy
| | | | - Paola Ostano
- Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, BI, Italy
| | - Francesco Ilardi
- Fondazione Edo ed Elvo Tempia, Via Malta 3, 13900, Biella, BI, Italy
| | | | - Mario Clerico
- S.C.Oncologia ASL BI, Via dei Ponderanesi 2, Ponderano, 13875, Biella, BI, Italy
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Hatano Y, Shikata Y, Izumi H, Kawaguchi A. Discrepancies between Reasons of Palliative Care Team Consultation and Palliative Care Team Activities. J Palliat Med 2018; 21:1278-1283. [DOI: 10.1089/jpm.2018.0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Yutaka Hatano
- Centre for Palliative Care, Kindai University Hospital, Osaka, Japan
| | - Yuko Shikata
- Centre for Palliative Care, Kindai University Hospital, Osaka, Japan
| | - Hiroaki Izumi
- Centre for Palliative Care, Kindai University Hospital, Osaka, Japan
| | - Akinori Kawaguchi
- Centre for Palliative Care, Kindai University Hospital, Osaka, Japan
- Department of Pharmacy, Kindai University Hospital, Osaka, Japan
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Abstract
Cancer-related fatigue (CRF) significantly interferes with usual functioning because of the distressing sense of physical, emotional, and cognitive exhaustion. Assessment of CRF is important and should be performed during the initial cancer diagnosis, throughout cancer treatment, and after treatment using a fatigue scoring scale (mild-severe). The general approach to CRF management applies to cancer survivors at all fatigue levels and includes education, counseling, and other strategies. Nonpharmacologic interventions include psychosocial interventions, exercise, yoga, physically based therapy, dietary management, and sleep therapy. Pharmacologic interventions include psychostimulants. Antidepressants may also benefit when CRF is accompanied by depression.
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Affiliation(s)
- Chidinma C Ebede
- Department of General Internal Medicine, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1465, Houston, TX 77030-4008, USA
| | - Yongchang Jang
- Department of General Internal Medicine, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1465, Houston, TX 77030-4008, USA
| | - Carmen P Escalante
- Department of General Internal Medicine, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street, Unit 1465, Houston, TX 77030-4008, USA.
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Matsuo N, Morita T, Matsuda Y, Okamoto K, Matsumoto Y, Kaneishi K, Odagiri T, Sakurai H, Katayama H, Mori I, Yamada H, Watanabe H, Yokoyama T, Yamaguchi T, Nishi T, Shirado A, Hiramoto S, Watanabe T, Kohara H, Shimoyama S, Aruga E, Baba M, Sumita K, Iwase S. Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study. J Palliat Med 2017; 20:352-359. [PMID: 28379811 DOI: 10.1089/jpm.2016.0323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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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Affiliation(s)
- Naoki Matsuo
- 1 Hospice, Medical Corporation Junkei-kai Sotoasahikawa Hospital , Akita, Japan
| | - Tatsuya Morita
- 2 Palliative and Supportive care Division, Seirei Mikatahara General Hospital , Hamamatsu, Japan
| | - Yoshinobu Matsuda
- 3 Department of Psychosomatic Internal Medicine, National Hospital, Organization Kinki-Chuo Chest Medical Center , Sakai, Japan
| | - Kenichiro Okamoto
- 4 Palliative Medicine, Showa University Northern Yokohama Hospital , Yokohama, Japan
| | - Yoshihisa Matsumoto
- 5 Department of Palliative Medicine, National Cancer Center Hospital East , Kashiwa, Japan
| | - Keisuke Kaneishi
- 6 Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center , Tokyo, Japan
| | | | - Hiroki Sakurai
- 8 Department of Palliative Care and Pain Management, Cancer Institute Hospital , Tokyo, Japan
| | | | | | | | | | - Taro Yokoyama
- 12 Department of Palliative Medicine, Yokohama Municipal Citizens Hospital , Yokohama, Japan
| | - Takashi Yamaguchi
- 13 Department of Palliative Medicine, Kobe University Graduate School of Medicine , Kobe, Japan
| | | | - Akemi Shirado
- 15 Seirei Mikatahara General Hospital , Hamamatsu, Japan
| | - Shuji Hiramoto
- 16 Department of Oncology, Mitsubishi Kyoto Hospital , Kyoto, Japan
| | | | - Hiroyuki Kohara
- 18 Department of Palliative Care, Hiroshima Prefectural Hospital , Hiroshima, Japan
| | - Satofumi Shimoyama
- 19 Department of Palliative Care, Aichi Cancer Center Hospital , Nagoya, Japan
| | - Etsuko Aruga
- 20 Department of Palliative medicine, Teikyo University School of Medicine , Tokyo, Japan
| | - Mika Baba
- 21 Palliative care Division, Saito Yukoukai Hospital , Osaka, Japan
| | | | - Satoru Iwase
- 23 Research Hospital, The Institute of Medical Science, The University of Tokyo , Tokyo, Japan
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Matsuo N, Morita T, Matsuda Y, Okamoto K, Matsumoto Y, Kaneishi K, Odagiri T, Sakurai H, Katayama H, Mori I, Yamada H, Watanabe H, Yokoyama T, Yamaguchi T, Nishi T, Shirado A, Hiramoto S, Watanabe T, Kohara H, Shimoyama S, Aruga E, Baba M, Sumita K, Iwase S. Predictors of responses to corticosteroids for anorexia in advanced cancer patients: a multicenter prospective observational study. Support Care Cancer 2016; 25:41-50. [PMID: 27539132 DOI: 10.1007/s00520-016-3383-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/08/2016] [Indexed: 11/25/2022]
Abstract
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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Affiliation(s)
- Naoki Matsuo
- Hospice, Medical Corporation Junkei-kai Sotoasahikawa Hospital, 42, Aza-Sangoden, Sotoasahikawa, Akita, Akita, 010-0802, Japan.
| | - Tatsuya Morita
- Palliative and Supportive care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital, Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, 591-8555, Japan
| | - Kenichiro Okamoto
- Palliative Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo Tsuduki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Yoshihisa Matsumoto
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Keisuke Kaneishi
- Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku, Tokyo, 162-0815, Japan
| | - Takuya Odagiri
- Komaki City Hospital, 1-20 Jobushi, Komaki-city, Aichi, 485-8520, Japan
| | - Hiroki Sakurai
- Department of Palliative Care and Pain Management, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hideki Katayama
- NHO Yamaguchi-Ube Medical Center, 685, Higashi-Kiwa, Ube, Yamaguchi, 755-0241, Japan
| | - Ichiro Mori
- Gratia Hospital Hospice, 6-14-1 Aomadaninishi, Mino, Osaka, 562-8567, Japan
| | - Hirohide Yamada
- Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hiroaki Watanabe
- Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi, 485-8520, Japan
| | - Taro Yokoyama
- Department of Palliative Medicine, Yokohama Municipal Citizens Hospital, 56, Okazawa-cho, Hodogaya-ku, Yokohama, Kanagawa, 240-8555, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomohiro Nishi
- Kawasaki Municipal Ida Hospital, Nakahara-ku Ida, Kawasaki, Kanagawa, 2-27-1, Japan
| | - Akemi Shirado
- Seirei Mikatahara General Hospital, 3453, Mikatahara-Cho, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan
| | - Shuji Hiramoto
- Department of Oncology, Mitsubishi Kyoto Hospital, Katsura Goshocho1, Nisikyo-ku, Kyoto, 615-8087, Japan
| | - Toshio Watanabe
- Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama, Toyama, 930-8550, Japan
| | - Hiroyuki Kohara
- Department of Palliative Care, Hiroshima Prefectural Hospital, 1-5-54, Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Satofumi Shimoyama
- Department of Palliative Care, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Etsuko Aruga
- Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Mika Baba
- Palliative Care Division, Saito Yukoukai Hospital, 7-2-18 Saito Asagi, Ibaragi, Osaka, 567-0085, Japan
| | - Koki Sumita
- Matsue City Hospital, 32-1, Noshira-cho, Matsue, Shimane, 690-8509, Japan
| | - Satoru Iwase
- Research Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
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