Preferences for pharmacist counselling in patients with breast cancer: a discrete choice experiment

With the shift of a large proportion of cancer chemotherapy recipients to ambulatory care, the role of hospital pharmacists has changed, and their provision of information is essential care for cancer patients. There is little research on pharmacist-patient relations, particularly about pharmacist counselling, in Japan. To meet patients' needs, pharmacist counselling should be optimized. Here, breast cancer patients' preferences for pharmacist counselling were assessed using a discrete choice experiment. Bayesian nonlinear optimal methodology was employed to obtain six attributes (attitude of pharmacist, quality of information, explanation of side effects, frequency of pharmacist counselling before starting chemotherapy, cost of pharmacist counselling, and follow-up with the pharmacist after starting chemotherapy) of two to three levels each. The attributes and levels were used to create 12 hypothetical scenarios that were divided into two questionnaires of six choice sets each. Two hundred eighty participants were randomly assigned to complete one of these questionnaires (blocks). Attributes were analyzed by conditional logit model to determine significant predictors of patient preferences. The responses of 278 patients to 1667 scenarios were analyzed. Attitude of pharmacist, quality of information, cost of pharmacist counselling, and follow-up with the pharmacist after starting chemotherapy were significant predictors of patient preferences, with quality of information receiving the highest priority. Thus patients receiving pharmacist counselling before starting chemotherapy prefer to interact with a pharmacist with a friendly, interested attitude who provides individualized information. Further research is needed to elucidate the information that Japanese patients consider most important and to enhance pharmacist-patient communication.

[Assessment of health-related quality of life in cancer outpatients treated with chemotherapy]

PURPOSE

Few studies have been conducted to elucidate the health-related quality of life(HR-QOL)of cancer outpatients treated with chemotherapy. In this study, we attempted to determine the physical and psychological distress of cancer outpatients treated with chemotherapy.

METHODS

Two-hundred and ninety-six outpatients with various malignancies, including malignant lymphoma, and esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, were investigated using the Japanese version of the M. D. Anderson symptom inventory from March through June 2010 in Tokyo Medical University Hospital.

RESULTS

The results of the survey questionnaire indicated that 59 patients suffered from fatigue, 56 experienced numbness or tingling, 48 felt drowsy, 39 had low moods, 40 felt distressed, 38 had no appetite, 38 had dry mouth, 37 were in pain, 37 had disturbed sleep, 31 had shortness of breath, 24 had nausea, 17 suffered from vomiting, and 13 patients had memory problems. Furthermore, these symptoms interfered with work(65 patients), walking(56 patients), mood(52 patients), life enjoyment(49 patients), general activity(49 patients), and relationships with other people(42 patients). Medications prescribed for HR-QOL control were non-steroidal anti-inflammatory drugs(93 patients), morphine(32 patients), and adjuvant analgesics(47 patients).

CONCLUSION

The present findings may help in the development of management strategies for physical and psychological distress, and improve HR-QOL of cancer outpatients treated with chemotherapy.

[Assessment of psychological distress in cancer outpatients treated with chemotherapy]

PURPOSE

Few studies have been conducted to elucidate the psychological distress of cancer outpatients being treated with chemotherapy. In this study, we attempted to determine the types of psychological distress endured by cancer outpatients being treated with chemotherapy.

METHODS

We investigated 194 outpatients with various malignancies, including hematological, esophageal, gastric, pancreatic, colon, lung, breast, ovarian, uterine and skin cancers, using the Japanese version of the Self-Rating Depression Scale, from June through December 2010, in our hospital.

RESULTS

The results of the survey questionnaire indicated suspected adjustment disorders in 84 patients(43. 3%)and major depression in 14 patients(7. 2%). Medications prescribed for psychological distress were antianxiety drugs(18 patients: 9. 3%), antidepressant drugs(2 patients: 1. 0%), and sleeping pills(50 patients: 25. 8%).

CONCLUSION

Our findings may be useful for the development of management strategies for psychological distress, and we suggest that there is a need for improvement in the quality of life of cancer outpatients being treated with chemotherapy.

Preventive effect of rebamipide gargle on chemoradiotherpy-induced oral mucositis in patients with oral cancer: a pilot study

Objectives

To assess the efficacy and safety of rebamipide in preventing chemoradiotherapy-induced oral mucositis in patients with oral cancer.

Material and Methods

Patients with oral cancer treated with chemoradiotherapy (daily radiotherapy plus docetaxel hydrate once a week) were enrolled for this study. They were assigned in a double-blind fashion to receive either rebamipide gargle or placebo on the days of chemoradiotherapy. Oral mucositis was assessed using the WHO grading system. The primary endpoint of this study was the incidence of grade 3 - 4 mucositis after exposure to 40 Gy radiation (4 weeks). The secondary endpoint was the effect of rebamipide gargle on tumour response to chemoradiotherapy.

Results

Twenty-four patients were randomly assigned to receive rebamipide gargle (n = 12) or placebo-gargle (n = 12) during chemoradiotherapy. The number of patients with severe mucositis (WHO ≥ 3) was higher in the placebo group than in the rebamipide group (83.3% vs. 33.3%, P = 0.036). In addition, no effect of rebamipide gargle on tumour response to chemoradiotherapy was recognized compared with the placebo group.

Conclusions

For patients with oral cancer undergoing chemoradiotherapy, rebamipide gargle may contribute to decrease the severity of oral mucositis.

[A retrospective analysis of neurotoxicity induced by vinca alkaloids combined with azole anti-fungal agents in hematological malignancies]

Vinca alkaloids (VA) are some of the key anti-tumor agents for patients with hematological malignancies, and various adverse events such as paralytic ileus, peripheral neuropathy, and constipation were now recognized as adverse VA effects. Furthermore, azole anti-fungal agents are known to enhance VA toxicity because they delay the metabolism and excretion of VA by inhibiting CYP3A4. However, their clinical relationship has not been clearly described. Therefore, we studied neurotoxicity as a possible adverse event associated with VA in patients treated with azole anti-fungal agents, retrospectively. In our study, 100 patients (479 episodes) who received VA in our department from August 2008 to December 2010 were analyzed. Adverse events attributed to the combined administration of vincristine (VCR) and azole anti-fungal agents were grade 3 paralytic ileuses in 8 patients (8 episodes), grade 3 or 4 constipation in 16 patients (16 episodes), and grade 3 peripheral neuropathy in 10 patients (16 episodes). In addition, we investigated whether temporal discontinuation of azole anti-fungal agents during VA treatment decreases the frequency of these adverse events, and detected that it is likely to help avoid neurotoxicities enhanced by itraconazole, such as severe constipation (p=0. 0308) and paralytic ileus (p=0. 0967). Our findings indicated that we should pay much more attention to these adverse events, and must select patients carefully when we administer azole anti-fungal agents to them while they are being treated with VA.

[A pilot study of rebamipide-gargle for chemoradiotherapy-induced mucositis in oral cancer patients]

BACKGROUND

Mucositis induced by chemoradiotherapy is one of the serious side effects of cancer therapy for oral cancer. It is caused by toxic free radicals(activated oxygen)produced by these therapeutic modalities. Rebamipide is a novel anti-ulcer drug which possesses various cytoprotective activities such as free radical scavenging, induction of prostaglandin-E and acceleration of ulcer healing. We report the results of a pilot study on rebamipidegargle for inhibition of mucositis induced by chemo-radiotherapy.

METHOD

The present study was conducted on 13 patients(7 men and 6 women; age range 53-88)with oral cancer. They received radiotherapy(30-60 Gy)for the oro-facial area and chemotherapy(docetaxel: 11 cases; UFT: 1 case; radiotherapy alone: 1 case)with simultaneous addition of 1% rebamipidegargle treatment(10-15 times/day)to prevent the onset of mucositis. Informed consent was obtained prior to entry.

RESULTS

Nine cases had grade 1-2 according to the WHO criteria, and 4 patients were classified as grade 3-4. No adverse reactions that could be caused by the rebamipide gargle were observed.

CONCLUSIONS

These results suggested that rebamipide gargle could inhibit the occurrence of stomatitis induced by chemoradiotherapy.

Comparative studies on proteasomes (multicatalytic proteinases) isolated from spermatozoa and eggs of sea urchins

1. Proteasomes (multicatalytic proteinases) have been purified from spermatozoa and eggs of sea urchins by successive chromatographies on DEAE-cellulose, hydroxylapatite, and Sepharose 6B. 2. The isolated sperm and egg proteasomes showed similar properties such as molecular weight (both 630,000) and multiple catalytic activity (pH optimum, substrate specificity, inhibitor-susceptibility and SDS-stimulation). 3. Distinct protein components were detected between sperm and egg proteasomes by SDS-polyacrylamide gel electrophoresis and immunoblot analysis using antibody against egg proteasome.